Resuscitation
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Serum glial fibrillary acidic protein (GFAP) has recently been identified as a specific predictor of brain damage and neurological outcome in patients with head trauma. In this study, serum GFAP was assessed as a predictor of neurological outcome in post-cardiac-arrest (PCA) patients. ⋯ Although this study is preliminary, serum GFAP after ROSC reflected a poor neurological outcome in PCA patients.
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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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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.
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Case Reports
Electrical injury during "hands on" defibrillation-A potential risk of internal cardioverter defibrillators?
Despite clear guidance for the need for rescuers to avoid contact with a patient during external defibrillation, the advice regarding the potential dangers of rescuer contact during the firing of an internal cardioverter defibrillator [ICD] generally implies that such contact is safe. This case report describes documented nerve injury to a rescuer by a shock delivered from an ICD during chest compression on a patient in cardiac arrest. The authors also discuss the existing literature on the subject and make suggestions for future management.
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The Emergency Medical Services (EMS) in Oman is a relatively new project in the country. It has been developed based on the Anglo-American system of EMS. Currently, it is run by trained Omani Advanced Emergency Medical Technicians (AEMT) under the auspices of the Royal Oman Police (ROP) Ambulance Division. ⋯ It is state-funded and free of charge for all people in Oman. There are plans to incorporate aero-medical services into the system, to support the land ambulance service, and there are also plans to expand its coverage to the whole country by 2012. The EMS in Oman has hard challenges ahead but there are also promising plans in place to improve the system.