Resuscitation
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This study was done, using a swine model of prolonged ventricular fibrillation out-of-hospital cardiac arrest, to determine the feasibility of inducing therapeutic hypothermia after successful resuscitation by giving an intraosseous infusion of iced saline. ⋯ Mild therapeutic hypothermia can be effectively induced in swine after successful resuscitation of prolonged ventricular fibrillation by infusion of iced saline through an IO needle.
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Therapeutic hypothermia improves outcomes in resuscitated cardiac arrest patients, but prior application rates are less than 30%. We sought to evaluate self-reported physician adoption, predictors of adoption, and barriers to use among Canadian emergency and critical care physicians. A web-based modified Dillman questionnaire asked all physicians on the membership lists of the Canadian Association of Emergency Physicians and the Canadian Critical Care Forum physicians to report their experience with therapeutic hypothermia using the Pathman framework of changing physician behaviour. ⋯ Common barriers included: lack of awareness of recommended practice (31%), perceptions of poor prognosis (25%), too much work required to cool (20%) and staffing shortages (20%). Therapeutic hypothermia after cardiac arrest has not been universally adopted. Adoption might be improved through protocol implementation, education about benefits and prognosis, and strategies to make administration easier.
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Hypocalcemia associated with cardiac arrest has been reported. However, mechanistic hypotheses for the decrease in ionized calcium (iCa) vary and its importance unknown. The objective of this study was to assess the relationships of iCa, pH, base excess (BE), and lactate in two porcine cardiac arrest models, and to determine the effect of exogenous calcium administration on post-resuscitation hemodynamics. ⋯ Ionized hypocalcemia occurs following ROSC. CaCl(2) improves post-ROSC hemodynamics suggesting that hypocalcemia may play a role in early post-resuscitation myocardial dysfunction.
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Comparative Study
Tracheal temperature for monitoring body temperature during mild hypothermia in pigs.
Out-of-hospital induction of mild therapeutic hypothermia after cardiac arrest needs easy to use and accurate body temperature monitoring. The aim of the study was to evaluate the best temperature probe position on a specially designed tracheal tube, as compared to pulmonary artery temperature (Tpa) during cooling to mild hypothermia in pigs. ⋯ Tracheal temperature is an accurate surrogate for body temperature during fast and slow cooling to mild hypothermia in pigs and regardless of the location of the temperature probe on the tube.
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Case Reports
Imaging the human microcirculation during cardiopulmonary resuscitation in a hypothermic victim of submersion trauma.
The microcirculation is essential for delivery of oxygen and nutrients to tissue. However, the human microvascular response to cardiopulmonary resuscitation (CPR) is unknown. We report on the first use of sidestream dark field imaging to assess the human microcirculation during CPR with a mechanical chest compression/decompression device (mCPR). mCPR was able to provide microvascular perfusion. ⋯ However, indices of microvascular perfusion were low and improved vastly after return of spontaneous circulation. Microvascular perfusion was relatively independent from blood pressure. The microcirculation may be a useful monitor for determining the adequacy of CPR.