Current opinion in critical care
-
Refractory cardiac arrest still has a grave prognosis under conventional cardiopulmonary resuscitation (CPR). We present the recent studies in extracorporeal CPR (ECPR) for the treatment of refractory cardiac arrest. ⋯ In this review, survival after ECPR was generally best after pediatric IHCA (38-57%), followed by adult IHCA (34-46%) and then adult OHCA (4-36%). Most studies reported that longer conventional CPR duration was associated with mortality after ECPR; however, there was no consensus on the optimal conventional CPR duration before ECPR initiation. Future studies might focus on the indications for ECPR, which should maximize the survival potential after ECPR while reducing the overuse of this resource-intensive facility.
-
To describe the theory behind arterial waveform analysis, the different variables that may be obtained using this method, reliability of measurements and their clinical relevance. Areas for future research are identified. ⋯ Despite significant limitations in measurement accuracy and inter-device differences, arterial waveform analysis is a potentially useful tool for monitoring the central circulation in critically ill patients. Future studies investigating the effects of haemodynamic management guided by arterial waveform variables in critically ill patients are urgently needed. The evaluation of cardiopulmonary interactions and usefulness of dP/dt are other areas that require further investigation.
-
Cardiopulmonary resuscitation (CPR) is a fundamental component of initial care for the victim of cardiac arrest. In the past few years, increasing quantitative evidence has demonstrated that survival from cardiac arrest is dependent on the quality of delivered CPR. This review will focus on this body of evidence and on a range of practical approaches to improving CPR performance. ⋯ A number of strategies have been evaluated to improve CPR performance. While many questions remain surrounding the relative value of each approach, it is likely that combinations of these methods may be useful in a variety of care settings to improve care for cardiac arrest victims.
-
Evidence of suboptimal cardiopulmonary resuscitation (CPR) delivery in practice has driven interest in strategies to improve CPR quality. Early data suggest that debriefing may be an effective strategy. In this review, we analyse types of debriefing and the evidence to support their usage. ⋯ Debriefing is a useful strategy to improve resuscitation performance, but the optimal delivery method remains unclear. Future high-quality research is required to identify the most effective form of debriefing.