Resuscitation
-
Review Randomized Controlled Trial Clinical Trial
The Public Access Defibrillation (PAD) trial: study design and rationale.
The PAD Trial is a prospective, multicenter, randomized clinical study testing whether volunteer, non-medical responders can improve survival from out-of-hospital cardiac arrest (OOH-CA) by using automated external defibrillators (AEDs). These lay volunteers, who have no traditional responsibility to respond to a medical emergency as part of their primary job description, will form part of a comprehensive, integrated community approach to the treatment of OOH-CA. The study is being conducted at 24 field centers in the United States and Canada. ⋯ The primary endpoint is the number of OOH-CA victims who survive to hospital discharge. Secondary endpoints include neurological status, health-related quality of life (HRQL), cost, and cost-effectiveness. Data collection will last approximately 15 months and is expected to be completed in September 2003.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of a defibrillator-basic cardiopulmonary resuscitation programme for non medical personnel.
To improve the outcome for out-of-hospital patients with ventricular fibrillation/pulseless ventricular tachycardia (VF/VT), the use of automated external defibrillators (AEDs) by first responders including non-medical personnel with a duty to respond to an emergency is recommended. A special CPR-AED course has been developed. We wanted to test the results (quality and speed of operating an AED and CPR) after completion of such a course and retention after approximately 1-year. ⋯ The retention group had a lower frequency of correct inflations than the pre-course group, and the post-course group the highest number of correct ventilations per minute. These findings suggest that use of an AED by untrained laypersons may be feasible and that complex and time-consuming training programmes may not be necessary. The present study also supports the need for annual training and recertification.
-
The physiology behind sudden violent death is considered in the light of information from a wide variety of clinical, experimental, forensic and veterinary sources. Physiological causes can be classified under the headings of blood loss; asphyxia; electrocution; tissue loss; destruction of brain; disconnection of brain; and poisoning. Death, although sudden, is not necessarily instantaneous; asphyxia and electrocution take some time to kill the subjects. ⋯ The chemistry of dying, death and changes post mortem, needs more research in order to design further rational resuscitation procedures.
-
Comparative Study
Public access defibrillation in Helsinki--costs and potential benefits from a community-based pilot study.
In cardiac arrest the interval between the collapse and defibrillation may be shortened by teaching lay people to use defibrillators. We conducted a 3-year prospective, community-based study on public access defibrillation (PAD) in an urban emergency medical services system. All public sites with a cardiac arrest incidence of at least one per year were equipped with automated external defibrillators. ⋯ The direct costs were 110,270 Eur and only 13.5-16% of this figure would be related to the cost of defibrillators during their 8 years lifespan. This study showed that a community based model of PAD shortens the time to CPR and defibrillation significantly in an urban environment but various challenges have to be solved before wider implementation of PAD. In future projects the nature of the costs especially should be considered.
-
Comparative Study
Magnesium reduces free radical concentration and preserves left ventricular function after direct current shocks.
Our objective was to determine if magnesium reduces free radicals generated by direct current countershock and preserves left ventricular contractile function. ⋯ Magnesium pre-treatment reduced oxygen free radicals generated by direct current shocks; post-shock left ventricular contractile function was not impaired. Magnesium may be cardioprotective during epicardial ('surgical') defibrillation.