Resuscitation
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Comparative Study
Very high survival among patients defibrillated at an early stage after in-hospital ventricular fibrillation on wards with and without monitoring facilities.
The association between the interval between collapse and defibrillation and outcome is well described in out of hospital cardiac arrest but not as well in in-hospital cardiac arrest. We report the outcome among patients who suffered an in-hospital cardiac arrest and were found in ventricular fibrillation (VF) with the emphasis on the delay to defibrillation. ⋯ If patients with in hospital VF were defibrillated early in both monitored and non monitored wards survival to hospital discharge was high. This highlights the importance of being prepared for the rapid defibrillation on wards without monitoring facilities.
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Comparative Study
Hospital-wide first-responder automated external defibrillator programme: 1 year experience.
The first year experience with a hospital-wide first-responder automated external defibrillator (AED) programme implemented in a 683-bed University Hospital is reported. Throughout the hospital, 14 "AED access spots" were identified which could be easily reached from all wards and diagnostic rooms within 30s. AEDs were installed (Lifepak 500; Medtronik PhysioControl Corp., Redmond, USA, equipped with a Biolog 3000i portable ECG monitor; Micromedical Industries Ltd., Labrador, Australia). ⋯ In 18 of 27 cases in which the AED was installed promptly, the primary arrest rhythm was either VT or VF, and the AED delivered a shock. For this subgroup, the rate of return of spontaneous circulation and the rate of discharge at home were 88.9 and 55.6%, respectively. This encourages us to extend the concept of first-responder AED-defibrillation throughout our hospital.
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To report a patient with a large gastrointestinal stromal tumor (GIST) who received multiple blood transfusions intraoperatively and developed a transfusion-related acute lung injury (TRALI). ⋯ Rapid infusion of albumin might be a rescue option in cases of severe TRALI with extensive pulmonary capillary leak during the acute phase.
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Comparative Study
Reversible myocardial dysfunction after cardiopulmonary resuscitation.
Myocardial stunning frequently has been described in patients with an acute coronary syndrome. Recently, it has also been described in critically ill patients without ischaemic heart disease. It is possible that the most severe form of any syndrome, leading to cardio-respiratory arrest, may cause myocardial stunning. Myocardial stunning appears to have been demonstrated in experimental studies, though this phenomenon has not been sufficiently studied in human models. The aim of the present work has been to study and describe the possible development of myocardial dysfunction in patients resuscitated after cardio-respiratory arrest, in the absence of acute or previous coronary artery disease. ⋯ After successful CPR, reversible myocardial dysfunction, consisting of systolic myocardial dysfunction and disturbances of segmental contractility, may occur.
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Comparative Study
Induction of profound hypothermia modulates the immune/inflammatory response in a swine model of lethal hemorrhage.
Profound hypothermic arrest ("suspended animation") is a new strategy to improve outcome following uncontrolled lethal hemorrhage (ULH). However, the impact of this approach on the immune/inflammatory response is unknown. This experiment was conducted to test the influence of profound hypothermia on markers of immune/inflammatory system. ⋯ Profound hypothermia modulates the post-shock immune/inflammatory system by attenuating the pro-inflammatory IL-6, increasing anti-inflammatory IL-10 and augmenting the protective heat shock responses.