Resuscitation
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Multicenter Study
The effect of a critical care outreach service and an early warning scoring system on respiratory rate recording on the general wards.
To determine whether the implementation of a Reading-Modified Early Warning Scoring (R-MEWS) system, is associated with an increased recording of respiratory rate (RR) in hospital inpatients, and whether the presence of a critical care outreach (CCO) service has a further impact on the recording of patient's vital signs. ⋯ The introduction of an early warning scoring (EWS) was associated with improved respiratory rate recording, which may have been further enhanced by the presence of a CCO service.
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No accurate, independent biomarker has been identified that could reliably predict neurological outcome early after cardiac arrest. We speculated that brain natriuretic peptide (BNP) measured at hospital admission may predict patient outcome. ⋯ Brain natriuretic peptide levels on admission predict neurological outcome at 6 months and survival after cardiac arrest.
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Nitric oxide (NO) is a critical regulator of vascular tone, and signal transduction. NO is produced via three unique synthases (NOS); endothelial (eNOS), and neuronal (nNOS) are both constitutively expressed and inducible (iNOS) produced primarily after stimulation. NO has been implicated during and after ischemia reperfusion injury as both a detrimental and cardioprotective mediator. Since cardiopulmonary resuscitation (CPR) in ventricular fibrillation (VF) is a model of whole body ischemia reperfusion injury, it provides an opportunity to assess the effects of NO from the three NOS isoforms. ⋯ Intact basal nNOS activity is vital for survival from whole body ischemia reperfusion injury. iNOS inhibition prior to ischemia reperfusion, protects myocardial function after ROSC and decreases myocardial and brain hyperemic response after ROSC.
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Chest compressions are interrupted during cardiopulmonary resuscitation (CPR) due to human error, for ventilation, for rhythm analysis and for rescue shocks. Earlier data suggest that the recommended 15:2 compression to ventilation (C:V) ratio results in frequent interruptions of compressions during CPR. We evaluated a protocol change from the recommended C:V ratio of 15:2-30:2 during CPR in our municipal emergency medical system. ⋯ Retraining first responders to use a C:V ratio of 30:2 instead of the traditional 15:2 during out-of-hospital cardiac arrest increased the number of compressions delivered per minute and decreased the number of pauses for ventilation. These data are new as they produced persistent and quantifiable changes in practitioner behavior during actual resuscitations.
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To investigate whether transoesophageal cardiac pacing can induce ventricular fibrillation (VF) and how long the cardiac pacing has to be sustained to prevent the reversion of the VF induced. ⋯ Transoesophageal cardiac pacing can induce VF in rats. However, the cardiac pacing is required for at least 120-180 s to ensure that VF does not spontaneously convert. We can use the technique to establish a new and simpler rat cardiac arrest (CA) model, which may facilitate experimental investigation on CPR.