Resuscitation
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Multicenter Study
Time used for ventilation in two-rescuer CPR with a bag-valve-mask device during out-of-hospital cardiac arrest.
Professional rescuers only deliver chest compressions 39% of the available time before intubation during out-of-hospital cardiac arrest. In manikin-studies lay rescuers need approximately 15s to deliver two ventilations. It is not known how much time professional rescuers use for two ventilations and we hypothesised that the time used for two ventilations with a bag-valve-mask device before tracheal intubation is longer than recommended and that the extended time contributes to the high no flow time. ⋯ Professional rescuers delivered two bag-valve-mask ventilations within the 5-6s as indicated in the 2000 Guidelines, slightly longer than the 3-4s recommended in the 2005 Guidelines. However, only half the pauses were used for two ventilations, and the total time for two ventilations accounted for only 27% of the time without chest compressions. Excessive time for ventilation cannot explain the high no-flow time during CPR by professional rescuers before intubation.
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Randomized Controlled Trial
Physical strain on advanced life support providers in different out of hospital environments.
To examine to what extent the type of emergency medical transportation influences the physical response of advanced life support providers. ⋯ External chest compression CPR is possible in a flying helicopter as it is in a moving ambulance vehicle. There is no clinical relevant difference in physical strain during ALS between a flying helicopter and a moving ambulance car. As would be expected, the exertion increases with duration of CPR.
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Good quality basic life support (BLS) improves outcome during cardiac arrest. As fatigue may reduce BLS performance over time we wanted to examine the quality of chest compressions in a single-rescuer scenario during prolonged BLS with different compression:ventilation ratios (C:V ratios). ⋯ Increasing the C:V ratio increases the number of chest compressions during 10 min of BLS. Compression depth and compression rate were within guideline recommendations for all three ratios. We found no decline in chest compression quality below guideline recommendations during 10 min of BLS with any of the three different C:V ratios.
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Good quality basic life support (BLS) results in better survival. BLS is a core competence of nurses but despite regular refresher training, the quality of BLS is often poor and the reasons for this are not well known. We therefore investigated the relation between BLS quality and some of its potential determinants. ⋯ Male gender, greater self-confidence, recent BLS training and recent CPR were associated with better quality of BLS.
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Comparative Study
Periodic acceleration (pGz) CPR in a swine model of asphyxia induced cardiac arrest. Short-term hemodynamic comparisons.
Asphyxia is one of the most common causes of pediatric cardiac arrest, and becoming a more frequently recognized cause in adults. Periodic acceleration (pGz) is a novel method of cardiopulmonary resuscitation (CPR). pGz is achieved by rapid motion of the supine body headward-footward that generates adequate perfusion and ventilation during cardiac arrest. In a swine ventricular fibrillation cardiac arrest model, pGz produced a higher return of spontaneous circulation (ROSC), superior neurological outcome, less echocardiography evidence of post resuscitation myocardial stunning, and decreased indices of tissue injury. In contrast to standard chest compression CPR, pGz does not produce rib fractures. We investigated the feasibility of pGz in severe asphyxia cardiac arrest and assessed whether beneficial effects seen in the VF model of cardiac arrest could be realized. ⋯ In a lethal model of asphyxia cardiac arrest, pGz is equivalent to standard CPR, with respect to acute outcomes and resuscitation survival rates but is associated with significantly lower pulmonary artery pressures and does not produce traumatic rib fractures.