Resuscitation
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Despite recent advances in its management, the outcome from cardiac arrest is often poor despite appropriate cardiopulmonary resuscitation (CPR). The coronary perfusion pressure (CPP) achieved during CPR is associated with successful return of spontaneous circulation (ROSC). Continuous balloon occlusion of the descending aorta is an experimental method that can occlude the 'unnecessary' part of the circulation, thus diverting generated pressure and blood flow to the heart and brain. We present a case report with a patient unresponsive to standard CPR in which constant intraaortic balloon occlusion achieved ROSC and successful survival.
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Randomized Controlled Trial
Predictive power of serum NSE and OHCA score regarding 6-month neurologic outcome after out-of-hospital ventricular fibrillation and therapeutic hypothermia.
To determine the predictive power of the out-of-hospital cardiac arrest (OHCA) score and serum neuron-specific enolase (NSE) in patients resuscitated from ventricular fibrillation treated with therapeutic hypothermia (TH) and glucose control. ⋯ Increase in NSE between 24 and 48h and NSE at 48h is specific but only moderately sensitive markers of 6-month outcome. Outcome prediction at ICU admission using the OHCA score was not possible in this selected patient population.
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Randomized Controlled Trial
Is there any room for shortening hands-off time further when using an AED?
Automated external defibrillators (AEDs) play a very important role in out-of-hospital cardiopulmonary resuscitation (CPR). The mandatory hands-off time imposed by current AEDs is not short enough to bring about the full benefits of rapid defibrillation with an AED into light. The aim of this study is to examine whether a change in the process of charging the capacity and removing explanations from the prompts of the AEDs shortens hands-off time. ⋯ Full precharging of the capacitor and exclusion of explanations from the voice prompts of AEDs can shorten the hands-off time in both 1 and 2-rescuer CPR.
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In the current guidelines of the European Resuscitation Council (ERC), tracheal intubation, as an instrument for securing the airway during resuscitation, has become less important for persons not trained in this method. For those persons, different supraglottic airway devices are recommended by the ERC. The present investigation deals with the application of the laryngeal tube disposable (LT-D) during pre-hospital resuscitation by paramedics. ⋯ As an alternative airway device recommended by the ERC in 2005, the LT-D may enable airway control rapidly and effectively. Additionally, by using the LT-D, a reduced "no-flow-time" and a better outcome may be possible.
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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.