Resuscitation
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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.
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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.
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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.
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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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Chest compressions before initial defibrillation attempts have been shown to increase successful defibrillation. This animal study was designed to assess whether ventricular fibrillation mean frequency after 90 s of basic life support cardiopulmonary resuscitation (CPR) may be used as an indicator of coronary perfusion and mean arterial pressure during CPR. ⋯ In this porcine laboratory model, 90 s and 3 min of CPR improved ventricular fibrillation mean frequency, which correlated positively with coronary perfusion pressure, and mean arterial pressure.