Resuscitation
-
Comparative Study
Out-of-hospital cardiac arrest in patients aged 35 years and under: a 4-year study of frequency and survival in London.
The aim of this study was to describe the frequency and characteristics of cardiac arrest patients of 35 years and under attended by the London Ambulance Service NHS Trust between April 2003 and March 2007. Few large studies have described the occurrence, mechanism, resuscitation viability and outcome of this substantial subset of the cardiac arrest population. By documenting over 3000 cardiac arrests in young people we sought to improve understanding, awareness and ultimately survival of a condition notorious for high mortality rates. ⋯ Mortality in young cardiac arrest patients remains high. Focus should be placed on tackling social and psychological causes of cardiac arrest as well as cardiac aetiologies.
-
There is mismatch in age between those usually trained in CPR and those witnessing out-of-hospital cardiac arrest with mean age reported at 30 and 65 years old, respectively. Two tier mass CPR self-training with manikin-DVD sets using school children has been reported. We have studied high school students as first tier and encouraged them to train older people. ⋯ People trained at home with a manikin-DVD set and high school students as facilitators were able to perform CPR as recommended by ERC guidelines with a reasonable percentage aged 50 or older.
-
Randomized Controlled Trial
Quality of closed chest compression on a manikin in ambulance vehicles and flying helicopters with a real time automated feedback.
Automated verbal and visual feedback improves quality of resuscitation in out-of-hospital cardiac arrest and was proven to increase short-term survival. Quality of resuscitation may be hampered in more difficult situations like emergency transportation. Currently there is no evidence if feedback devices can improve resuscitation quality during different modes of transportation. ⋯ Real time automated feedback improves certain aspects of CPR quality in flying helicopters and moving ambulance vehicles. The effect of feedback guidance was most pronounced for chest compression rate.
-
Comparative Study
Comparison of intravenous and intraosseous access by pre-hospital medical emergency personnel with and without CBRN protective equipment.
Rapid intravascular access is a prerequisite component of emergency care and resuscitation. Peripheral intravenous (IV) access is the first-choice for most of the medical or trauma patients, but may be delayed in emergency conditions because of various difficulties. Elsewhere, intraosseous (IO) access may now be easily performed with a new semi-automatic battery-powered IO-insertion device (EZ-IO. The aim of this study was to compare the overall time to establish IO infusion with the EZ-IO device and the equivalent time for peripheral IV infusion, performed by emergency personnel in standard (No-CBRN) and in chemical, biological, radiological, and nuclear (CBRN) protective equipment. ⋯ The time to establish IO infusion was significantly shorter than that for peripheral IV infusion, under both No-CBRN and CBRN conditions. Further clinical studies are required to confirm that IO access would effectively save time over IV access in real pre-hospital emergency settings.
-
Hypothermia treatment with cold intravenous infusion and ice packs after cardiac arrest has been described and used in clinical practice. We hypothesised that with this method a target temperature of 32-34 degrees C could be achieved and maintained during treatment and that rewarming could be controlled. ⋯ Intravenous cold saline infusion combined with ice packs is effective in inducing and maintaining therapeutic hypothermia, with good temperature control even during rewarming.