Resuscitation
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The quality of cardiopulmonary resuscitation (CPR), especially adequate compression depth, is associated with return of spontaneous circulation (ROSC) and is therefore recommended to be measured routinely. In the current study, we investigated the relationship between changes of transthoracic impedance (TTI) measured through the defibrillation electrodes, chest compression depth and coronary perfusion pressure (CPP) in a porcine model of cardiac arrest. ⋯ Amplitude change of TTI was correlated with compression depth and CPP in this porcine model of cardiac arrest. The TTI measured from defibrillator electrodes, therefore has the potential to serve as an indicator to monitor the quality of chest compression and estimate CPP during CPR.
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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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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 Prehospital Trauma Life Support (PHTLS) course has been widely implemented and approximately half a million prehospital caregivers in over 50 countries have taken this course. Still, the effect on injury outcome remains to be established. The objective of this study was to investigate the association between PHTLS training of ambulance crew members and the mortality in trauma patients. ⋯ PHTLS training of ambulance crew members may be associated with reduced mortality in trauma patients, but the precision in this estimate was low due to the overall low mortality. While there may be a relative risk reduction, the predicted absolute risk reduction in this population was low.
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The presence or absence of the pupillary light reflex following cardiopulmonary resuscitation has been shown to have prognostic value. We asked whether the light reflex could be objectively measured during cardiopulmonary resuscitation in humans and whether the quality of the reflex was associated with outcome. ⋯ Portable infrared pupillary measurements can reliably demonstrate the presence and quality of the pupillary light reflex after cardiac arrest and during resuscitation. In our limited case series, the presence of the pupillary light reflexes obtained in serial measurements during resuscitation was associated with early survival and a favorable neurological status in the recovery period.