Resuscitation
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Comparative Study
Comparison of esophageal Doppler monitor generated minute distance and cardiac output in a porcine model of ventricular fibrillation.
The primary goal of cardiopulmonary resuscitation (CPR) is to increase cardiac output (CO), providing adequate tissue perfusion and oxygenation to maintain normal organ function. A non-invasive, easy to use, commercially available esophageal doppler monitor (EDM, Deltex) has been found to provide minute distance (MD), which is the distance moved by a column of blood through the aorta in 1 min. The goal of our study was to determine if CO measurements correlate with the EDM MD, before and during cardiac arrest, in a porcine model of ventricular fibrillation. ⋯ MD measurement using EDM, and CO measurement using florescent microsphere injections were compared before and during CPR. MD correlated well with CO (r2 = 0.96) before and during CPR. Based on the excellent correlation between MD as determined by EDM and CO by florescent microsphere technique, it appears that the non-invasive use of the EDM may play a valuable role in determination of CO during CPR.
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This paper examines the initial actions that should take place following the sudden collapse of a patient in a hospital. The current Basic Life Support guidelines are not designed for this situation, yet are commonly taught to hospital staff. ⋯ Additional factors, such as the recognition of the sick patient and the importance of audit should be included in hospital resuscitation training. A tiered approach to resuscitation training within a hospital should be adopted and national standards developed.
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Comparative Study
Electrocardiographic evaluation of defibrillation shocks delivered to out-of-hospital sudden cardiac arrest patients.
Following out-of-hospital defibrillation attempts, electrocardiographic instability challenges accurate assessment of defibrillation efficacy and post-shock rhythm. Presently, there is no precise definition of defibrillation efficacy in the out-of-hospital setting that is consistently used. The objective of this study was to characterize out-of-hospital cardiac arrest rhythms following low-energy biphasic and high-energy monophasic shocks in order to precisely define defibrillation efficacy and establish uniform criteria for the evaluation of shock performance. ⋯ Defibrillation should uniformly be defined as termination of VF for a minimum of 5-s after shock delivery. Rhythms should be reported at 5-s after shock delivery to assess early effects of the defibrillation shock and at 60-s after shock delivery to assess the interaction of the defibrillation therapy and factors such as post-shock myocardial dysfunction and the patient's underlying cardiac disease.
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Current European Resuscitation Council (ERC) guidelines for paediatric basic life support advocate delivery of 20 cycles/min at a compression rate of 100/min and a compression:ventilation ratio of 5:1 (Resuscitation 1997;34:115-27; Resuscitation 1998;37(2):97-100). We have evaluated whether cardiopulmonary resuscitation (CPR) can be delivered at this rate by hospital providers. We recruited 24 rescuers, all of whom had successfully completed a training course in paediatric life support. ⋯ The guidelines make no allowance for time spent moving between compression and ventilation activity. Future consensus statements should take account of this transfer time. Any changes in recommendations should obviously be prospectively audited with Utstein-style reporting and studies of practicability.