Resuscitation
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Randomized Controlled Trial
Time matters - Realism in resuscitation training.
The advanced life support guidelines recommend 2min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation-based resuscitation training, the recommended 2-min CPR cycles are often deliberately decreased in order to increase the number of scenarios. The aim of this study was to test if keeping 2-min CPR cycles during resuscitation training ensures better adherence to time during resuscitation in a simulated setting. ⋯ This study indicates that time is an important part of fidelity. Variables critical for performance, like adherence to time in resuscitation, should therefore be kept realistic during training to optimise outcome.
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Multicenter Study
Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit.
To report the incidence, characteristics and outcome of adult in-hospital cardiac arrest in the United Kingdom (UK) National Cardiac Arrest Audit database. ⋯ These first results from the NCAA database describing the current incidence and outcome of adult in-hospital cardiac arrest in UK hospitals will serve as a benchmark from which to assess the future impact of changes in service delivery, organisation and treatment for in-hospital cardiac arrest.
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To evaluate the incidence of postresuscitation myocardial depression (PRMD) and hemodynamical parameters associated with PRMD in patients treated with therapeutic hypothermia (TH) after out-of-hospital cardiac arrest with ventricular fibrillation (OHCA-VF). ⋯ Two-thirds of the OHCA-VF patients develops transient postresuscitation myocardial depression not easily detected without monitoring of CI during therapeutic hypothermia. Further controlled studies are warranted to evaluate the value of different hemodynamic targets and monitoring after cardiac arrest in terms of outcome.
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Triage after resuscitation from cardiac arrest is hindered by reliable early estimation of brain injury. We evaluated the performance of a triage model based on early bispectral index (BIS) findings and cardiac risk classes. ⋯ Neurocardiac triage based on very early processed EEG (BIS) is feasible, and may identify patients appropriate for individualized post-resuscitation care. This and other triage models warrant further study.
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The timing of and interval between events in prehospital care is important for system design, patient outcome, and prehospital research. Since these data can guide treatment recommendations, it is imperative that time-based prehospital documentation is accurate and precise, especially for time-sensitive conditions such as out-of-hospital cardiac arrest (OHCA). We compared the times of select events documented in the medical record (PCR) with times from time-stamped audio recordings in the monitor-defibrillator (AUD). ⋯ We found a 2 (IQR 1-4) min imprecision in the documented timing of select events during OHCA resuscitation. This imprecision contributes to uncertainty in analyses that incorporate time-stamped variables.