Resuscitation
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The in-hospital Utstein template for cardiopulmonary resuscitation (CPR) was assessed in four secondary hospitals (334-441 beds) which did not have systematic data collection. ⋯ The in-hospital Utstein template was logical but laborious and it provided tools for resuscitation management evaluation in the study hospitals. For continuous use, a slightly compressed model may be warranted. In the present material, the overall survival rate to hospital discharge was in line with previous reports but there were somewhat less neurologically satisfactory survivors. There is an evident need to improve the outcome of patients suffering CA on the wards. An important step is to reduce the time interval to defibrillation.
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During normovolaemic haemodilution arterial O(2)-content decreases exponentially. Nevertheless, tissue oxygenation is first maintained initially by increased organ perfusion and O(2)-extraction. As soon as these compensatory mechanisms are exhausted, myocardial ischaemia and tissue hypoxia occur at an individual 'critical' haematocrit (Hct) value. This study was conducted in order to assess whether tissue hypoxia at the critical Hct is reversed by hyperoxic ventilation with 100% O(2). ⋯ Hyperoxic ventilation reversed tissue hypoxia at the critical Hct due to preferential utilization of plasma O(2) and allowed temporary preservation of tissue oxygenation. During haemodilution, hyperoxic ventilation might offer an effective bridge until red cells are ready for transfusion.
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Randomized Controlled Trial Clinical Trial
Dispatcher-assisted cardiopulmonary resuscitation. An evaluation of efficacy amongst elderly.
Bystander cardiopulmonary resuscitation (CPR) increases survival rates. The largest group of cardiac arrest patients are men over the age of 60 in the home, and the most probable potential CPR provider is an older woman who is not likely to have received CPR training. One method to increase the percentage of bystander-initiated CPR in this setting is for CPR instruction to be provided by nurse dispatchers via telephone. ⋯ The median period from dispatcher contact until continuous CPR was significantly longer for standard instructions than for compression only, 4.9 versus 3.4 min, and fewer chest compressions were provided during the 9 min test period, median 124 versus 334 compressions. In both groups the overall CPR performance was of very poor quality, and unlikely to have affected outcome in a real situation. Other telephone assisted CPR scripts should be tested in this potential bystander group.
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Comparative Study
In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway.
While pre-hospital factors related to outcome after out-of-hospital cardiac arrest (OHCA) are well known, little is known about possible in-hospitals factors related to outcome. ⋯ Both pre-arrest, pre- and in-hospital factors were associated with in-hospital survival after OCHA. It seems important also to report in-hospital factors in outcome studies of OCHA. The design of the study precludes a conclusion on causability.
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To examine whether induced hypothermia could prolong short-term survival after volume-controlled hemorrhagic shock (HS). ⋯ In lightly anesthetized pigs during volume-controlled HS, induced hypothermia may prolong their short-term survival for reasons that remain to be clarified.