Resuscitation
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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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Recent reports consistently point to a substantial decline in the incidence of ventricular fibrillation (VF) as the initial rhythm observed by Emergency Medical Service (EMS) responders and a complementary increase in pulseless electrical activity (PEA) and asystole. Historically, efforts at improving survival have focused primarily on patients found in VF. ⋯ However, the "yield" of survivors comes largely from the non-shocked patients. Therefore, it is critical that we start evaluating treatments specifically for the PEA and asystole groups.
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Comparative Study
Tuition of emergency medical dispatchers in the recognition of agonal respiration increases the use of telephone assisted CPR.
Bystanders cardiopulmonary resuscitation (CPR) increases survival in out-of-hospital cardiac arrest (OHCA). Emergency medical dispatchers (EMDs) can provide even totally inexperienced bystanders with instructions by telephone on how to resuscitate victims (T-CPR) until the emergency medical services (EMS) arrive. Agonal respiration makes it difficult for EMDs to identify cardiac arrests (CAs) which will prevent or delay initiation of T-CPR. The aim of this investigation was to study if tuition of EMDs can improve their ability to identify agonal respiration in OHCA to allow for more frequent offers of T-CPR. ⋯ Teaching EMDs to understand and recognize bystander descriptions of agonal respiration in patients with OHCA has resulted in a significant increase in offers of T-CPR in these situations.
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Comparative Study
Analysis of limited resuscitations in patients suffering in-hospital cardiac arrest.
Although clinicians are expected to help patients make decisions about end-of-life care, there is insufficient data to help guide patient preferences. The objective of this study was to determine the frequency of patients who undergo 'limited code' and compare survival to discharge with those who undergo maximum resuscitative efforts ('full code'). ⋯ Patients who opt for limited code have a significantly lower probability of survival compared to patients who choose full code. Patients who choose limited code should be informed of the likely negative outcome as compared to full resuscitation.