Resuscitation
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Following the publication of the Leuven Intensive Insulin Therapy (IIT) study in 2001, tight glycemic control has become regarded as the standard of care in intensive care units throughout the world. The Leuven IIT study, was however, an unblinded, single center study with unique patient and institutional characteristics that may not extrapolate to practice elsewhere in the world. Indeed, recent randomized controlled studies have been unable to demonstrate any benefit from tight glucemic control. We suggest that the widespread adoption of tight glycemic control be abandoned at this time.
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This study evaluates inter-rater reliability and comfort of BLS providers with the application of an out-of-hospital Basic Life Support Termination of Resuscitation (BLS TOR) clinical prediction rule. This rule suggests that continued BLS cardiac resuscitation is futile and can be terminated in the field if the following three conditions are met: (1) no return of spontaneous circulation; (2) no shock given prior to transport; (3) cardiac arrest not witnessed by EMS personnel. ⋯ The vast majority of providers were able to apply the BLS TOR clinical prediction rule correctly and were comfortable doing so. This suggests that both reliability and comfort will remain high during routine application of the rule when paramedics are well trained as users of the rule.
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Review
Drug administration in animal studies of cardiac arrest does not reflect human clinical experience.
To date, there is no evidence showing a benefit from any advanced cardiac life support (ACLS) medication in out-of-hospital cardiac arrest (OOHCA), despite animal data to the contrary. One explanation may be a difference in the time to first drug administration. Our previous work has shown the mean time to first drug administration in clinical trials is 19.4min. We hypothesized that the average time to drug administration in large animal experiments occurs earlier than in OOHCA clinical trials. ⋯ Shorter drug delivery time in animal models of cardiac arrest may be one reason for the failure of animal studies to translate successfully into the clinical arena.
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Randomized Controlled Trial
Practical impact of the European Resuscitation Council's BLS algorithm 2005.
The European Resuscitation Council (ERC) guidelines 2005 have brought major changes in the BLS algorithm. The aim of our investigation was to look for the practical impact of these modifications. ⋯ Compared to the 2000 BLS algorithm, the 2005 BLS sequence seems to be easier to learn and to retain, though nearly 60% of participants did not follow the new algorithm correctly. As expected, there was a significantly shorter time elapsing before the start of chest compressions when applying the 2005 algorithm. These findings should translate to better survival after cardiac arrest.
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Randomized Controlled Trial
Artificial acrylic finger nails may alter pulse oximetry measurement.
Pulse oximetry is the most common technique to monitor oxygen saturation (SpO(2)) during intensive care therapy. However, intermittent co-oximetry is still the "gold standard" (SaO(2)). Besides acrylic nails, numerous other factors have been reported to interfere with pulse oximetry. Data of measurements with artificial finger nails are not sufficiently published. ⋯ Acrylic finger nails may impair the measurement of oxygen saturation depending on the pulse oximeter used and may cause significant inaccuracy. Hence, removal of artificial acrylic finger nails may be helpful to assure an accurate and precise measurement with pulse oximetry.