Resuscitation
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Comparative Study
Oxygen delivery and return of spontaneous circulation with ventilation:compression ratio 2:30 versus chest compressions only CPR in pigs.
The need for rescue breathing during the initial management of sudden cardiac arrest is currently being debated and reevaluated. The present study was designed to compare cerebral oxygen delivery during basic life support (BLS) by chest compressions only with chest compressions plus ventilation in pigs with an obstructed airway mimicked by a valve hindering passive inhalation. Resuscitability was then studied during the subsequent advanced life support (ALS) period. ⋯ Haemodynamic data did not differ between the groups. In this model of very ideal BLS, ventilation improved arterial oxygenation and the median time to ROSC was shorter. We believe that in cardiac arrest with an obstructed airway, pulmonary ventilation should still be strongly recommended.
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To determine the incidence of sonographic hepatic portal venous gas (HPVG) and to clarify the relationship between the presence of HPVG and clinical outcomes in patients with out-of-hospital cardiac arrest (OHCA). ⋯ HPVG is not uncommon in patients receiving resuscitation for OHCA and is associated with poor outcome in these patients.
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Ambulance crews may alert hospitals for patients who are severely unwell. This allows the hospital time to prepare space and equipment, and to assemble an appropriate clinical team to receive and manage the patient immediately on arrival. Over and under alerting by ambulance crews is to be avoided to avoid complacency on one hand, and inadequate reception of severely injured patients on the other. There are currently no formal guidelines for the ambulance service to alert hospitals in appropriate cases. ⋯ The majority of patients with major trauma (ISS > 15) were not the subject of a hospital alert by the ambulance service. Seventy-five percent of the patients who were the subject of an alert were not eligible for inclusion into TARN, implying that they did not have serious injury. Pre-hospital trauma severity assessment needs developing with appropriate ambulance protocols, to ensure appropriate alert calls.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized trial of suprasternal palpation to determine endotracheal tube position in neonates.
To compare suprasternal palpation, a previously described bedside technique, with standard chest radiography for correct positioning of the endotracheal tube (ETT) in newborn infants. ⋯ Suprasternal palpation is a simple, safe, teachable, method of confirming ETT position in neonates when CXR is unavailable, and may especially helpful during neonatal resuscitation prior to surfactant administration.
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To describe the change in the occurrence of ventricular fibrillation as initially observed arrhythmia among patients suffering from out-of-hospital cardiac arrest in Sweden. ⋯ During 11 years in Sweden, there was a marked decrease in the proportion of patients found in ventricular fibrillation among patients with a bystander witnessed cardiac arrest regardless whether the arrest occurred at home or outside home. A modest increase in age and interval between call for, and arrival of, the ambulance was associated with these findings.