Resuscitation
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Multicenter Study
Effectiveness and long-term outcome of cardiopulmonary resuscitation in paediatric intensive care units in Spain.
To analyse the immediate effectiveness of resuscitation and long-term outcome of children who suffered a cardiorespiratory arrest when admitted to paediatric intensive care units (PICU). ⋯ One-third of children who suffer a cardiac or respiratory arrest when admitted to PICU survive, and most of them had a good long-term neurological and functional outcome. The duration of cardiopulmonary resuscitation attempts is the best indicator of mortality.
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Randomized Controlled Trial
Incomplete chest wall decompression: a clinical evaluation of CPR performance by trained laypersons and an assessment of alternative manual chest compression-decompression techniques.
Complete chest wall recoil improves hemodynamics during CPR by generating relatively negative intrathoracic pressure, which draws venous blood back to the heart, providing cardiac preload prior to the next chest compression. ⋯ The Hands-Off Technique decreased compression duty cycle but was 46.3 times more likely to provide complete chest wall recoil (OR: 46.3; CI: 16.4-130.3) compared to the Standard Hand Position without differences in accuracy of hand placement, adequate depth of compression, or perceived discomfort with its use. All forms of manual CPR tested (including the Standard Hand Position) in trained laypersons produced an inadequate depth of compression for two-thirds of the time. These data support development and testing of more effective layperson CPR training programmes and more effective means to deliver manual as well as mechanical CPR.
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Randomized Controlled Trial
Accuracy of clinical assessment of infant heart rate in the delivery room.
Heart rate (HR) dictates intervention during neonatal resuscitation. Guidelines recommend that HR be assessed by auscultation or palpation. ⋯ Clinical assessment by 23 observers randomly allocated to assess HR by one of two methods in 26 infants, was found to be inaccurate and underestimate ECG HR. The mean difference between HR assessed by auscultation and palpation ECG and HR using methodology recommended by the Neonatal Resuscitation Programme was 14 and 22 beats per minute respectively.
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Comparative Study
Discussing and documenting (do not attempt) resuscitation orders in a Dutch Hospital: a disappointing reality.
To determine whether the introduction of a patient information sheet about do not attempt resuscitation (DNAR) orders and personal motivation of the medical staff results in an improvement in the documentation of the DNAR orders in the medical records. ⋯ Giving patients more information about DNAR orders and motivating medical staff personally does not influence the documentation of DNAR orders. If documented, it occurred more in the elderly and the deceased patients. Only a few DNAR orders were specified and most were initiated by the doctor.