Resuscitation
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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.
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Much of the knowledge about the optimal way to perform chest compressions (CC) in newborn infants is derived from animal studies. The objective of this review was to identify studies of CC in newborn term animal models and review the evidence. We also provide an overview of the different models. ⋯ Animal studies should be performed and reported with the same rigor as in human randomized trials. Good transitional and survival models are needed to further increase the strength of the evidence derived from animal studies of newborn chest compressions.
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Observational Study
Public Access Defibrillation: Great benefit and potential but infrequently used.
In Copenhagen, a volunteer-based Automated External Defibrillator (AED) network provides a unique opportunity to assess AED use. We aimed to determine the proportion of Out-of-Hospital Cardiac Arrest (OHCA) where an AED was applied before arrival of the ambulance, and the proportion of OHCA-cases where an accessible AED was located within 100 m. In addition, we assessed 30-day survival. ⋯ We found that 3.8% of all OHCAs had an AED applied prior to ambulance arrival, but 15.1% of all OHCAs occurred within 100 m of an accessible AED. This indicates the potential of utilising AED networks by improving strategies for AED accessibility and referring bystanders of OHCA to existing AEDs.
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Determination of clinical outcomes following resuscitation from cardiac arrest remains elusive in the immediate post-arrest period. Echocardiographic assessment shortly after resuscitation has largely focused on left ventricular (LV) function. We aimed to determine whether post-arrest right ventricular (RV) dysfunction predicts worse survival and poor neurologic outcome in cardiac arrest patients, independent of LV dysfunction. ⋯ Echocardiographic findings of post-arrest RV dysfunction were equally prevalent as LV dysfunction. RV dysfunction was significantly predictive of worse outcomes in post-arrest patients after accounting for LV dysfunction. Post-arrest RV dysfunction may be useful for risk stratification and management in this high-mortality population.
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The Neonatal Resuscitation Program (NRP) algorithm serves as a guide to healthcare professionals caring for neonates transitioning to extrauterine life. Despite this, adherence to the algorithm is challenging, and errors are frequent. Information-dense, high-risk fields such as air traffic control have proven that formal classification of errors facilitates recognition and remediation. This study was performed to determine and characterize common deviations from the NRP algorithm during neonatal resuscitation. ⋯ Errors of commission, especially when performing advanced life support interventions such as positive pressure ventilation, intubation, and chest compressions, are common during neonatal resuscitation and are sources of potential harm. The adoption of error reduction strategies capable of decreasing cognitive and technical load and standardizing communication - strategies common in other industries - should be considered in healthcare.