Current opinion in critical care
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To discuss the advantages and disadvantages of various methods of airway management during cardiopulmonary resuscitation. The role of ventilation during out-of-hospital cardiopulmonary resuscitation is also discussed. ⋯ Supraglottic airway devices are a logical alternative to tracheal intubation when cardiopulmonary resuscitation is undertaken by individuals who are not highly skilled and experienced intubators. By teaching laypeople compression-only cardiopulmonary resuscitation, it is hypothesized that rates of bystander cardiopulmonary resuscitation, and therefore survival after out-of-hospital cardiac arrest, will increase.
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To review the current status of the use of automated external defibrillators by lay persons, a concept known as public access defibrillation. ⋯ Public access defibrillation can save lives but further studies are required to define the optimal placement and use of automated external defibrillators in communities and the training of the personnel who use them.
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Curr Opin Crit Care · Jun 2008
ReviewUrgent invasive coronary strategy in patients with sudden cardiac arrest.
To review the evidence on urgent coronary angiography and percutaneous coronary intervention after resuscitated cardiac arrest and during ongoing cardiocerebral resuscitation. ⋯ Urgent coronary angiography and percutaneous coronary intervention should be attempted in conscious patients after reestablishment of spontaneous circulation similarly as in patients with acute coronary syndromes without preceding cardiac arrest. In comatose survivors, urgent coronary strategy is reasonable if acute ischemic cause is suspected and if there is realistic hope for neurological recovery that should be facilitated with mild induced hypothermia. Urgent coronary invasive strategy may be successful also during ongoing resuscitation in selected patients without advanced heart diseases and significant comorbidities.
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Cardiac arrest of patients during anesthesia has been the driving force behind the development of this specialty. Safer procedures, new anesthetics, and technical improvements such as monitoring devices and ventilators have successfully reduced intraoperative mortality. Nevertheless, modern technology itself creates specific risks; and causes, diagnosis, and management of anesthesia-related cardiac arrest differ considerably from situations encountered elsewhere. ⋯ The anesthetic environment has become much safer than it was 50 years ago. For a successful management of cardiac arrest during operative procedures, not only individual knowledge and skills but also institutional safety culture have to be implemented into education, training, and everyday practice of this specialty.