Resuscitation
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Comparative Study
Rapid cardiac ultrasound of inpatients suffering PEA arrest performed by nonexpert sonographers.
Cardiac arrest presenting as pulseless electrical activity (PEA) currently has a very low survival rate. Many of the conditions underlying PEA (cardiac tamponade, hypovolemia, and pulmonary embolus) are associated with specific cardiac ultrasound findings. The aim of this study was to evaluate a rapid cardiac ultrasound assessment performed by trained nonexpert sonographers integrated into the ACLS response system at a major medical center. ⋯ Rapid cardiac sonography can be successfully integrated in the ACLS response. Nonexpert sonographers may be able to provide useful interpretive information when sufficiently trained.
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Comparative Study
Trends in treated ventricular fibrillation in out-of-hospital cardiac arrest: ischemic compared to non-ischemic heart disease.
The incidence of ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA) treated by first responders has declined over the past decade. Since VF OHCA occurs primarily in the setting of severe coronary artery disease, primary and secondary prevention strategies may in part account for the decline. However, such strategies may not have a similar impact on non-ischemic arrest. ⋯ The incidence of VF OHCA is declining. The decline is attributable to the reduction of VF cardiac arrest with ischemic heart disease; suggesting an impact of treatment strategies targeted at coronary artery disease. The relative increasing incidence of non-ischemic VF OHCA suggests that more efforts are required to minimize mortality in this cohort population.
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Automated external defibrillators (AEDs) are currently not recommended for use in children under 1 year of age. We report the first description of successful AED defibrillation in an infant using a 50 J shock and provide rationale for employing these life-saving devices in infants at risk for sudden cardiac death.
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Comparative Study
Use of an impedance threshold device improves short-term outcomes following out-of-hospital cardiac arrest.
An impedance threshold device (ITD) has been developed for the treatment of cardiac arrest to augment circulation to the heart and brain during cardiopulmonary resuscitation (CPR). The ITD has ventilation timing lights that flash at 12 min(-1) to discourage excessive ventilation rates. ⋯ The ITD was used safely and effectively in a large, diverse EMS system and markedly improved short-term survival for adult patients in non-traumatic cardiac arrest.
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Comparative Study
Independent evaluation of a defibrillation outcome predictor for out-of-hospital cardiac arrested patients.
We evaluated the ability of a previously derived outcome predictor to discriminate between ECG segments corresponding to return of spontaneous circulation (ROSC) or not in validation data from 136 patients with cardiac arrest. The new data used for validation were totally independent from the predictor derivation data used in the original study. ⋯ Outcome predictor performance was reproducible. As in the present study, future testing should be performed on totally independent data not included in the design of the outcome predictor to get a reliable impression of expected performance.