Resuscitation
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Emergencies arising during commercial airline flights may have serious consequences. We report the experience of the Paris Emergency Medical Service (SAMU) in providing in-flight assistance to Air France between 1989 and 1999. ⋯ However the relative frequency of cardiac and neurological emergencies in our analysis supports the necessity of carrying adequate medical equipment and of having direct access to expert medical advice. The results suggest the requirement for a rigorous prospective epidemiological study of in-flight emergencies to evaluate the effectiveness of current practice and possible modifications of equipment and protocols for patient management.
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Review Case Reports
Cardiac arrest during surgery and ventilation in the prone position: a case report and systematic review.
We present a case report of successful resuscitation following cardiac arrest in a patient undergoing surgery in the prone position. A systematic review of the literature identified 22 further cases. ⋯ Management of prone cardiac arrest may be improved by identification of high-risk patients, careful patient positioning, use of invasive monitoring and placement of self-adhesive defibrillator paddles. Suitable techniques for cardiopulmonary resuscitation including methods for chest compression, defibrillation and the management of air embolism are discussed.
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Low incidence of bystander-initiated cardiopulmonary resuscitation (CPR) is allegedly responsible for poor survival from out-of-hospital cardiac arrest (OHCA) in Japan. This study was conducted to determine significant predictors for survival after collapse-witnessed OHCA of presumed cardiac etiology to investigate the impact of bystander-initiated CPR. Logistic regression analysis of OHCA of presumed cardiac etiology was performed on retrospective data sets from three Japanese suburban communities. ⋯ Patient age (70 years or less/over 70 years), interval from collapse to EMS response, and bystander-initiated CPR were significantly associated with VF in an initial ECG. The effectiveness of bystander-initiated CPR for OHCA can be successfully predicted based on the interval from collapse to CPR and initial ECG rhythm. The increase in the proportion of bystander-initiated CPR from the present level of 20-50% would be expected to rescue another 1800 victims of OHCA per year in Japan.
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To identify patients who should not have resuscitation started or continued. ⋯ CPR survival is problematic, and it is especially poor in field/BR arrests. Emergency squads should terminate CPR for pulseless patients after communicating with the ER physician. Age is not a determinant of recovery or survival. Arrest outside of the hospital, sepsis, three or more co-morbid conditions, previous CPR, asystole or resuscitation for >25 min all decrease the chance of hospital discharge and survival. Instituting or continuing CPR in a great majority of these patients is futile. Families should be so advised.