Resuscitation
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The optimum duration of cardiopulmonary resuscitation (CPR) prior to first rescue shock is unknown. Clinical trials have used 90 and 180 s. Neither of these durations may be optimal. We sought to determine the optimum duration of CPR prior to first defibrillation attempt and whether this varied depending on the duration of ventricular fibrillation (VF). In this porcine model of basic life support, our outcomes were rates of return of spontaneous circulation (ROSC), survival, and coronary perfusion pressure (CPP). ⋯ ROSC and survival were equivalent regardless of VF duration and CPR duration. When CPR begins late, CPPs are low, stressing the importance of early CPR. We do not recommend 300 s of CPR unless a defibrillator is unavailable.
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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.
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Randomized Controlled Trial Comparative Study
Effectiveness of simplified chest compression-only CPR training for the general public: a randomized controlled trial.
To compare the quality of resuscitation between those with a simplified chest compression-only cardiopulmonary resuscitation (CPR) program and those with a conventional CPR program. ⋯ A simplified chest compression-only CPR program makes it possible for the general public to perform a greater number of appropriate chest compressions than the conventional CPR program (UMIN-CTR C0000000321).
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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 growing evidence that therapeutic hypothermia and other post-resuscitation care improves outcomes in out-of-hospital cardiac arrest (OHCA). Thus, transporting patients with return of spontaneous circulation (ROSC) to specialized facilities may increase survival rates. However, it is unknown whether prolonging transport to reach a designated facility would be detrimental. ⋯ Survival was not significantly impacted by transport interval. This suggests that a modest increase in transport interval from bypassing the closest hospital en route to specialized care is safe and warrants further investigation.