Resuscitation
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Review Case Reports
Survival of a subarachnoid hemorrhage patient who presented with prehospital cardiopulmonary arrest: case report and review of the literature.
A 63-year-old woman was admitted to the intensive care unit after resuscitation from prehospital cardiopulmonary arrest (CPA). A brain CT scan revealed a subarachnoid hemorrhage (SAH), which was considered to be the cause of the CPA. The patient recovered neurologically after admission, and the elevated intracranial pressure (ICP) was controlled by inducing mild hypothermia. ⋯ After rehabilitation, the patient was discharged to her home with severe disability. Although aneurysmal SAH is one of the most common causes of CPA, survival of SAH patients after CPA is rare. This case illustrates the ability and possibility of multidisciplinary treatment, including the use of endovascular techniques and mild hypothermia, to improve the outcome of SAH patients with CPA who have been considered to be inoperable and untreatable.
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Insufficient oxygenation, ventilation and gastric inflation with 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). The European Resuscitation Council has recommended smaller tidal volumes of approximately 500 ml as an effort to reduce gastric inflation; furthermore, the intubating laryngeal mask airway and the laryngeal tube have been recently developed in order to provide rapid ventilation and to secure the airway. The purpose of our study was to examine whether usage of a newly developed medium-size self-inflating bag (maximum volume, 1100 ml) in association with the intubating laryngeal mask airway, and laryngeal tube may provide adequate lung ventilation, while reducing the risk of gastric inflation in a bench model simulating the initial phase of CPR. ⋯ M. lung tidal volumes (605+/-22 vs. 832+/-4 ml, and 666+/-27 vs. 887+/-37 ml, respectively), but comparable peak airway pressures. No gastric inflation occurred when using both devices with either ventilation bag. In conclusion, both the intubating laryngeal mask airway and laryngeal tube in combination with both an 1100 and 1500 ml maximum volume self inflating bag proved to be valid alternatives for emergency airway management in a bench model of a simulated unintubated cardiac arrest victim.
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Comparative Study
Precordial compression without airway management induces lung injury in the rodent cardiac arrest model with central apnea.
To investigate whether the lung injury induced by precordial compression without ventilation or not, in the cardiac-arrest animal model with central apnea. Thirty male Sprague-Dawley rats were anesthetized with halothane. The cardiac arrest was induced by 100 mg/kg ketamine (IV) and accompanied with central apnea. ⋯ The pathological findings also demonstrated the lung injuries, such as edema, migration, and destruction of structure in group A. The precordial compression alone did not improve CO(2) elimination in the gasping-less cardiac arrest model, as well as maybe inducing more severe lung injury than that with the protective management. This experimental model raises the possibility that chest compressions without airway management might result in lung injury.
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The oesophageal-tracheal Combitube (Kendall-Sheridan Catheter Corp., Argyle, NY) is a device designed for difficult airways and emergency intubation. The manufacturer recommends that the Combitube size 37F SA be used in patients with a height of between 122 and 152 cm. The aim of this study was to evaluate whether ventilation is effective and reliable in anaesthetized patients taller than 152 cm using the size 37F SA in the oesophageal position. ⋯ The trachea could be directly intubated with the Combitube in the oesophageal position in patients with normal airways and in patients involved in trauma. In all patients in the emergency group, blind insertion of the Combitube resulted in the device being placed in the oesophagus. The airway protection appears to be adequate.