Resuscitation
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While limiting and forgoing therapy at the end of life is now accepted on medical, ethical, moral and legal grounds, many Americans continue to die with heroic measures being taken to prevent their death. Recent studies have demonstrated that physicians frequently attend to their patients without knowledge of their preferences with regards to end-of-life issues. It is postulated that a physician's personal preferences with regard to the limitation and withdrawal of life support and active euthanasia would effect the discussion they had with their patients. ⋯ The majority of physicians surveyed volunteered that they would want life-sustaining measures to be limited at the end of their life. A significant number were in favor of active euthanasia. This study suggests that it is unlikely that physicians' personal beliefs in regards to end-of-life care result in the failure to discuss these issues with their patients.
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Cardiopulmonary resuscitation (CPR) leads to an excessive stimulation of the sympathetic nervous system that may result in tachycardia and malignant arrhythmias in the postresuscitation phase. The attenuation of this reaction by a specific bradycardic agent has not been compared to beta-blockade and placebo. After 4 min of ventricular fibrillation, and 3 min of CPR, 21 pigs were randomized to receive 45 microg/kg epinephrine in combination with either a specific bradycardic agent (0.5 mg/kg zatebradine; n = 7), or a beta-blocker (1 mg/kg esmolol; n = 7), or placebo (normal saline; n = 7). ⋯ This reduction in heart rate was associated with a significantly higher right ventricular ejection fraction, stroke volume, and endocardial/epicardial perfusion ratio at 5 min after ROSC. In comparison with placebo, esmolol administration decreased heart rate only moderately, but significantly reduced right ventricular stroke volume and cardiac output at 5 min after ROSC. Although only one dose and only one administration pattern of zatebradine has been investigated, we conclude that zatebradine administration during CPR effectively reduced heart rate without compromising myocardial contractility during the postresuscitation phase in pigs.
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The formation of reactive oxygen species during reperfusion is one trigger for neuronal injury after global cerebral ischemia. Because formation of reactive oxygen species requires delivery of molecular oxygen to ischemic tissue, restricting inspired oxygen during reperfusion may decrease neurological damage. This study examined whether ventilation with room air rather than pure oxygen during resuscitation would improve neurological recovery after cardiac arrest in rats. ⋯ Neurological deficit scores did not differ between normoxia and hyperoxia conditions at any time point. The number of ischemic neurons in the hippocampus also did not differ between groups. These data indicate neither benefit nor detriment of reducing inspired oxygen concentration during resuscitation from asphyxial cardiac arrest in rats.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomised comparison of three laryngoscopes with the Macintosh.
The Macintosh laryngoscope blade was compared with three modified blades--the Bizzarri-Giuffrida, the 'Improved Vision' Macintosh, and the Wiemers blade. Before and after a training session 24 participants intubated a Laerdal Airway Management Trainer with the four blades in random order. Intubation time was measured, oesophageal malpositions and 'clicks' indicating possible teeth damage, were counted. ⋯ In regard to the intubation time before training (P < 0.02), the intubation time after training (P < 0.003), and handling (P < 0.0005), the Bizzarri-Giuffrida was significantly inferior to the Macintosh. The 'Improved Vision' Macintosh and the Wiemers were not significantly different to the Macintosh. No significant difference was seen for oesophageal malpositioning and 'clicks' between any of the blades.
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Randomized Controlled Trial Clinical Trial
Active compression-decompression cardiopulmonary resuscitation: a population-based, prospective randomised clinical trial in out-of-hospital cardiac arrest.
Different mechanical devices have been developed to improve cardiopulmonary resuscitation (CPR). The aim of this study was to evaluate active compression-decompression (ACD) CPR applied by Emergency Medical Service (EMS) in a defined population. The Trondheim region EMS (population 154,000) employs simultaneous paramedic and physician response. ⋯ This is the largest, single-centre, randomised, population based study of ACD CPR in out-of-hospital cardiac arrest to date. Even when considering a wider outcome spectrum than crude survival, we found no evidence of clinical benefit. In a quarter of cases ACD CPR was inapplicable, further limiting its potential usefulness.