Resuscitation
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Randomized Controlled Trial Comparative Study
Learning on a simulator does transfer to clinical practice.
Cricoid pressure is recommended during positive pressure ventilation CPR and during anaesthesia when there is a risk of regurgitation. Studies suggest that cricoid pressure is frequently applied incorrectly placing patients at risk of regurgitation. Simulation training has been shown to improve the performance of cricoid pressure on a simulator, but whether simulation training improves the clinical performance of cricoid pressure was unknown. The aim of our study was to determine if simulator training improved the clinical performance of cricoid pressure. ⋯ Simulation training with force feedback significantly improved the performance of cricoid pressure in the clinical setting. Simulation training should be used more frequently to train and maintain resuscitation skills.
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Drowning associated with hypothermia and cardiopulmonary resuscitation has a very poor prognosis. We report two such cases, where impossible oxygenation due to severe pulmonary oedema was treated with extracorporeal membrane-oxygenation (ECMO). Following cardiac arrest, mild therapeutic hypothermia for 24h was maintained as recommended, but subsequent rewarming precipitated additional pulmonary oedema. ⋯ Both patients survived with no neurological sequelae. We speculate that prolonged hypothermia was not only neuroprotective, but also minimized reperfusion injury including pulmonary oedema. Extension of hypothermia for several days seems safe and feasible in selected cases.
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Comparative Study
Aspects on the increase in bystander CPR in Sweden and its association with outcome.
To describe changes in the proportion of bystanders performing cardiopulmonary resuscitation (CPR) in out of hospital cardiac arrest (OHCA) in Sweden and to study the impact of bystander CPR on ventricular fibrillation and on survival during various times. ⋯ There was a marked increase in bystander CPR in OHCA, when performed by lay persons, during the last 14 years in Sweden. Bystander CPR was associated with positive effects both on ventricular fibrillation and survival.
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Comparative Study
The approach to delayed resuscitation in paediatric cardiac arrest: A survey of paediatric intensivists in Canada.
To determine how long a period of having had no cardiopulmonary-resuscitation (CPR) (delay time) is considered to result in subsequent futile efforts at resuscitation. ⋯ A delay time of 15 [10-20] (range 5-30)min was considered futile for survival. This has implications for pronouncing death in donation after cardiac death.
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To discuss challenges in representing resuscitation data from Utstein style reports and devices like defibrillators with focus on unified and efficient handling of variety of resuscitation research objectives. ⋯ A scheme for representing resuscitation data should combine essential information stored in different locations after a resuscitation attempt. The resulting representation should enable data analysis to enable studies of the relationship between therapy and patient response. As the complexity and amount of data generated during resuscitation efforts are ever increasing, the time is mature for using modern information technology tools to provide infrastructure for efficient data management and analysis to identify and meet future challenges in resuscitation data analysis.