Resuscitation
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The need for rescue breaths in bystander CPR has been questioned after several studies have shown that omitting ventilation does not worsen outcome. Chest compression may produce passive tidal volumes large enough to provide adequate ventilation in animal studies, but no recent clinical studies have examined this phenomenon. We measured passive ventilation during optimal chest compression to determine whether compression-only CPR provides adequate gas exchange during cardiac arrest. ⋯ At an advanced stage of cardiac arrest, passive ventilation during compression-only CPR is limited in its ability to maintain adequate gas exchange, with gas transport mechanisms associated with high frequency ventilation perhaps generating a very limited gas exchange. The effectiveness of passive ventilation during the early stages of CPR, when chest and lung compliance is greater, remains to be investigated.
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Haemothorax resulting from injury to a great vessel is a potential complication during transvenous pacemaker implantation that can be caused by perforation by the electrode. If the amount of bleeding is massive, control needs thoracotomy. ⋯ This complication was controlled successfully by using positive end-expiratory pressure (PEEP). We conclude that this simple but reproducible experience may offer effective haemostasis for a massive haemothorax caused by transvenous catheter perforation.
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To examine survival rates for paediatric trauma patients requiring cardiopulmonary resuscitation (CPR) in the pre-hospital setting, and to identify characteristics that may be associated with survival. ⋯ This study confirms the poor outcome for children requiring pre-hospital CPR following trauma. However, the results are better in this physician-attended group than in other studies where physicians were not present. They also suggest that cardiac arrest associated with trauma in children has a better outcome than in adults. In common with adults treated in this system, those patients with hypovolaemic cardiac arrest did not survive (Ann Emerg Med 2006;48:240-4). A large proportion of the survivors suffered hypoxic or asphyxial injuries. Targeted aggressive out-of-hospital resuscitation in certain patient groups can produce good outcomes.
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Randomized Controlled Trial
The voice advisory manikin (VAM): an innovative approach to pediatric lay provider basic life support skill education.
To determine the efficacy of immediate, standardized, corrective audio feedback training as supplied by the voice advisory manikin (VAM) compared to high quality standardized instructor feedback training for the initial acquisition of 1-rescuer lay provider pediatric BLS skills. ⋯ Immediate, standardized, corrective audio feedback training as supplied by the voice advisory manikin (VAM) can improve initial pediatric basic life support skill acquisition for lay providers even when compared to one-on-one, standardized instructor-led training.
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The purpose of this study was to assess the long-term survival after OHCA. ⋯ Long-term survival after out-of-hospital cardiac arrest in a physician-staffed emergency system was comparable to survival after myocardial infarction with 46% being alive after ten years.