Resuscitation
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The incidence rate of out-of-hospital cardiac arrest (OHCA) among infants is high; however, little is known about effective life-support for this group. Thus, we examined factors related to 1-month survival after OHCA among infants. ⋯ The probability of survival after OHCA in infants may be improved by a bystander witnessing the arrest and providing the rescue breathing at the first sight of arrest.
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Defibrillators are used to treat many thousands of people each year using very high voltages, but, despite this, reported injuries to rescuers are rare. Although even a small number of reported injuries is not ideal, the safety record of the defibrillator using the current protocol is widely regarded as being acceptable. There is increasing evidence that clinical outcome is significantly improved with continuous chest compressions, but defibrillation is a common cause of interruptions; even short interruptions, such as those associated with defibrillation, may detrimentally affect the outcome. ⋯ Clearly any deviation from accepted practice should only be undertaken following careful consideration of the risks and benefits to the patient, rescuers and others. This review summarises the physical principles of electrical risk and identifies ways in which these could be managed. In doing so, it is hoped that in future it may be possible to deliver continuous and safe manual chest compressions during defibrillator discharge in order to improve patient outcome.
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Randomized Controlled Trial
Impaired β-adrenergic receptor signalling in post-resuscitation myocardial dysfunction.
Post-resuscitation myocardial dysfunction is a major cause of fatality in patients receiving successful cardiopulmonary resuscitation. The mechanism of post-resuscitation myocardial dysfunction is largely unknown, although is generally considered related to ischaemia occurring during cardiac arrest and resuscitation and/or reperfusion injury after restoration of circulation. A key mechanism responsible for reduced contractile reserves in chronic heart failure is impaired β-adrenergic receptor signalling. Thus, we hypothesised that β-adrenergic receptor signalling is markedly abnormal in the post-resuscitation period following cardiopulmonary resuscitation. ⋯ β-Adrenergic receptor signalling is markedly impaired in the post-resuscitation period, which may be a mechanism of post-resuscitation myocardial dysfunction.
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Randomized Controlled Trial
Fluoxetine has neuroprotective effects after cardiac arrest and cardiopulmonary resuscitation in mouse.
Fluoxetine, a selective serotonin reuptake inhibitor, is protective in a rat focal ischaemia model via anti-inflammatory mechanisms. Cardiac arrest and cardiopulmonary resuscitation (CA/CPR) were performed in mice to test the hypothesis that fluoxetine protects the brain following global cerebral ischaemia, even when administered after an insult. ⋯ Our data showed that 10mg/kg fluoxetine administered following global cerebral ischaemia decreases neuronal damage. Although long-term neuroprotection needs further study, the results of our study suggest that fluoxetine may have therapeutic potential when administered after global cerebral ischaemia, cardiac arrest and cardiopulmonary resuscitation.