Resuscitation
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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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Randomized Controlled Trial
Quality of BLS decreases with increasing resuscitation complexity.
Multiple procedures performed in parallel may cause each procedure to be performed less effectively than if performed in isolation. BLS performed by prehospital providers potentially includes artificial ventilations, chest compressions, and application of an automated external defibrillator (AED). This study examines the effectiveness of artificial ventilation and chest compressions both with and without an AED. ⋯ Both the quality and quantity of BLS decreases as the number of procedures performed simultaneously increases. Further decrements might occur when ALS skills enter into resuscitation. These results suggest a need to automate and/or prompt the performance of BLS to optimize resuscitation.