Resuscitation
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To describe the occurrence, characteristics and outcome among patients with out-of-hospital cardiac arrest who required continuation of cardiopulmonary resuscitation (CPR) on admission to the emergency department. ⋯ among consecutive patients with out-of-hospital cardiac arrest, CPR was ongoing in 68% of them on admission to hospital. Among these patients, 6% were hospitalized alive and 1.2% were discharged from hospital. Thus, among patients with ongoing CPR on admission to hospital, survivors can be found but they are few in numbers and extensive cerebral damage is frequently present.
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Comparative Study
Intubation with laryngoscope versus transillumination performed by paramedic students on manikins and cadavers.
Seventeen paramedic students, all of whom are novice intubators, performed laryngoscopic and Trachlight intubation after supervised training for 90 min on two manikins (Laerdal, AMBU) and 30 min on cadavers. A maximum of two intubation attempts lasting a maximum 30 s each were permitted on each manikin and the cadaver. The time for confirming tube placement by auscultation and securing the tube was added. ⋯ Intubation with the Trachlight was 100% successful in the Laerdal manikin, but significantly lower than with the laryngoscope in the AMBU manikin (65%), and in cadavers (50%). The mean intubation time was significantly longer (30-44 s) with the Trachlight compared with laryngoscopic intubation (10-23 s) in both manikins and cadavers. The present results do not indicate that intubation with the Trachlight is an improvement upon laryngoscopic intubation for novices.
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A large proportion of cardiac arrests outside hospital are caused by ventricular fibrillation. Although it is frequently used, the exact role for treatment with lidocaine in these patients remains to be determined. ⋯ In a retrospective analysis comparing patients who received lidocaine with those who did not in sustained ventricular fibrillation and after conversion to a pulse-generating rhythm, such treatment was associated with a higher rate at ROSC and hospitalization but was not associated with an increased rate of discharge from hospital.
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Outcome after prehospital cardiac arrest was examined in the EMS system of Bonn, a midsized urban community, and presented according to the Utstein style. The data were collected from January 1st, 1989 to December 31st, 1992 by the Bonn-north ALS unit, which serves 240,000 residents. Fifty-six patients suffered from cardiac arrest of non-cardiac aetiology and were excluded; 464 patients were resuscitated after cardiac arrest of presumed cardiac aetiology (incidence of CPR attempts: 48.33 per year/100,000 population). ⋯ Of them 41 (35%) could be discharged from hospital and 28 (24%) lived more than 1 year. The comparison of our data with those from double-response EMS systems of other communities revealed that, in midsized urban and suburban communities the highest discharging rates could be achieved. Our study demonstrated that survival depends crucially on short response intervals and life support which will be performed by well-trained emergency technicians, paramedics and physicians.