Resuscitation
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This observational study aims to describe: (1) the use of positive pressure ventilation (PPV) for resuscitation in the delivery room among newly born near-term infants; (2) the methods used for PPV resuscitation [e.g., bag-facial mask (BFM), laryngeal mask airway (LMA), endotracheal tube (ETT)]; and (3) the association of each device with short-term neonatal outcomes. ⋯ The LMA is an effective device for primary airway management of near-term infants and for secondary airway management among near-term infants failing BFM or ETT resuscitation.
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Randomized Controlled Trial
Performance of chest compressions by laypersons during the Public Access Defibrillation Trial.
Increasing evidence indicates that health professionals often may not achieve guideline standards for cardiopulmonary resuscitation (CPR). Little is known about layperson CPR performance. ⋯ In this study of trained laypersons, CPR varied substantially and often did not achieve guideline parameters. The findings suggest a need to improve CPR training, consider changes to CPR protocols, and/or improve the AED-rescuer interface.
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Comparative Study
Capnography and chest-wall impedance algorithms for ventilation detection during cardiopulmonary resuscitation.
Hyperventilation is both common and detrimental during cardiopulmonary resuscitation (CPR). Chest-wall impedance algorithms have been developed to detect ventilations during CPR. However, impedance signals are challenged by noise artifact from multiple sources, including chest compressions. Capnography has been proposed as an alternate method to measure ventilations. We sought to assess and compare the adequacy of these two approaches. ⋯ Both the impedance and capnography-based algorithms underestimated the ventilation rate. Reliable ventilation rate determination may require a novel combination of multiple algorithms during resuscitation.
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The risk of complications of cardiopulmonary resuscitation (CPR) does not outweigh the benefit of a successful restoration of a spontaneous circulation. Despite the frequent occurrence of gastric distension (caused by air entering the stomach because of too forceful and/or too quick rescue breathing), there are few reports of massive gastric distension causing gastric rupture and pneumoperitoneum after CPR. We reviewed all 67 case reports of gastric perforation that have been reported after CPR. Although uncommon, this review stresses the need to consider this potentially lethal complication after initial successful resuscitation.
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To assess the reliability and validity of scoring instruments designed to measure clinical performance during simulated resuscitations requiring the use of Pediatric Advanced Life Support (PALS) algorithms. ⋯ The instruments assessed in this study measure clinical performance during PALS scenarios in a reliable and valid manner. Measurement error could be minimized further through the use of additional scenarios but additional raters, for a given scenario, would not improve reliability. Further studies should assess validity of measurement with respect to actual clinical performance during resuscitations.