Resuscitation
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Randomized Controlled Trial Multicenter Study Clinical Trial
Conducting research using the emergency exception from informed consent: the Public Access Defibrillation (PAD) Trial experience.
The Public Access Defibrillation (PAD) Trial, a prospective, multicenter, randomized clinical trial comparing two prehospital resuscitation strategies, was conducted under the regulations for exception from informed consent (21CFR50.24) in 24 communities in North America. These regulations place additional requirements for human subject protection on investigators and Institutional Review Boards (IRBs), including conducting community consultation (CC) and public disclosure (PD). ⋯ The length of time to obtain IRB approval and the extent of community consultation and public disclosure varied greatly among trial sites in meeting the current regulations for conducting emergency research with exception from informed consent. This suggests that more specific guidance may be useful and that determination of effective strategies for community consultation and public disclosure is needed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Trials of teaching methods in basic life support (4): comparison of simulated CPR performance at unannounced home testing after conventional or staged training.
This study compares the retention of basic life support (BLS) skills after 6 and 12 months by lay persons trained either in a conventional manner, or using a staged approach. Three classes, each of 2h, were offered to volunteers over a period of 4 months. For the conventional group, the second and third classes consisted of review of skills. ⋯ At 12 months, those taught by the staged method were significantly better at shouting for help (P = 0.005), time to first compression (P < 0.0001), and compression depth (P = 0.003). Those taught conventionally were significantly better at checking for a carotid pulse at both 6 and 12 months (P < 0.0001). These results suggest that training lay persons in basic life support skills using a staged approach leads to overall better skill retention at 6 and 12 months, and has other advantages including a greater willingness to re-attend follow-up classes.
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The optimal tidal and minute ventilation during cardiopulmonary resuscitation (CPR) is not known. In the present study seven adult, non-traumatic, out-of-hospital cardiac arrest patients were intubated and mechanically ventilated at 12 min(-1) with 100% oxygen and a tidal volume of 700 ml (10 +/- 2 ml kg(-1)). Arterial blood gas samples were analysed after 6-8 min of unsuccessful resuscitation and mechanical ventilation. ⋯ The patient with the highest (14 ml kg(-1)) and lowest (8 ml kg(-1)) tidal volumes per kg had the lowest and highest PaCO2 values of 2.6 and 6.8 kPa, respectively. Linear regression analysis confirmed a significant correlation between arterial pCO2 and tidal volume in ml/kg, r2 = 0.87. We conclude that aiming for an estimated ventilation of 10 ml kg(-1) tidal volume at frequency of 12 min(-1) might be expected to achieve normocapnia during ALS.
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Emergency medicine service (EMS) systems in the five Nordic countries have more similarities than differences. One similarity is the involvement of anaesthesiologists as pre-hospital physicians and their strong participation for all critically ill and injured patients in-hospital. ⋯ Main problems and challenges emphasized by the authors are: (1) Denmark: the dispatch centres are presently not under medical control and are without a national criteria based system. Access to on-line medical advice of a physician is not available; (2) Finland: the autonomy of the individual municipalities and their responsibility to cover for primary and specialised health care, as well as the EMS, and the lack of supporting or demanding legislation regarding the EMS; (3) Iceland is the only country that has emergency medicine (EM) as a recognised speciality but there is a need for more fully trained specialists in EM; (4) Norway: the ordinary ground ambulance is pointed out as the weakest link in the EM chain and a health reform demands extensive co-operation between the new health enterprises to re-establish a nation-wide air ambulance service; (5) Sweden: to create evidence based medicine standards for treatment in emergency medicine, a better integration of all part of the chain of survival, a formalised education in EM and a nation wide physician staffed helicopter EMS (HEMS) cover.
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Biography Historical Article
Resuscitation great. Brian Sellick, cricoid pressure and the Sellick Manoeuvre.