Resuscitation
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There is a need to measure cardiopulmonary resuscitation (CPR) in order to document whether ambulance personnel follow CPR guidelines. Our goal was to do this using defibrillator technology based on changes in transthoracic impedance (TTI) produced by chest compressions and ventilations. ⋯ Core CPR values can be measured from TTI signals by using a standard defibrillator and new software. NFR was 25% (20% adjusted) with great rescuer variability.
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Review Comparative Study
Is the combination of vasopressin and epinephrine superior to repeated doses of epinephrine alone in the treatment of cardiac arrest-a systematic review.
No evidence supports vasopressin over epinephrine in cardiac arrest; however animal and some clinical studies support their concurrent use. This systematic review compares the efficacy of vasopressin and epinephrine used together versus repeated doses of epinephrine alone in cardiac arrest. ⋯ This systematic review of the combination of vasopressin and epinephrine found trends towards better ROSC but equivocal effects on survival. At the present time, there is inadequate evidence to advocate the sequential use of vasopressin and epinephrine for cardiac arrest.
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Randomized Controlled Trial
Defibrillation or cardiopulmonary resuscitation first for patients with out-of-hospital cardiac arrests found by paramedics to be in ventricular fibrillation? A randomised control trial.
To determine whether in patients with an ambulance response time of >5min who were in VF cardiac arrest, 3min of CPR before the first defibrillation was more effective than immediate defibrillation in improving survival to hospital discharge. ⋯ For patient in out-of-hospital VF cardiac arrest we found no evidence to support the use of 3min of CPR before the first defibrillation over the accepted practice of immediate defibrillation.
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Indications for immediate cardiac catheterization in cardiac arrest survivors without ST elevation myocardial infarction (STEMI) are uncertain as electrocardiographic and clinical criteria may be challenging to interpret in this population. We sought to evaluate rates of early catheterization after in-hospital ventricular fibrillation (VF) arrest and the association with survival. ⋯ In patients receiving cardiac catheterization, more than half received this procedure for indications other than STEMI or new LBBB. Cardiac catheterization was associated with improved survival. Future recommendations need to be established to guide clinicians on which arrest survivors might benefit from immediate catheterization.
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Implantable cardioverter/defibrillators (ICDs) can detect ventricular fibrillation (VF) and terminate it. For determining the optimal defibrillation threshold, ventricular fibrillation is repetitively induced and terminated with DC shocks. Depending on the protocol, several fibrillation/defibrillation sequences are mandatory before the final implantation of an ICD. This procedure provides an elegant human model of circulatory arrest and resuscitation. ⋯ After DC termination of VF, the heart 'finds' relatively quickly a steady-state rhythm at the prefibrillatory level (22 beats), thereby normalizing CVP almost in parallel (14 beats). Peak LVP plateaus only after about 40 beats, although reasonable arterial pressures are reached within the first beats. Our data are limited to periods of ventricular fibrillation of no longer than 60s, which limits the generalisability to the setting of clinical cardiac arrest.