Resuscitation
-
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.
-
The vascular leucocyte adhesion molecule, L-selectin, plays an important early role in monocyte trafficking at sites of inflammation, a process which leads to the development of inflammatory organ failure. In this prospective observational study, we investigate whether early numerical and functional changes in circulating monocytes, expression of monocyte L-selectin (CD62L) and monocyte:neutrophil L-selectin ratios are related to the subsequent development of post-traumatic organ failure (OF) and multiple organ dysfunction syndrome (MODS). Monocyte counts and cell surface L-selectin were measured by an automated cell counter and flow cytometry, respectively. ⋯ The monocyte to neutrophil count ratio also decreased with injury severity (P=0.006). Using optimal cut off values for L-selectin mean channel, fluorescence, the positive and negative predictive values for OF was 43.5 and 91.4%, respectively and for MODS it was 25.4 and 92.9%, respectively. Alterations in early circulating monocyte counts and L-selectin expression after injury are related to the development of post-traumatic organ failure and suggest an area in the inflammatory pathway that may be influenced by L-selectin blockade.
-
Comparative Study
Pediatric transthoracic defibrillation: biphasic versus monophasic waveforms in an experimental model.
The purpose of this study was to determine and compare the efficacy of biphasic and monophasic waveforms in a porcine model of pediatric defibrillation. ⋯ Biphasic waveforms proved superior to monophasic waveforms in both infant and child models. High success rates were achieved with low-energy biphasic shocks. Biphasic waveform defibrillation is a promising advance in pediatric resuscitation.
-
Randomized Controlled Trial Clinical Trial
The effect of differing support surfaces on the efficacy of chest compressions using a resuscitation manikin model.
External chest compression (ECC) efficacy is influenced by factors including the surface supporting the patient. Air-filled support surfaces are deflated for cardiopulmonary resuscitation, with little evidence to substantiate this. We investigated the effect that differing support surfaces had on ECC efficacy using a CPR manikin model. ⋯ The efficacy of ECC is affected by the support surfaces. There seems little evidence to substantiate deflating all air-filled support surfaces for CPR.
-
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.