Resuscitation
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Comparative Study
Open-chest cardiac massage without major thoracotomy: metabolic indicators of coronary and cerebral perfusion.
To compare the coronary and cerebral perfusion achieved using a novel method of minimally-invasive, direct cardiac massage to that obtained using bimanual, open-chest cardiac massage. ⋯ Minimally-invasive, direct cardiac massage provides coronary and cerebral perfusion similar to that achieved using standard open-chest cardiac massage. This method may provide a more effective substitute for standard, closed-chest cardiac massage in cases of refractory cardiac arrest.
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During 138 weeks an emergency medical service (EMS) of mixed skill-level attempted to resuscitate 954 patients from prehospital cardiac arrest (883 attempts per million population per year); 75% of the arrests were of cardiac cause. This paper is one of the first analyses from europe to use the 'Utstein template' to report outcomes of such arrests. ⋯ Using univariate analysis factors associated with a greater likelihood of survival include the presence of a witness, bystander-initiated cardiopulmonary resuscitation (CPR), early CPR and VF as the arrest rhythm. Twenty of 155 cases (13%) survived where VF arrest was witnessed by non-EMS personnel.
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Randomized Controlled Trial Clinical Trial
Quality of mechanical, manual standard and active compression-decompression CPR on the arrest site and during transport in a manikin model.
The quality of mechanical CPR (M-CPR) was compared with manual standard CPR (S-CPR) and active compression-decompression CPR (ACD-CPR) performed by paramedics on the site of a cardiac arrest and during manual and ambulance transport. Each technique was performed 12 times on manikins using teams from a group of 12 paramedic students with good clinical CPR experience using a random cross-over design. Except for some lost ventilations the CPR effort using the mechanical device adhered to the European Resuscitation Council guidelines, with an added time requirement of median 40 s for attaching the device compared with manual standard CPR. ⋯ On the stairs, 68% of S-CPR compressions and 100% of ACD-CPR compressions were too weak. In conclusion, when evaluated on a manikin, in comparison with manual standard and ACD-CPR, mechanical CPR adhered more closely to ERC guidelines. This was particularly true when performing CPR during transport on a stretcher.
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We present a case of open-chest cardiac massage where ventricular fibrillation developed and a direct current shock was required. In the absence of 'surgical' electrode paddles, standard paddle electrodes were used; one small electrode was placed directly on the exposed epicardial surface and the second electrode was placed on the lateral chest wall. Defibrillation was achieved with a 100 J shock. This combined epicardial-transthoracic electrode paddle placement technique allows defibrillation to be accomplished when open chest cardiac massage is being performed and no 'surgical' electrode paddles are available.
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The aim of the study was to compare the effect of a 30 and 50% duty cycle on coronary perfusion pressure (CPP) and end tidal carbon dioxide (ETCO2) and to determine whether a duty cycle of 30% can be achieved manually. After 3 min of ventricular fibrillation cardiac arrest, pigs were resuscitated in two groups with changing duty cycles every 3 min: group A starting with 50 and then 30%; and group B starting with 30 and then 50%. After administration of epinephrine, duty cycles in group A were 50 and then 30%, in group B initially 30% and then 50% Before administration of epinephrine, no significant differences in CPP between the 30 and 50% duty cycles were found; after epinephrine CPP increased with both duty cycles. ⋯ Survival was 4/6 in group A and 3/5 in group B (NS). It is possible to perform a manual duty cycle of 30%. However, our data do not support the use of a 30% duty cycle during cardiopulmonary resuscitation (CPR).