Resuscitation
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Comparative Study
Smaller tidal volumes during cardiopulmonary resuscitation: comparison of adult and paediatric self-inflatable bags with three different ventilatory devices.
Gastric inflation and subsequent regurgitation of stomach contents is a major hazard of bag-valve-face mask ventilation during the basic life support phase of cardiopulmonary resuscitation (CPR). Recent investigations suggested that use of a paediatric self-inflating bag may reduce stomach inflation while ensuring sufficient lung ventilation. The purpose of our study was to examine whether use of a paediatric self-inflating bag in association with laryngeal mask airway, combitube, and bag-valve-face mask may provide adequate lung ventilation, while reducing the risk of gastric inflation in a bench model simulating the initial phase of CPR. ⋯ Lung tidal volumes were below the European Resuscitation Council recommendation with both self-inflatable bags in the bag-valve-face mask group (paediatric versus adult self-inflatable bag 256 +/- 77 ml versus 334 +/- 125 ml). Esophageal tidal volumes were significantly (P < 0.05) lower using the paediatric self-inflatable bag in the bag-valve-face mask group; almost no gastric inflation occurred with the laryngeal mask airway, and none with the combitube. In conclusion, use of the paediatric self-inflating bag may reduce gastric inflation, but measured lung tidal volumes are below the European Resuscitation Council recommendation when used with either, the laryngeal mask airway, combitube, or bag-valve-face mask.
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Active compression decompression (ACD) cardiopulmonary resuscitation (CPR) is possibly a superior alternative to standard (STD) CPR, but an optimal compression and decompression pattern has to be ensured. ACD-CPR can be evaluated during CPR training sessions using commercially available manikins; however devices for recording compression and decompression forces or frequency during real CPR are lacking. Using the Ambu CardioPump without changing its mechanical characteristics, two force transducers were integrated into the ACD device. ⋯ The system has been successfully used during CPR training, during ACD-CPR in 37 corpses under research conditions and in five out-of-hospital CPR casualties. Simple and safe in use, our modified CardioPump with integrated electronics provides an important, technically advanced solution for monitoring ACD-CPR on-line. It warrants quality assurance during ACD-CPR training and in real CPR scenarios and guarantees accurate recording of compression and decompression forces and compression frequency.
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The involvement of general practitioners in community based resuscitation of out-of-hospital cardiac arrest has been found to be effective in improving survival rates. The aim of the study was to assess the potential for including general practitioners in Nottinghamshire in the resuscitation of out-of-hospital cardiac arrest victims by first determining whether they had the skill, experience and equipment to provide cardio-pulmonary resuscitation in the community; and second to ascertain what proportion of them would be prepared to establish a 'rapid response' scheme for patients requiring resuscitation. ⋯ General practitioners may have an important role to play in improving the survival outcome of out-of-hospital cardiac arrest as many are ALS trained and have recent experience in resuscitation. However, few have access to a defibrillator and many do not have recent experience of defibrillation. Any proposed local resuscitation scheme would be particularly applicable to rural general practitioners as many have recent training in ALS, recent experience in advanced life support and most of all, are more willing to participate in such a scheme.
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This study evaluated the accuracy of pulse oximetry measured by a modified laryngeal mask airway (LMA). Ten anaesthetized patients (ASA I-II, aged 18-45) undergoing elective knee arthroscopies (mean-duration 40 min) were studied. A transmission pulse oximeter probe/sound OHMEDA was attached on the back of LMA (sizes 4 and 5) in an area in contact with the floor of the laryngeal part of the pharynx. ⋯ At T3 the cuff pressure was decreased at 60 cm H2O. Pharyngeal pulse oximetry correlated with finger pulse oximetry throughout the study and was not effected by over-inflation of the LMA. This modification of the LMA provides an accurate method of measuring pulse oximetry which may be of use in a variety of circumstances.