Resuscitation
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The new resuscitation guidelines permit compressions before delayed, defibrillation, a change that has generally been welcomed. The benefits are generally assumed to relate to the immediate provision of limited coronary perfusion with protection or replenishment of myocardial metabolic reserves. ⋯ We argue that changes in the size and shape of the ventricles are the most important reason for the narrow window of opportunity for defibrillation alone and for the value of compressions in extending this period. We also draw attention to the implication for clinical resuscitation and to one aspect of the current guidelines of the European Resuscitation Council that we believe to be inconsistent with the evidence that we review.
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Previous studies have documented poor quality CPR during real life resuscitation attempts. This study investigated whether poor quality CPR during advanced life support training could be contributing to poor performance in clinical practice. ⋯ The implementation of Guidelines 2005 into the ALS course appear to have improved the process of CPR by reducing no-flow time during simulated CPR. However, the quality of CPR during ALS training remains sub-optimal. Delays in starting CPR, inadequate compression depth, excessive interruptions in chest compressions and prolonged pre-shock pauses mirror observations from clinical practice. Strategies to improve CPR performance during ALS training should be explored and potentially may result in improvements in clinical practice.
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Several studies using a variety of assessment approaches have demonstrated that young doctors possess insufficient resuscitation competence. The aims of this study were to assess newly graduated doctors' resuscitation competence against an internationally recognised standard and to study whether teaching site affects their resuscitation competence. ⋯ Newly graduated doctors do not have sufficient competence in managing cardiopulmonary arrests according to the current guidelines published by ERC. There were significant differences in ALS-competence between sites. Change in teaching and assessment practice in undergraduate emergency medicine courses is needed in order to increase the level of ALS-competence of newly graduated doctors.
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While several techniques are used for the management of difficult intubation (DI) in planned conditions in the operating theatre, they are not always suitable or usable in pre-hospital emergencies. We decided to assess the intubating laryngeal mask airway (ILMA) after failure of tracheal intubation (TI) under direct laryngoscopy. ⋯ Emergency physicians were satisfied with using the ILMA. It allowed TI in 91% of cases of DI. The ILMA can be recommended to be included in the algorithm of DI in pre-hospital emergencies after initial training.
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Epinephrine (adrenaline) is widely used as a primary adjuvant for improving perfusion pressure and resuscitation rates during cardiopulmonary resuscitation (CPR). Epinephrine is also associated with significant myocardial dysfunction in the post-resuscitation period. We tested the hypothesis that the cardiac effects of epinephrine vary according to the duration of cardiac arrest. ⋯ As the duration of cardiac arrest increases, a paradoxical myocardial epinephrine response develops, in which epinephrine becomes increasingly more important to attain ROSC, but is increasingly associated with post-ROSC myocardial depression.