Resuscitation
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Implantable cardioverter/defibrillators (ICDs) can detect ventricular fibrillation (VF) and terminate it. For determining the optimal defibrillation threshold, ventricular fibrillation is repetitively induced and terminated with DC shocks. Depending on the protocol, several fibrillation/defibrillation sequences are mandatory before the final implantation of an ICD. This procedure provides an elegant human model of circulatory arrest and resuscitation. ⋯ After DC termination of VF, the heart 'finds' relatively quickly a steady-state rhythm at the prefibrillatory level (22 beats), thereby normalizing CVP almost in parallel (14 beats). Peak LVP plateaus only after about 40 beats, although reasonable arterial pressures are reached within the first beats. Our data are limited to periods of ventricular fibrillation of no longer than 60s, which limits the generalisability to the setting of clinical cardiac arrest.
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In the absence of identified risk factors, 7% of term newly borns require PPV-ETT (positive pressure ventilation and/or endotracheal intubation). Factors increasing need for resuscitation, and therefore for individuals with advanced resuscitation skills, require further evaluation. ⋯ Given the baseline risk (22%), factors that increase need for resuscitation in a tertiary centre may not alter the practice of the NRT attending all "at-risk" deliveries, with the exception of ElCS.
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To review the epidemiology, pathophysiology, treatment and prognostication in relation to the post-cardiac arrest syndrome. ⋯ A growing body of knowledge suggests that the individual components of the post-cardiac arrest syndrome are potentially treatable.
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Randomized Controlled Trial Comparative Study
The Medical Emergency Team System and not-for-resuscitation orders: results from the MERIT study.
To examine NFR orders in relation to adverse events and emergency team calls in hospitals with or without a Medical Emergency Team (MET) system during the MERIT study. ⋯ In a cohort of Australian hospitals, most deaths occurred in patients with a previously documented NFR order but NFR orders were uncommon before cardiac arrest calls or unplanned ICU admissions. During the conduct of a cluster randomised controlled trial, more NFR orders were issued by emergency teams in those hospitals that implemented a MET system than in control hospitals. MET allocation, teaching hospital status, number of hospital beds and metropolitan location could only explain less than 50% of variance in NFR orders.
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After return of spontaneous circulation (ROSC) from cardiac arrest, profound myocardial stunning and systemic inflammation may cause hemodynamic alterations; however, the prevalence of post-ROSC hemodynamic instability and the strength of association with outcome have not been established. We tested the hypothesis that exposure to arterial hypotension after ROSC occurs commonly (>50%) and is an independent predictor of death. ⋯ Early exposure to arterial hypotension after ROSC was common and an independent predictor of death. These data suggest that post-ROSC hypotension could potentially represent a therapeutic target in post-cardiac arrest care.