Resuscitation
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Comparative Study
Clinical consequences of the introduction of mechanical chest compression in the EMS system for treatment of out-of-hospital cardiac arrest-a pilot study.
To evaluate the outcome among patients suffering from out-of-hospital cardiac arrest (OHCA) after the introduction of mechanical chest compression (MCC) compared with standard cardiopulmonary resuscitation (SCPR) in two emergency medical service (EMS) systems. ⋯ In this pilot study, the results did not support the hypothesis that the introduction of mechanical chest compression in OHCA improves outcome. However, there is room for further improvement in the use of the device. The hypothesis that this will improve outcome needs to be tested in further prospective trials.
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Direct measurement of brain tissue oxygenation (PbtO2) is established during spontaneous circulation, but values of PbtO2 during and after cardiopulmonary resuscitation (CPR) are unknown. The purpose of this study was to investigate: (1) the time-course of PbtO2 in an established model of CPR, and (2) the changes of cerebral venous lactate and S-100B. ⋯ Though PbtO2 returned to pre-arrest values during CPR, PbtO2 and cerebral lactate were lower than during post-arrest reperfusion with 100% oxygen, which reflected the cerebral low-flow state during CPR. The transient increase of S-100B may indicate a disturbance of the blood-brain-barrier.
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As a component of cardiac rehabilitation (CR), cardiopulmonary resuscitation (CPR) training is widely recommended. These recommendations advocate the importance of offering CPR training to cardiac patients' families. Prior research examining the effect of CPR training on the cardiac patients spouse or family member, suggests that receiving CPR training within a supportive environment such as cardiac rehabilitation causes no adverse psychological effects in the family members. ⋯ Cardiac patients would appear to have a desire to learn CPR. It is recommended that cardiac patients be involved in CPR training as it poses them no adverse psychological consequences and may improve their perception of control. Inclusion of the patients in the CPR training may help increase the participation in CPR training by cardiac patients' families.
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The lay public have limited knowledge of the symptoms of myocardial infarction ("heart attack"), and inaccurate perceptions of cardiac arrest survival rates. Levels of CPR training and willingness to intervene in cardiac emergencies are also low. ⋯ Awareness and knowledge of CPR, and reactions to cardiac emergencies, reflect relatively low levels of CPR training in London. Publicising cardiac arrest survival figures may be instrumental in prompting members of the public to train in CPR and motivating those who have been trained to intervene in a cardiac emergency.
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Hospitalised patients, who suffer cardiac arrest and require unanticipated intensive care unit (ICU) admission or die, often exhibit premonitory abnormalities in vital signs. Sometimes, the deterioration is well documented, though there is little discernable evidence of intervention. In other cases, monitoring and recording of vital signs is infrequent or incomplete. ⋯ Early and direct contact with members of the patient's primary clinical team or rapid response team can be made through an automated alerting system, triggered by the EWS data. The ability to capture physiological data at the bedside, and to make these available to anyone with appropriate access rights at any time and in any place, should provide previously unattainable, clinical and administrative benefits. Analysis of the raw physiological data and patient outcomes will also make it possible to validate existing and future "track and trigger" systems.