Resuscitation
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The laryngeal mask airway (LMA) was used within the hospital in 50 cardiac arrest cases during cardio-pulmonary resuscitation (CPR). The LMA was inserted mainly by junior anaesthesia staff members with no previous experience with its use. The LMA was easily inserted providing a clear and unobstructed airway in 98% of the patients with clinically satisfactory ventilation and very good blood gas values. No signs of regurgitation or aspiration were detected.
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Out-of-hospital defibrillation has been shown to improve survival in out-of-hospital cardiac arrests. The maximum performance of defibrillation-based systems is dependent on the proportion of cardiac arrests due to tachyarrhythmias. We reviewed 4248 reported arrests in the Heartstart Scotland database. ⋯ None of the patients with bradycardic arrests survived. Preceding chest pain was noted in 79% of patients subsequently developing ventricular fibrillation as the cause of arrest compared to only 37% of those suffering bradycardic arrests. It would appear that public awareness of the importance of early contact with the emergency services after the onset of chest pain could substantially improve the survival from out-of-hospital arrests.
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Medical records of all expired patients as well as all patients designated on billing logs as having received cardiopulmonary resuscitation (CPR) during a 6-month period were reviewed. Patients were considered to have been 'coded' if they were found unresponsive and if the advanced cardiac life support (ACLS) protocol of the American Heart Association (AHA) was subsequently initiated. Of 105 patients who received CPR, 98 died during their hospital stay. ⋯ Patients who underwent CPR at least once during their hospitalization were more likely to have had cardiac diagnoses on admission (P < 0.001), to have been postoperative (P = 0.02), to have been admitted to a monitored bed on admission (P < 0.001) to have received more days of intensive care (P < 0.001) and to have received more specialist consultations (P = 0.004). Patients not receiving CPR were more likely to have had a primary diagnosis of neoplastic disease (P < 0.001), stroke or intracranial hemorrhage (P = 0.02) or dementia (P < 0.001). Age, race, or gender did not differ significantly between the two groups.
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End-tidal carbon dioxide concentration in the expired air (ETCO2) is measured with different technologies. ETCO2 allows the global evaluation of three main body functions: metabolism, circulation and ventilation. If two of these parameters are held constant, changes in ETCO2 reflect a variation of the third. ⋯ However, recent laboratory and clinical investigations demonstrated that various pharmacological and physical interventions may influence ETCO2. Especially, the use of the CO2 generating buffer NaHCO3 increase and alpha-adrenergic agents constantly decrease ETCO2. Thus, although ETCO2 remains a necessary tool during anaesthesia, it may loose the potential for prediction of survival when monitoring the resuscitative efforts during cardiopulmonary resuscitation.
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The key to improving survival from pre-hospital cardiac arrest lies in reducing the time interval between onset of cardiac arrest and defibrillation. Placing automated external defibrillators at strategic points in the community could potentially reduce this time interval, but would necessitate widespread training in defibrillation for lay people in addition to health care workers. There are unanswered questions regarding the ability of lay people to acquire and retain this skill when the training programme is, by necessity, very brief, (otherwise it would not be possible to train large enough numbers of people) and the skill is used infrequently. ⋯ Using stringent assessment criteria, 54% of volunteers passed the assessment at every session. Little difference in acquisition or retention of skills between the nurse and lay volunteers, and the 2- and 4-h course groups was found. It is concluded that brief training in defibrillation for volunteer first-aiders is feasible.