Resuscitation
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Review
The use of CPR feedback/prompt devices during training and CPR performance: A systematic review.
In lay persons and health care providers performing cardiopulmonary resuscitation (CPR), does the use of CPR feedback/prompt devices when compared to no device improve CPR skill acquisition, retention, and real life performance? ⋯ There is good evidence supporting the use of CPR feedback/prompt devices during CPR training to improve CPR skill acquisition and retention. Their use in clinical practice as part of an overall strategy to improve the quality of CPR may be beneficial. The accuracy of devices to measure compression depth should be calibrated to take account of the stiffness of the support surface upon which CPR is being performed (e.g. floor/mattress). Further studies are needed to determine if these devices improve patient outcomes.
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The quality of life support delivered during cardiopulmonary resuscitation affects outcomes. However, little data exist regarding the quality of resuscitation delivered to children and factors associated with adherence to American Heart Association (AHA) resuscitation guidelines. ⋯ Pediatric residents do not meet performance standards set by the AHA. Future curricula should focus training on identified defects including: (1) equal emphasis on "airway and breathing" and "circulation" and (2) hands-on training with using and discharging a defibrillator in order to improve safety and outcomes.
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Multicenter Study
Australasian resuscitation of sepsis evaluation (ARISE): A multi-centre, prospective, inception cohort study.
Determine current resuscitation practices and outcomes in patients presenting to the emergency department (ED) with sepsis and hypoperfusion or septic shock in Australia and New Zealand (ANZ). ⋯ Management of ANZ patients presenting to ED with sepsis does not routinely include protocolised, ScvO(2)-directed resuscitation. In-hospital mortality compares favourably with reported mortality in international sepsis trials and nationwide surveys of resuscitation practices.
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Clinical Trial
Hemostasis in cardiac arrest patients treated with mild hypothermia initiated by cold fluids.
Application of mild hypothermia (32-33 degrees C) has been shown to improve neurological outcome in patients with cardiac arrest. However, hypothermia affects hemostasis, and even mild hypothermia is associated with bleeding and increased transfusion requirements in surgery patients. On the other hand, crystalloid hemodilution has been shown to induce a hypercoagulable state. The study aim was to elucidate in which way the induction of mild therapeutic hypothermia by a bolus infusion of cold crystalloids affects the coagulation system of patients with cardiac arrest. ⋯ Mild hypothermia only slightly prolonged clotting time as measured by rotation thrombelastography. Therefore, therapeutic hypothermia initiated by cold crystalloid fluids has only minor overall effects on coagulation in patients with cardiac arrest.