Resuscitation
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Comparative Study
Difficult prehospital endotracheal intubation - predisposing factors in a physician based EMS.
For experienced personnel endotracheal intubation (ETI) is the gold standard to secure the airway in prehospital emergency medicine. Nevertheless, substantial procedural difficulties have been reported with a significant potential to compromise patients' outcomes. Systematic evaluation of ETI in paramedic operated emergency medical systems (EMS) and in a mixed physician/anaesthetic nurse EMS showed divergent results. In our study we systematically assessed factors associated with difficult ETI in an EMS exclusively operating with physicians. ⋯ In a physician staffed EMS difficult prehospital ETI occurred in 13% of cases. Predisposing factors were limited surrounding space on scene and certain biophysical conditions of the patient (short neck, obesity, face and neck injuries, and anatomical restrictions). Unexpected difficult ETI occurred in 5% of the cases.
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Comparative Study
Visual evaluation of left ventricular performance predicts volume responsiveness early after resuscitation from cardiac arrest.
Haemodynamic optimisation is a fundamental goal of post-cardiac arrest therapy. Therefore, predicting volume responsiveness is a key issue in therapy of these high-risk patients and transoesophageal echocardiography (TEE) may provide helpful information. The aim of the present study was to evaluate the performance of visual evaluation (eyeballing) of standardised TEE-loops to predict volume responsiveness during post-cardiac arrest period. ⋯ In post-cardiac arrest period, visual evaluation of long-axis TEE loops allows prediction of volume responsiveness with good sensitivity and reasonable specificity even by novice users, and may therefore be suitable for implementation into treatment protocols.
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Comparative Study
Good outcome in every fourth resuscitation attempt is achievable--an Utstein template report from the Stavanger region.
Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the western world. We wanted to study changes in survival over time and factors linked to this in a region which have already reported high survival rates. ⋯ Overall, good outcome is now achievable in every fourth resuscitation attempt and in every second resuscitation attempt when patients have a shockable rhythm. The reason for the better outcomes is most likely multi-factorial and linked to improvements in the local chain of survival.
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Comparative Study
Mobile phone technology identifies and recruits trained citizens to perform CPR on out-of-hospital cardiac arrest victims prior to ambulance arrival.
In a two-parted study, evaluate a new concept were mobile phone technology is used to dispatch lay responders to nearby out-of-hospital cardiac arrests (OHCAs). ⋯ Mobile phone technology can be used to identify and recruit nearby CPR-trained citizens to OHCAs for bystander CPR prior to ambulance arrival.
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Comparative Study
Prevalence and hemodynamic effects of leaning during CPR.
Cardiopulmonary resuscitation (CPR) guidelines recommend complete release between chest compressions (CC). ⋯ Leaning during CPR increases intrathoracic pressure, decreases coronary perfusion pressure, and decreases cardiac output and myocardial blood flow. Leaning is common during CPR.