Resuscitation
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To determine whether open-chest compression-active-decompression (CAD) could improve cardiac output, coronary blood flow, blood gases, and resuscitation compared to open-chest manual compression in a porcine model of cardiac arrest. ⋯ We found no benefit using CAD. Both low coronary blood flow and hyperkalemia may have limited resuscitation.
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The aim of this study is to study the quality of chest compressions over a period of 5 min with a compression-ventilation ratio of 5/1 and 15/2. ⋯ Effective closed chest compression was significantly better with a ratio of 5/1 than 15/2. Better management of cardiac arrest suggested by an increase in a number of compressions with a ratio of 15/2 could be attenuated by cardiac compressions of lesser quality.
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Case Reports
Intra-aortic balloon counterpulsation for cardiogenic shock due to cardiac contusion in an elderly trauma patient.
Blunt thoracic trauma may cause cardiac contusion and cardiogenic shock resistant to inotropic support. The use of intra-aortic balloon counterpulsation (IABCP) as a mechanical means of augmenting cardiac function following cardiac contusion is rare with case reports largely limited to its use in young trauma patients. ⋯ She was successfully managed with invasive monitoring, inotropic support and IABCP. This case provides support for aggressive resuscitation even in the very elderly as recovery from severe cardiac contusion may be possible.
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Revision open heart surgery may be impeded by a dense network of pericardial adhesions rendering cardiac mobilization laborious or incomplete, and internal defibrillation impossible. External defibrillation, the current alternative to internal defibrillation, may result in myocardial stunning secondary to the delivery of escalating, monophasic, high-energy shocks. Automated external defibrillation, by delivering consecutive, non-escalating, impedance-compensated, low-energy, biphasic electric shocks to the myocardium, may provide a more effective and safer option whilst reducing the risk of myocardial stunning.
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Previous studies indicate that Norwegian physicians hold conservative attitudes towards ethically controversial end-of-life decisions. The present study was undertaken to explore whether in Norway euthanasia may be hidden under labels such as death after analgesic injections and withholding or withdrawing treatment. ⋯ Only a small minority of Norwegian physicians has committed euthanasia. However, patient death has occurred following ethically questionable decisions such as withdrawal of treatment based on resource considerations and requests from the family.