Resuscitation
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To describe the occurrence, characteristics and outcome among patients with out-of-hospital cardiac arrest who required continuation of cardiopulmonary resuscitation (CPR) on admission to the emergency department. ⋯ among consecutive patients with out-of-hospital cardiac arrest, CPR was ongoing in 68% of them on admission to hospital. Among these patients, 6% were hospitalized alive and 1.2% were discharged from hospital. Thus, among patients with ongoing CPR on admission to hospital, survivors can be found but they are few in numbers and extensive cerebral damage is frequently present.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of three methods of bag valve mask ventilation.
A method of bag valve mask ventilation in which the resuscitator compresses the self inflating bag between their open palm and the side of their body was compared with conventional single and two resuscitator bag valve mask ventilation. Fifteen nurses each ventilated three patients for 4 min following the induction of general anaesthesia, using one method per patient in random order. ⋯ D.); 'open palm': 270 ml (160); single resuscitator: 260 ml (220); two resuscitators: 480 ml (210). Peak mask pressure (mmHg): mean (SD); 'open palm': 19 (8); single resuscitator: 17(9); two resuscitator: 28 (11).
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Randomized Controlled Trial Comparative Study Clinical Trial
Airway management training using the laryngeal mask airway: a comparison of two different training programmes.
Nurses without prior experience in the use of the laryngeal mask airway (LMA) were randomly allocated to one of two groups to be trained in the emergency technique of insertion of an LMA. Group A (32 nurses) were trained only on a manikin and group B (20 nurses) were trained on a manikin and with live anaesthetised patient practice in theatre (five successful insertions). Without further practice, both groups were asked to insert an LMA in a live patient in theatre 3 months after initial training. ⋯ Skill performance and retention were shown to be high following either training method, with no significant difference between the performance of either group (chi 2). We have shown that manikin-only training in the emergency technique for LMA insertion is as effective as live patient training. It is proposed that manikin training alone may be adopted as a future training modality if, as is expected, the use of the LMA in resuscitation becomes more commonplace.
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Comparative Study Clinical Trial Controlled Clinical Trial
Automated external versus blind manual defibrillation by untrained lay rescuers.
sudden cardiac death is an important cause of mortality in the United States today. A major determinant of survival from sudden cardiac death is rapid defibrillation. Communities with high rates of bystander cardiopulmonary resuscitation (CPR) and early defibrillation enjoy the highest survival rates from out-of-hospital cardiac arrest. First responders and emergency medical technicians (EMTs) have been trained to use external defibrillators (AEDs). The period of instruction for successful use of the AED remains to be determined. It was the purpose of this study to compare AED versus blind manual defibrillation (BMD) by untrained lay rescuers using a simple instruction sheet and following a 20-min training period. ⋯ untrained lay rescuers demonstrated a very high success rate using the AED during simulated cardiac arrest. Success with BMD by untrained rescuers is poor. This study suggests that prehospital personnel can be successfully trained in the use of AED in a substantially shorter period of time than in current practice. Strategic placement of AEDs like fire hoses and pool-side life preservers could result in improved survival from sudden cardiac death.
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Accumulating experience with the use of continuous renal replacement therapy (CRRT) in critically ill patients with acute renal failure suggests that these treatment modalities have distinct advantages relative to conventional dialysis in terms of solute clearances, fluid removal and hemodynamics, which may translate in improved renal and patient outcome. Recent data point to a possible beneficial effect of CRRT on the clinical course, independent from an impact on fluid balance, in critically ill patients with shock which is attributed to the continuous elimination of inflammatory mediators from the circulation. This has raised the question as to whether CRRT might be used for 'non-renal' indications such as the systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). ⋯ However, no significant survival advantage has yet been shown for critically ill patients with SIRS/MODS when treated with CRRT as an adjunct to conventional therapy. Only prospective controlled studies of appropriate sample size, which requires a multicenter approach, might answer the question whether use of CRRT may alter the clinical course and outcome in critically ill patients with SIRS and MODS. Until such studies are performed, the rationale for the use of CRRT in the absence of conventional indications for dialytic support remains unproven.