Resuscitation
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To gain more insight into decision making around the termination of resuscitation (CPR), we studied factors which influenced the time before discontinuing resuscitation, and the criteria on which those decisions were based. These criteria were compared with those of the European Resuscitation Council (ERC) and the American Heart Association (AHA). For this study, we reviewed the audiotapes of resuscitation attempts in a hospital. ⋯ The ERC and the AHA criteria were not sufficient to cover all termination decisions. We conclude that the point in time to terminate resuscitation is not always rationally chosen. Updating of the current guidelines for terminating resuscitation and training resuscitation teams to use these guidelines is recommended.
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Randomized Controlled Trial Comparative Study Clinical Trial
Carbon dioxide levels during pre-hospital active compression--decompression versus standard cardiopulmonary resuscitation.
In a prospective randomised study we investigated end-tidal carbon dioxide levels during standard versus active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) assuming that the end-tital carbon dioxide reflects cardiac output during resuscitation. In each group 60 patients with out-of-hospital cardiac arrest were treated either with the standard or the ACD method. End-tidal CO2 (p(et)CO2, mmHg) was assessed with a side-stream capnometer following intubation and then every 2 min up to 10 min or restoration of spontaneous circulation (ROSC). ⋯ However, CO2 was significantly higher in patients who were admitted to hospital as compared to patients declared dead at the scene. All of the admitted patients had a p(et)CO2 of at least 15 mmHg no later than 2 min following intubation, none of the dead patients ever exceeded 15.5 mmHg. From these data we conclude that capnometry adds valuable information to the estimation of a patient's prognosis in the field (threshold, 15 mmHg), but we could not detect any difference in p(et)CO2 between ACD and standard CPR.
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To describe the characteristics and outcome among patients with a suspected in-hospital cardiac arrest. ⋯ We conclude that, during a 14-month period at Sahlgrenska University Hospital in Göteborg, almost half the patients with a cardiac arrest in which the CPR team was called were discharged from hospital. Among survivors, 81% had a CPC score of 1 at hospital discharge. Survival seems to be closely related to the relative effectiveness of the resuscitation organisation in different parts of the hospital.
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The removal of inhaled foreign bodies using the Heimlich manoeuvre is recommended as part of the immediate management of the choking child. We report on a case of witnessed laryngeal obstruction by a foreign body in which repeated Heimlich manoeuvres failed to expel the foreign body, but temporarily relieved the obstruction. The repeated Heimlich manoeuvres dislodged the foreign body into the trachea and may have contributed to the rapid development of extensive surgical emphysema, pneumomediastinum and pneumopericardium. The purpose of this report is to demonstrate that the Heimlich manoeuvre was effective in relieving the airway obstruction, but was associated with potentially severe complications.
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Randomized Controlled Trial Clinical Trial
Modification of the closed circuit underwater breathing apparatus LAR V makes it suitable for cardiopulmonary resuscitation (CPR).
This pilot study was carried out in order to determine whether or not a modified closed circuit underwater oxygen rebreathing device could serve as an adjunct for ventilation during CPR in remote locations. As a control a common self-inflating bag valve ventilation device was used. ⋯ This modification of the LAR V makes it suitable for CPR performed by military divers when conventional ventilatory devices are not available. It would be necessary, however, to teach the proper use of the modified ventilation mode and to provide repeated training.