Resuscitation
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Among patients who survive after out-of-hospital cardiac arrest (OHCA), a large proportion are recruited from cases witnessed by the Emergency Medical Service (EMS), since the conditions for success are most optimal in this subset. ⋯ In Sweden, in a 20-year perspective, there was a successive increase in the proportion of EMS-witnessed OHCA. Among these patients, survival to one month increased over time. EMS-witnessed OHCA had a higher survival than bystander-witnessed OHCA. Independent predictors of an increased chance of survival were initial rhythm, aetiology, place and age.
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To investigate the effects of early intravenous adrenaline administration on circulatory recovery, cerebral reoxygenation, and plasma catecholamine concentrations, after severe asphyxia-induced bradycardia and hypotension. ⋯ The high endogenous catecholamine levels, especially those of noradrenaline, may explain why early administered adrenaline did not significantly improve resuscitation outcome.
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The objectives of this study are to characterize the total hospital and professional charges for patients with out of hospital cardiac arrest both with and without therapeutic hypothermia treatment. ⋯ Empirical patient level data confirm that charges for patients with out of hospital cardiac arrest are substantial, even among patients that do not survive to hospital admission. Treatment with therapeutic hypothermia is associated with better outcomes, more procedures, and higher charges.
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The external pumping action in CPR should generate sufficient flow and pressure, but the pump must also be 'primed' by ongoing venous return. Different additions to standard CPR are in use just for this purpose. Active decompression of the thorax (ACD-CPR) to 'suck in' venous blood has proven successful, but, theoretically, compression of venous reservoirs in the abdomen should be even more effective. We compared different techniques for improved CPR with specific attention to the pulmonary circulation. We did our comparisons 'in silico' rather than 'in vivo' in a well-evaluated computer model. ⋯ IAC-CPR outperforms the other techniques in achieving good aortic pressure and cardiac output. However, abdominal pressure should be limited.