Resuscitation
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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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Comparative Study
Rhythmic abdominal compression CPR ventilates without supplemental breaths and provides effective blood circulation.
Standard chest-compression CPR has an out-of-hospital resuscitation rate of less than 10% and can result in rib fractures or mouth-to-mouth transfer of infection. Recently, we introduced a new CPR method that utilizes only rhythmic abdominal compressions (OAC-CPR). The present study compares ventilation and hemodynamics produced by chest and abdominal compression CPR. ⋯ OAC-CPR generated ventilatory volumes significantly greater than the dead space and produced equivalent, or larger, CPP than with chest compressions. Thus, OAC-CPR ventilates a subject, eliminating the need for mouth-to-mouth breathing, and effectively circulates blood during VF without breaking ribs. Furthermore, this technique is simple to perform, can be administered by a single rescuer, and should reduce bystander reluctance to administer CPR.
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Indications for immediate cardiac catheterization in cardiac arrest survivors without ST elevation myocardial infarction (STEMI) are uncertain as electrocardiographic and clinical criteria may be challenging to interpret in this population. We sought to evaluate rates of early catheterization after in-hospital ventricular fibrillation (VF) arrest and the association with survival. ⋯ In patients receiving cardiac catheterization, more than half received this procedure for indications other than STEMI or new LBBB. Cardiac catheterization was associated with improved survival. Future recommendations need to be established to guide clinicians on which arrest survivors might benefit from immediate catheterization.
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Determine anesthesiologists' knowledge of the 2005 American Heart Association (AHA) Pediatric Advanced Life Support (PALS) recommendations. ⋯ Deficiencies exist in the knowledge of current AHA PALS guidelines among anesthesiologists. Formal resuscitation training programs should be considered in ongoing continuing medical education.
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Prehospital termination of resuscitation rules are used to decide on one of two actions: to continue resuscitation and transport to hospital or to terminate resuscitation. The literature is confusing as some rules are derived with survival as the outcome of interest (predicting when to transport and reporting sensitivity and negative predictive value) and other rules use death (predicting when to terminate resuscitation and reporting specificity and positive predictive value). Very few publish the EMS transport rate when the rule is applied; the outcome of interest to EMS services. ⋯ We suggest that the diagnostic test characteristics of termination of resuscitation rules should be reported with death as the primary outcome which identifies for the paramedics futile resuscitations that should be terminated in the field. We also emphasize the need to report transport rates to provide the EMS services with an implementation benchmark.