Resuscitation
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Randomized Controlled Trial Clinical Trial
Incomplete chest wall decompression: a clinical evaluation of CPR performance by EMS personnel and assessment of alternative manual chest compression-decompression techniques.
Complete chest wall recoil improves hemodynamics during cardiopulmonary resuscitation (CPR) by generating relatively negative intrathoracic pressure and thus draws venous blood back to the heart, providing cardiac preload prior to the next chest compression phase. ⋯ Incomplete chest wall decompression was observed at some time during resuscitative efforts in 6 (46%) of 13 consecutive adult out-of-hospital cardiac arrests. The Hands-Off Technique decreased compression duty cycle but was 129 times more likely to provide complete chest wall recoil (OR: 129.0; CI: 43.4-382.0) compared to the Standard Hand Position without differences in accuracy of hand placement, depth of compression, or reported increase in fatigue or discomfort with its use. All forms of manual CPR tested (including the Standard Hand Position) in professional EMS rescuers using a recording manikin produced an inadequate depth of compression more than half the time. These data support development and testing of more effective means to deliver manual as well as mechanical CPR.
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Randomized Controlled Trial Comparative Study Clinical Trial
The evolution of serum astroglial S-100 beta protein in patients with cardiac arrest treated with mild hypothermia.
To study the effects of mild hypothermia on the 24h concentration of serum astroglial of S-100 beta protein in patients who survived cardiac arrest (CA). ⋯ Induced mild hypothermia reduced the 24h astroglial serum S-100 beta protein concentration and might play a neuroprotective effect after cardiac arrest.
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Randomized Controlled Trial Comparative Study Clinical Trial
CPR for children: one hand or two?
Current guidelines for chest compressions in CPR advocate a one handed technique in children (1-8 years old) and a two handed technique in adults (>8 years old). No previous study has examined whether these two techniques generate different compression pressures. This study assesses the relative difference in intrathoracic compression pressures generated by one- and two handed chest compression techniques in a paediatric manikin. ⋯ Two handed chest compression CPR seems to be easier to perform on a paediatric resuscitation manikin and produces significantly higher mean and peak pressures. Further work is needed to determine the comparative effects on children and which technique produces better clinical outcomes.
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Randomized Controlled Trial Comparative Study Clinical Trial
CPREzy: an evaluation during simulated cardiac arrest on a hospital bed.
CPREzy is a new adjunct designed to improve the application of manual external chest compressions (ECC) during cardiopulmonary resuscitation (CPR). The aim of this study was to determine the effect of using the CPREzy device compared to standard CPR during the simulated resuscitation of a patient on a hospital bed. Twenty medical student volunteers were randomised using a cross over trial design to perform 3 min of continuous ECC using CPREzy and standard CPR. ⋯ This was due to a higher number of low compressions (26% of total compressions for CPREzy versus 1% for standard CPR, P < 0.001). In conclusion, CPREzy was associated with significant improvements in ECC performance. Further animal and clinical studies are required to validate this finding in vivo and to see if it translates to an improvement in outcome in human victims of cardiac arrest.
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Randomized Controlled Trial Comparative Study Clinical Trial
Teaching public access defibrillation to lay volunteers--a professional health care provider is not a more effective instructor than a trained lay person.
Survival improves in witnessed out-of-hospital cardiac arrest if the victim receives bystander-initiated cardiopulmonary resuscitation and rapid defibrillation (BLS/AED). The European Resuscitation Council has a simple programme to teach these life-saving skills that require no previous experience of automated external defibrillators (AEDs). To be able to implement the use of AEDs widely, many instructors are needed, and therefore, lay persons may also be used as trainers. The purpose of this randomized study was to compare lay volunteers trained by a lay person with those trained by a health care professional using the Objective Structured Clinical Examination (OSCE). ⋯ No significant benefit exists in the trainer being a health care professional, but thorough training and subsequent rehearsing of the skills learned are crucial.