Resuscitation
-
Observational Study
Double sequential defibrillation therapy for out-of-hospital cardiac arrests: the London experience.
Despite advances in treatment for out-of-hospital cardiac arrest (OHCA), a subgroup of patients remain in refractory ventricular fibrillation (RVF) during resuscitation. Recent evidence suggests that double sequential defibrillation (DSD), where two shocks are delivered to the patient in quick succession, may provide an effective therapy for RVF. This study describes the characteristics and survival outcomes of OHCA patients treated by ambulance clinicians using a local DSD protocol in an attempt to resolve RVF. ⋯ Our observational study did not find any clear benefit of DSD use by EMS in the treatment of RVF. However, we find that 3 patients, who were treated with DSD following unsuccessful single shocks, had their VF terminated. Prospective randomised clinical trials are urgently needed to investigate the potential value of DSD in the pre-hospital setting.
-
Multicenter Study
Validation of a new proposal to avoid donor resuscitation in controlled donation after circulatory death with normothermic regional perfusion.
The use of abdominal normothermic regional perfusion (nRP) and premortem interventions in controlled donation after circulatory death (cDCD) may represent a significant advance to increase the number and quality of grafts recovered in cDCD. The main limitation for the widespread acceptance of nRP in cDCD is the concerns of restoring circulation to the brain once death has been declared should the thoracic aorta not be adequately blocked. ⋯ A total of 78 procedures with premortem cannulation and abdominal nRP were performed in four different hospitals. No case of heart or brain resuscitation was observed after nRP CONCLUSION: The use of premortem interventions before nRP and the aortic occlusion balloon may increase the number of grafts recovered in cDCD. Our proposed methodology avoids the ethical problem of resuscitation by guaranteeing that circulation to the heart and brain is not restored after nRP.
-
Multicenter Study Pragmatic Clinical Trial
The cost-effectiveness of a mechanical compression device in out of hospital cardiac arrest.
To assess the cost-effectiveness of LUCAS-2, a mechanical device for cardiopulmonary resuscitation (CPR) as compared to manual chest compressions in adults with non-traumatic, out-of-hospital cardiac arrest. ⋯ Our study demonstrates that the use of the mechanical chest compression device LUCAS-2 represents poor value for money when compared to standard manual chest compression in out-of-hospital cardiac arrest.