Resuscitation
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Randomized Controlled Trial Multicenter Study Comparative Study
Alternating providers during continuous chest compressions for cardiac arrest: every minute or every two minutes?
Studies have shown that the quality of chest compressions for cardiac arrest decreases markedly after only a brief time. This is thought to be an important contributor to an adverse outcome of resuscitation, which has led to recommendations to alternate chest compression providers. This study compared alternating rescuers every 1 min versus every 2 min in a manikin simulation. ⋯ Power calculations with these results show that an unfeasibly large number of scenarios would be needed to definitively demonstrate the superiority of one of the scenarios. It seems reasonable to alternate chest compression providers every 2 min, to prevent the loss of effective compressions due to fatigue and to minimise interruptions of chest compressions. The ideal time to do this would be during the rhythm and pulse check as dictated by current guidelines.
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Comparative Study
Tuition of emergency medical dispatchers in the recognition of agonal respiration increases the use of telephone assisted CPR.
Bystanders cardiopulmonary resuscitation (CPR) increases survival in out-of-hospital cardiac arrest (OHCA). Emergency medical dispatchers (EMDs) can provide even totally inexperienced bystanders with instructions by telephone on how to resuscitate victims (T-CPR) until the emergency medical services (EMS) arrive. Agonal respiration makes it difficult for EMDs to identify cardiac arrests (CAs) which will prevent or delay initiation of T-CPR. The aim of this investigation was to study if tuition of EMDs can improve their ability to identify agonal respiration in OHCA to allow for more frequent offers of T-CPR. ⋯ Teaching EMDs to understand and recognize bystander descriptions of agonal respiration in patients with OHCA has resulted in a significant increase in offers of T-CPR in these situations.
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Comparative Study
Subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest: a prospective computed tomography study.
Aneurysmal subarachnoid haemorrhage (SAH) is a relatively common cause of out-of-hospital cardiac arrest (OHCA). Early identification of SAH-induced OHCA with the use of brain computed tomography (CT) scan obtained immediately after resuscitation may help emergency physicians make therapeutic decision as quickly as they can. ⋯ Aneurysmal SAH causes OHCA more frequently than had been believed. Immediate brain CT scan may particularly be useful in excluding SAH-induced OHCA from thrombolytic trial enrollment, for whom the use of thrombolytics is contraindicated. The low VF incidence suggests that VF by itself may not be a common cause of SAH-induced OHCA.
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Early and accurate prediction of survival to hospital discharge following resuscitation after cardiac arrest (CA) is a major challenge. Our aim was to investigate the levels of ischemia-modified albumin (IMA) and malondialdehyde (MDA) in CA patients and whether IMA levels are valuable early marker of post-cardiopulmonary resuscitation prognosis in CA patients. ⋯ In conclusion, though the result may not be applied clinically in every patient, the ischemia-modified albumin may be a valuable prognostic marker in cardiac arrest patients following CPR.
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Comparative Study
Development of a rapid, safe, fiber-optic guided, single-incision cricothyrotomy using a large ovine model: a pilot study.
We present a pilot study in which we use an ovine model to develop a rapid, safe cricothyrotomy technique using a Melker cuffed 5.0 cricothyrotomy catheter loaded over a fiberoptic stainless steel optical stylet. The technique requires a single incision. The stylet allows easy placement and facilitates visual, tactile, and transillumination confirmation of intratracheal placement. We recorded this process on video to facilitate the development of the procedure and to allow others to replicate it for further research or refinement. All devices used in this technique are currently employed in clinical practice. ⋯ The procedure is rapid, incorporates redundant safety features, and uses equipment increasingly available to anesthesiologists, emergency physicians, intensivists and surgeons. The promising outcome of this pilot study should be verified in a larger controlled, comparative trial.