Resuscitation
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Randomized Controlled Trial
The impact of a step stool on cardiopulmonary resuscitation: a cross-over mannequin study.
Shallow chest compressions and incomplete recoil are common during cardiopulmonary resuscitation (CPR) and negatively affect outcomes. A step stool has the potential to alter these parameters when performing CPR in a bed but the impact has not been quantified. ⋯ Using a step stool when performing CPR in a bed results in a trade-off between increased compression depth and increased incomplete recoil. Given the nonlinear relationship between the increase in compression depth and rescuer height, the benefit of a step stool may outweigh the risks of incomplete release for rescuers ≤167 cm in height. The benefit is less clear in taller rescuers.
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Randomized Controlled Trial
BML-111, a lipoxin receptor agonist, protects haemorrhagic shock-induced acute lung injury in rats.
The main pathogenesis of acute lung injury induced by haemorrhagic shock is inflammation. BML-111, a lipoxinA(4)-receptor agonist, promotes acute inflammatory resolution. We sought to elucidate whether BML-111 protects haemorrhagic shock-induced acute lung injury in rats. ⋯ BML-111 protects haemorrhagic shock-induced acute lung injury in rats.
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Mild therapeutic hypothermia (TH) has been shown to improve neurologic outcome in patients experiencing cardiac arrest after return of spontaneous circulation (ROSC). The best timing to initiate TH is currently not known. The aim of this study by the ICE (Italian Cooling Experience) group was to investigate the relationship between the timing of initiation of therapeutic hypothermia (TH) and both patient survival and neurologic outcome. ⋯ Despite similar neurologic outcomes at every time point, mortality was significantly higher when therapeutic hypothermia was started within 2h of cardiac arrest than when it was started later. Due to the lack of possibility to control several putative confounding factors, such results should be considered as preliminary observations warranting further research.
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To explore the molecular mechanisms by which mild hypothermia following resuscitation improves neurological function in a porcine model of cardiac arrest. ⋯ Brain protection induced by hypothermia involves inhibition of inflammatory and brain edema pathways.
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The amount of myocardial perfusion required for successful defibrillation after cardiac arrest is unknown. Coronary perfusion pressure (CPP) is a surrogate for myocardial perfusion. One limited clinical study identifies a threshold of 15 mmHg required for return of spontaneous circulation (ROSC). Our exploration of threshold and dose models of CPP during the initial bout of CPR indicates higher levels than previously demonstrated are required. CPP required for shock success throughout on-going resuscitation is unknown and other conceptual models of CPP have not been explored. ⋯ Threshold, delta, cumulative delta, dose, and cumulative dose CPP predict individual defibrillation success throughout resuscitation.