Resuscitation
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To test our hypothesis that the hemoglobin based oxygen carrier HBOC-201 would have similar or superior efficacy to 6% hetastarch (HEX) as a pre-hospital 'bridging' fluid for hemorrhagic shock when delay to definitive medical care is prolonged to 24h. ⋯ HBOC-201 restored hemodynamics, maintained tissue oxygenation, and decreased blood transfusions in comparison to HEX in severe controlled HS with 24h delay to simulated hospital care. These results support the potential use of HBOC-201 as a bridging resuscitation fluid for HS.
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The primary aim was to derive a new termination of resuscitation (TOR) clinical prediction rule for advanced life support paramedics (ALS) and to measure both its pronouncement rate and diagnostic test characteristics. Secondary aims included measuring the test characteristics of a previously derived and published basic life support termination of resuscitation (BLS TOR) clinical prediction rule [Morrison LJ, Visentin LM, Kiss A, et al. Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest. N Engl J Med 2006;355(5):478-87] on the same cohort of patients for comparison purposes. ⋯ Cardiac arrest patients may be considered for prehospital ALS TOR when there is no ROSC prior to transport, no shock delivered, no bystander CPR and the arrest was not witnessed by bystanders or EMS. A single EMS termination clinical prediction rule for all levels of providers would be optimal for EMS systems to implement. Prospective evaluation of the ALS TOR clinical prediction rule in the hands of ALS providers will be required before implementation.
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Advanced life support (ALS) in a cardiac arrest is usually performed by a team consisting of three people. The medical team of a Helicopter Emergency Medical Service (HEMS) often consists of two rescuers only. Due to that reason an algorithm was developed to provide ALS with two people. During the initial phase the rescuer in the over-the-head position provides one man CPR while the second rescuer prepares all advanced measures. When all preparations are complete both rescuers are able to provide ALS. ⋯ We proved the feasibility of the algorithm in a manikin setting. Further observations have to prove the algorithm in real CPR situations.
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Supplementary oxygen is used routinely during cardiopulmonary resuscitation (CPR). High ambient oxygen levels from ventilation circuits have caused fatal fires and explosions. The Lund University Cardiopulmonary Assist System (LUCAS) device is driven by > 70 l min(-1) oxygen which is also likely to increase ambient oxygen concentrations and cause similar risk of fire and explosion. This study used simulated CPR with a LUCAS device to measure resulting ambient oxygen concentrations and assess safety of the device. ⋯ The use of oxygen to drive the LUCAS device results in a rapid increase in ambient oxygen concentration to levels likely to risk injury or death from fire. Ambulance services and hospitals using the device must be alerted to these dangers immediately.