Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Feb 2009
Review Practice GuidelineGuidelines for indications for the use of extracorporeal life support in refractory cardiac arrest. French Ministry of Health.
Around 50,000 cardiac arrests (CA) occur each year in France and survival remains as low as 3 to 5%. Cardiopulmonary resuscitation (CPR) includes several treatment techniques for CA that are regularly updated in French, European, and international guidelines. Extracorporeal life support (ECLS) has been suggested as a therapeutic option in refractory CA since 1976. ⋯ Therefore, French medical scientific societies, under the auspices of the French Ministry of Health, selected a group of experts to propose guidelines that could help physicians performing CPR for refractory CA in deciding if ECLS should be used or not. The following text reflects a consensus obtained by these experts coming from different scientific and medical background at the present time. It should be noted that the views expressed are very likely to be modified in the near future because this topic is evolving rapidly.
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The use of ultrasound is the latest major evolution in regional anaesthesia. Review of available literature shows significant changes in clinical practice. Ultrasound guidance allows the visualization of anatomical variations or unsuspected intraneural injections, reduces the volume of local anaesthetic injections and confirms correct local anaesthetic distribution or catheter placement. ⋯ Optimizing safety and clinical results must remain a key priority in regional anaesthesia. Finally, specific regulations concerning the transducers are described. Paediatric specificities are also mentioned.