Resuscitation
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Housestaff residents are often the primary participants in codes that occur in a hospital setting, yet it is unknown how much confidence and knowledge they possess in the management of these medical emergencies. A study to learn the effect of a mock code program on residents' level of confidence and knowledge regarding code situations was initiated in a children's tertiary care hospital. Thirty-three residents completed a questionnaire before initiation of the study. ⋯ There was no difference in the pre- and post-questionnaires of the control group. Residency programs are not meeting the educational and confidence needs of pediatric residents. A mock code program improves residents' perceived need for more knowledge before supervising a code and improves their confidence in doing many lifesaving procedures.
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Letter Case Reports
CT scanning as a helpful tool for decision-making during CPR.
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Comparative Study
Effects of various degrees of compression and active decompression on haemodynamics, end-tidal CO2, and ventilation during cardiopulmonary resuscitation of pigs.
The effects of various degrees of compression and active decompression during cardiopulmonary resuscitation were tested in a randomized cross-over-design during ventricular fibrillation in eight pigs using an automatic hydraulic chest compression device. Compared with 4/0 (compression/decompression in cm), mean carotid arterial blood flow rose by 60% with 5/0, by 90% with 4/2 and 4/3, and 105% with 5/2. Two cm active decompression increased mean brain and myocardial blood flow by 53% and 37%, respectively, as compared with 4/0. Increasing standard compression from 4 to 5 cm caused no further increase in brain or heart tissue blood flow whether or not combined with active decompression. Tissue blood flow remained unchanged or decreased when active decompression (4/3) caused that 50% of the pigs were lifted from the table due to the force required. Myocardial blood flow was reduced with 5/0 vs. 4/0 despite no reduction in end decompression coronary perfusion pressure ((aortic-right atrial pressure) (CPP), (7 +/- 8 mmHg with 4/0, 14 +/- 11 mmHg with 5/0)(NS)). End decompression CPP increased by 186% with 4/2 vs. 4/0, by 200% with 4/3, and by 300% with 5/2. Endo-tracheal partial pressure of CO2 was significantly increased during the compression phase of active decompression CPR compared with standard CPR. Active decompression CPR generated an significantly increased ventilation compared with standard CPR. ⋯ Carotid and tissue blood flow, ventilation, and CPP increase with 2 cm of active decompression. An attempt to further increase the level of active decompression or increasing the compression depth from 4 to 5 cm did not improve organ blood flow.
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Multicenter Study Comparative Study
Optimal defibrillation strategy and follow-up of out-of-hospital cardiac arrest. The Belgian CPCR Study Group.
In the current climate of rising healthcare cost, resuscitation efforts performed outside the hospital are critically evaluated because of their limited success rate in some settings. As part of a quality assurance program between the 1st January 1991 and 31st December 1993, six centres of the Belgian CPCR study group prospectively registered cardiac arrest (CA) patients and their treatment according to the Ustein Style recommendations. ⋯ In a second part of the study we describe long-term management of the 28 surviving VF patients, treated by the single EMS system of Brugge between 1st January 1991 and 30th April 1995: only 6 patients eventually received an implantable cardioverter defibrillator (ICD), whereas coronary revascularization was performed in 9 patients, and 3 patients were discharged on amiodarone only. Satisfactory long-term survival after out-of-hospital VF can be achieved by an early shock followed by advanced life support and appropriate definitive treatment.
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This study was designed to assess whether median frequency of ventricular fibrillation (VF) correlates with myocardial blood flow and defibrillation success during cardiopulmonary resuscitation (CPR) after epinephrine or vasopressin administration. ⋯ We conclude that median frequency of VF reflects myocardial blood flow and the chance of successful defibrillation during closed-chest CPR after vasopressor treatment in a porcine model of VF.