Resuscitation
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Meta Analysis
Biphasic and monophasic shocks for transthoracic defibrillation: a meta analysis of randomised controlled trials.
Biphasic waveforms are routinely used for implantable defibrillators. These waveforms have been less readily adopted for external defibrillation. This study was performed in order to evaluate the efficacy and harms of biphasic waveforms over monophasic waveforms for the transthoracic defibrillation of patients in ventricular fibrillation (VF) or haemodynamically unstable ventricular tachycardia. ⋯ Biphasic waveforms defibrillate with similar efficacy at lower energies than standard 200 J monophasic waveforms, and greater efficacy than monophasic shocks of the same energy. Available data suggests that lower delivered energy and voltage result in less post-shock myocardial injury.
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Comparative Study
In-hospital cardiac arrest leads to chronic memory impairment.
To assess the prevalence and severity of memory deficits in a group of patients who survived an in-hospital cardiac arrest (IHCA) in comparison with patients resuscitated after cardiac arrest outside hospital (OHCA) and patients with acute myocardial infarction (MI). ⋯ Clinically important memory impairment was found in one in four patients surviving IHCA. The shorter arrest durations that are thought to be associated with IHCA may not be sufficient to protect patients from memory impairment associated with cerebral hypoxia.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, randomised and blinded comparison of first shock success of monophasic and biphasic waveforms in out-of-hospital cardiac arrest.
Evidence suggests that biphasic waveforms are more effective than monophasic waveforms for defibrillation in out-of-hospital cardiac arrest (OHCA), yet their performance has only been compared in un-blinded studies. ⋯ BTE-waveform AEDs provide significantly higher rates of successful defibrillation with return of an organized rhythm in OHCA than MDS waveform AEDs.
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Multicenter Study
Preliminary experience with a prospective, multi-centered evaluation of out-of-hospital endotracheal intubation.
Previous out-of-hospital airway management data are limited by small, single-site designs. We sought to evaluate the feasibility of performing a prospective, multi-centered evaluation of out-of-hospital endotracheal intubation (ETI) using a standardized data collection tool. ⋯ We successfully obtained complete data for the majority of ETI attempted across multiple EMS services. Our data also indicate the need to address problems with non-response. Preliminary cross-sectional data highlight areas of current interest in out-of-hospital airway management.
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Programs for research and practice in resuscitation have focused on identification and reversal of ventricular fibrillation (VF). While substantial progress has been achieved, evidence is accumulating that clinical death is less likely to be caused by fibrillation now than in the 1960s and 1970s. Pulseless electrical activity (PEA) has emerged as the most common rhythm found in arrests in the hospital and is rapidly rising in pre-hospital reports. ⋯ VF is a manifestation of severe, undiagnosed coronary artery disease (CAD). Rates of death from CAD increased from rare in 1930 to become the most common cause of death in the US. CAD death rates peaked in the early 1960s and had declined over 50% by the late 1990s. Primary and secondary prevention, early diagnosis and aggressive, successful treatment have contributed to this decline. PEA is a brief phase in clinical death that occurs after losses in consciousness, ventilatory drive and circulation but before decay to asystole; survival rates are poor. PEA is a common stage in clinical death from any of a variety of tissue hypoxic/anoxic insults. Research on PEA is needed; 50 years of attention to CAD and VF have resulted in improved survival and changed the disease spectrum. Similar attention to animal and clinical research on PEA may have the potential to improve survival.