Resuscitation
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Multicenter Study
Rapid induction of therapeutic hypothermia using convective-immersion surface cooling: safety, efficacy and outcomes.
Therapeutic hypothermia has become an accepted part of post-resuscitation care. Efforts to shorten the time from return of spontaneous circulation to target temperature have led to the exploration of different cooling techniques. Convective-immersion uses a continuous shower of 2 degrees C water to rapidly induce hypothermia. ⋯ Conductive-immersion surface cooling using the ThermoSuit System is a rapid, effective method of inducing therapeutic hypothermia. Although the study was not designed to demonstrate impact on outcomes, survival and neurologic function were superior to those previously reported, suggesting comparative studies should be undertaken. Shortening the delay from return of spontaneous circulation to hypothermic target temperature may significantly improve survival and neurologic outcome and warrants further study.
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Comparative Study
Scandinavian pre-hospital physician-manned Emergency Medical Services--same concept across borders?
In Scandinavia, scattered populations and challenging geographical and climatic conditions necessitate highly advanced medical treatment by qualified pre-hospital services. Just like every other part of the health care system, the specialized pre-hospital EMS should aim to optimize its resource use, and critically review as well as continuously assess the quality of its practices. This study aims to provide a comprehensive profile of the pre-hospital, physician-manned EMS in the Scandinavian countries. ⋯ This survey documented several significant similarities among pre-hospital physician-staffed EMS systems in Scandinavia. Although medical data registration is currently under-developed, Scandinavian physician-manned EMS is a feasible arena for future multi-centre research.
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Comparative Study
Monitoring in resuscitation: comparison of cardiac output measurement between pulmonary artery catheter and NICO.
The cardiac output and coronary perfusion pressure generated from chest compressions during resuscitation manoeuvres can predict effectiveness and successful outcome. Until now, there is no good method for haemodynamic monitoring during resuscitation. Noninvasive partial carbon dioxide rebreathing system (NICO, Novametrix Medical Systems, Inc., Wallingford, CT, USA) is a relatively new non-invasive alternative to thermodilution for measuring cardiac output. The accuracy of the NICO system has not been evaluated during resuscitation. The aim of this study is to compare thermodilution cardiac output method with NICO system and to assess the utility of NICO during resuscitation. ⋯ There is a high degree of agreement between cardiac output measurements obtained with NICO and thermodilution cardiac output during resuscitation. The present study suggests that the NICO system may be useful to measure cardiac output generated during cardiopulmonary resuscitation.
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Both a written cognitive knowledge evaluation and a practical evaluation that tests psychomotor skills, cognitive knowledge, and affective behaviors such as leadership and team skills are required for successful completion of American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) course. The 2005 International Liaison Committee on Resuscitation (ILCOR) Consensus on Science and Treatment Recommendations noted that in Basic Life Support (BLS) there is little to no correlation between written and practical skills. The current study was conducted to determine if there is a correlation between written and practical evaluations in an ACLS course. ⋯ The ACLS written evaluation was not a predictor of participant skills in managing a simulated cardiac arrest event immediately following an ACLS course. The single case simulations used in ACLS skills evaluation test a narrow portion of ACLS content while written evaluation tests can more practically test a broader spectrum of content. Both work in concert to define participant knowledge and neither should be used exclusively to determine participant competence.