Resuscitation
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Randomized Controlled Trial Clinical Trial
Effectiveness of ventilation-compression ratios 1:5 and 2:15 in simulated single rescuer paediatric resuscitation.
Current guidelines for paediatric basic life support (BLS) recommend a ventilation-compression ratio of 1:5 during child resuscitation compared with 2:15 for adults, based on the consensus that ventilation is more important in paediatric than in adult BLS. We hypothesized that the ratio 2:15 would provide the same minute ventilation as 1:5 during single-rescuer paediatric BLS due to the reduced time required to change between ventilations and compressions. Fourteen lay rescuers were trained with both ratios and thereafter performed single rescuer BLS for approximately 4 min with each of the two ratios in random order on a child-sized manikin with a built-in respiratory monitor. ⋯ Nearly all chest compressions were within acceptable limits for depth and place with both methods, but the mean number of chest compressions per minute was 48+/-15% greater with ratio 2:15. In conclusion, there was no difference in ventilation, but nearly one and a half times as many compressions with a ratio of 2:15 than 1:5 for lay rescuers during single rescuer paediatric CPR. In order to simplify CPR training for laypersons, we recommend a 2:15 ratio for both single- and two-person, adult and paediatric layperson BLS.
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The latest Adult Basic Life Support (BLS) guidelines support the inclusion of the use of the automated external defibrillator (AED), as part of basic life support (BLS). Emphasis on the provision of early defibrillation as part of BLS acknowledges the importance of this manoeuvre in the successful termination of ventricular fibrillation. The ramifications of such changes for both first responders and organisations implementing the guidelines should not be underestimated. ⋯ Additionally, defibrillation has been identified as one of the key competencies that all trained nurses and other health care providers should be able to undertake. This paper will consider the background to the current guideline changes, analyse the wider implications of translating the recommendations into practice, and offer possible solutions to address the issues raised. Whilst the analysis is particularly pertinent to the United Kingdom, many of the issues raised have international importance.
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Severe metabolic acidosis develops following prolonged periods of cardiopulmonary arrest (CPA), and excessive hydrogen ions derived from lactate and other noxious acids cause marked hyperkalemia in most CPA patients. This study investigated whether the serum electrolyte imbalance in resuscitated CPA patients is affected by the etiology of the CPA. Between 1999 and 2000, return of spontaneous circulation (ROSC) was achieved and serum electrolyte concentration measurements and blood gas analysis (BGA) were performed in 65 of 270 CPA patients treated. ⋯ The SAH group had significantly lower serum potassium concentrations than the other two groups and significantly higher glucose concentrations than the asphyxia group. Massive amounts of catecholamines are released into the systemic circulation of SAH patients and our results may indicate that the amount of catecholamines released in resuscitated SAH patients is greater than in heart attack or asphyxia patients, resulting in a lower serum potassium concentration despite the presence of severe metabolic acidosis. It should be clarified in a prospective study whether the presence of normokalemia and hyperglycemia in resuscitated CPA patients reliably predicts the presence of SAH.
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Transthoracic impedance and current flow are determinants of defibrillation success with monophasic shocks. Whether transthoracic impedance, either independently or via its association with body weight, is a determinant of biphasic waveform shock success has not been determined. ⋯ Body weight is a determinant of shock success with biphasic waveforms at low energy levels in this swine model.
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The recurrence rate of lethal cardiac events after the survival of a primary cardiac arrest in patients not having received an implantable cardioverter defibrillator (ICD) is investigated. ⋯ Cardiac arrest survivors without an apparent indication for an ICD have a high risk of suffering from a re-arrest of cardiac origin.