Resuscitation
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Conventional biphasic truncated exponential (BTE) waveforms have been studied extensively but less is known about "chopping modulated" BTE shocks. Previous studies comparing chopped and unchopped waveforms have found conflicting results. This study compared the defibrillation thresholds (DFTs) of a variety of chopped and unchopped BTE waveforms. ⋯ When treating swine with short-duration VF, chopped waveforms require more energy to defibrillate than unchopped waveforms. More study is required to assess the performance of chopped waveforms when treating cardiac arrest patients.
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Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for ST-elevation acute myocardial infarction (STEMI). In comatose survivors of cardiac arrest, mild induced hypothermia (MIH) improves neurological recovery. In the present study, we investigated feasibility and safety of combining primary PCI and MIH in comatose survivors of ventricular fibrillation with signs of STEMI after reestablishment of spontaneous circulation. ⋯ Hospital survival with cerebral performance category 1 and 2 was significantly better in MIH group (55% versus 16%; p=.001). Our preliminary experience indicates that primary PCI and MIH are feasible and may be combined safely in comatose survivors of ventricular fibrillation with signs of STEMI. Such a strategy may improve survival with good neurological recovery.
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The deleterious effects of positive pressure ventilation may be prevented by substituting passive oxygen insufflation during advanced cardiac life support (ACLS) cardiopulmonary resuscitation (CPR). ⋯ Passive insufflation may be an acceptable alternative to the currently recommended positive pressure ventilation during resuscitation efforts for out-of-hospital VF cardiac arrest. Potential advantages of this technique include: (1) easier to teach, (2) easier to administer, (3) prevention of the adverse effects of positive pressure ventilation and (4) allows EMS personnel to concentrate upon other critically important duties.