Resuscitation
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In preparation for the World Congress on Drowning uniform reporting consensus document of drowning incidents we reviewed systematically the medical literature for the terms and definitions used to describe drowning incidents to assess the uniformity of these terms in the medical literature. ⋯ A review of existing drowning literature demonstrates a lack of a standard definition of drowning and a lack of agreement on measures of outcome. This variability in definitions and outcomes makes it very difficult to assess and analyze studies both individually and as a whole and draw conclusions that will influence practice. These objective findings support the need for the drowning Utstein focus on one definition of drowning and validated measures of functional and neurological outcome.
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To describe the characteristics, cause of hospitalisation and symptoms prior to death in patients dying in hospital without resuscitation being started and the extent to which these decisions were documented. ⋯ In patients who died at a Swedish University Hospital, we did not find a single case in which it was regarded as unethical not to start CPR. The patient group studied here had a poor prognosis due to a severe deterioration in their condition. To support this, we also found a high degree of documentation of DNAR. The low rate of CPR attempts after in-hospital cardiac arrest appears to be justified.
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Multicenter Study
International Resuscitation Network Registry: design, rationale and preliminary results.
There is a lack of high-quality information about the effectiveness of resuscitation interventions and international differences in structure, process and outcome after out-of-hospital cardiac arrest and cardiopulmonary resuscitation because data are not collected uniformly. An internet-based international registry could make such evaluations possible, and enable the conduct of large randomized controlled trials of resuscitation therapies. A prospective international cohort study was performed that included 571 infants, children and adults (a) who experienced cardiac arrest requiring chest compressions or external defibrillation, (b) outside the hospital in the study communities and (c) upon whom resuscitation was attempted by EMS personnel. ⋯ The resuscitation process was highly variable across centers, and survival and neurological outcome were also significantly and independently different across centers. This study shows that it is possible to collect data prospectively describing the structure, process and outcome associated with cardiac arrest in multiple international sites via the internet. Therefore, it is feasible to conduct adequately powered randomized trials of resuscitation therapies in international settings.
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To investigate the level of cardiopulmonary resuscitation (CPR) training among cardiac patients and their co-habitants and to describe the possibilities for, and obstacles to, CPR training among this group. ⋯ Two-thirds of the patients did not believe that their co-habitant had taken part in CPR training. More than half of these would like their co-habitant to attend such a course. Seventy-two percent were willing to participate in CPR instruction together with their co-habitant. Major obstacles to CPR training were doubts concerning the co-habitant's willingness or physical ability and their own medical status.
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Anecdotal evidence suggests that anxiety and lack of confidence in managing acutely ill patients adversely affects performance. We evaluated the impact of attending an ALERT course on the confidence levels and attitudes of healthcare staff in relation to the recognition and management of acutely ill patients. A questionnaire, which examined knowledge, experience, confidence and teamwork, was distributed to participants prior to commencing an ALERT course. ⋯ More staff said that they would approach a registrar or a consultant for help (chi2 = 3.29, n = 131, p < 0.05; chi2 = 7.51, n = 131, p < 0.01). There was a significant improvement in attendees' confidence in working in an interdisciplinary team when caring for critically ill patients (pre 40.66; post 42.91; t = 2.32; p = 0.05). We conclude that attending an ALERT course has beneficial effects on the confidence levels and attitudes of healthcare staff in relation to the recognition and management of acutely ill patients.