Resuscitation
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Randomized Controlled Trial Clinical Trial
Effects of smaller tidal volumes during basic life support ventilation in patients with respiratory arrest: good ventilation, less risk?
When ventilating an unintubated patient in cardiac or respiratory arrest, smaller tidal volumes of 500 ml instead of 800-1200 ml may be beneficial to decrease peak airway pressure, and to minimise stomach inflation. The purpose was to determine the effects of small (approximately 500 ml) versus large (approximately 1000 ml) tidal volumes given with paediatric versus adult self-inflatable bags and approximately 50% oxygen on respiratory parameters in patients during simulated basic life support ventilation. ⋯ Administering smaller tidal volumes with a paediatric instead of an adult self-inflatable bag in unintubated adult patients with respiratory arrest maintains good oxygenation and carbon dioxide elimination while decreasing peak airway pressure, which makes stomach inflation less likely.
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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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In a prospective study of 38 cadavers of patients older than 18 without previous chest injury or cardiopulmonary resuscitation (CPR), active compression-decompression (ACD) resuscitation manoeuvres were performed to determine possible factors influencing sternal and/or rib fractures. ACD was performed for 60 s, with compression and decompression forces being continuously recorded. A stepwise logistic regression analysis was applied. ⋯ Even though a significantly higher incidence of sternal fractures was observed when the compression cushion was used (P = 0.045), inclusion of this variable in the regression analysis only marginally improved the prediction for correct classification of sternal fractures. In conclusion, when well controlled ACD-CPR is performed in cadavers, age is the most important factor determining the incidence of rib fracture. Sternal fractures were more common in female cadavers.
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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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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.