Resuscitation
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Randomized Controlled Trial Multicenter Study
The impact of increased chest compression fraction on return of spontaneous circulation for out-of-hospital cardiac arrest patients not in ventricular fibrillation.
Greater chest compression fraction (CCF, or proportion of CPR time spent providing compressions) is associated with better survival for out-of-hospital cardiac arrest (OOHCA) patients in ventricular fibrillation (VF). We evaluated the effect of CCF on return of spontaneous circulation (ROSC) in OOHCA patients with non-VF ECG rhythms in the Resuscitation Outcomes Consortium Epistry. ⋯ This is the first study to demonstrate that increased CCF among non-VF OOHCA patients is associated with a trend toward increased likelihood of ROSC.
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Randomized Controlled Trial Comparative Study
Comparison of prehospital insertion success rates and time to insertion between standard endotracheal intubation and a supraglottic airway.
To compare paramedic insertion success rates and time to insertion between standard ETI and a supraglottc airway device (King LTS-D™) in patients needing advanced airway management. ⋯ In this study, no differences in placement success rate or time to insertion were detected between the King LTS-D and ETI.
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Early bystander cardiopulmonary resuscitation (CPR) provides an essential bridge to successful defibrillation from sudden cardiac arrest (SCA) and there is a need to increase the prevalence and quality of bystander CPR. Emergency medical dispatchers can give CPR instructions to a bystander calling for an ambulance enabling even an inexperienced bystander to start CPR. The impact of these instructions has not been evaluated. ⋯ There is limited evidence supporting the survival benefit of dispatch-assisted CPR instructions. All studies comparing survival outcomes when CPR is provided with or without the assistance of dispatch-assisted CPR instructions lack the statistical power to draw significant conclusions. Since it has been demonstrated that such instructions can improve bystander CPR rates, it is reasonable to recommend they should be provided to all callers reporting a victim in cardiac arrest.
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As a part of the chain of survival, the emergency medical communication centre (EMCC) and the emergency medical dispatcher (EMD) has an important role in early identification of out-of-hospital cardiac arrests (OHCA). The EMD may provide instructions to the caller and thereby initiate cardiopulmonary resuscitation in a substantial number of subjects and thus contribute to increased survival. The EMCC provides a response with first responders, ambulances, physician manned units and potentially other health care providers. ⋯ In research there is a growing focus on the EMCC/EMDs impact on survival in OHCA. The lack of standards in reporting results from medical dispatching is an obstacle for thorough evaluation of results in this area and comparison of data. The objective for this paper is to introduce a framework for uniform reporting of the dispatching process for quality improvement, collecting and reporting data and exchanging information regarding OHCA.
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Randomized Controlled Trial Comparative Study
Comparison of six different intubation aids for use while wearing CBRN-PPE: a manikin study.
Respiratory failure following chemical exposure can be fatal and although supraglottic airway devices have been evaluated for use in the management of CBRN casualties' intubation remains the gold standard airway. ⋯ In this manikin-based study all intubation aids evaluated while wearing CBRN-PPE were adversely affected by the loss of dexterity associated with wearing Butyl gloves. Standard intubation and intubation utilising a stylet resulted in the fastest intubation times; whereas the ILMA offers the highest intubation success rate and was deemed to be the easiest intubating aid to use. An important consideration with regards future research is the impact of a learning curve with regards to different intubation aids and whether preassembling all the intubation aids prior to the intubation attempt may improve intubation speed. The impact of intubator familiarity with regards to individual intubation aids is also an important consideration but established intubation aids like the Bougie are more difficult to use when dexterity is reduced due to CBRN-PPE.