Resuscitation
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Comparative Study
King LT-D use by urban basic life support first responders as the primary airway device for out-of-hospital cardiac arrest.
The objective of this study was to compare the frequency of first attempt success between basic life support (BLS) first responder initiated King LT-D placement and paramedic initiated endotracheal intubation (ETI) among patients experiencing out-of-hospital cardiac arrest (OOHCA). ⋯ In this analysis of OOHCA airway management, first attempt BLS King LT-D placement success exceeded that of first attempt paramedic ETI success. In addition, patients in the King LT-D group were more likely to have had an advanced airway attempted and to have had a successful advanced airway placed when multiple attempts were required.
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Comparative Study
Optimizing the duration of CPR prior to defibrillation improves the outcome of CPR in a rat model of prolonged cardiac arrest.
This study was to investigate whether optimal duration of CPR prior to defibrillation could be guided by Amplitude Spectrum Analysis (AMSA) in the setting of prolonged VF on outcome of CPR. ⋯ After prolonged VF, optimal duration of CPR prior to defibrillation guided by AMSA improves the outcome of CPR.
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Comparative Study
A combination of metabolic strategies plus cardiopulmonary bypass improves short-term resuscitation from prolonged lethal cardiac arrest.
The metabolic or late phase of cardiac arrest is highly lethal. Emergency cardiopulmonary bypass (ECPB) can resuscitate many patients even after prolonged cardiac arrest and provides immediate vascular access for correction of metabolic derangement during the reperfusion process. We developed a rodent model of ECPB resuscitation which showed the superiority of ECPB over conventional CPR, especially when combined with hypothermia. For this study we examined a metabolic strategy against ischemia-reperfusion injury (MS-IR) that included: leukoreduction, low Ca(2+), Mg(2+), buffered pH, red blood cells and a colloid. We tested whether ECPB plus MS-IR and/or hypothermia improves short-term hemodynamic outcomes compared to a standard ECPB reperfusate. ⋯ While most human ECPB is applied with a normothermic crystalloid priming solution, we observed that in rodents the addition of MS-IR plus hypothermia resulted in considerable short-term benefit after prolonged arrest. Future long-term and translational survival studies are warranted to optimize ECPB resuscitation methods.
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Comparative Study
Improving microcirculation with therapeutic intrathoracic pressure regulation in a porcine model of hemorrhage.
Intrathoracic pressure regulation (IPR) has been used to treat hypotension and states of hypoperfusion by providing positive pressure ventilation during inspiration followed by augmentation of negative intrathoracic pressure during expiration. This therapy augments cardiac output and lowers intracranial pressure, thereby providing greater circulation to the heart and brain. The effects of IPR on microcirculation remain unknown. ⋯ In this animal model, we observed that microcirculation and systemic blood pressures are correlated and may be significantly improved by using IPR therapy.