Resuscitation
-
Comparative Study
Upper airway patency during ventilation with a new airway device-the glossopalatinal tube.
We studied a new rescue breathing device consisting of a mouthcap and a "glossopalatinal" tube reaching between tongue and palate (the "GPT"), with a connector for a bag, ventilator or rescuers mouth. By tilting the connector in a cranial direction, the tongue can be "scooped" out of the hypopharynx. The study was to test the efficacy and the ease of application of the GPT in anaesthetised patients. It was compared with a conventional face mask with and without an oropharyngeal (OP) airway. ⋯ Inspiratory resistance with the GPT and mask did not differ (1.31+/-0.96 vs. 1.38+/-0.66 kPa s/l at 1 l/s, mean+/-standard deviation (S.D.); reduction of resistance by "scooping" the tongue through angulation of the GPT (to 0.64+/-0.32; P<0.05 vs. GPT without angulation) was equivalent to that by an OP tube used with the mask (to 0.68+/-0.26; P<0.05 vs. mask solo). Pharyngoscopy showed that the effectiveness of the GPT depended on the individual anatomy. The angulating motion caused some fatigue. The GPT is an alternative to established breathing adjuncts; despite not protruding into the pharynx it can enhance airway patency like an OP.
-
Comparative Study
Immediate defibrillation versus interventions first in a swine model of prolonged ventricular fibrillation.
we compared time-dependent rescue shock success when delivered immediately, to defibrillation preceded by 3 min of CPR, with and without high dose epinephrine (HDE) in a swine model of prolonged ventricular fibrillation (VF). Our hypotheses were that pretreatment with CPR and HDE would produce higher rates of successful first-shock defibrillation and would prevent decay of the VF waveform, as measured by the scaling exponent (ScE), when compared to immediate defibrillation. We also sought to determine the predictive value of the ScE in determining post-shock outcomes. ⋯ HDE-11 showed a tendency for producing a higher rate of first-shock success and ROSC. Interventions prior to rescue shock prevented deterioration of the VF waveform and improved rescue shock outcomes. The ScE accurately predicted 81-85% of post-rescue shock outcomes.
-
Meta Analysis Comparative Study
Is vasopressin superior to adrenaline or placebo in the management of cardiac arrest? A meta-analysis.
Vasopressin is currently recommended in the management of patients with cardiac arrest, but its efficacy is still incompletely established. We systematically reviewed randomized trials comparing vasopressin to control treatment in the management of cardiac arrest in humans and animals. Two human and 33 animal studies were retrieved. ⋯ In animal trials (N=669) vasopressin appeared instead significantly superior to both placebo (ROSC, respectively 93 [98/105] vs 19% [14/72], P<0.001) or adrenaline (ROSC, respectively 84 [225/268] vs 52% [117/224], P<0.001). In conclusion, vasopressin is superior to both placebo or adrenaline in animal models of cardiopulmonary resuscitation. Evidence in humans is still limited and confidence intervals estimates too wide to reliably confirm or disprove results obtained in experimental animal settings.
-
Comparative Study
Feasibility of life-supporting first-aid (LSFA) training as a mandatory subject in primary schools.
Life-supporting first-aid (LFSA) training in primary schools might prove a useful means of increasing cardiac arrest survival rates. We thus studied the feasibility of introducing first-aid training to 6-7-year old primary school children. ⋯ LSFA training is a feasible proposition for 6-7-year olds who might well be in a position to save the lives of cardiac-arrest victims. Future training sessions should determine the impact of repeat courses and the findings should be used to convince politicians and administrators of the need of LSFA training as a mandatory subject in schools.
-
Comparative Study
Defibrillation waveform and post-shock rhythm in out-of-hospital ventricular fibrillation cardiac arrest.
The importance of the defibrillation waveform on the evolving post-shock cardiac rhythm is uncertain. The primary objective of this study was to evaluate cardiac rhythms following the first defibrillation shock, comparing biphasic truncated exponential (BTE), monophasic damped sinusoidal (MDS), and monophasic truncated exponential (MTE) waveforms in patients experiencing out-of-hospital ventricular fibrillation cardiac arrest (OHCA). ⋯ In this retrospective cohort investigation, MDS and BTE waveforms had higher first shock defibrillation rates than the MTE waveform, while patients treated with the BTE waveform were more likely to develop an organized rhythm within 60 s of the initial shock. The results of this investigation, however, do not provide evidence that these surrogate advantages are important for improving survival. Additional investigation is needed to improve the understanding of the role of waveform and its potential interaction with other clinical factors in order to optimize survival in OHCA.