Resuscitation
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Ventilation during neonatal resuscitation involves the use of self-inflating bags, flow-inflating bags, and T-piece resuscitators. The ability of operators to deliver desired peak inspiratory pressures (PIP), positive end expiratory pressures (PEEP), prolonged inflations and the length of time to transition between different pressures has not been compared for all three of these devices. ⋯ The T-piece resuscitator delivered the desired pressures more accurately, but required greater time to increase the PIP from 20 to 40 cmH2O. It was difficult to maintain a prolonged inflation and deliver the desired PEEP with the self-inflating bag even with the PEEP valve in place. There is a need for improvement in the design and function of current manual resuscitation devices and for prospective trials to evaluate the optimal method of bag and mask ventilation during resuscitation of the newborn infant.
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Review Case Reports
Recovery of a hypothermic drowned child after resuscitation with cardiopulmonary bypass followed by prolonged extracorporeal membrane oxygenation.
Drowning is a leading cause of death in children worldwide. However, there is uncertainty about the initiation and the extent of adequate therapeutic interventions after drowning accidents. ⋯ After a prolonged period in a vegetative state eventually she made an almost complete neurological recovery. We do not have knowledge of any case of drowning reported with a favourable neurological outcome after such a prolonged period of ECMO.
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Comparative Study
Effect of nitric oxide synthase modulation on resuscitation success in a swine ventricular fibrillation cardiac arrest model.
We have demonstrated previously that the nitric oxide synthase (NOS) inhibitor N(G)-nitro-L-arginine (L-NNA) decreases free radical generation and nitrosative injury via peroxynitrite formation after epicardial dc shocks. ⋯ NOS inhibition pre-arrest did not improve survival, but did reduce requirements for epinephrine and closed-chest compression in a swine resuscitation model.
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Comparative Study
Differential effects of out-of-hospital interventions on short- and long-term survival after cardiopulmonary arrest.
The aim of this study was to describe the relationship between prehospital clinical variables, interventions and survival time after cardiac arrest and to determine whether various factors affect the risk of death differently at early and late time periods. ⋯ Survival after out-of-hospital cardiac was characterized by a large number of deaths on day 1. Most subsequent deaths were identified within 14 days after collapse. Prehospital factors have markedly different relationships with short- and long-term survival. Linkage between prehospital intervention and short- and long-term outcomes must consider the survival time characteristics of this population.
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Comparative Study
Reducing no flow times during automated external defibrillation.
There has recently been an increased attention focused on the importance of reducing time without blood flow from chest compressions (no flow time, NFT) during cardiopulmonary resuscitation (CPR). In this study we have analyzed and quantified the NFTs during external automatic defibrillation in 105 cardiac arrest patients. We found that for around half of the time (about 10 min), these patients were not perfused. ⋯ The potential reduction in NFT using these methods was calculated theoretically and we found a reduction in the total NFT of about 4.5 and 1 min, respectively, in the subgroups of patients having at least one shock and patients having received no shocks. In the present study, the median NFT ratio could theoretically be reduced from 51% to 34% or 49% to 39% depending on if the patient would have a shockable rhythm or not. By introducing the proposed methods into an AED, the NFT would be significantly reduced, hopefully increasing the survival.