Current opinion in critical care
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The aim of this review is to update and discuss the use of mechanical chest compression devices in treatment of cardiac arrest. ⋯ Mechanical chest compression devices have been developed to better deliver uninterrupted chest compressions of good quality. Prospective large randomized studies have not been able to prove a better outcome compared to manual chest compressions; however, latest guidelines support their use when high-quality manual chest compressions cannot be delivered. Mechanical chest compressions can also be preferred during transportation, in the cath-lab and as a bridge to more invasive support like extracorporeal membrane oxygenation.
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This article summarizes current knowledge of the causes and consequences of interruption of chest compressions during cardiopulmonary resuscitation. ⋯ It is important to avoid any unnecessary pause in chest compressions before and after a defibrillation shock. Pauses should be kept to an absolute minimum, preferably to less than 10 s.
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This article describes and discusses the importance of monitoring patient-ventilator asynchrony, and the advantages and limitations of the specific techniques available at the bedside to evaluate it. ⋯ The prevalence and consequences of asynchronies may be largely underestimated because of a frequent lack of monitoring. Dedicated software solutions that continuously and automatically detect asynchronies may allow both clinical research and clinical applications aimed at determining the effects of asynchronies and minimizing their incidence among critically ill patients.
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Left ventricular (LV) outflow tract (LVOT) obstruction (LVOTO) is not unusual in ICU patients particularly with septic shock. ⋯ LVOTO is not uncommon in ICU patients and can be observed at the early phase of septic shock. Treatment should include discontinuation of dobutamine infusion and fluid infusion. β blockers can be useful in this clinical situation.
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Curr Opin Crit Care · Jun 2016
ReviewSee through ECG technology during cardiopulmonary resuscitation to analyze rhythm and predict defibrillation outcome.
Automated external defibrillators require preshock interruptions in cardiopulmonary resuscitation (CPR) to perform rhythm analysis. Artifact filtering technology may provide the opportunity to visualize the underlying ECG trace during CPR. Moreover, a continuous ventricular fibrillation analysis may be performed such to prioritize CPR interventions, that is, chest compression or defibrillation. ⋯ The feasibility of ventricular fibrillation detection during CPR is a challenging issue that, if solved, would enable CPR to continue during the automated external defibrillator rhythm analysis. Furthermore, it would allow a continuous ventricular fibrillation analysis to optimize the timing of defibrillation and maximize the shock success.