Resuscitation
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Multicenter Study Comparative Study
In-hospital cardiac arrest: impact of monitoring and witnessed event on patient survival and neurologic status at hospital discharge.
In-hospital cardiac arrest is a significant public health problem with a low probability of patient survival to hospital discharge. ⋯ Patients who are witnessed and/or monitored at the time of cardiac arrest demonstrate a significantly higher rate of survival to hospital discharge compared to those patients who are neither monitored nor witnessed. Monitored and/or witnessed cardiac arrest patients were also more likely to be discharged with favorable neurologic outcome. Cardiac monitoring confers no additional outcome benefit over direct observation of patients suffering in-hospital cardiac arrest.
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Randomized Controlled Trial Comparative Study
A randomised control trial comparing two techniques for locating chest compression hand position in adult Basic Life Support.
Chest compressions performed correctly have the potential to increase survival post cardiac arrest. The 2005 European Resuscitation Council (ERC) guidelines altered and simplified instructions for hand position placement to increase the number of chest compressions performed. This randomised controlled trial compares chest compression efficacy (hand position and number of effective chest compressions) after training using the 2005 guidelines or the 2005 guidelines with a hand position modification based on 2000 ERC guidelines. ⋯ The use of landmark measurement techniques in hand placement for external chest compressions does not have a detrimental effect on the number of chest compressions performed during BLS and increases correct hand positioning.
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Mild hypothermia treatment (32-34°C) in survivors after cardiac arrest (CA) is clearly recommended by the current guidelines. The effects of cooling procedure towards QT interval have not been evaluated so far outside of case series. In a prospective study 34 consecutive survivors after cardiac arrest were continuously monitored with Holter ECG over the first 48 h. ⋯ The QTc interval was found to be significantly prolonged during MTH treatment, and some severe prolongations >670 ms were observed, without a higher incidence of life-threatening arrhythmias, especially no Torsade des pointes were detected. However, routine and frequent ECG recording with respect to the QTc interval should become part of any hypothermia standard operation protocol and should be recommended by official guidelines.
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Comparative Study
Level of agreement on resuscitation decisions among hospital specialists and barriers to documenting do not attempt resuscitation (DNAR) orders in ward patients.
This study assessed the level of agreement on CPR decisions among intensive care doctors and specialist physicians and surgeons, and the barriers to documenting do not attempt resuscitation (DNAR) orders for ward patients during Medical Emergency Team (MET) calls. ⋯ This study shows a high level of agreement on DNAR orders among intensive care doctors, physicians and surgeons for deteriorating ward patients. Barriers to timely documentation need to be addressed. Delay in documentation and communication of DNAR orders is common. The MET system provides an opportunity to identify patients for whom a DNAR order should be considered.