Resuscitation
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Comparative Study
Comparison of mechanical characteristics of the human and porcine chest during cardiopulmonary resuscitation.
Most studies investigating cardiopulmonary resuscitation (CPR) interventions or functionality of mechanical CPR devices have been performed using porcine models. The purpose of this study was to identify differences between mechanical characteristics of the human and porcine chest during CPR. ⋯ In conclusion, human and porcine chest behave relatively similarly during CPR with respect to chest stiffness, but differences in chest viscosity at medium and deep chest compression depth should at least be kept in mind when extrapolating porcine results to humans.
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Safety precautions during defibrillation and cardioversion are generally taken very seriously. The actual hazard for bystanders and rescuers, however, has rarely been investigated. Recently, continuing chest compressions during defibrillation has been suggested to improve outcome from cardiac arrest. This article is to review reports on electric shocks to persons other than patients and to discuss the pertinent biomedical principles. ⋯ External electric therapy is likely to be safer than traditionally assumed, especially with self-adhesive thoracic electrodes. Sound clinical experiments are urgently needed before safety measures are revised.
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Controlled Clinical Trial
Diffusion and perfusion MRI of the brain in comatose patients treated with mild hypothermia after cardiac arrest: a prospective observational study.
Outcome for resuscitated cardiac arrest (CA) patients is poor. The 1-year survival rate with favourable neurological outcome (CPC 1-2) after out-of-hospital CA is reported to be 4%. Among resuscitated patients treated within an ICU, approximately 50% regain consciousness, whereas the other 50% remain comatose before they die. Induced hypothermia significantly improves the neurological outcome and survival in patients with primary CA who remain comatose after return of spontaneous circulation. ⋯ Diffusion and perfusion MRI are potentially helpful tools for the evaluation of ischaemic brain damage in resuscitated comatose patients treated with hypothermia after CA.
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Determine the use of bispectral index (BIS) as prognostic tool in therapeutic hypothermia (TH) treated comatose survivors after cardiac arrest (CA), regardless of initial rhythm, location or cause. ⋯ BIS values of 0 help predict bad neurological outcome after CA and induced hypothermia.
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Pauses during chest compressions are thought to have a detrimental effect on resuscitation outcome. The Guidelines 2005 have recently eliminated the post-defibrillation pause. Previous animal studies have shown that multiple pauses of increasing duration decrease resuscitation success. We investigated the effect of varying the characteristics of a single pause near defibrillation on resuscitation outcome. ⋯ These results suggest that the Guidelines 2005 recommendation to omit the post-shock pulse check and immediately resume chest compressions may be an important resuscitation protocol change. However, these results also suggest that clinical maneuvers further altering a single pre-shock chest compression pause provide no additional benefit.