Annals of emergency medicine
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Maintaining an unobstructed airway and providing adequate oxygenation and CO2 elimination, by artificial means if necessary, are among the highest priorities in all life-threatening circumstances. How this goal can best be met in the prehospital setting has become a controversial issue. The esophageal obturator airway (EOA) frequently is used in the prehospital setting, but its use and effectiveness recently have been criticized. ⋯ Many perceived EOA problems are due to poor mask fit and can be rectified. Although endotracheal intubation is the accepted standard for airway management in the apneic patient, its limitations in the prehospital setting are many. These utilization problems and complications remain undefined and must be addressed.
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While rapid intervention with basic cardiac life support and prompt delivery of prehospital care using advanced cardiac life support (ACLS) have yielded impressive results in the resuscitation of other arrest rhythms, very little improvement has been shown in the rates of resuscitation from asystole. Anecdotal reports list instances in which patients in asystole have had normal cardiac activity restored after defibrillation. Current ACLS protocols for initial evaluation recommend a single-lead "quick-look" interpretation of cardiac rhythm using portable defibrillator paddles. ⋯ For an eight-month period 119 patients were entered into the study and compared to system controls of asystolic patients presenting in the previous year. While ten patients (8.4%) showed an immediate rhythm change after initial countershock and six of ten reached the hospital with a rhythm and a pulse, no statistically significant comparison could be made regarding improved resuscitation or survival rates. The finding of no statistically significant deterioration of resuscitation or survival rates, however, justifies the continuation of the study.
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Randomized Controlled Trial Comparative Study Clinical Trial
Calcium chloride: reassessment of use in asystole.
Calcium chloride has been advocated since the 1920s for resuscitation of asystole and ventricular fibrillation. Most reports have been anecdotal, and have failed to substantiate its effectiveness. In two large retrospective series with a collective experience of 181 patients, investigators reviewed the effectiveness of calcium chloride in asystole and did not support its use. ⋯ Groups were analyzed for sex, age, cardiac history, and cardiac drugs, and there were no statistically significant differences. No patient who was successfully resuscitated in the field was discharged alive from the hospital. Calcium chloride is of no value in resuscitating refractory asystole in the prehospital cardiac arrest setting.
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Randomized Controlled Trial Clinical Trial
Automatic external defibrillation: evaluations of its role in the home and in emergency medical services.
Many recent efforts to improve emergency medical services (EMS) and increase survival rates are simply efforts to get defibrillation to patients as rapidly as possible. In the 1960s physicians traveled in mobile coronary care units to bring the defibrillator to cardiac arrest patients. Later, paramedics, rather than physicians, were used. ⋯ This study was designed to determine whether family members can be trained adequately to use the device effectively. Psychological tests measure the effect of learning about, living with, and using such technology. These studies may help define the role of AEDs in the future management of out-of-hospital VF.
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Comparative Study Clinical Trial
Interposed abdominal compression CPR versus standard CPR in prehospital cardiopulmonary arrest: preliminary results.
Recent studies evaluating interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) have demonstrated a significant increase in cardiac output, mean arterial pressure, and cerebral perfusion compared with standard CPR. A clinical evaluation of IAC-CPR effectiveness on resuscitation outcome has not been reported. A prospective, randomized study comparing IAC-CPR with standard CPR for resuscitation of prehospital cardiopulmonary arrest was developed utilizing the Milwaukee County Paramedic System. ⋯ The difference between study groups was not significant. To determine if abdominal compression increases regurgitation, the frequency of emesis before and after intubation was analyzed. No significant difference was found between the IAC-CPR and standard CPR groups.(ABSTRACT TRUNCATED AT 250 WORDS)