Resuscitation
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Multicenter Study Comparative Study
Airway management in pediatric patients at referring hospitals compared to a receiving tertiary pediatric ICU.
To describe the current practice of pediatric airway management at referring hospitals and the associated adverse events compared to a receiving tertiary pediatric ICU. ⋯ Provider reported adverse TIAEs are common during airway management in children requiring critical care transport, but not higher compared to PICU intubations. Most inter-hospital transport patients are intubated with an uncuffed tracheal tube. Subsequent tracheal tube change from uncuffed to cuffed tube is rarely required.
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Randomized Controlled Trial Comparative Study
Performance of an automated external defibrillator during simulated rotor-wing critical care transports.
This study aimed to evaluate whether an automated external defibrillator (AED) was accurate enough to analyze the heart rhythm during a simulated rotor wing critical care transport. We hypothesized that AED analysis of the simulated rhythms during a helicopter flight would result in significant errors (i.e., inappropriate shocks, analysis delay). ⋯ This study suggested that current AEDs could analyze the heart rhythm correctly during simulated helicopter transport. Further studies using an animal model would be needed before applying to patients.
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Induced mild hypothermia after cardiac arrest interferes with clinical assessment of the cardiovascular status of patients. In this situation, non-invasive cardiac output measurement could be useful. Unfortunately, arterial pulse contour is altered by temperature, and the performance of devices using arterial blood pressure contour analysis to derive cardiac output may be insufficient. ⋯ Induced hypothermia was not associated with increased bias or limits of agreement for the comparison of Vigileo and continuous thermodilution, but percentage error was high during normothermia and increased further during hypothermia. Less than 50% of clinically relevant CO changes during hypothermia were concordant.
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Comparative Study
Clinical emergencies and outcomes in patients admitted to a surgical versus medical service.
The merit of rapid response systems (RRSs) remains controversial. A tailored approach to specific groups may increase the efficacy of these teams. The purpose of this study was to compare differences in triggers for RRS activation, interventions, and outcomes in patients on medical and surgical services. ⋯ Implementation of a RRS had greater impact on reduction of out of ICU cardiac arrest and mortality in medical inpatients. Triggers for activation and interventions were similar between groups; however, surgical patients demonstrated substantial risk for decompensation within the first 24 h following operation. More research is needed to evaluate the disproportionate benefit observed between cohorts.
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Editorial Comment
Prehospital intubation in cardiac arrest: the debate continues.