Resuscitation
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Mild to moderate therapeutic hypothermia (TH) has been shown to improve survival and neurological outcome in patients resuscitated from out-of-hospital cardiac arrest (OHCA) with ventricular fibrillation (VF) as the presenting rhythm. This approach entails the management of physiological variables which fall outside the realm of conventional critical cardiac care. Management of serum potassium fluxes remains pivotal in the avoidance of lethal ventricular arrhythmia. ⋯ Therapeutic hypothermia is associated with a significant decline in serum potassium during cooling. Hypothermic core temperatures do not appear to protect against ventricular arrhythmia in the context of severe hypokalemia and cautious supplementation to maintain potassium at 3.0 mmol l(-1) appears to be both safe and effective.
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Out-of-hospital cardiac arrest (OHCA) is a leading cause of pre-hospital mortality. Chest compressions performed during cardiopulmonary resuscitation aim to provide adequate perfusion to the vital organs during cardiac arrest. Poor resuscitation technique and the quality of pre-hospital CPR influences outcome from OHCA. Transthoracic impedance (TTI) measurement is a useful tool in the assessment of the quality of pre-hospital resuscitation by ambulance crews but TTI telemetry has not yet been performed in the United Kingdom. We describe a pilot study to implement a data network to collect defibrillator TTI data via telemetry from ambulances. ⋯ Trans-thoracic impedance analysis is an effective means of recording important measures of resuscitation quality including the hands-on-the-chest time, compression rate and defibrillation interval time. TTI data transmission via telemetry is straightforward, efficient and allows resuscitation data to be captured and analysed from a large geographical area. Further research is warranted on the impact of post-resuscitation reporting on the quality of resuscitation delivered by ambulance crews.
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Review Comparative Study
Are patients brain-dead after successful resuscitation from cardiac arrest suitable as organ donors? A systematic review.
To compare the outcome of organs retrieved from patients brain dead due to cardiac arrest (CA) with that of organs retrieved from patients brain dead due to other causes (non-CA). ⋯ Survival rates of kidneys, livers, hearts and intestines retrieved from CA donors were not significantly different from that of organs transplanted from non-CA donors. Patients brain dead after having been resuscitated from cardiac arrest can be considered as potential donors for organ transplantation.
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Randomized Controlled Trial
Pharmacotherapy and hospital admissions before out-of-hospital cardiac arrest: a nationwide study.
For out-of-hospital cardiac arrest (OHCA) to be predicted and prevented, it is imperative the healthcare system has access to those vulnerable before the event occurs. We aimed to determine the extent of contact to the healthcare system before OHCA. ⋯ Contrary to general belief, the majority of OHCA patients are in contact with the healthcare system shortly before OHCA.
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Improvement in the quality of cardiopulmonary resuscitation (CPR) may improve the survival rate following cardiac arrest. The aims of our study were to describe how recording of CPR maneuvers performed in our emergency department with real-time video and regular feedback learning may improve CPR. ⋯ We analyzed 45 cases, divided into three groups of 15 consecutive patients. Instantaneous rates of chest compression showed variation with 75% exceeding 110 cpm. There was a significant difference in instantaneous rates among groups (135 [112-150] in group 1, 123 [110-136] in group 2 and 124 [111-137] cpm in group 3, P<0.001). Ratio of hands-off time to total manual compression time (%) significantly decreased over time (Spearman correlation=-0.30, P=0.04). There were significant differences in hands-off time per minute among the groups (11 [3-28], 6 [2-21] and 7 [2-19] s min(-1), P<0.001). There was a significant improvement in time delay to first chest compression (11 [5-50], 20 [8-68] and 0 [0-12] s, P=0.01), but not in time delay to first ventilation (91 [31-190], 65 [17-121] and 24 [9-64] s, P=0.08). Data are median [25-75% interquartile]. Regular feedback learning from real-time video recording may improve the quality of major CPR variables.