Resuscitation
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Clinical Trial
The impact of medical emergency teams on ICU admission rates, cardiopulmonary arrests and mortality in a regional hospital.
In-hospital cardiac arrests are commonly associated with poor outcomes and preceded by observable signs of clinical deterioration. Medical emergency teams (METs) have emerged to provide early specialist care intervention to critically ill patients. ⋯ Implementation of the MET in a regional hospital was associated with statistically significant reductions in hospital-wide mortality rates, ICU admissions and cardiopulmonary arrests.
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Outcome studies in patients with anoxic-ischemic encephalopathy focus on the early and reliable prediction of an outcome no better than a vegetative state or severe disability. We determined the effect of mild therapeutic hypothermia on the validity of the currently used clinical practice parameters. ⋯ No single clinical or electrophysiological parameter has sufficient accuracy to determine prognosis and decision making in patients after cardiac arrest, treated with hypothermia.
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Multicenter Study Clinical Trial
Performance of a rectilinear biphasic waveform in defibrillation of presenting and recurrent ventricular fibrillation: a prospective multicenter study.
We tested the hypothesis that shock success differs with initial and recurrent episodes of ventricular fibrillation (VF). ⋯ Presenting VF was terminated with one shock in 87.8% of cases. We observed no significant difference in the frequency of shock success between initial versus recurrent VF. VF recurred in the majority of patients and did not adversely affect shock success, ROSC, or survival.
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Randomized Controlled Trial
Bystander CPR in out-of-hospital cardiac arrest: the role of limited English proficiency.
The proportion of non-native English speakers is increasing in the United States. We sought to determine if limited English proficiency in callers to 9-1-1 for out-of-hospital cardiac arrest is associated with provision of bystander cardiopulmonary resuscitation (CPR) and delays in telephone-assisted CPR. ⋯ In this observational study of dispatcher-identified cardiac arrest, limited English proficiency in 9-1-1 callers was associated with less frequent provision of bystander CPR and delays in arrest recognition and implementation of telephone CPR, underscoring the health challenges and potential disparities of pre-hospital care related to limited English proficiency.
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In adult cardiac arrest, antiarrhythmic drugs are frequently utilized in acute management and legions of medical providers have memorized the dosage and timing of administration. However, data supporting their use is limited and is the focus of this comprehensive review. ⋯ Amiodarone may be considered for those who have refractory VT/VF, defined as VT/VF not terminated by defibrillation, or VT/VF recurrence in out of hospital cardiac arrest or in-hospital cardiac arrest. There is inadequate evidence to support or refute the use of lidocaine and other antiarrythmic agents in the same settings.