Resuscitation
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Randomized Controlled Trial
Use of the learning conversation improves instructor confidence in life support training: An open randomised controlled cross-over trial comparing teaching feedback mechanisms.
Feedback is vital for the effective delivery of skills-based education. We sought to compare the sandwich technique and learning conversation structured methods of feedback delivery in competency-based basic life support (BLS) training. ⋯ This is the first direct comparison of two feedback techniques in clinical medical education using both quantitative and qualitative methodology. The learning conversation is preferred by instructors providing competency-based life support training and is perceived to favour skills acquisition.
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Spontaneous alterations in temperature homeostasis after cardiac arrest (CA) are associated with worse outcome. However, it remains unclear the prognostic role of temperature variability (TV) during cooling procedures. We hypothesized that low TV during targeted temperature management (TTM) would be associated with a favourable neurological outcome after CA. ⋯ Among comatose survivors treated with TTM after CA, 25% of patients had high TV; however, this was not associated with a worse neurologic outcome.
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The management of non-compressible torso hemorrhage can be problematic. Current therapy requires either open or interventional radiologic control of bleeding vessels and/or organs. ⋯ REBOA is applicable by trauma professionals, including emergency physicians, at the bedside in the emergency department, but its use needs to be considered within the context of available evidence and a robust system encompassing training, accreditation, multidisciplinary involvement and quality assurance. We review the evolving role of REBOA and discuss unanswered questions and future applications.
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To investigate the association between impaired cerebrovascular autoregulation (CVAR) and outcome in comatose survivors of cardiac arrest. ⋯ Early impairment of CVAR following cardiac arrest is independently associated with mortality at three months follow-up. Assessments of CVAR could add to the management and prognostication during post-resuscitation care and should be further investigated as a guide to optimise cerebral perfusion pressure.
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Multicenter Study
Advantage of CPR-first over call-first actions for out-of-hospital cardiac arrests in nonelderly.
To assess the benefit of immediate call or cardiopulmonary resuscitation (CPR) for survival from out-of-hospital cardiac arrests (OHCAs). ⋯ Immediate CPR-first action followed by an emergency call without a large delay may be recommended when a bystander with sufficient skills to perform CPR witnesses OHCAs in nonelderly people and of noncardiac aetiology.