Resuscitation
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Multicenter Study
Body temperature management after severe traumatic brain injury: methods and protocols used in the United Kingdom and Ireland.
To establish whether there is consensus in the management of body temperature in patients with severe traumatic brain injury (TBI) admitted to hospitals in the United Kingdom and Ireland for neurosurgical intensive care. ⋯ From this survey, it is evident that there is no consensus in the approach to temperature management in neurosurgical intensive care patients with severe TBI. Review and rationalisation of systems of care may be required in an effort to develop evidence-based nationwide guidelines.
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Propofol has been shown to protect against neuronal damage induced by brain ischaemia in small animal models. We reported previously that mild hypothermia (33 degrees C) in combination with extracorporeal lung and heart assist (ECLHA) improved the neurological outcome in dogs with cardiac arrest (CA) of 15 min induced during normothermia. In the present study, we investigated the neuroprotective effect of propofol infusion under mild hypothermia with ECLHA in this model. ⋯ The combination of propofol infusion at a rate of 4 mg/(kg h), 24h and rapidly induced mild hypothermia (33 degrees C) with ECLHA might provide a successful means of cerebral resuscitation from CA.
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Multicenter Study Comparative Study
Influence of medical direction on the management of prehospital myocardial infarction.
Prehospital management of myocardial infarction was evaluated in two differently structured Emergency Medical Service (EMS) systems in Southern Finland: a physician directed EMS with on-site physician involvement (physician EMS) and an EMS without operational physician involvement with paramedics only (non-physician EMS). The management of 641 consecutive acute ST-elevation myocardial infarction (STEMI) patients between 1997 and 1999 (263 patients in the physician EMS group and 378 patients in non-physician EMS group) were studied. Patients treated in the physician EMS received all necessary medical care including thrombolytic therapy at the scene whereas patients in the non-physician EMS were transported to hospital for definitive treatment after initial care. ⋯ Fifty-two patients (20%) in the physician EMS received thrombolytic therapy after cardiopulmonary resuscitation compared to two patients in the non-physician EMS (p<0.001). Of the resuscitated patients in the physician directed EMS group 60% were discharged from the hospital, and 44% of these had a good neurological recovery. We conclude that a physician directed EMS is able to reduce the pain to therapy delays significantly in STEMI patients and may offer thrombolytic therapy to a wider patient group compared to an EMS without operational medical involvement.
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Comparative Study
Emergency medical service providers' experience with family presence during cardiopulmonary resuscitation.
To describe emergency medical service providers' experiences with family member presence during resuscitation, and to determine whether those experiences are similar within urban and suburban settings. ⋯ EMS providers have substantial experience with family witnessed resuscitations, are uncomfortable about their presence, and often must provide support for families. While urban providers tended to report more negative experiences and perceptions, there were minimal differences between the two groups.
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Advanced cardiac life support (ACLS) guidelines suggest transcutaneous cardiac pacing (TCP) for the treatment of symptomatic bradycardia (SB) and bradyasystolic cardiac arrest (BACA). Many EMS systems are extrapolating these guidelines and employing TCP in the prehospital setting. Our objective was to conduct a systematic review to determine the efficacy of prehospital TCP in the management of these two conditions. ⋯ In the prehospital setting, there is no evidence to support the use of TCP in bradyasystolic cardiac arrest. There is inadequate evidence to determine the efficacy of prehospital TCP in the treatment of symptomatic bradycardia.