Resuscitation
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Randomized Controlled Trial
Effects of repetitive or intensified instructions in telephone assisted, bystander cardiopulmonary resuscitation: An investigator-blinded, 4-armed, randomized, factorial simulation trial.
Compression depth is frequently suboptimal in cardiopulmonary resuscitation (CPR). We investigated effects of intensified wording and/or repetitive target depth instructions on compression depth in telephone-assisted, protocol driven, bystander CPR on a simulation manikin. ⋯ In protocol driven, telephone-assisted, bystander CPR, intensified wording and/or repetitive target depth instruction will not improve compression depth compared to the standard instruction.
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Randomized Controlled Trial Comparative Study
Quality of CPR performed by trained bystanders with optimized pre-arrival instructions.
Telephone-CPR (T-CPR) can increase initiation of bystander CPR. We wanted to study if quality oriented continuous T-CPR would improve CPR performance vs. standard T-CPR. ⋯ In our simulated scenario with CPR trained lay rescuers, experimental continuous T-CPR gave better chest compression rate and less hands-off time during CPR, but resulted in delayed time to first chest compression compared to standard T-CPR instructions.
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Adherence to advanced cardiac life support (ACLS) guidelines during in-hospital cardiac arrest (IHCA) is associated with improved outcomes, but current evidence shows that sub-optimal care is common. Successful execution of such protocols during IHCA requires rapid patient assessment and the performance of a number of ordered, time-sensitive interventions. Accordingly, we sought to determine whether the use of an electronic decision support tool (DST) improves performance during high-fidelity simulations of IHCA. ⋯ Use of an electronic DST provided a significant improvement in the management of simulated IHCA by senior medical students as measured by adherence to published guidelines.
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Advanced Cardiac Life Support (ACLS) algorithms are the default standard of care for in-hospital cardiac arrest (IHCA) management. However, adherence to published guidelines is relatively poor. The records of 149 patients who experienced IHCA were examined to begin to understand the association between overall adherence to ACLS protocols and successful return of spontaneous circulation (ROSC). ⋯ Our results show that adherence to ACLS protocols throughout an event is correlated with increased ROSC in the setting of cardiac arrest. Furthermore, the results suggest that, in addition to correct actions, both wrong actions and omissions of indicated actions lead to decreased ROSC after IHCA.
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The National Early Warning Score (NEWS) is being introduced across the UK, but there are concerns about its specificity in patients with chronic hypoxaemia, such as some patients with COPD. This could lead to frequent clinically insignificant triggers and alarm fatigue. ⋯ CREWS is a simple variant of NEWS for patients with chronic hypoxaemia that could reduce clinically insignificant triggers and alarm fatigue, whilst still identifying the sickest patients.