Resuscitation
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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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Randomized Controlled Trial Comparative Study
Online resuscitation training. Does it improve high school students' ability to perform cardiopulmonary resuscitation in a simulated environment?
There are no published data on the efficacy of online first aid or resuscitation learning programmes in Australia. Our goal was to compare the knowledge and first aid skills of subjects who have undertaken the St. John Ambulance Australia (WA) "online crash course", with those who have no first aid training. ⋯ There were significant differences in the performance of the written test, between the group who completed the course and the group who did not complete the course (P = 0.036: Mann-Whitney U-test). There were no significant differences in the performance of any other practical tasks between the two groups. We conclude from this that the online course improved course participant's knowledge of BLS significantly, but not their ability to perform; that online first aid courses may be useful for knowledge acquisition but that they do not confer any benefit, in performance of BLS skills.
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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.
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Few prospective studies of the incidence and outcome of paediatric in-hospital cardiopulmonary arrest have been reported to enable quality assurance comparisons within and between institutions. ⋯ In-patient paediatric cardiac arrest has a mediocre outcome with a better outlook if the initial rhythm is hypotensive-bradycardia, VF or pulsatile VT. Doses of adrenaline greater than 15 mcg/kg given for non-shockable rhythms may cause secondary VF which has a worse outcome than primary VF.
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An intrathoracic pressure regulator (ITPR) is a device that can be added to the external end of a tracheal tube to create controlled negative airway pressure between positive pressure ventilations. The resulting downward bias of the airway pressure baseline promotes increased venous return and enhanced circulation during CPR and also during hypovolemic shock. ⋯ Thereafter perfusion pressure plateaus. Negative bias pressures exceeding -10 cm H2O are not needed in ITPR-CPR.