Resuscitation
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The outcome following a cardiac arrest is affected by the length of time that elapses before cardiopulmonary resuscitation is initiated. Only 10-15% of patients experiencing cardiac arrest in hospital settings survive to discharge. Therefore, the time between cardiac arrest and administration of cardiopulmonary resuscitation in a metropolitan hospital was examined. ⋯ Also in 37% of the cases where a BVM was needed, one was not readily present because of difficulty in locating the crash cart immediately. Although initiation of cardiopulmonary resuscitation within a minute of a cardiac or respiratory arrest is the standard of care, in the non-intensive care in-patient cases surveyed, typically more than a minute elapsed, and frequently 3 or more minutes, before resuscitation was started. If the time elapsing before an arresting in-patient is ventilated can be shortened, which is easily and effectively achieved by mouth-to-mouth or mouth-to-mask resuscitation, an increase in both the survival rate and the number of good neurological outcomes should be expected.
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It is essential that all health care professionals are regularly trained in the practice of basic life support (BLS). In most cases of cardiac arrest, the chances of a favourable outcome depend not only on efficient BLS, but also on the early use of defibrillation. In a hospital environment, the first responders are most likely to be members of the nursing staff. ⋯ Throughout retraining all nurses appreciated the key importance of early defibrillation. We conclude that, although the initial workload is high, it is entirely feasible to augment BLS training for health care professionals with instruction in the use of AEDs. We recommend that this potentially life-saving tuition programme be widely adopted.
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Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) has been evaluated in animal cardiac arrest models and in human outcome studies. Blood flow to the brain and heart is significantly increased during ACD-CPR compared to standard CPR. Transoesophageal Doppler analysis indicates that ACD-CPR increases left ventricular blood volume, velocity of blood flow through the mitral valve (82-140%), and stroke volume (85%). ⋯ There is no evidence that ACD-CPR is worse than standard CPR. Appropriate ACD-CPR training using a standardized curriculum must preceed its implementation. Long-term neurologic outcome studies are needed.
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We describe a case of tracheal rupture following an emergency intubation during cardiopulmonary resuscitation. This complication occurring during resuscitation has not apparently been reported previously. Possible causes during the management of cardiac arrest are discussed with references to previously described cases of tracheal rupture.
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Randomized Controlled Trial Comparative Study Clinical Trial
High dose and standard dose adrenaline do not alter survival, compared with placebo, in cardiac arrest.
This trial compared blinded 10 mg aliquots of adrenaline with placebo in 194 cardiac arrest patients treated in hospital using American Heart Association guidelines. In-hospital and out-of-hospital arrests were included. Of the 339 eligible patients a large proportion (145 (45%)) were not randomised and received open 1 mg aliquots of adrenaline. ⋯ No significant differences in immediate survival (IS) or hospital discharge (HD) exists between open 1 mg adrenaline (IS 14 (9.7%), HD 3 (2%)) or the 10 mg adrenaline (IS 9 (9.6%), HD 0) vs. placebo (IS 7 (7%), HD 0) trial arms. Patients reaching the point of use of adrenaline have a uniformly poor immediate survival (8.8%) and hospital discharge rate (0.9%). Dosing with 10 mg or 1 mg adrenaline does not influence outcome compared with placebo.