Resuscitation
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The use of an inspiratory impedance threshold valve (ITV) during cardiopulmonary resuscitation (CPR) should reduce intrathoracic pressure during natural chest recoil or active chest decompression. This might in turn improve venous return and thereby organ blood flow. The haemodynamic effects during both standard CPR and active compression-decompression (ACD)-CPR with and without the ITV, therefore, were studied in a well-established porcine model with cross-over design. ⋯ ACD-CPR caused a similar increase, while adding the ITV to ACD-CPR only tended to increase myocardial blood flow (P=0.077). Varying the technique had no effect on cerebral, kidney or carotid blood flow, coronary perfusion pressure, expired CO(2) concentrations or blood gases. The valve is a promising new tool in CPR, but more independent studies of the device are needed.
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Comparative Study
Optimizing ventilation in conjunction with phased chest and abdominal compression-decompression (Lifestick) resuscitation.
The best method for employment of phased chest and abdominal compression-decompression (Lifestick) cardiopulmonary resuscitation (CPR) has yet to be determined. Of particular concern with using this technique is the combining of ventilation with the phased compressions and decompressions. Twenty domestic swine (50+/-1 kg) were equally divided into four groups. ⋯ Optimizing other forms of basic and advanced cardiac life support through different ventilation methods deserves new consideration, including a re-examination of the current single rescuer recommendation of a 15:2 ratio. Optimal ventilation strategy when using the LS device at 60 compressions per min appears to be 5:1 S. Such data is important for conducting clinical trials with this new CPR adjunct.
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The most appropriate airway device for use in EMS systems staffed by basic skilled EMTs with (EMT-Ds) or without (EMT-Bs) defibrillation capabilities is still a matter of debate. The purpose of this study was to assess the feasibility, safety and effectiveness of the Esophageal Tracheal Combitube (ETC) when used by EMT-Ds in cardiorespiratory arrest patients of all etiologies. The EMTs had automatic external defibrillator (AED) training but no prior advanced airway technique skills. ⋯ Immediate complications encountered, but not necessarily related to the use of the ETC, were; subcutaneous emphysema (18), tension pneumothorax (5), blood in the oropharynx (15), and swelling of the pharynx (three). An autopsy was done in 133 patients; no esophageal lesions or significant injury to the airway structures were observed. Our results suggest that EMT-Ds can use the ETC for control of the airway and ventilation in cardiorespiratory arrest patients safely and effectively.