Resuscitation
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Comparative Study
Vasopressors are essential during cardiopulmonary resuscitation in rats: Is vasopressin superior to adrenaline?
Vasopressors are recommended for cardiopulmonary resuscitation (CPR) after cardiac arrest. In order to assess possible benefits regarding neurological recovery, vasopressin versus adrenaline and the combination of both was tested against placebo in a cardiac arrest model in rats. ⋯ Administration of arginine-vasopressin during CPR does not improve behavioural and cerebral histopathological outcome, compared to the use of adrenaline or the combination of both vasopressors, after cardiac arrest in rats.
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Randomized Controlled Trial
Hypertonic saline during CPR: Feasibility and safety of a new protocol of fluid management during resuscitation.
In experimental studies infusion of hypertonic saline during cardiopulmonary resuscitation (CPR) increased resuscitation success rate and improved myocardial and cerebral reperfusion during CPR. We tested the feasibility and the safety of this new therapeutic measure in a randomised, preclinical pilot study. ⋯ HHS after CA is feasible and safe and might improve short term survival after CPR. However, whether giving HHS could be a useful measure to increase resuscitation success after out-of-hospital CA requires a larger preclinical trial.
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Multicenter Study
Increased survival despite a reduction in out-of-hospital ventricular fibrillation in north-east Italy.
We have reported the epidemiology and survival rate of out-of-hospital cardiac arrest (OOH-CA) in a north-east region of Italy previously, the Friuli-Venezia-Giulia Arrest Cooperative Study (FACS). We present the results of a second observational, prospective, multicentre study on OOH-CA victims in a local area in the same geographical Italian region. ⋯ Despite a reduction in the rate of VF/VT as presenting rhythm, survival was almost tripled. Manning all ambulances with professional emergency medical personnel and ACLS training together with dispatch-guided CPR may have contributed to the improvements observed in survival rates.
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Making an accurate clinical diagnosis in the field can be a great challenge with pediatric out-of-hospital cardiac arrest (OHCA). We aimed to compare the etiology of pediatric OHCA by pre-hospital clinical diagnosis with etiology by coroner's diagnosis and autopsy. ⋯ Even in an ideal situation, a clinician in the field might be unable to determine the etiology of pediatric cardiac arrest in 14.5% of cases. There is poorer agreement for 'medical' compared to 'trauma' cases. This is the largest study to date comparing clinical diagnosis of the causes of OHCA in children to the 'gold-standard' of coroner's diagnosis.
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Comparative Study
Outcome prediction for guidance of initial resuscitation protocol: Shock first or CPR first.
Ventricular fibrillation (VF) is treated optimally with a defibrillation shock shortly after patient collapse, but may benefit from initial cardiopulmonary resuscitation (CPR) if the shock is delayed. An objective measure of potential responsiveness to defibrillation could help decide optimal initial therapy. ⋯ Both call-to-shock interval and a real-time ECG analysis are predictive of patient outcome. The ECG analysis is more predictive of neurologically intact survival. Moreover, the ECG analysis is dependent only upon the patient's condition at the time of treatment, with no need for knowledge of the response interval, which may be difficult to estimate at the time of treatment.