Resuscitation
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Clinical Trial Controlled Clinical Trial
The role of laryngeal mask airway in cardiopulmonary resuscitation.
The laryngeal mask airway (LMA) has been newly introduced to anaesthesia practice as an alternative to the endotracheal tube (ETT) or face mask for airway management. It is capable of providing a rapid and easily achieved patent airway that permits positive pressure ventilation within confined limits. In this study, we aim to evaluate the role of the LMA in cardiopulmonary resuscitation (CPR) in 20 patients as an alternative to tracheal intubation. ⋯ In the LMA groups I and III, 12 patients had LMA inserted at the first attempt and three at a second attempt. We concluded that LMA is a good alternative to ETT, although it may not protect against aspiration. We recommend it to be included in CPR chart cards and all medical doctors, nurses and paramedical staff should learn how to use it.
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Within the last several years a new method of CPR, termed active compression-decompression (ACD) CPR was developed. Based upon the theory that active rather than passive chest wall decompression would augment venous return and ventilation by causing an increase in negative intrathoracic pressure during the decompression phase of CPR, a hand-held device was designed and is now being used clinically. ⋯ Clinical studies comparing ACD to standard CPR in patients in cardiac arrest demonstrate that immediate resuscitation rates are nearly doubled when ACD CPR is started within 10 min after cardiac arrest. The potential long term benefits of ACD CPR remain under investigation.
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We report echocardiographic observations during external chest compression in a patient with marked abnormalities in thoracic anatomy following emergency surgery of aortic arch aneurysm. Transesophageal echocardiography demonstrated direct right ventricular, aortic and left atrial compression, only minimal left ventricular compression and an open mitral valve during closed chest heart massage. Colour flow doppler demonstrated forward blood flow across the mitral valve and along the left ventricular outflow tract during the compression phase. Echocardiographic findings indicate that factors apart from simple cardiac pump mechanism contributed to blood flow during cardiopulmonary resuscitation (CPR) in this postoperative patient after a major thoracic surgical intervention.
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Comparative Study
Ventilation caused by external chest compression is unable to sustain effective gas exchange during CPR: a comparison with mechanical ventilation.
To compare the tidal volume, minute ventilation, and gas exchange caused by mechanical chest compression with and without mechanical ventilatory support during cardiopulmonary resuscitation (CPR) in a laboratory model of cardiac arrest. ⋯ Standard chest compression alone produced measurable tidal volume and minute ventilation. However, after 10 min of chest compression following 6 min of untreated ventricular fibrillation, it failed to sustain pulmonary gas exchange as indicated by significantly greater arterial and mixed venous hypercarbic acidosis when compared with a group receiving mechanical ventilation.