Current opinion in critical care
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To summarize recent advances in pediatric cardiopulmonary arrest prevention, resuscitation and postresuscitation management. ⋯ Pediatric cardiac arrest is not a futile condition; many children are successfully resuscitated each year. The implementation of new prearrest, intraarrest and postresuscitative therapies has the potential to further improve survival rates following pediatric cardiac arrest.
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Echocardiography has become more widely available to noncardiologists because of the technological advances in smaller, multipurpose ultrasound units with basic cardiac capabilities. In this review, we discuss the type of clinical information a trained intensivist can hope to obtain from bedside echocardiography and suggest the ways in which this complements traditional hemodynamic monitoring. ⋯ Intensivists can safely and accurately perform goal-oriented echocardiography. Although not yet proven to influence clinical outcome, we suggest that the major utility of echocardiography is for those with distributive or mixed shock in whom target central venous pressure has been achieved without evidence of adequate tissue perfusion. In this subset of patients, echocardiography can aid in selecting those most likely to benefit from further fluid or inotropic support.
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Curr Opin Crit Care · Jun 2009
ReviewVentilation during resuscitation efforts for out-of-hospital primary cardiac arrest.
To discuss recent findings surrounding the role of ventilation during cardiopulmonary resuscitation for individuals with out-of-hospital primary cardiac arrest. ⋯ Assisted ventilation during the initial provision of cardiopulmonary resuscitation is less important than previously believed. It is hypothesized that, by training prehospital medical providers to utilize passive oxygen insufflation for individuals with primary cardiac arrest, critical organ perfusion will increase and, therefore, survival after out-of-hospital cardiac arrest will improve.
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Curr Opin Crit Care · Jun 2009
ReviewImproving performance of emergency medical services personnel during resuscitation of cardiac arrest patients: the McMAID approach.
The article presents the method we developed to improve emergency medical service personnel training. ⋯ It is possible to train personnel to routinely execute an organized resuscitation if the approach to training is modified.