Resuscitation
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Comparative Study Clinical Trial
Effects of induced hypothermia in patients with septic adult respiratory distress syndrome.
To test the hypothesis that treatment with hypothermia affects the course of overwhelming acute respiratory failure associated with sepsis. ⋯ This study suggests that hypothermia was effective in improving oxygenation and survival in patients with severe ARDS associated with sepsis, even though VO2 was unchanged.
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Standard two-resuscitator cardiopulmonary resuscitation (CPR) (one resuscitator providing Bag Valve Mask (BVM) ventilation and one chest compressions) was compared with a modified method where one resuscitator held the mask while the second provided ventilation and compressions. Twenty-two subjects used both methods in random order on a recording manikin equipped to measure minute volume (Vm), tidal volume (Vt), respiratory rate (RR), compression rate (CR) and depth. Vm and Vt were greater with modified CPR, but the CR was slower. ⋯ D. 37), > 51 mm 38% (S. D. 38)). Modified CPR greatly improves ventilation but reduces CR.
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This investigation was designed to test the hypothesis that active compression-decompression resuscitation is able to independently provide improved levels of minute ventilation when compared to high-impulse manual cardiopulmonary resuscitation (CPR). Eight adult beagles (10-15 kg) were studied after induction of ventricular fibrillation. Single 1-min CPR trials were performed while arterial blood gases and minute ventilation were monitored. ⋯ We conclude that ACD CPR provides improved levels of minute ventilation when compared to high-impulse manual CPR in this canine model of cardiac arrest. Improved minute ventilation may contribute to the mechanism of improved cardiopulmonary hemodynamics reported in previous investigations of ACD CPR. Further investigation is warranted to determine the effects of ACD CPR on pulmonary ventilation in human subjects after cardiac arrest.
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Multicenter Study Comparative Study
Initial countershock in the treatment of asystole.
Routine provision of defibrillatory countershock (CS) in the initial management of asystolic cardiac arrest has been advocated because certain cases of ventricular fibrillation (VF) may present as asystole (AS). ⋯ Although, statistically, the results for both groups were not distinguishable, outcomes for asystolic patients had a tendency to be better when the initial therapy did not involve CS. Larger study populations are recommended to confirm these preliminary observations.
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Comparative Study
The optimum timing of resuscitative thoracotomy for non-traumatic out-of-hospital cardiac arrest.
Open-chest cardiopulmonary resuscitation (CPR) is a promising method for non-traumatic cardiac arrest. In this preliminary study, we investigated the optimum timing of thoracotomy which brings high rate of return of spontaneous circulation (ROSC) and keeps the incidence of unnecessary thoracotomy minimal. Ninety-five adult patients with non-traumatic out-of-hospital cardiac arrest were analyzed. ⋯ Similar tendency was noted when the timing of thoracotomy was counted from the ambulance call. In the standard CPR group, only two patients obtained ROSC during the initial 5 min of hospital course. These results suggest that thoracotomy within 5 min of hospital arrival brings the highest ROSC rate while keeps the incidence of unnecessary thoracotomy acceptable.