Resuscitation
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Randomized Controlled Trial Comparative Study
Pediatric advanced life support re-training by videoconferencing compared to face-to-face instruction: a planned non-inferiority trial.
Videoconferencing technology may be useful for providing Pediatric Advanced Life Support (PALS) re-training to geographically isolated providers. Yet, it is unclear whether learning outcomes will be similar to those obtained with traditional, face-to-face instruction. This study assess whether PALS re-training provided via live, interactive videoconferencing was as effective as the same instruction provided in a face-to-face format on PALS knowledge, psychomotor skills, and confidence in performing resuscitation skills. ⋯ For outcomes assessed following instruction and at 1 year, videoconferencing was not inferior to face-to-face delivery. These findings hold promise for use of videoconferencing to deliver PALS re-training to geographically isolated providers.
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There is no up-to-date literature review of physiologically-based, single-parameter weighted "track and trigger" systems (SPTTS) and little data on their sensitivity and specificity to predict adverse outcomes. The aim of this study was to describe the SPTTS in clinical use and measure their sensitivity and specificity when using admission vital signs data for predicting in-hospital mortality. ⋯ There is a wide range of unique, but very similar, SPTTS in clinical use. Although specificities were high, sensitivities were too low to provide institutions with confidence that these SPTTS could identify patients at risk of in-hospital death using admission vital signs. Institutions may wish to consider these data when selecting which, if any, single-parameter track and trigger systems to introduce.
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The 2005 revised guidelines for cardiopulmonary resuscitation (CPR) suggest a universal compression-to-ventilation (C:V) ratio of 30:2. The effects of this ratio in a realistic CPR scenario have not been investigated completely. ⋯ Increasing the chest compression ratio from 15:2 to 30:2 resulted in changes in arterial, but not mixed-venous, blood gases; therefore, the advantages of more chest compressions may outweigh a decrease in gas exchange.
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Randomized Controlled Trial
Instructions to "push as hard as you can" improve average chest compression depth in dispatcher-assisted cardiopulmonary resuscitation.
Cardiopulmonary resuscitation (CPR) with adequate chest compression depth appears to improve first shock success in cardiac arrest. We evaluate the effect of simplification of chest compression instructions on compression depth in dispatcher-assisted CPR protocol. ⋯ Modifying dispatcher-assisted CPR instructions by changing "push down firmly 2in. (5cm)" to "push as hard as you can" achieved improvement in chest compression depth at no cost to total release or average chest compression rate.