Resuscitation
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Randomized Controlled Trial Comparative Study
Effectiveness of a 30-min CPR self-instruction program for lay responders: a controlled randomized study.
The length of current 4-h classes in cardiopulmonary resuscitation (CPR) is a barrier to widespread dissemination of CPR training. The effectiveness of video-based self-instruction (VSI) has been demonstrated in several studies; however, the effectiveness of this method with older adults is not certain. Although older adults are most likely to witness out-of-hospital cardiac arrests, these potential rescuers are underrepresented in traditional classes. We evaluated a VSI program that comprised a 22-min video, an inflatable training manikin, and an audio prompting device with individuals 40-70 years old. The hypotheses were that VSI results in performance of basic CPR skills superior to that of untrained learners and similar to that of learners in Heartsaver classes. ⋯ Older adults learned the fundamental skills of CPR with this training program in about half an hour. If properly distributed, this type of training could produce a significant increase in the number of lay responders who can perform CPR.
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Randomized Controlled Trial Comparative Study
Out-of-hospital cardiac arrest rectilinear biphasic to monophasic damped sine defibrillation waveforms with advanced life support intervention trial (ORBIT).
Although biphasic defibrillation waveforms appear to be superior to monophasic waveforms in terminating VF, their relative benefits in out-of-hospital resuscitation are incompletely understood. Prior comparisons of defibrillation waveform efficacy in out-of-hospital cardiac arrest (OHCA) are confined to patients presenting in a shockable rhythm and resuscitated by first responder (basic life support). This effectiveness study compared monophasic and biphasic defibrillation waveform for conversion of ventricular arrhythmias in all OHCA treated with advance life support (ALS). ⋯ Shock success to an organized rhythm comparing step-up protocol for energy settings demonstrated the RLB waveform was superior to MDS in ALS treatment of OHCA. Survival rates for both waveforms are consistent with current theories on the circulatory and metabolic phases of out-of-hospital cardiac arrest.
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Randomized Controlled Trial Clinical Trial
Effect of an inspiratory impedance threshold device on hemodynamics during conventional manual cardiopulmonary resuscitation.
In animals in cardiac arrest, an inspiratory impedance threshold device (ITD) has been shown to improve hemodynamics and neurologically intact survival. The objective of this study was to determine whether an ITD would improve blood pressure (BP) in patients receiving CPR for out-of-hospital cardiac arrest. ⋯ Use of the active ITD was found to increase systolic pressures safely and significantly in patients in cardiac arrest compared with sham controls.
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Randomized Controlled Trial Clinical Trial
The effect of prophylactic topical steroid cream on the incidence and severity of cutaneous burns following external DC cardioversion.
Cutaneous burns are a common cause of morbidity following direct current (DC) cardioversion. We designed a prospective double-blinded controlled study to determine whether the application of steroid cream prior to cardioversion reduces their incidence and severity. ⋯ Topical betamethasone 0.1% cream applied 2 h before elective DC cardioversion is no more effective than placebo at reducing the pain and inflammation from cardioversion burns.
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Randomized Controlled Trial Clinical Trial
The effect of topical non-steroidal anti-inflammatory cream on the incidence and severity of cutaneous burns following external DC cardioversion.
Cutaneous burns are a common cause of morbidity following direct current (DC) cardioversion. We designed a study to determine whether the application of non-steroidal anti-inflammatory cream prior to cardioversion reduces their incidence and severity. ⋯ Prophylactic application of topical ibuprofen 5% cream 2h prior to elective DC cardioversion reduces pain and inflammation. Consideration should be given to use of prophylactic application of topical ibuprofen as routine treatment for elective DC cardioversion.