Resuscitation
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Comparative Study
Plasma and myocardial visfatin expression changes are associated with therapeutic hypothermia protection during murine hemorrhagic shock/resuscitation.
Cytokine production during hemorrhagic shock (HS) could affect cardiac function during the hours after resuscitation. Visfatin is a recently described protein that functions both as a proinflammatory plasma cytokine and an intracellular enzyme within the nicotinamide adenine dinucleotide (NAD(+)) salvage pathway. We developed a mouse model of HS to study the effect of therapeutic hypothermia (TH) on hemodynamic outcomes and associated plasma and tissue visfatin content. ⋯ In a mouse model of HS, TH improves hemodynamics and alters plasma and tissue proinflammatory cytokines including the novel cytokine visfatin. TH modulation of cytokines may attenuate cardiac dysfunction following HS.
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Recent adult reports have demonstrated sub-optimal performance of basic cardiopulmonary resuscitation (CPR) skills in advanced training scenarios and real life arrest situations. We studied the adequacy of chest compressions performed by advanced trained pediatric providers in code scenarios. ⋯ Advanced training of pediatric providers does not ensure adequate delivery of chest compressions. Rate standards and adequate depth of chest compressions are infrequently achieved and both may need more emphasis in CPR training and attention during resuscitations.
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Comparative Study
A comprehensive investigation of cardiac arrest before and after arrival of emergency medical services.
Many of the factors that affect survival from out-of-hospital cardiac arrest are not relevant in patients who arrest after arrival of emergency medical services (EMS). Because all arrests that occur after arrival of EMS are witnessed and care is immediate, one might expect survival to be very high. Several studies have described communities' experiences of arrest after arrival but few have compared survival rates stratified by rhythm and witness status. The purpose of this paper was to describe the characteristics of patients who arrested after arrival of EMS and to compare survival in this population to those who had witnessed and unwitnessed arrests before EMS arrival. ⋯ Patients whose arrests were witnessed by EMS were more likely to have survived their cardiac arrests than those who arrested before EMS arrived. We suggest that survival rates from VF arrests that occur after EMS arrival should be widely reported in order to measure overall EMS performance since many factors such as response times, bystander actions, and witness status are equalized in this subset of patients.
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Comparative Study
Glucagon-like peptide-1 (GLP-1) attenuates post-resuscitation myocardial microcirculatory dysfunction.
Post-resuscitation syndrome leads to death in approximately 2 out of every 3 successfully resuscitated victims, and myocardial microcirculatory dysfunction is a major component of this syndrome. The aim of this study was to determine if glucagon-like peptide-1 (GLP-1) improves post-resuscitation myocardial microcirculatory function. ⋯ In this swine model of prolonged VF followed by successful resuscitation, myocardial microcirculatory function was enhanced with administration of GLP-1. However, GLP-1 treatment was not associated with a clinically significant improvement in post-resuscitation myocardial function.
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The application of non-technical skills (NTSs) in health care has previously been described in other health-care educational programmes. NTSs are behavioural principles such as leadership, task distribution and communication. The aim of this study was to identify NTSs suitable for improving team performance in multi-professional cardiac arrest teams, and to describe barriers to the use and implementation of such NTSs by using a qualitative method. ⋯ Interview participants pointed out that NTSs of teams could improve the treatment of cardiac arrest, but several barriers to this exist. Improving resuscitation training should include considerations regarding team leader experience, structured communication, mandatory use of cognitive aids, avoidance of task overload and mutual performance monitoring to avoid unnecessary interruptions in chest compressions.