Resuscitation
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of standard and a modified method of two resuscitator adult cardiopulmonary resuscitation: description of a new system for research into advanced life support skills.
The study compares two methods of Advanced Life Support by a pair of resuscitators using a bag-valve-mask (BVM) technique. Standard two resuscitator cardiopulmonary resuscitation (CPR) was compared with a modified method of two resuscitator CPR. During the modified CPR one resuscitator held the face mask while the other resuscitator alternates between squeezing the self inflating bag and performing simulated cardiac compressions. ⋯ Modified CPR produced a greater tidal volume (TV) (P < 0.001), a slower respiratory rate (RR) (P < 0.001) and a faster compression rate (CR) (P < 0.01) (means with (S. D.): modified CPR: TV 990 (220) ml, RR 6 (1) min(-1), CR 82 (8) min(-1); standard CPR: TV 570 (190) ml, RR 10 (2) min(-1), CR 65 (11) min(-1)). A new method for the simultaneous computerised recording of simulated cardiac compressions together with mask pressure and expired gas composition in anaesthetised patients is described.
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This report describes an unusual case of partial transsection of the neonatal trachea after intubation. Mucosal injury led to the formation of a balloon-shaped, air-filled cyst that did not allow ventilation of the airways either via a tracheal tube or with a face mask. Several minutes after death, the cyst had collapsed and bag and mask ventilation produced adequate chest movements.
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Comparative Study
Splanchnic and renal blood flow after cardiopulmonary resuscitation with epinephrine and vasopressin in pigs.
In laboratory investigations, vasopressin given during CPR resulted in improved vital organ blood flow when compared with epinephrine. Given the profound and long lasting vasopressor effects of vasopressin, we tested the hypothesis that vasopressin given during CPR would result in renal and splanchnic hypoperfusion in the post-resuscitation period when compared with epinephrine. After 4 min of ventricular fibrillation, 16 pigs were randomly assigned to receive either 0.045 mg x kg(-1) epinephrine or 0.4 U X kg(-1) vasopressin before defibrillation. ⋯ Thirty minutes after ROSC, renal and adrenal blood flow were significantly lower in the vasopressin group (300 [273-334] and 256 [170-284] ml X min(-1) x 100 g(-1)) (median and 25th and 75th percentile) as compared with the epinephrine group (370 [346-429] and 360 [326-420] ml x min(-1) x 100 g(-1); P < 0.05). Pancreatic, intestinal, and hepatic blood flow were not significantly different in animals after receiving epinephrine or vasopressin. In comparison to epinephrine, vasopressin given during cardiac arrest impairs renal and adrenal perfusion temporarily but does not lead to intestinal or hepatic hypoperfusion in the post-resuscitation phase.
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Review Case Reports
Prehospital thrombolytic treatment of massive pulmonary embolism with reteplase during cardiopulmonary resuscitation.
A 52-year-old previously healthy man experienced acute severe dyspnoea after suffering from gastroenteritis for 3 days. After arrival of the ambulance, cardiac arrest with an initial rhythm of electro mechanical dissociation occurred. Circulation was restored after 10 min of cardiopulmonary resuscitation but soon cardiac arrest reoccurred. ⋯ The diagnosis of pulmonary embolism was confirmed by a ventilation-perfusion scan and by spiral computerised tomography. The patient was discharged from intensive care after 2 days with a cerebral performance category I. Based on previous calculations, the annual number of patients who present with massive pulmonary embolism leading to cardiac arrest (and thus who would theoretically be candidates for thrombolytic treatment) was estimated to be 0.7/100000 inhabitants in this emergency medical services system.
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Review Case Reports
Successful resuscitation using aminophylline in refractory cardiac arrest with asystole.
Adenosine antagonists may have therapeutic potential in cardiopulmonary resuscitation. Aminophylline, a widely available adenosine antagonist, is not included in the Guidelines for Advanced Life Support by the European Resuscitation Council or the American Heart Association. This report addresses a case of out-of-hospital cardiac arrest caused by inferior wall myocardial infarction in which effective circulation was restored subsequent to aminophylline administration, after prolonged conventional resuscitation had resulted in asystole.