Resuscitation
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Comparative Study
Predicting unsuccessful cardiopulmonary resuscitation (CPR): a comparison of three morbidity scores.
The aim of the study was to assess the usefulness of three different morbidity scores in predicting unsuccessful resuscitation. We reviewed the records of adult patients who underwent CPR between September 1994 and June 1996 in The Royal Hampshire County Hospital, Winchester. Demographic data and enough clinical data to calculate the Pre-Arrest Morbidity score (PAM), the Prognosis After Resuscitation score (PAR) and the Modified PAM Index (MPI) were collected. ⋯ Each score identified a different group of patients for whom CPR was unsuccessful. Using all three scores in combination identified 42% of the unsuccessful CPR attempts. Morbidity scores are likely to need further refinement in order to be a useful bedside tool for predicting success for individual patient resuscitation attempts.
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Current European neonatal resuscitation guidelines (Zideman et al. Resuscitation 1998;37:103-110) advocate cardiopulmonary resuscitation (CPR) at 120 compressions per minute in a ratio of 3:1. This is commonly interpreted as a net rate, thus requiring delivery of 40 breaths per minute, which is the upper end of the range of 30-40 breaths per minute suggested in the guidelines. ⋯ Single rescuers were unable to achieve the rate of CPR suggested by current guidelines. Only 22% of paired rescuers were able to achieve this standard in the first minute, falling to less than 20% by the fifth minute. We recommend modifying the guidelines to make them unambiguous and practicable, with the emphasis shifted onto the quality of compressions and ventilations, rather than quantity.
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We report a case of on scene resuscitative thoracotomy performed by an anaesthetist on a patient in cardiac arrest following a stab wound to the chest. The patient made a good recovery and was discharged from hospital within 2 weeks. The rationale for performing resuscitative thoracotomy and who should perform this procedure are discussed.
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Comparative Study
Pharmacokinetics and pharmacodynamics of hydroxyethyl starch in hypovolemic pigs; a comparison of peripheral and intraosseous infusion.
Intraosseous (i.o.) infusion is considered a useful technique for the administration of medications and fluids in emergency situations when peripheral intravascular access is not possible. This study investigated the effectiveness of i.o. versus intravenous (i.v.) infusion of hydroxyethyl starch (HES 200/0.5) in hypovolemic pigs. Twenty-three pigs (8- to 9-week-old) were anaesthesized, instrumented and blood was withdrawn (25-30 ml/kg) to < 50 mmHg mean arterial pressure (MAP). ⋯ Infusion was discontinued after 30 min and the animals were monitored for 1 h. Analysis of HES-pharmacokinetics and pharmacodynamics revealed no significant differences between i.o. and the i.v. administration. The results demonstrate i.o. infusion of HES to be a rapid and effective method for fluid resuscitation in hypovolemic shock.
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Existing cardiopulmonary resuscitation (CPR) training programmes have failed to reach those most likely to witness a cardiac arrest, such as families of cardiac patients. In 1993, the Scottish Health Service Advisory Committee suggested that CPR training could be offered as part of cardiac rehabilitation programmes. A survey was carried out to identify the current extent and nature of such training and factors influencing its provision. ⋯ Reasons for not providing training ranged from lack of resources and lack of staff training, to not having considered it. CPR training is provided as part of cardiac rehabilitation programmes to a limited extent. Ways of recruiting and increasing the number of family members of cardiac patients who are trained in CPR need to be found.