Resuscitation
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Pre-hospital airway management represents the intervention most likely to impact outcomes in critically injured patients. As such, airway management issues dominate quality improvement (QI) reviews of aero-medical programs. The purpose of this study was to evaluate current practice patterns of airway management in trauma among U.S. aero-medical service (AMS) programs. ⋯ The majority of AMS programs have well defined RSI and in-flight sedation protocols, while protocols for in-flight NMB are uncommon. Despite this, nearly all programs administer long-acting NMB following RSI, irrespective of GCS or flight time. Given the impact of in-flight NMB on initial assessment, early intervention, and injury severity scoring, a critical appraisal of current AMS airway management practices appears warranted.
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Recent data have demonstrated potent cardioprotective and neuroprotective effects of the application of growth hormones like erythropoietin (EPO) after focal cardiac or cerebral ischemia. In order to assess possible benefits regarding survival and resuscitation conditions, EPO was tested against placebo in a model of cardiac arrest in the rat. ⋯ EPO, when administrated before cardiac arrest, improved initial resuscitation and increased the duration of post-resuscitation survival.
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The optimal depth of sternal compressions during cardiopulmonary resuscitation (CPR) in infants is unknown; current guidelines recommend compressing to a depth of 1/3rd to 1/2 the anterior-posterior (AP) diameter of the chest. Our experience to compress the chest at 1/3rd the AP diameter often fails to provide an adequate blood pressure response. We reviewed our experience with CPR, depth of compressions, and arterial blood pressure response in a cohort of 6 infants having cardiac surgery and subsequent cardiac arrest. ⋯ The mean diastolic pressure was similar with both strategies (30.5 vs. 30.6mm Hg, p=0.99). In this cohort of 6 infants having cardiac surgery and subsequent cardiac arrest, attempting to compress the chest at 1/2 the AP diameter increased systolic blood pressure by 62% compared to attempting to compress 1/3rd the AP diameter. Perhaps resuscitators should attempt to compress infants' chests 1/2 rather than 1/3rd the AP diameter of the chest.
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Hyperglycemia is associated with poor outcomes in critically ill patients. We examined blood glucose values following in-hospital cardiac arrest (IHCA) to (1) characterize post-arrest glucose ranges, (2) develop outcomes-based thresholds of hyperglycemia and hypoglycemia, and (3) identify risk factors associated with post-arrest glucose derangements. ⋯ Hyperglycemia is common in diabetics and non-diabetics following IHCA. Survival odds in diabetics are relatively insensitive to blood glucose with decreased survival only associated with severe (>240 mg/dL, >13.3 mmol/dL) hyperglycemia. In non-diabetics, survival odds were sensitive to hypoglycemia (<70 mg/dL, <3.9 mmol/L).