Resuscitation
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Animal studies indicate that maintaining physiologic O2 levels (normoxia) immediately after restoration of spontaneous circulation (ROSC) from cardiac arrest (CA) results in less hippocampal neuronal death compared to animals ventilated with 100% O2. This study tested the hypothesis that beneficial effects of avoiding hyperoxia following CA are apparent in the cerebellum and therefore not limited to one brain region. ⋯ Hyperoxic resuscitation increased the number of injured Purkinje cells by 278% and the number of activated microglia/macrophages by 18% compared to normoxic resuscitation. These results indicate that normoxic resuscitation promotes favorable histopathologic outcomes in the cerebellum (in addition to hippocampus) following CA/ROSC. These findings emphasize the importance of avoiding unnecessary hyperoxia following CA/ROSC.
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To assess characteristics and outcome of patients treated with Impella for acute myocardial infarction (AMI) complicated by severe cardiogenic shock (CS) or cardiac arrest (CA). ⋯ In this registry of patients with AMICS treated with Impella, hypertension and older age were found to be negatively predictive for survival. Patients without CA had the highest 30-day survival. In patients with ROSC, survival was strongly related to age and comorbidity. Patients with ongoing CPR had very high mortality.
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Comparative Study
Closed chest compressions reduce survival in an animal model of haemorrhage-induced traumatic cardiac arrest.
Closed chest compressions (CCC) are recommended for medical cardiac arrest, but there is little evidence to support their inclusion for traumatic cardiac arrest (TCA). This laboratory study evaluated CCC following haemorrhage-induced TCA and whether resuscitation with blood improved survival compared to saline. The study was conducted with the authority of UK Animals (Scientific Procedures) Act 1986 (received institutional ethical approval and a Home Office Licence) using 39 terminally anesthetised, instrumented, juvenile Large White pigs. ⋯ Some significant differences were present at the end of the Resuscitation Phase for Group 4 versus Group 2 but these differences were no longer present by Study End. CCC were associated with increased mortality and compromised haemodynamics compared to intravenous fluid resuscitation. Whole blood resuscitation was better than saline.
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Public access of automated external defibrillator (AED) is an important public health strategy for improving survival of cardiac arrest. Major metropolitan cities in China are increasingly investing and implementing public access defibrillator programs, but the effectiveness of these programs remains unclear. This study aims to evaluate the public accessibility of AED in Shanghai, a major metropolitan city in China. ⋯ Public placement and accessibility of AEDs, related public signs and information on AED, and staff's awareness about AED were not optimal in Shanghai. Continuing efforts should be made to improve public accessibility and public awareness, knowledge, and user skills of AED.
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Nasopharygeal airways are used in urgent situations to alleviate airway obstruction. Guidelines for measuring the length of the NPA differ between national and international guidelines, and the evidence base for these measurements is lacking. The purpose of this study was to measure the nares-epiglottis and nares-vocal cord distances in young children (neonates to 12 years) on 3D reconstructed Magnetic Resonance Imaging (MRI) brain volume scans, and to examine the relationship of these distances with the nares-tragus and nares-mandible distances. ⋯ In conclusion, the length of a nasopharyngeal airway in children under the age of twelve years can be predicted using the nares-tragus external anatomical distance minus 10 mm.