Resuscitation
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To update a comprehensive systematic review of the use of therapeutic hypothermia after cardiac arrest that was undertaken initially as part of the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. The specific question addressed was: 'in post-cardiac arrest patients with a return of spontaneous circulation, does the induction of mild hypothermia improve morbidity or mortality when compared with usual care?' ⋯ There is evidence supporting the use of mild therapeutic hypothermia to improve neurological outcome in patients who remain comatose following the return of spontaneous circulation after a cardiac arrest; however, much of the evidence is from low-level, observational studies. Of seven randomised controlled trials, six use data from the same patients.
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Comparative Study
Benefits and shortcomings of mandatory first aid and basic life support courses for learner drivers.
Annually, more than 127,000 people are killed and at least 2.4 million people injured in road accidents in Europe. Consequently, in half of all countries in the European Union a first aid and basic life support course has become mandatory for learner drivers. The aim of this study was to evaluate the effect of this course on participants' knowledge and self-assessed first aid and basic life support skills. ⋯ A mandatory course for learner drivers significantly improves participants' knowledge and their self-assessed skills in first aid and basic life support. However, improvements of the course should be considered on a number of key topics.
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Comparative Study
Extra corporeal life support makes advanced radiologic examinations and cardiac interventions possible in patients with cardiac arrest.
Extra corporeal life support (ECLS) with a mobile system is an option in the treatment of cardiac arrest often of unknown reason. After commencing ECLS the search for a provoking origin may include advanced radiologic examinations before deciding further treatment. ⋯ It is possible to make radiological examinations i.e., CT scans, pulmonary and coronary angiography in patients suffering heart arrest of unknown origin with the use of ECLS in order to improve patient treatment in this very high-risk population.
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This study investigated the systemic and microvascular hemodynamic changes related to increased nitric oxide (NO) availability following significant hemorrhage, made available by administration of NO releasing nanoparticles (NO-nps). Hemodynamic responses to hemorrhagic shock were studied in the hamster window chamber. Acute hemorrhage was induced by arterial controlled bleeding of 50% of blood volume, and the resulting hemodynamic parameters were followed over 90 min. ⋯ Paradoxically, the peripheral vasodilation induced by the NO-nps did not decrease blood pressure, and combined with NO's effects on vascular resistance, NO-nps promoted intravascular pressure redistribution and blood flow, avoiding tissue ischemia. Therefore, by increasing NO availability with NO-nps during hypovolemic shock, it is possible that cardiac stability and microvascular perfusion can be preserved, ultimately increasing survivability and local tissue viability, and reducing hemorrhagic shock sequelae. The relevance, stability, and efficacy of exogenous NO therapy in the form of NO-nps will potentially facilitate the intended use in battlefield and trauma situations.