Resuscitation
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Randomized Controlled Trial Multicenter Study Comparative Study
Alternating providers during continuous chest compressions for cardiac arrest: every minute or every two minutes?
Studies have shown that the quality of chest compressions for cardiac arrest decreases markedly after only a brief time. This is thought to be an important contributor to an adverse outcome of resuscitation, which has led to recommendations to alternate chest compression providers. This study compared alternating rescuers every 1 min versus every 2 min in a manikin simulation. ⋯ Power calculations with these results show that an unfeasibly large number of scenarios would be needed to definitively demonstrate the superiority of one of the scenarios. It seems reasonable to alternate chest compression providers every 2 min, to prevent the loss of effective compressions due to fatigue and to minimise interruptions of chest compressions. The ideal time to do this would be during the rhythm and pulse check as dictated by current guidelines.
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Multicenter Study Comparative Study
Validation for a scoring system of the ALS cardiac arrest simulation test (CASTest).
The cardiac arrest simulation test (CASTest) assesses resuscitation knowledge and skills during a simulated cardiac arrest. The aim of this study is to validate an alternative scoring system for measuring individual candidate performance during research involving the CASTest. ⋯ This new simple scoring system can be used to better characterise performance on the ALS course CASTest than the current binary pass-fail outcome.
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Comparative Study
Subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest: a prospective computed tomography study.
Aneurysmal subarachnoid haemorrhage (SAH) is a relatively common cause of out-of-hospital cardiac arrest (OHCA). Early identification of SAH-induced OHCA with the use of brain computed tomography (CT) scan obtained immediately after resuscitation may help emergency physicians make therapeutic decision as quickly as they can. ⋯ Aneurysmal SAH causes OHCA more frequently than had been believed. Immediate brain CT scan may particularly be useful in excluding SAH-induced OHCA from thrombolytic trial enrollment, for whom the use of thrombolytics is contraindicated. The low VF incidence suggests that VF by itself may not be a common cause of SAH-induced OHCA.
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Early and accurate prediction of survival to hospital discharge following resuscitation after cardiac arrest (CA) is a major challenge. Our aim was to investigate the levels of ischemia-modified albumin (IMA) and malondialdehyde (MDA) in CA patients and whether IMA levels are valuable early marker of post-cardiopulmonary resuscitation prognosis in CA patients. ⋯ In conclusion, though the result may not be applied clinically in every patient, the ischemia-modified albumin may be a valuable prognostic marker in cardiac arrest patients following CPR.
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Comparative Study
Development of a rapid, safe, fiber-optic guided, single-incision cricothyrotomy using a large ovine model: a pilot study.
We present a pilot study in which we use an ovine model to develop a rapid, safe cricothyrotomy technique using a Melker cuffed 5.0 cricothyrotomy catheter loaded over a fiberoptic stainless steel optical stylet. The technique requires a single incision. The stylet allows easy placement and facilitates visual, tactile, and transillumination confirmation of intratracheal placement. We recorded this process on video to facilitate the development of the procedure and to allow others to replicate it for further research or refinement. All devices used in this technique are currently employed in clinical practice. ⋯ The procedure is rapid, incorporates redundant safety features, and uses equipment increasingly available to anesthesiologists, emergency physicians, intensivists and surgeons. The promising outcome of this pilot study should be verified in a larger controlled, comparative trial.