Resuscitation
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Multicenter Study Comparative Study
Initial countershock in the treatment of asystole.
Routine provision of defibrillatory countershock (CS) in the initial management of asystolic cardiac arrest has been advocated because certain cases of ventricular fibrillation (VF) may present as asystole (AS). ⋯ Although, statistically, the results for both groups were not distinguishable, outcomes for asystolic patients had a tendency to be better when the initial therapy did not involve CS. Larger study populations are recommended to confirm these preliminary observations.
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Comparative Study
The optimum timing of resuscitative thoracotomy for non-traumatic out-of-hospital cardiac arrest.
Open-chest cardiopulmonary resuscitation (CPR) is a promising method for non-traumatic cardiac arrest. In this preliminary study, we investigated the optimum timing of thoracotomy which brings high rate of return of spontaneous circulation (ROSC) and keeps the incidence of unnecessary thoracotomy minimal. Ninety-five adult patients with non-traumatic out-of-hospital cardiac arrest were analyzed. ⋯ Similar tendency was noted when the timing of thoracotomy was counted from the ambulance call. In the standard CPR group, only two patients obtained ROSC during the initial 5 min of hospital course. These results suggest that thoracotomy within 5 min of hospital arrival brings the highest ROSC rate while keeps the incidence of unnecessary thoracotomy acceptable.
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Comparative Study
The effect of intravenous magnesium administration on aortic, right atrial and coronary perfusion pressures during CPR in swine.
To determine the effect of magnesium administration on aortic, right atrial and coronary perfusion pressure (CPP) during cardiopulmonary resuscitation (CPR). ⋯ In this model of prolonged cardiac arrest, the administration of magnesium with epinephrine appeared to have a negative effect on aortic pressures during CPR. Further study is needed to determine the confounding effect of serum bicarbonate on the response to epinephrine and magnesium during CPR.
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Early defibrillation by emergency medical technicians or even less qualified personnel has been shown to improve survival rates for out-of-hospital cardiac arrest caused by ventricular fibrillation. It has been questioned whether these favourable results can be applied within the context of physician-attended emergency medical systems. ⋯ The first 2 years of experience with 499 technician-initiated resuscitation attempts in which the mobile intensive care unit of Klinikum Steglitz was involved, confirmed the results of the pilot study with an improved long-term survival rate (18%) for patients with ventricular fibrillation. We conclude that EMT defibrillation should be introduced in emergency physician-attended two-tiered emergency medical systems, whenever a thorough analysis of the existing rescue systems exhibits a 'relevant frequency' of resuscitation and response interval of 15 min or less.
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Comparative Study
Quality and efficiency of bystander CPR. Belgian Cerebral Resuscitation Study Group.
Incorrectly performed bystander CPR might compromise survival of the cardiac arrest patient. We therefore evaluated the outcome in 3306 out-of-hospital primary cardiac arrests of which 885 received bystander CPR. bystanders performed CPR correctly in 52%, incorrectly in 11%, 31% performed only external chest compressions (ECC) and 6% only mouth-to-mouth ventilation (MMV). ⋯ Bystander CPR might have a beneficial effect on survival by maintaining the heart in ventricular fibrillation by ECC. A negative effect of badly performed bystander CPR was not observed compared to cases which had not received bystander CPR.