The American journal of emergency medicine
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Randomized Controlled Trial Clinical Trial
A randomized clinical study of cardiopulmonary-cerebral resuscitation: design, methods, and patient characteristics. Brain Resuscitation Clinical Trial I Study Group.
The Brain Resuscitation Clinical Trial (BRCT) was established as a multi-institutional, clinical study of brain resuscitation. The BRCT was designed to test the hypothesis that the addition of thiopental loading to the protocol of standard therapy for cardiac arrest survivors, comatose at 10-50 minutes after restoration of spontaneous circulation, would significantly increase the number of patients recovering good cerebral function. Twelve hospitals in nine countries collaborated in this randomized, controlled clinical trial. ⋯ The majority of the arrests (74%) occurred out of hospital, and major pathology underlying arrest was cardiac. Arrest time was greater than 5 minutes in 36% of the patients. As a result of randomization, patient characteristics at entry as well as the characteristics associated with the brain insult in the standard group were similar to those in the thiopental group.
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The case of a 3-month-old male infant who was found unresponsive and cyanotic in a crib at home is presented. On arrival in the emergency department the child was receiving basic cardiopulmonary resuscitation (CPR) by a rescue squad and was without vital signs in asystole. The patient achieved a stable rhythm and blood pressure before intravenous access was obtained. Epinephrine and atropine were given via the endotracheal route and sodium bicarbonate through intraosseous infusion.
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Vascular access during advanced life support is essential. Vascular access in the critically ill child can be particularly difficult and often causes unacceptable delay. ⋯ A case is presented illustrating the value of familiarity with this procedure. Use of the bone marrow for emergency administration of fluids and medications should be considered early in resuscitation until vascular access is obtained.
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Prior to approval of the EOA, this device had not been documented to be effective in oxygenation and ventilation in the pre-hospital arena. The studies quoted to demonstrate its usefulness were done in the very controlled environment of the operating room or of the emergency department. Indeed, the studies on blood gases obtained immediately upon entry into the emergency department would indicate that the esophageal obturator airway is an inadequate and ineffectual pre-hospital airway. ⋯ It has been tested in the operating room and the emergency department. In a study done on unsuccessfully resuscitated patients, it was as effective as an ETT. However, no study has shown that the PTL can be used successfully in the pre-hospital setting by ambulance personnel.(ABSTRACT TRUNCATED AT 250 WORDS)