Resuscitation
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Observational Study
The Duration of Cardiopulmonary Resuscitation in Emergency Departments after Out-of-Hospital Cardiac Arrest is Associated with the Outcome: A Nationwide Observational Study.
The appropriate duration of cardiopulmonary resuscitation (CPR) for patients who experience out-of-hospital cardiac arrest (OHCA) remains unknown. This study aimed to evaluate the duration of CPR in emergency departments (EDs) and to determine whether the institutions' median duration of CPR was associated with survival-to-discharge rate. ⋯ The duration of CPR varied widely among hospitals. The institutional duration of CPR less than 20 min was significantly associated with lower survival-to-discharge rate.
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To determine the effects of cardiopulmonary resuscitation (CPR) with AutoPulse™ (LDB-CPR) on post-resuscitation injuries identified by post-mortem computed tomography (PMCT). AutoPulse™ is a novel mechanical chest-compression device with a load-distributing band (LDB) that may affect post-resuscitation injury identified by PMCT. ⋯ LDB-CPR was associated with higher frequencies of posterior rib fracture and abdominal injury identified by PMCT. PMCT findings should be carefully examined after LDB-CPR.
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Randomized Controlled Trial
Two minutes CPR versus five cycles CPR prior to reanalysis of the cardiac rhythm: A prospective, randomized simulator-based trial.
While the 2005 cardiopulmonary resuscitation (CPR) guidelines recommended to provide CPR for five cycles before the next cardiac rhythm check, the current 2010 guideline now recommend to provide CPR for 2 min. Our aim was to compare adherence to both targets in a simulator-based randomized trial. ⋯ This randomized simulator-based trial found better adherence and less variance to an instruction to continue CPR for five cycles before the next cardiac rhythm check compared to continuing CPR for 2 min. Avoiding temporal targets whenever possible in guidelines relating to stressful events appears advisable.
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Randomized Controlled Trial Multicenter Study
Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest.
Time to Return of Spontaneous Circulation (ROSC) has a plausible relation to severity of hypoxic injury before and during resuscitation in Out-of-Hospital Cardiac Arrest (OHCA), and has consistently been associated with adverse outcome. The effect of Targeted Temperature Management (TTM) may not be similar over the full spectrum of time to ROSC. This study investigated the possible beneficial effect of targeting 33°C over 36°C on the prognostic importance of time to ROSC. ⋯ Time to ROSC remains a significant prognostic factor in comatose OHCA patients with regards to risk of death and risk of adverse neurological outcome. For any time to ROSC, targeting 33°C in TTM was not associated with benefit with regards to reducing mortality or risk of adverse neurological outcome compared to targeting 36°C.
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High quality chest compressions are the cornerstone of effective cardiopulmonary resuscitation (CPR). There is no available method of real time noninvasive hemodynamic measurement and feedback to inform rescuers of the efficacy of compressions. Ultrasound-based measures of blood flow may provide immediate, noninvasive hemodynamic information. Our objective was to determine the feasibility and safety of using ultrasound to measure blood flow on patients with cardiac arrest. ⋯ Ultrasound measurement of common carotid artery blood flow during CPR is feasible. Further studies are necessary to correlate carotid blood flow to other hemodynamic measures and its effects on patient outcomes.