Resuscitation
-
To show whether in an in-hospital cardiac arrest, early defibrillation can also be performed by hospital staff trained only in basic life support. ⋯ Using an automatic defibrillator without any prior instruction, even persons trained only in BLS were able to deliver three sequential shocks in a simulated persistent ventricular fibrillation cardiac arrest.
-
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.
-
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.
-
Clinical Trial
Preliminary clinical outcome study of mild resuscitative hypothermia after out-of-hospital cardiopulmonary arrest.
The effects of mild hypothermia (MH) were investigated. From 1995 to 1996, 28 adult patients with out-of-hospital cardiopulmonary arrest (CPA) had return of spontaneous circulation and survived for more than two days. Thirteen patients were in the MH group. ⋯ Eleven of 13 MH patients, as compared to 6/15 controls developed pneumonia. Our study, although preliminary, suggests that MH might confer improved outcome, as has been shown in animal models, after CPA. This treatment is associated with an increase in pneumonic complications.
-
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.