Singap Med J
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Bystander cardiopulmonary resuscitation (CPR) is important for survival from out-of-hospital cardiac arrest (OHCA). However, recent research indicates that the quality of CPR is an important and often overlooked factor affecting survival. Individual factors, training, awareness, technique and rescuer fatigue may influence the quality of CPR. ⋯ Locally, limited information is available regarding the quality of CPR being performed for OHCA. Strategies to improve the quality of CPR include research, training, education as well as incorporating appropriate technologies that measure and feedback the quality of CPR. These technologies are at the heart of recent advances, as they now make it feasible to provide routine feedback to rescuers providing CPR, through the integration of feedback devices into training equipment, defibrillators and standalone CPR assist devices.
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The implementation of guidelines released by the National Resuscitation Council in 2006 involved all the main areas of resuscitation, especially basic life support and defibrillation. The emphasis was on community training, creation of simplified programmes, combining cardiopulmonary resuscitation (CPR) and defibrillation, and using simpler training devices. As a result, public access defibrillation programmes have been increasingly implemented together with the CPR + automated external defibrillator programmes. A large number of instructors have also been trained.
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We present the revised guidelines for newborn and paediatric resuscitation for Singapore. The 2010 International Liaison Committee on Resuscitation consensus on science as well as the main recommendations from the European Resuscitation Council and American Heart Association were debated and discussed. The final recommendations for the Singapore National Resuscitation Council were derived after carefully reviewing the current available evidence in the literature and balancing the local clinical climate of practice. In addition, much effort was spent on aligning the paediatric and neonatal recommendations with the adult (especially Basic Cardiac Life Support) recommendations.
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Drug therapy is recommended after effective cardiopulmonary resuscitation and defibrillation in cardiac arrest. Some drugs appear to have short-term benefits, such as improved survival to hospital, e.g. vasopressor and antiarrhythmics. Hence, they have been included in the cardiac life support algorithm. ⋯ This review is an update on drugs during resuscitation, including the choice of agents, dosing, sequence and route. Specific drugs may have benefits in correcting identified causes of collapse. Drug usage during resuscitation is an evolving science, with the use of medications improving as results of clinical studies become available.
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Cardiac arrest occurring on board aeroplanes is rare, but remains a common cause of inflight incidents. This review examines some of the management problems unique to inflight cardiac arrests, and emphasises the use of cardiopulmonary resuscitation and automated external defibrillators.