Resuscitation
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Comparative Study
Feasibility and safety of combined percutaneous coronary intervention and therapeutic hypothermia following cardiac arrest.
Mild therapeautic hypothermia (MTH) has been associated with cardiac dysrhythmias, coagulopathy and infection. After restoration of spontaneous circulation (ROSC), many cardiac arrest patients undergo percutaneous coronary intervention (PCI). The safety and feasibility of combined MTH and PCI remains unclear. This is the first study to evaluate whether PCI increases cardiac risk or compromises functional outcomes in comatose cardiac arrest patients who undergo MTH. ⋯ Percutaneous coronary intervention seems to be feasible when combined with MTH, and is not associated with increased cardiac or neurological risk.
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Comparative Study
Scandinavian pre-hospital physician-manned Emergency Medical Services--same concept across borders?
In Scandinavia, scattered populations and challenging geographical and climatic conditions necessitate highly advanced medical treatment by qualified pre-hospital services. Just like every other part of the health care system, the specialized pre-hospital EMS should aim to optimize its resource use, and critically review as well as continuously assess the quality of its practices. This study aims to provide a comprehensive profile of the pre-hospital, physician-manned EMS in the Scandinavian countries. ⋯ This survey documented several significant similarities among pre-hospital physician-staffed EMS systems in Scandinavia. Although medical data registration is currently under-developed, Scandinavian physician-manned EMS is a feasible arena for future multi-centre research.
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Survival after out-of-hospital cardiac arrest (OHCA) depends on a well functioning Chain of Survival. We wanted to assess if targeted attempts to strengthen the weak links of our local chain; quality of advanced life support (ALS) and post-resuscitation care, would improve outcome. ⋯ Survival after OHCA was increased after improving weak links of our local Chain of Survival, quality of ALS and post-resuscitation care.
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Comparative Study
Monitoring in resuscitation: comparison of cardiac output measurement between pulmonary artery catheter and NICO.
The cardiac output and coronary perfusion pressure generated from chest compressions during resuscitation manoeuvres can predict effectiveness and successful outcome. Until now, there is no good method for haemodynamic monitoring during resuscitation. Noninvasive partial carbon dioxide rebreathing system (NICO, Novametrix Medical Systems, Inc., Wallingford, CT, USA) is a relatively new non-invasive alternative to thermodilution for measuring cardiac output. The accuracy of the NICO system has not been evaluated during resuscitation. The aim of this study is to compare thermodilution cardiac output method with NICO system and to assess the utility of NICO during resuscitation. ⋯ There is a high degree of agreement between cardiac output measurements obtained with NICO and thermodilution cardiac output during resuscitation. The present study suggests that the NICO system may be useful to measure cardiac output generated during cardiopulmonary resuscitation.
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It is possible that the exportation of North American and European models has hindered the creation of a structured cardiopulmonary resuscitation (CPR) training programme in developing countries. The objective of this paper is to describe the design and present the results of a European paediatric and neonatal CPR training programme adapted to Honduras. ⋯ The training of independent paediatric CPR groups with the collaboration and scientific assessment of an expert group could be a suitable model on which to base paediatric CPR training in Latin American developing countries.