Resuscitation
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To examine the impact of administration of cardioactive drugs on the outcome from out of hospital cardiac arrest. ⋯ The addition of cardioactive drug administration to the treatment of out of hospital cardiac arrest does not improve survival.
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End-tidal CO2 concentration correlates with pulmonary blood flow during cardiopulmonary resuscitation and has been claimed to be a useful tool to judge the effectiveness of chest compression. A high concentration of end-tidal CO2 has been related to a better outcome. However, most authors have noticed a decrease in end-tidal CO2 concentration after administration of epinephrine, concomitant with an increase in coronary perfusion pressure and an increased incidence of return of spontaneous circulation. ⋯ M.), and 43 +/- 1%, respectively, and pulmonary blood flow by 134 +/- 13 and 125 +/- 16%, respectively, within 1 min, simultaneously increasing coronary perfusion pressure from 10 +/- 2 to 45 +/- 5 mm Hg and from 11 +/- 1 to 38 +/- 5 mm Hg, respectively. The coronary perfusion pressure slowly fell, but the effects on end-tidal CO2 and pulmonary blood flow were prolonged. In conclusion, vasopressors increased coronary perfusion pressure and the likelihood of a return of spontaneous circulation, but decreased end-tidal CO2 concentration and induced a critical deterioration in cardiac output and thus oxygen delivery in this model of cardiopulmonary resuscitation.
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Randomized Controlled Trial Clinical Trial
Effects of smaller tidal volumes during basic life support ventilation in patients with respiratory arrest: good ventilation, less risk?
When ventilating an unintubated patient in cardiac or respiratory arrest, smaller tidal volumes of 500 ml instead of 800-1200 ml may be beneficial to decrease peak airway pressure, and to minimise stomach inflation. The purpose was to determine the effects of small (approximately 500 ml) versus large (approximately 1000 ml) tidal volumes given with paediatric versus adult self-inflatable bags and approximately 50% oxygen on respiratory parameters in patients during simulated basic life support ventilation. ⋯ Administering smaller tidal volumes with a paediatric instead of an adult self-inflatable bag in unintubated adult patients with respiratory arrest maintains good oxygenation and carbon dioxide elimination while decreasing peak airway pressure, which makes stomach inflation less likely.
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Active compression decompression (ACD) cardiopulmonary resuscitation (CPR) is possibly a superior alternative to standard (STD) CPR, but an optimal compression and decompression pattern has to be ensured. ACD-CPR can be evaluated during CPR training sessions using commercially available manikins; however devices for recording compression and decompression forces or frequency during real CPR are lacking. Using the Ambu CardioPump without changing its mechanical characteristics, two force transducers were integrated into the ACD device. ⋯ The system has been successfully used during CPR training, during ACD-CPR in 37 corpses under research conditions and in five out-of-hospital CPR casualties. Simple and safe in use, our modified CardioPump with integrated electronics provides an important, technically advanced solution for monitoring ACD-CPR on-line. It warrants quality assurance during ACD-CPR training and in real CPR scenarios and guarantees accurate recording of compression and decompression forces and compression frequency.
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In a prospective study of 38 cadavers of patients older than 18 without previous chest injury or cardiopulmonary resuscitation (CPR), active compression-decompression (ACD) resuscitation manoeuvres were performed to determine possible factors influencing sternal and/or rib fractures. ACD was performed for 60 s, with compression and decompression forces being continuously recorded. A stepwise logistic regression analysis was applied. ⋯ Even though a significantly higher incidence of sternal fractures was observed when the compression cushion was used (P = 0.045), inclusion of this variable in the regression analysis only marginally improved the prediction for correct classification of sternal fractures. In conclusion, when well controlled ACD-CPR is performed in cadavers, age is the most important factor determining the incidence of rib fracture. Sternal fractures were more common in female cadavers.