Resuscitation
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Comparative Study
Simultaneous sterno-thoracic cardiopulmonary resuscitation improves short-term survival rate in canine cardiac arrests.
We have reported previously that simultaneous sterno-thoracic cardiopulmonary resuscitation (SST-CPR) using a device that compresses the sternum and constricts the thorax circumferentially during a compression systole that can be achieved using standard cardiopulmonary resuscitation (STD-CPR). This study was designed to assess whether SST-CPR improves the survival rate of dogs with cardiac arrest compared with STD-CPR. Twenty-nine mongrel dogs (19-31 kg) were enrolled in this study. ⋯ SST-CPR resulted in a significantly (P<0.001) higher systolic arterial pressure (91+/-47 vs 47+/-24 mmHg), diastolic pressure (43+/-24 vs 17+/-10 mmHg), coronary perfusion pressure (35+/-25 vs 13+/-9 mmHg), and end tidal CO(2) tension (9+/-4 vs 3+/-2 mmHg). Two of 15 animals (13%) resuscitated by STD-CPR and seven of 14 animals (50%) resuscitated by SST-CPR survived for 12 h after cardiac arrest (P<0.05). In conclusion, SST-CPR improves the short-term survival rate in canine cardiac arrest compared with STD-CPR.
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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.
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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.