Resuscitation
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Review
Design and implementation of resuscitation research: special challenges and potential solutions.
Evaluation of the effectiveness of resuscitation interventions is challenging. We describe these challenges, which include design, enrolment and analysis issues. Randomized trials establish if interventions work in predefined populations. "Efficacy" trials determine whether interventions work under ideal conditions. "Effectiveness" trials determine whether interventions work under usual practice conditions. ⋯ Allocating groups of episodes to interventions by randomizing by clusters, rather than by individual patients reduces provider noncompliance. Waiver from consent for emergency research and use of novel technologies could facilitate enrolment despite time constraints. Rigorous statistical methods can be used to analyze multiple data without an excessive increase in the chance of a false-positive result.
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Randomized Controlled Trial
An evaluation of objective feedback in basic life support (BLS) training.
Studies show that acquisition and retention of BLS skills is poor, and this may contribute to low survival from cardiac arrest. Feedback from instructors during BLS training is often lacking. This study investigates the effects of continuous feedback from a manikin on chest compression and ventilation techniques during training compared to instructor feedback alone. ⋯ This study demonstrated that objective feedback during training improves the performance of BLS skills significantly when tested immediately after training and at re-testing 6 weeks later. However, CPR performance declined substantially over time in both groups.
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Comparative Study
Laryngoscopic versus intubating LMA guided tracheal intubation by novice users--a manikin study.
Airway control is a potentially lifesaving procedure but tracheal intubation by direct laryngoscopy is difficult. This pilot study was conducted to determine whether tracheal intubation was more rapid and the success rate higher using an intubating laryngeal mask airway. ⋯ Laryngoscopic orotracheal intubation is difficult for the untrained, but all participants were successful with ILMA-TI. These data suggest that alternative devices such as the ILMA should be included in the medical school curriculum for airway management.
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Clinical Trial
Introduction of a treatment algorithm can improve the early management of emergency patients in the resuscitation room.
Successful management of emergency patients with multiple trauma in the hospital resuscitation room depends on the immediate diagnosis and rapid treatment of the most life-threatening injuries. In order to reduce the time spent in the resuscitation room, an in-hospital algorithm was developed in an interdisciplinary team approach with respect to local structures. The aim of the study was to analyse whether this algorithm affects the interval between hospital admission and the completion of diagnostic procedures and the start of life-saving interventions. Moreover, in-hospital mortality was investigated before and after the algorithm was introduced. ⋯ The introduction of an algorithm for early management of emergency patients significantly reduced the time spent in the resuscitation room. The periods to completion of sono, CF, and CCT, respectively, and the start of life-saving interventions were significantly shorter after introduction of the algorithm. Moreover, introduction of the algorithm reduced mortality in the most severely injured patients. Although further investigations are needed to evaluate the effects of the Heidelberg treatment algorithm in terms of outcome and mortality, the time reduction in the resuscitation room seems to be beneficial.