Resuscitation
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Appropriate assessment and resuscitation is an important part of neonatal care provided during the first minutes of life. Midwifery and junior medical staff are often in the frontline of neonatal resuscitation. Appropriate education and training of midwifery staff is therefore essential if the standard of care delivered to babies in the delivery suite is to be improved and maintained. Evaluation of any such educational interventions is necessary to assess their effectiveness. ⋯ We have shown that the intervention has been related temporally to an improvement in the quality of care delivered by midwifery staff to newborn babies. Practical courses in neonatal resuscitation can contribute to improvements in the quality of care provided to babies immediately after birth. These courses are more effective than theoretical teaching alone.
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To determine etiology of pediatric OHCA in a population-based sample from autopsy and coroner's diagnosis. ⋯ The highest mortality rates were among children age <4 years. 52.6% of deaths were from 'unnatural' causes (accidental, suicide, homicide, undetermined). Our findings will be useful for planning prevention, treatment and future research of pediatric OHCA.
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Randomized Controlled Trial
Post-shock myocardial stunning: a prospective randomised double-blind comparison of monophasic and biphasic waveforms.
Compared with monophasic defibrillation, biphasic defibrillation is associated with less myocardial stunning and earlier activation of sodium channels. We therefore hypothesised that earlier sodium channel activation would result in earlier restoration of the first sinus beat following elective DC cardioversion. ⋯ Biphasic defibrillation for elective DC cardioversion achieved more rapid restoration of the first sinus beat compared with a monophasic waveform. Waveform, but not energy level that achieved defibrillation, was an independent predictor of time to restoration of the first sinus beat. The mechanism for this may be related to the earlier reactivation of sodium channels associated with the biphasic waveform.
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The inspiratory impedance threshold device (ITD) has been shown to improve hemodynamic variables and survival outcomes during cardiopulmonary resuscitation in animals and humans. We hypothesized that use of an ITD, with a resistance of -10 cm H2O, will improve hemodynamics and short-term survival rates during hypovolemic hypotension in spontaneously breathing pigs. ⋯ Use of an ITD improved blood pressure and short-term survival rates in a spontaneously breathing porcine model of hypovolemic hypotension.
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Case Reports
Complete neurological recovery following delayed initiation of hypothermia in a victim of warm water near-drowning.
Induced hypothermia has been demonstrated to improve outcome following cardiac arrest and is now widely endorsed. However, the optimal method of cooling and the identification of patients most likely to benefit from this therapy remains to be determined. We report a patient in whom there was a long delay in return of spontaneous circulation (at least 45 min) and the initiation of induced hypothermia (12 h) who made an almost complete neurological recovery following cardiac arrest from warm-water near-drowning.