Resuscitation
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Review Case Reports
Out-of-hospital cardiac arrest from air embolism during sexual intercourse: case report and review of the literature.
We report the successful resuscitation of a 38-year-old woman in cardiac arrest following heterosexual intercourse 7 days after spontaneous abortion and an instrumental uterine evacuation. The collapse was thought to be due to venous air embolism (VAE). Her survival neurologically intact was attributed to appropriate first aid, pre-hospital and subsequent hospital intensive care. ⋯ Diagnostics and management techniques for venous air embolism are discussed. Air embolism should be included in the differential diagnosis for all young women in cardiac arrest, particularly when occurring during sexual activity. Instructions in risks of sexual intercourse during pregnancy and the puerperium should become part of pregnant women's education.
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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.