Resuscitation
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Letter Meta Analysis
Achieved glucose level and mortality risk in randomized clinical trials.
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In various motion pictures, medical TV shows and internet chatrooms, non-medical devices were presented as tools for life-saving cricothyroidotomies. However, there is uncertainty about whether it is possible for a bystander to perform a cricothyroidotomy and maintain gas exchange using improvised household items. This study examines the ability of bystanders to carry out an emergency cricothyroidotomy in fresh human cadavers using only a pocket knife and a ballpoint pen. ⋯ In this cadaveric model, bystanders with variable medical knowledge were able to establish an emergency cricothyroidotomy in 80% of the cases only using a pocketknife and a ballpoint pen. No major complications (particularly injuries of arterial blood vessels or the oesophagus) occurred. Although a pocket knife and ballpoint pen cricothyroidotomy seem a very extreme procedure for a bystander, the results of our study suggest that it is a feasible option in an extreme scenario. For a better outcome, the anatomical landmarks of the neck and the incision techniques should be taught in emergency courses.
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Observational Study
Middle cerebral artery flow, the critical closing pressure, and the optimal mean arterial pressure in comatose cardiac arrest survivors-An observational study.
This study estimated the critical closing pressure (CrCP) of the cerebrovascular circulation during the post-cardiac arrest syndrome and determined if CrCP differs between survivors and non-survivors. We also compared patients after cardiac arrest to normal controls. ⋯ CrCP is high after cardiac arrest with high cerebrovascular resistance and low MFV. This suggests that cerebral perfusion pressure should be maintained at a sufficient high level to avoid secondary brain injury. Failure to normalize the cerebrovascular profile may be a parameter of poor outcome.
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No European data currently describe the relation between neighbourhood socio-economic status (SES) and rates of out-of-hospital cardiac arrest (OHCA) bystander cardiopulmonary resuscitation (CPR). This study aims to analyse this effect with a robust deprivation index. ⋯ In the city of Paris, OHCA victims were less likely to receive bystander CPR in low SES neighbourhoods. These first European data are consistent with observations in North America and Asia.
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Early and good quality cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) improve cardiac arrest patients' survival. However, AED peri- and post-shock/analysis pauses may reduce CPR effectiveness. ⋯ AEDs showed different performances that may reduce CPR quality mostly for those rescuers following AED instructions. Both technological improvements and better lay rescuers training might be needed.