Resuscitation
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Survival of hypothermic avalanche victims with cardiac arrest is rare. This report describes full recovery of a 29-year-old backcountry skier completely buried for 100 min at 3.0m (9.8 ft) depth. On extrication he was unconscious, but breathing spontaneously into an air pocket; core body temperature measured 22.0 degrees C (71.6 degrees F). ⋯ This report confirms previous literature that an air pocket with patent airways is essential for survival of a completely buried avalanche victim after 35 min and endorses the recommended management strategies of the International Commission for Mountain Emergency Medicine ICAR MEDCOM. In particular, all hypothermic victims extricated with an air pocket and free airways must be treated optimistically, even despite prolonged cardiac arrest. This remarkable case documents the fastest drop in core temperature ever recorded during snow burial, namely 9.0 degrees C (16.2 degrees F)/h, and the second-lowest reversible core temperature in avalanche literature.
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(1) To describe the introduction of standardised cardiac arrest documentation to Auckland City Hospital, highlighting how barriers to using the Utstein template were overcome. (2) To determine the adequacy of documentation of cardiac arrest time intervals. ⋯ Designated 'hands-off' senior clinicians were required for accurate documentation of time intervals. Time interval documentation was sub-optimal and further efforts are required to improve this. Transfer of ownership beyond the key facilitator was integral to sustainability of the process. Future reports of in-hospital cardiac arrest outcomes should include baseline information on the adequacy of documentation of time intervals.
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Comparative Study
Characteristics and outcome among patients suffering out-of-hospital cardiac arrest due to drowning.
To describe the characteristics and outcome among patients with out-of-hospital cardiac arrest (OHCA) caused by drowning as compared with OHCA caused by a cardiac etiology (outside home). ⋯ Among patients with OHCA 0.9% were caused by drowning. They had a similar survival rate to 1 month as compared with OHCA outside home with a cardiac etiology. The factor associated with survival was the ambulance response time; a higher survival with a shorter response time.
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Public access defibrillation (PAD) has shown potential to increase cardiac arrest survival rates. ⋯ We found a definite geographical distribution pattern of cardiac arrest. This study demonstrates the utility of GIS with a national cardiac arrest database and has implications for implementing a PAD program, targeted CPR training, AED placement and ambulance deployment.