Resuscitation
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Randomized Controlled Trial
Defibrillation and the quality of layperson cardiopulmonary resuscitation-dispatcher assistance or training?
To examine whether basic life support-defibrillation (BLS-D) training of laypersons enhances the speed of defibrillation and the quality of cardiopulmonary resuscitation (CPR) during a simulated ventricular fibrillation scenario compared with a situation where the care provider has no previous BLS-D training but receives dispatcher assistance with the use of an automated external defibrillator (AED) and the performance of CPR. ⋯ Training improved the quality of mouth-to-mouth ventilation performed by laypersons but had only a minor effect on defibrillation and the quality of compressions.
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Haemorrhagic shock causes ischaemia and subsequent fluid resuscitation causes reperfusion injury, jointly resulting in high morbidity and mortality. We tested whether the anti-inflammatory fibrin-derived peptide, Bbeta(15-42), also called FX06, is tissue protective in a model of haemorrhagic shock. ⋯ FX06 - when administered as an adjunct to fluid resuscitation therapy - is organ protective in pigs. Further investigations are warranted to reveal the protective mechanism of FX06.
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This study aimed to determine factors linked to hypothermia (<35 degrees C) in Queensland trauma patients. The relationship of hypothermia with mortality, admission to intensive care and hospital length of stay was also explored. ⋯ Trauma patients in a predominantly sub-tropical climate are at risk of accidental and endogenous hypothermia, with associated higher mortality and care requirements. Prevention of hypothermia is important for all severely injured patients.
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It has been suggested that out-of-hospital bispectral (BIS) index monitoring during advanced cardiac life support (ACLS) might provide an indication of cerebral resuscitation. The aims of our study were to establish whether BIS values during ACLS might predict return to spontaneous circulation, and whether BIS values on hospital admission might predict survival. ⋯ Although BIS monitoring during resuscitation was not difficult, it did not predict return to spontaneous cardiac activity, nor survival after admission to intensive care. Its use to monitor cerebral function during ACLS is therefore pointless.
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Under current resuscitation guidelines symptomatic ventricular tachycardia (VT) with a palpable pulse is treated with synchronised cardioversion to avoid inducing ventricular fibrillation (VF), whilst pulseless VT is treated as VF with rapid administration of full defibrillation energy unsynchronised shocks. The additional delay in setting up the ECG to provide accurate synchronisation has been the main reason for advocating this approach, although many current defibrillators allow accurate synchronisation via just the adhesive defibrillator pads. The aim of this study was to investigate whether the timing of defibrillatory shocks in rapid VT-affected resuscitation outcome. ⋯ Defibrillator shocks within the QRS complex had a success rate of 93% compared to a success rate of 42% for outside the QRS complex (p=0.0016 two-tailed Fishers' exact test, odds ratio=19.6, 95% limits=3.1-123.1). There was no significant effect of age or sex of the patient, the underlying heart disease, rate of VT or anti-arrhythmic medication on the outcome, although the number of patients was too small to definitively exclude this. Therefore, defibrillation shocks delivered shortly after the peak of the QRS complex in rapid VT do appear to offer significant advantages over defibrillation shocks at other parts of the cardiac cycle for very rapid ventricular tachycardia.