Resuscitation
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Randomized Controlled Trial Clinical Trial
Effect of an inspiratory impedance threshold device on hemodynamics during conventional manual cardiopulmonary resuscitation.
In animals in cardiac arrest, an inspiratory impedance threshold device (ITD) has been shown to improve hemodynamics and neurologically intact survival. The objective of this study was to determine whether an ITD would improve blood pressure (BP) in patients receiving CPR for out-of-hospital cardiac arrest. ⋯ Use of the active ITD was found to increase systolic pressures safely and significantly in patients in cardiac arrest compared with sham controls.
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Review Case Reports
Thoracic lavage in accidental hypothermia with cardiac arrest--report of a case and review of the literature.
Accidental hypothermia resulting in cardiac arrest poses numerous therapeutic challenges. Cardiopulmonary bypass (CPB) should be used if feasible since it optimally provides both central rewarming and circulatory support. However, this modality may not be available or is contraindicated in certain cases. Thoracic lavage (TL) provides satisfactory heat transfer and may be performed by a variety of physicians. This paper presents the physiological rationale, technique, and role for TL in accidental hypothermia with cardiac arrest. ⋯ Patients presenting in cardiac arrest from accidental hypothermia may be rewarmed effectively using TL. Among survivors, normal neurological recovery is seen. Thoracic lavage should be strongly considered for these patients if CPB is not available or contraindicated.
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Management of septic shock (SS) with a norepinephrine (noradrenaline)-based haemodynamic algorithm. ⋯ In conclusion, our data support extended use of an algorithm based on norepinephrine for treating septic shock patients. This is the first clinical study that uses NE as the initial vasopressor drug systematically, and although not comparative, the mortality rates adjusted to APACHE II, are comparable to other studies. It also gives support for future clinical trials comparing norepinephrine with dopamine in this setting.
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Comparative Study
Echocardiographic comparison of cardiopulmonary resuscitation (CPR) using periodic acceleration (pGz) versus chest compression.
This investigation compared the effects of conventional cardiopulmonary resuscitation (CPR) using an automated Thumper chest compression device to periodic acceleration CPR (pGz-CPR) on early post-resuscitation ventricular function assessed by echocardiography, in an adult pig model of CPR. ⋯ pGz holds promise as a new method for CPR with better left ventricular (LV) function post-CPR than the more traditional chest compression method.
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Comparative Study
Evaluation of out-of-hospital cardiopulmonary resuscitation with resuscitative drugs: a prospective comparative study in Japan.
This study aimed at evaluating two emergency medical service systems, one in which emergency life-saving technicians (ELSTs) are allowed to administer epinephrine (adrenaline) to patients with out-of-hospital cardiac arrest and one in which ELSTs are allowed to administer epinephrine, lidocaine, and atropine. ⋯ Use of resuscitative drugs for non-traumatic prehospital CPR appears to be effective in terms of resuscitation rates and 1-month survival rates.