Resuscitation
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We present a case of open-chest cardiac massage where ventricular fibrillation developed and a direct current shock was required. In the absence of 'surgical' electrode paddles, standard paddle electrodes were used; one small electrode was placed directly on the exposed epicardial surface and the second electrode was placed on the lateral chest wall. Defibrillation was achieved with a 100 J shock. This combined epicardial-transthoracic electrode paddle placement technique allows defibrillation to be accomplished when open chest cardiac massage is being performed and no 'surgical' electrode paddles are available.
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Review Practice Guideline Guideline
Paediatric life support. An advisory statement by the Paediatric Life Support Working Group of the International Liaison Committee on Resuscitation.
This document reflects the deliberations of ILCOR. The epidemiology and outcome of paediatric cardiopulmonary arrest and the priorities, techniques and sequence of paediatric resuscitation assessments and interventions differ from those of adults. The working group identified areas of conflict and controversy in current paediatric basic and advanced life support guidelines, outlined solutions considered and made recommendations by consensus. ⋯ Most paediatric resuscitation reports have been retrospective in design and plagued with inconsistent resuscitation definitions and patient inclusion criteria. Careful and thoughtful application of uniform guidelines for reporting outcomes of advanced life support interventions using large, randomized, multicenter and multinational clinical trials are clearly needed. Paediatric advisory statements from ILCOR will, by necessity, be vibrant and evolving guidelines fostered by national and international organizations intent on improving the outcome of resuscitation for infants and children worldwide.
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Despite all the progress made in emergency medicine, out-of-hospital resuscitative efforts still remain unsuccessful in the majority of cases and a decision concerning termination of cardiopulmonary resuscitation (CPR) has to be made. We used a multi-question survey to assess the attitude of emergency physicians towards the duration of an unsuccessful resuscitation attempt in non-traumatic cardiac arrest, and to identify the criteria affecting the decision to terminate CPR in the prehospital setting. More than 400 physicians participated in the inquiry on CPR in adults. ⋯ A high rate of respondents include criteria of weak diagnostic value such as the pupillary status, or factors of doubtful prognostic significance such as the patient's age. Concerning the patient's history and underlying diseases, the emergency physician often has to resort to presumptions. We conclude that the decision to terminate CPR is made by most physicians considering the specific circumstances of the cardiac arrest.
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Randomized Controlled Trial Clinical Trial
Active compression-decompression cardiopulmonary resuscitation in standing position over the patient: pros and cons of a new method.
Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) has been introduced to improve outcome of CPR after cardiac arrest. Usually, ACD-CPR is performed with the rescuer kneeling beside the patient (ACD-B), but ACD-CPR with the rescuer in standing position (ACD-S) has been taught and applied in some centres in addition to conventional ACD-CPR (ACD-B). The aim of this randomised and cross-over study was to evaluate the new technique of ACD-S and to compare it with conventional ACD-B. ⋯ Compression forces decreased in ACD-S from 55.1 to 48.9 kp (P = 0.002) and in ACD-B from 52.8 to 47.0 kp (P = 0.069). We conclude that ACD-CPR in standing position can be considered equal to ACD-B in view of maximal duration of CPR, exhaustion of the rescuers and decompression forces. The decrease of compression forces in ACD-S and ACD-B as well as the difference between compression forces in ACD-S and ACD-B seem to be of no clinical relevance, and exhaustion was judged to be similar despite oxygen consumption being higher in ACD-S than in ACD-B.