Resuscitation
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Observational Study
Hemodynamic targets during therapeutic hypothermia after cardiac arrest: A prospective observational study.
In analogy with sepsis, current post-cardiac arrest (CA) guidelines recommend to target mean arterial pressure (MAP) above 65 mmHg and SVO2 above 70%. This is unsupported by mortality or cerebral perfusion data. The aim of this study was to explore the associations between MAP, SVO2, cerebral oxygenation and survival. ⋯ we showed that a MAP range between 76-86 mmHg and SVO2 range between 67% and 72% were associated with maximal survival. Optimal cerebral saturation was achieved with a MAP between 87-101 mmHg and a SVO2 between 70% and 75%. Prospective interventional studies are needed to investigate whether forcing MAP and SVO2 in the suggested range with additional pharmacological support would improve outcome.
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To determine the effectiveness of ventilations in bystander cardiopulmonary resuscitation (BCPR) and to identify the factors associated with ventilation-only BCPR. ⋯ Ventilation is a significant component of BCPR, but alone is less effective than compression in improving neurologically favourable survival after OHCAs.
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Observational Study
Survival after Public Access Defibrillation in Stockholm, Sweden - A striking success.
In Stockholm, a first responder system and a Public Access Defibrillation (PAD) program has been implemented. Additionally, the number of "unregulated" public Automated External Defibrillators (AEDs) sold "over-the-counter" has increased. The aim of this study was to evaluate the impact on survival from different defibrillation strategies in cases of out-of-hospital cardiac arrest (OHCA) available for PAD. ⋯ In OHCAs available for PAD, 70% of patients survived if a public AED was used. Both the structured AED program as well as the spread of unregulated AEDs was associated with very high survival rates, but the structured approach was more efficient in relation to the number of AEDs used.
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Observational Study
Videographic assessment of cardiopulmonary resuscitation quality in the pediatric emergency department.
To describe the adherence to guidelines for CPR in a tertiary pediatric emergency department (ED) where resuscitations are reviewed by videorecording. ⋯ CPR in a tertiary pediatric ED frequently met recommended parameters for compression rate, pause duration, and compression fraction. Hyperventilation and failure of C:V coordination were very common. Future studies should focus on the impact of training methods on CPR performance as documented by videorecording.
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Proposed Irish legislation aimed at increasing survival from out-of-hospital-cardiac-arrest (OHCA) mandates the provision of automated external defibrillators (AEDs) in a comprehensive range of publicly accessible premises in urban and rural areas. This study estimated the clinical and cost effectiveness of the legislation, compared with alternative programme configurations involving more targeted AED placement. ⋯ National PAD programmes involving widespread deployment of static AEDs are unlikely to be cost-effective. To improve cost-effectiveness any prospective programmes should target locations with the highest incidence of OHCA and be supported by efforts to increase AED utilisation, such as improving public awareness, increasing CPR and AED training, and establishing an EMS-linked AED register.