Resuscitation
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Early bystander cardiopulmonary resuscitation (CPR) provides an essential bridge to successful defibrillation from sudden cardiac arrest (SCA) and there is a need to increase the prevalence and quality of bystander CPR. Emergency medical dispatchers can give CPR instructions to a bystander calling for an ambulance enabling even an inexperienced bystander to start CPR. The impact of these instructions has not been evaluated. ⋯ There is limited evidence supporting the survival benefit of dispatch-assisted CPR instructions. All studies comparing survival outcomes when CPR is provided with or without the assistance of dispatch-assisted CPR instructions lack the statistical power to draw significant conclusions. Since it has been demonstrated that such instructions can improve bystander CPR rates, it is reasonable to recommend they should be provided to all callers reporting a victim in cardiac arrest.
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Comparative Study
Difficult prehospital endotracheal intubation - predisposing factors in a physician based EMS.
For experienced personnel endotracheal intubation (ETI) is the gold standard to secure the airway in prehospital emergency medicine. Nevertheless, substantial procedural difficulties have been reported with a significant potential to compromise patients' outcomes. Systematic evaluation of ETI in paramedic operated emergency medical systems (EMS) and in a mixed physician/anaesthetic nurse EMS showed divergent results. In our study we systematically assessed factors associated with difficult ETI in an EMS exclusively operating with physicians. ⋯ In a physician staffed EMS difficult prehospital ETI occurred in 13% of cases. Predisposing factors were limited surrounding space on scene and certain biophysical conditions of the patient (short neck, obesity, face and neck injuries, and anatomical restrictions). Unexpected difficult ETI occurred in 5% of the cases.
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Comparative Study
Visual evaluation of left ventricular performance predicts volume responsiveness early after resuscitation from cardiac arrest.
Haemodynamic optimisation is a fundamental goal of post-cardiac arrest therapy. Therefore, predicting volume responsiveness is a key issue in therapy of these high-risk patients and transoesophageal echocardiography (TEE) may provide helpful information. The aim of the present study was to evaluate the performance of visual evaluation (eyeballing) of standardised TEE-loops to predict volume responsiveness during post-cardiac arrest period. ⋯ In post-cardiac arrest period, visual evaluation of long-axis TEE loops allows prediction of volume responsiveness with good sensitivity and reasonable specificity even by novice users, and may therefore be suitable for implementation into treatment protocols.
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Comparative Study
Good outcome in every fourth resuscitation attempt is achievable--an Utstein template report from the Stavanger region.
Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the western world. We wanted to study changes in survival over time and factors linked to this in a region which have already reported high survival rates. ⋯ Overall, good outcome is now achievable in every fourth resuscitation attempt and in every second resuscitation attempt when patients have a shockable rhythm. The reason for the better outcomes is most likely multi-factorial and linked to improvements in the local chain of survival.
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Comparative Study
Prevalence and hemodynamic effects of leaning during CPR.
Cardiopulmonary resuscitation (CPR) guidelines recommend complete release between chest compressions (CC). ⋯ Leaning during CPR increases intrathoracic pressure, decreases coronary perfusion pressure, and decreases cardiac output and myocardial blood flow. Leaning is common during CPR.