Resuscitation
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Multicenter Study
Rapid induction of therapeutic hypothermia using convective-immersion surface cooling: safety, efficacy and outcomes.
Therapeutic hypothermia has become an accepted part of post-resuscitation care. Efforts to shorten the time from return of spontaneous circulation to target temperature have led to the exploration of different cooling techniques. Convective-immersion uses a continuous shower of 2 degrees C water to rapidly induce hypothermia. ⋯ Conductive-immersion surface cooling using the ThermoSuit System is a rapid, effective method of inducing therapeutic hypothermia. Although the study was not designed to demonstrate impact on outcomes, survival and neurologic function were superior to those previously reported, suggesting comparative studies should be undertaken. Shortening the delay from return of spontaneous circulation to hypothermic target temperature may significantly improve survival and neurologic outcome and warrants further study.
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Induction of hypothermia is generally accepted to increase survival of out-of-hospital cardiac arrest, but lack of initiation of this treatment has been frequently reported. When patients remain in coma after treatment with hypothermia, determination of prognosis is difficult. Furthermore, little is known about the methods used in clinical practice to predict outcome after cardiopulmonary resuscitation (CPR). The aim of the present survey was to evaluate self-reported implementation of hypothermia after CPR and the methods used to predict neurological outcome at Intensive Care Units (ICUs) in the Netherlands. ⋯ In the Netherlands, the use of therapeutic hypothermia after CPR is reported by 92% of ICUs which, compared to previous reports, is an exceedingly high percentage. Neurological outcome is reported to be predicted mainly by neurological examination and SSEP or a combination of these and other assessments. The method used varies substantially between ICUs.
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Most reports of Rapid Response Systems (RRS) focus on the efferent, response component of the system, although evidence suggests that improved vital sign monitoring and recognition of a clinical crisis may have outcome benefits. There is no consensus regarding how best to detect patient deterioration or a clear description of what constitutes patient monitoring. ⋯ The major findings include: (1) vital sign aberrations predict risk, (2) monitoring patients more effectively may improve outcome, although some risk is random, (3) the workload implications of monitoring on the clinical workforce have not been explored, but are amenable to study and should be investigated, (4) the characteristics of an ideal monitoring system are identifiable, and it is possible to categorize monitoring modalities. It may also be possible to describe monitoring levels, and a system is proposed.
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Both a written cognitive knowledge evaluation and a practical evaluation that tests psychomotor skills, cognitive knowledge, and affective behaviors such as leadership and team skills are required for successful completion of American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) course. The 2005 International Liaison Committee on Resuscitation (ILCOR) Consensus on Science and Treatment Recommendations noted that in Basic Life Support (BLS) there is little to no correlation between written and practical skills. The current study was conducted to determine if there is a correlation between written and practical evaluations in an ACLS course. ⋯ The ACLS written evaluation was not a predictor of participant skills in managing a simulated cardiac arrest event immediately following an ACLS course. The single case simulations used in ACLS skills evaluation test a narrow portion of ACLS content while written evaluation tests can more practically test a broader spectrum of content. Both work in concert to define participant knowledge and neither should be used exclusively to determine participant competence.
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Comparative Study
Comparing the systolic blood pressure (SBP) and pulse rate (PR) in injured children with and without traumatic brain injury.
Following evidence that injured children have higher systolic blood pressures (SBP) than similar-aged resting uninjured children, we investigate whether the initial cardiovascular physiology differs between forms of injury. ⋯ Although injured children remain hypertensive as compared to resting norms, we have seen no difference in the initial systolic blood pressure of moderately and severely injured children with and without traumatic brain injury. The relative bradycardia in the younger children appears to be an early sign of a severe traumatic brain injury.