Resuscitation
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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.
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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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Comparative Study
External artifacts by advanced life support providers misleading automated external defibrillators.
The ECG analysis algorithm of automated external defibrillators (AEDs) shows reduced sensitivity and specificity in the presence of external artifacts. Therefore, ECG analyses are preceded by voice prompts. We investigated if advanced life support (ALS) providers follow these prompts, and the consequences if they do not. ⋯ External artifacts were frequently found, sometimes leading to important errors. Consequently, more training is needed, especially for ALS providers.
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The only large-scale report (1988) by the Israeli national ambulance service Magen David Adom (MDA) on the outcome of cardiac arrest victims who underwent cardiopulmonary resuscitation (CPR) by paramedics called for more frequent and more promptly initiated CPR and shorter time to arrival of paramedic care to improve survival. We report the 1987-2007 experience of resuscitation of out-of-hospital cardiac arrest victims who were 'SHL'-Telemedicine subscribers and who underwent CPR by SHL-Telemedicine mobile intensive care units (MICUs) personnel or under their instructions. ⋯ 'SHL'-Telemedicine's policy of bi-monthly contact with its subscribers led to heightened awareness of warning signs and need for rapid summoning of medical assistance in the setting of out-of-hospital sudden cardiac arrest.
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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.