Resuscitation
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To determine whether open-chest compression-active-decompression (CAD) could improve cardiac output, coronary blood flow, blood gases, and resuscitation compared to open-chest manual compression in a porcine model of cardiac arrest. ⋯ We found no benefit using CAD. Both low coronary blood flow and hyperkalemia may have limited resuscitation.
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Acute coagulopathy is a common clinical complication after trauma, and contributes to posttraumatic multiple organ failure. The phenomenon may be due to the effect of stress hormones on platelet adhesion molecule expression after trauma. Catecholamine levels correlate with injury severity scores and changes of L-selectin expression on leucocytes, whilst adrenaline (ADR) (epinephrine) alone also activates platelets. ⋯ The percentage of platelets expressing fibrinogen receptors increased significantly with ADR and NOR even at the lowest dose (1 nmol/l) and continued to increase in a dose-dependent manner. Although the effect of ADR was greater than NOR in stimulating platelets to express fibrinogen receptors, the average number of fibrinogen receptors on each platelet was constant. ADR and NOR activated platelets to express fibrinogen receptors at doses that are similar to those found in the plasma of trauma patients.
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Previous studies indicate that Norwegian physicians hold conservative attitudes towards ethically controversial end-of-life decisions. The present study was undertaken to explore whether in Norway euthanasia may be hidden under labels such as death after analgesic injections and withholding or withdrawing treatment. ⋯ Only a small minority of Norwegian physicians has committed euthanasia. However, patient death has occurred following ethically questionable decisions such as withdrawal of treatment based on resource considerations and requests from the family.
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Since adrenaline (epinephrine) also has negative effects during and after cardiopulmonary resuscitation (CPR) a non-adrenergic vasoconstrictor like endothelin might be an alternative to increase vital organ blood flow. We studied the effect of different doses of endothelin-1 compared with adrenaline on the ability to resuscitate, cerebral and myocardial blood flow (MBF) in a closed chest cardiac arrest pig model. After 5 min of ventricular fibrillation, CPR with a ventilator and a mechanical compression device was started. ⋯ There was no difference in MBF between the treatment groups despite a higher coronary perfusion pressure (CoPP) in the endothelin-1 groups. Restoration of spontaneous circulation could be only achieved in the endothelin-1 50 microg (3 of 7; 43%) and 100 microg (5 of 7; 71%) group. This study suggests that endothelin-1 enhances CBF during CPR better than adrenaline and increases resuscitation success.
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The aim of this study is to study the quality of chest compressions over a period of 5 min with a compression-ventilation ratio of 5/1 and 15/2. ⋯ Effective closed chest compression was significantly better with a ratio of 5/1 than 15/2. Better management of cardiac arrest suggested by an increase in a number of compressions with a ratio of 15/2 could be attenuated by cardiac compressions of lesser quality.