Resuscitation
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Multicenter Study
Cardiac arrest patients rarely receive chest compressions before ambulance arrival despite the availability of pre-arrival CPR instructions.
To determine the proportion of out-of-hospital cardiac arrest (OOHCA) patients who received chest compressions, before EMS arrival, from bystanders who called the EMS emergency telephone number (9-1-1) at dispatch centers that provided telephone CPR instructions and to describe barriers to following instructions. ⋯ Few 9-1-1 callers provided chest compressions following telephone CPR instructions that included airway and breathing steps. The majority of callers were unwilling or emotionally or physically unable to follow the instructions.
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Good quality basic life support (BLS) results in better survival. BLS is a core competence of nurses but despite regular refresher training, the quality of BLS is often poor and the reasons for this are not well known. We therefore investigated the relation between BLS quality and some of its potential determinants. ⋯ Male gender, greater self-confidence, recent BLS training and recent CPR were associated with better quality of BLS.
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Comparative Study
Periodic acceleration (pGz) CPR in a swine model of asphyxia induced cardiac arrest. Short-term hemodynamic comparisons.
Asphyxia is one of the most common causes of pediatric cardiac arrest, and becoming a more frequently recognized cause in adults. Periodic acceleration (pGz) is a novel method of cardiopulmonary resuscitation (CPR). pGz is achieved by rapid motion of the supine body headward-footward that generates adequate perfusion and ventilation during cardiac arrest. In a swine ventricular fibrillation cardiac arrest model, pGz produced a higher return of spontaneous circulation (ROSC), superior neurological outcome, less echocardiography evidence of post resuscitation myocardial stunning, and decreased indices of tissue injury. In contrast to standard chest compression CPR, pGz does not produce rib fractures. We investigated the feasibility of pGz in severe asphyxia cardiac arrest and assessed whether beneficial effects seen in the VF model of cardiac arrest could be realized. ⋯ In a lethal model of asphyxia cardiac arrest, pGz is equivalent to standard CPR, with respect to acute outcomes and resuscitation survival rates but is associated with significantly lower pulmonary artery pressures and does not produce traumatic rib fractures.
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We sought to assess the prevalence of shock-induced sustained return of spontaneous circulation (ROSC) and neurologically intact discharge survival before (1990-1997) and after (1998-2006) transition to biphasic waveform defibrillation in our population-controlled EMS setting. ⋯ Return of sustained pulses with shocks alone increased after transition to biphasic waveform defibrillation, with no other differences to explain the increase. High survival was noted in both periods, with a trend toward higher survival in the second period.
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Ventilation with tidal volumes sufficient to raise the victim's chest is an integral part of guidelines for lay-rescuer basic life support, but optimal tidal volume, frequency and ratio to chest compressions are not known. ⋯ Ventilation during basic life support performed according to international guidelines (2000) resulted in arterial hypercapnia and hypoxia.