Resuscitation
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To ascertain important factors in the improvement of out-of-hospital cardiac arrest survival rates through analysis of data for Osaka Prefecture with the focus on time factors. ⋯ This study using the standardized format according to the Utstein style clearly elucidates the specific delay of the start of defibrillation by paramedics and also indicates the inappropriate rule for this procedure in Japan.
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An asphyxial cardiac arrest rat model, originally developed for Sprague-Dawley rats, was transferred to a Wistar rat model. Several strain specific life support adjustments, i.e. ventilator settings, anaesthesia, and drug requirements, were necessary to stabilize the model for Wistar rats. Despite these arrangements numerous resuscitation related variables appeared different. ⋯ Without strict temperature control (as in groups 2+3 rats) group 1 rats went into spontaneous mild to moderate hypothermia during the first 24 h after restoration of spontaneous circulation (ROSC). Spontaneous hypothermia delayed the development of overall visible CA1 neuronal damage 24-48 h, but did not prevent it; therefore the model seemed to be suitable for future studies. Neuronal damages in the CA1 region in Wistar rats appeared to be more as shrunken cell bodies and pyknotic nuclei before resorption took place, whereas in Sprague-Dawley rats appeared in the same region.
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Surf lifesavers in Australia undertake numerous resuscitation scenarios in the course of their training and examination. The standard teaching and examination strategy is for the scenario to end with return of spontaneous circulation (ROSC) and then breathing. This study was performed to assess the effect of this training technique on lifesavers' expectation of successful resuscitation and to determine the effect of experience on these expectations. ⋯ Surf lifesavers in the Sydney Northern Beaches branch have an exaggerated expectation of the chances of successful CPR following cardiac arrest. This expectation did not change with time since learning CPR or participation in actual resuscitations. New models for CPR education need to be investigated.
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Randomized Controlled Trial Comparative Study Clinical Trial
Trials of teaching methods in basic life support (3): comparison of simulated CPR performance after first training and at 6 months, with a note on the value of re-training.
A randomised controlled trial comparing staged teaching of cardiopulmonary resuscitation (CPR) with conventional training provided the additional opportunity to investigate skill acquisition and retention in those attending conventional CPR classes. All subjects were tested immediately after their first instruction period and again at 6-9 months at an unheralded home visit. We were able to assess how far performance was related to poor acquisition of skills and how far it was related to skill decay. ⋯ This improvement was significant for only two of them, but all were relatively small with limited practical value. Many who attend conventional CPR classes fail to acquire the necessary skills, and the skills that are acquired decline appreciably over the subsequent 6-9 months. The value of conventional re-training was modest in this study of community volunteers.
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To investigate how emergency medical dispatchers (EMDs) perceive their experience of identifying suspected cardiac arrests (CA), and offer and provide instructions in cardiopulmonary resuscitation via telephone (t-CPR). ⋯ By listening in an open-minded way, a vast amount of information can be collected. Using criteria-based dispatch (CBD) and their own resources, the possibilities and difficulties of the situation are analysed. The EMDs believe that they are being an empathic support, relieving the witness of the burden of responsibility, and connecting with them mentally to enable them to act at the scene. There are EMDs who feel competent and experienced in managing these cases, and other EMDs who feel insecure and despair. The choice between providing t-CPR and answering incoming calls is prioritised differently among EMDs. There is also a broad subjective assessment among EMDs of offering t-CPR, especially to persons over 70 years old whom they consider incapable of performing CPR. The competence of the EMDs in t-CPR is dependent on re-training and a feedback on patient outcome. Witnesses who are negative towards acting constitute a common problem. There are witnesses with physical impediments or psychologically not susceptible to suggestions. The EMD is also dependent on the knowledge and trustworthiness of the witness. Convincing answers from witnesses prompt a more secure feeling in the EMDs, just as lack of knowledge in the witness has a negative effect on the efforts.