Resuscitation
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To assess the regional vulnerability to ischemic damage and perfusion/metabolism mismatch of reperfused brain following restoration of spontaneous circulation (ROSC) after cardiac arrest. ⋯ The cortical regions tended most vulnerable to the ischemic insult with an oligaemic pattern and a low CMRO(2) whereas the cerebellum instead showed a pattern of luxury perfusion.
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Intraosseous needle insertion for vascular access is a standard procedure used in paediatric resuscitation. The introduction of newer automated intraosseous devices has recently expanded its role to include resuscitation in patients of all ages. Managing resuscitation can be challenging and a misplaced intraosseous needle may confound effective resuscitation. Colour Doppler ultrasound has been recently proposed as a method to confirm intraosseous needle placement. The ability to rapidly determine the correct position of an intraosseous needle during resuscitation would allow the delivery of medication or fluid infusion into the vascular space to be verified, thus optimizing resuscitation. Furthermore, complications from intraosseous infusion extravasating into soft tissues, such as compartment syndrome, or tissue necrosis can be avoided. ⋯ The use of point-of-care colour Doppler ultrasound to determine the location of both manually inserted or automated placement of intraosseous access during resuscitation is feasible, can be rapidly performed, may verify delivery of resuscitative medications or infusions, and avoid complications from extravasation.
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The Resuscitation Council (UK) Immediate Life Support (ILS) course provides training in the prevention and management of cardiac arrest. This course was introduced at our institution and we subsequently undertook an analysis to determine its impact on the incidence and outcome of in-hospital cardiac arrest. ⋯ The introduction of a simple and widespread educational programme was associated with a reduction in both the number of in-hospital cardiac arrests and unsuccessful cardiopulmonary resuscitation attempts.
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Editorial Comment
Are we closer to a new strategy in the treatment of cardiac arrest?