Resuscitation
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Comparative Study
HBOC-201 improves survival in a swine model of hemorrhagic shock and liver injury.
Blunt abdominal trauma that leads to hemorrhagic shock and cardiac arrest is almost always fatal in the prehospital setting. The current study investigated whether a hemoglobin-based oxygen carrier (HBOC-201) could maintain organ viability during an exsanguinating liver injury and allow for prolonged survival. This hypothesis was tested in a large animal model that simulated blunt abdominal trauma with major organ injury. ⋯ HBOC resuscitation during liver bleeding in a swine model of hemorrhagic shock and liver injury allowed for 96 h survival. No fluid or HES in the same model was fatal.
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Comparative Study
Treatment of post resuscitation myocardial dysfunction: aortic counterpulsation versus dobutamine.
Post resuscitation myocardial stunning is well described and recognized as a significant contributor to poor long-term outcome following cardiac arrest. Optimal strategies for treatment have not been determined. ⋯ Dobutamine was superior to IABP for treatment of post resuscitation left ventricular systolic and diastolic dysfunction. The hypothesized advantage of IABP for treatment of post resuscitation myocardial stunning without excessively raising the heart rate like dobutamine was not realized.
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Prompt and effective cardiopulmonary resuscitation (CPR) is the first link in the chain of survival following cardiac arrest. We assessed a new device, the CPR-Ezy (Medteq Innovations Pty Ltd., Brisbane, Australia), to aid timing and effectiveness of external cardiac compressions (ECC), by 32 subjects who had prior community-based training in CPR. ⋯ Effectiveness of compressions was also improved over the whole time period, especially so in the last minute. We conclude that the CPR-Ezy can improve timing and effectiveness of ECC, and reduce the effects of resuscitator fatigue, in community-trained subjects.
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Hanging as a method of attempting suicide is increasing in incidence. A retrospective review of victims of hanging injuries presenting to our institution over a 5-year period was performed. Forty-two cases were reviewed. ⋯ There was an 88% survival rate, with a low incidence (5%) of poor neurological outcome. The Glasgow Coma Score at scene or on arrival at hospital was found to be a prognostic indicator. Victims without spontaneous cardiac output at scene did not survive, even if cardiopulmonary resuscitation was successful initially.
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Clinical Trial
Prevention of deterioration of ventricular fibrillation by basic life support during out-of-hospital cardiac arrest.
Survival of cardiac arrest is improved by basic life support (BLS). This study investigated the relationship between ventricular fibrillation (VF) characteristics and survival. In a 2-year prospective study out-of-hospital witnessed non-traumatic cardiac arrests were observed. ⋯ Our study demonstrated that BLS and VF as initial rhythm, considered being "baseline" predictors in survival models, were proved not independent of each other. The decrease of VF amplitude and increase in prevalence of asystole is slowed significantly by BLS. Predicting survival from VF amplitude and baseline crossings alone is limited.