Resuscitation
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Review
The use of CPR feedback/prompt devices during training and CPR performance: A systematic review.
In lay persons and health care providers performing cardiopulmonary resuscitation (CPR), does the use of CPR feedback/prompt devices when compared to no device improve CPR skill acquisition, retention, and real life performance? ⋯ There is good evidence supporting the use of CPR feedback/prompt devices during CPR training to improve CPR skill acquisition and retention. Their use in clinical practice as part of an overall strategy to improve the quality of CPR may be beneficial. The accuracy of devices to measure compression depth should be calibrated to take account of the stiffness of the support surface upon which CPR is being performed (e.g. floor/mattress). Further studies are needed to determine if these devices improve patient outcomes.
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There is mounting evidence to support the concept of chest compression-only CPR for out-of-hospital cardiac arrest victims, not least because it is simple and does not require rescuers to perform unpleasant mouth-to-mouth ventilation. The problem is that for a small, but important, minority of victims (children and those suffering an asphyxial or prolonged arrest) this is suboptimal treatment. The forthcoming guidelines revision process will require a compromise to be reached. The solution proposed is citizen training in two stages: adult compression-only CPR initially, then a second, follow-up stage when ventilation is added to satisfy the needs of minority victims.
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Drowning is a unique form of cardiac arrest and is often preventable. "Utstein Style for Drowning" was published in 2003 by the International Liaison Committee on Resuscitation (ILCOR) to improve the knowledge-base, to provide epidemiological stratification, to recommend appropriate treatments and to ultimately save lives. We report on the largest single-center study of the Utstein Style resuscitation for drowning. ⋯ Our report is the largest single-center study of OHCA due to drowning reported according to the guidelines of the Utstein Style. Being witnessed, having a short duration of submersion, having early resuscitation by EMS, and rapid transportation are important for survival after drowning.
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Technical data now gathered by automated external defibrillators (AEDs) allows closer evaluation of the behavior of defibrillation shocks administered during out-of-hospital cardiac arrest. We analyzed technical data from a large case series to evaluate the change in transthoracic impedance between shocks, and to assess the heterogeneity of the probability of successful defibrillation across the population. ⋯ Impedance change between consecutive shocks is minimal and inconsistent. Therefore, to increase current of a subsequent shock requires an increase of the energy setting. Distribution of failed shocks is far from random. First shock defibrillation failure is often predictive of low efficacy for subsequent shocks.