Resuscitation
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Randomized Controlled Trial Multicenter Study Comparative Study
A randomized controlled trial comparing the Arctic Sun to standard cooling for induction of hypothermia after cardiac arrest.
Hypothermia improves neurological outcome for comatose survivors of out-of-hospital cardiac arrest. Use of computer controlled high surface area devices for cooling may lead to faster cooling rates and potentially improve patient outcome. ⋯ While the proportion of subjects reaching target temperature within 4h was not significantly different, the Arctic Sun cooled patients to a temperature of 34 degrees C more rapidly than standard cooling blankets.
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Comparative Study
A comparison of the I-gel supraglottic airway as a conduit for tracheal intubation with the intubating laryngeal mask airway: a manikin study.
Insertion of a supraglottic airway and tracheal intubation through it may be indicated in resuscitation scenarios where conventional laryngoscopy fails. Various supraglottic devices have been used as conduits for tracheal intubation, including the intubating laryngeal mask airway (ILMA), the Ctrach laryngeal mask and the I-gel supraglottic airway. ⋯ The results of this study show that, in manikins, fibreoptic intubation through both ILMA and I-gel is a highly successful technique. Blind intubation through the I-gel showed a low success rate and should not be attempted.
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Comparative Study
Comparison of intravenous and intraosseous access by pre-hospital medical emergency personnel with and without CBRN protective equipment.
Rapid intravascular access is a prerequisite component of emergency care and resuscitation. Peripheral intravenous (IV) access is the first-choice for most of the medical or trauma patients, but may be delayed in emergency conditions because of various difficulties. Elsewhere, intraosseous (IO) access may now be easily performed with a new semi-automatic battery-powered IO-insertion device (EZ-IO. The aim of this study was to compare the overall time to establish IO infusion with the EZ-IO device and the equivalent time for peripheral IV infusion, performed by emergency personnel in standard (No-CBRN) and in chemical, biological, radiological, and nuclear (CBRN) protective equipment. ⋯ The time to establish IO infusion was significantly shorter than that for peripheral IV infusion, under both No-CBRN and CBRN conditions. Further clinical studies are required to confirm that IO access would effectively save time over IV access in real pre-hospital emergency settings.
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Identifying early changes in hemostatic clot function as a result of tissue injury and hypoperfusion may provide important information regarding the mechanisms of traumatic coagulopathy. A combat-relevant swine model was used to investigate the development of coagulopathy during trauma by monitoring hemostatic function during increasing severity of shock. ⋯ In this swine model of traumatic shock, fibrinogen was significantly reduced and an isolated reduction in clot strength (MA) was found with increasing OD. Fibrinogen consumption and altered platelet function may account for the earliest changes in hemostatic function during traumatic shock.