Resuscitation
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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.
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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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Comparative Study
Improving the effectiveness of continuous closed chest compressions: an exploratory study.
This study was carried out to establish the length of time over which an individual can maintain effective chest compressions and the most effective pattern of rest and handover among a team. The continuing effectiveness of chest compressions was compared between groups of 2 or 3 rescuers performing chest compressions for 1, 2 or 3 min during scenarios lasting 18 min. Evaluation of the effectiveness of compressions was achieved using a computerised resuscitation manikin (Laerdal/Skillmeter) on a hospital trolley. Twenty-one volunteers competent in basic life support participated. The results were analysed using one-way analysis of variance and Dunnett's contrast of the various scenarios. The results demonstrated that a three person team delivering 1 min periods of chest compressions in rotation is significantly better than other sequences at 5 min and beyond (P<0.0001). At 18 min 91.5% of all chest compressions delivered by this three person team were greater than 70% effective. There was no significant difference between the first and final set of chest compressions. ⋯ Continuous chest compressions performed for 1 min, preferably by three rescuers in rotation, maintain a high level of effectiveness. Longer periods of chest compressions should be discouraged.
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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.