Resuscitation
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Multicenter Study
Characteristics and outcome of cardiorespiratory arrest in children.
To analyse the present day characteristics and outcome of cardio-respiratory arrest in children in Spain. ⋯ In Spain, the present mortality from cardio-respiratory arrest in children remains high. Survival after respiratory arrest is significantly higher than after cardiac arrest. The duration of cardiopulmonary resuscitation attempt is the best indicator of mortality of cardio-respiratory arrest in children.
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To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts. ⋯ Survival to discharge from hospital in all cases of OHCA was 6.2% but 20.5% in witnessed, presumed cardiac aetiology in VF. The decision to withhold resuscitation was based upon presumed prolonged anoxia in the majority of cases.
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Randomized Controlled Trial Comparative Study Clinical Trial
Teaching public access defibrillation to lay volunteers--a professional health care provider is not a more effective instructor than a trained lay person.
Survival improves in witnessed out-of-hospital cardiac arrest if the victim receives bystander-initiated cardiopulmonary resuscitation and rapid defibrillation (BLS/AED). The European Resuscitation Council has a simple programme to teach these life-saving skills that require no previous experience of automated external defibrillators (AEDs). To be able to implement the use of AEDs widely, many instructors are needed, and therefore, lay persons may also be used as trainers. The purpose of this randomized study was to compare lay volunteers trained by a lay person with those trained by a health care professional using the Objective Structured Clinical Examination (OSCE). ⋯ No significant benefit exists in the trainer being a health care professional, but thorough training and subsequent rehearsing of the skills learned are crucial.
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To review the evidence on the incidence of rib and sternal fractures after conventional closed-chest compression in the treatment of cardiac arrest in adults and children, and after active compression-decompression cardiopulmonary resuscitation (ACD-CPR). ⋯ Sound methodological studies on thoracic fractures due to chest compression do not exist and the available studies cannot be compared one with another. In infants and toddlers, manual CPR rarely causes skeletal chest injuries. In adults, sternal fractures occur in at least one-fifth and rib fractures as well as rib and/or sternal fractures in at least one-third of the patients during conventional CPR. There is no compelling evidence to show that an increased complication rate is associated with ACD-CPR. Rib or sternal fractures are unlikely to increase mortality, as they rarely cause severe internal organ damage. Further prospective studies are desirable to assess complications by post-mortem examinations that explicitly address them. In particular, clinical evaluation of mechanical CPR devices should be accompanied by a thorough assessment of the associated complications because data specific to this modality are not available.
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Although often preventable, drowning remains a leading cause of accidental death, especially in children. New definitions classify drowning as the process of experiencing respiratory impairment from submersion or immersion in a liquid. ⋯ Prompt and aggressive resuscitation attempts are crucial for optimal survival. This article reviews the epidemiology, pathophysiology, treatment, and prevention of drowning.