Resuscitation
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Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions are made in hospitals throughout the globe. International variation in clinicians' perception of DNACPR decision-making and implementation and the factors influencing such variation has not previously been explored. ⋯ The majority of countries surveyed make some form of DNACPR decision but differing cultures and economic status contribute towards a heterogeneity of approaches to resuscitation decision-making. Adequacy of relevant medical education and national policy are two areas that were regularly identified as impacting upon the processes of DNACPR decision-making and implementation.
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Multicenter Study
Defibrillation success during different phases of the mechanical chest compression cycle.
Animal studies indicate higher termination of VF/VT (TOF) rates after shocks delivered during the decompression phase of the compression cycle for manual and mechanical CPR. We investigated TOF for shocks delivered in different compression cycle phases during load distributing band (LDB) mechanical CPR in the CIRC trial. ⋯ Shocks delivered in the compression phase of LDB chest compressions had lower TOF rates than shocks delivered while pausing the LDB device. More research is needed to see how defibrillation during chest compressions affect ROSC and survival.
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Chest compressions and defibrillation are the only therapies proven to increase survival in cardiac arrest. Historically, rescuers must remove hands to shock, thereby interrupting chest compressions. This hands-off time results in a zero blood flow state. Pauses have been associated with poorer neurological recovery. ⋯ Nitrile gloves and neoprene pad prevent (99%) responder's detection of defibrillation of a cadaver. Fire gloves and compression decompression device prevented detection.
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Multicenter Study
Cardiopulmonary arrest is the most frequent cause of the unresponsive wakefulness syndrome: A prospective population-based cohort study in Austria.
The "Unresponsive wakefulness syndrome" (UWS) or previously termed vegetative state is a possible consequence of severe brain damage where individuals just open their eyes but show no conscious behavioural reaction. While head trauma has previously been considered the prevailing cause, clinical experience suggests shows that cardiopulmonary arrest plays an increasingly important role. We therefore attempted to study this hypothesis in a well-defined region of Austria. ⋯ Cardiopulmonary resuscitation has become the major cause of UWS which leads to an increasing incidence with age. These aspects may become even more prominent with the ageing of our population and need to be considered in the organisation of care.
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To describe the echocardiographic parameters of the right ventricle (RV) in first 24h post-cardiac arrest (CA) in humans; to determine if the etiology of arrest predicts RV dysfunction; to quantify parameters of the right ventricle in the first 24h post-CA. ⋯ RV dysfunction is present in the majority of post-CA patient regardless of the etiology of arrest. Further studies are needed to investigate if there are relationships between echocardiographic findings and survival and to assess temporal findings of RV function post-CA.