Resuscitation
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Significant amount of data on the incidence and outcome of out-of-hospital and in-hospital cardiac arrest have been published. Cardiac arrest occurring in the intensive care unit has received less attention. ⋯ At present data on intensive care unit cardiac arrest is quite limited and originates mostly from retrospective single center studies. The quality of data overall seems to be poor and thus focused prospective multi-center studies are needed.
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Randomized Controlled Trial
Basic Life Support trained nurses ventilate more efficiently with laryngeal mask Supreme than with facemask or laryngeal tube Suction-Disposable-a prospective, randomized clinical trial.
In some emergency situations resuscitation and ventilation may have to be performed by basic life support trained personnel, especially in rural areas where arrival of advanced life support teams can be delayed. The use of advanced airway devices such as endotracheal intubation has been deemphasized for basically-trained personnel, but it is unclear whether supraglottic airway devices are advisable over traditional mask-ventilation. ⋯ After one hour of introductory training, nurses were able to use LMA-S more effectively than facemask and LTS-D. High ventilation failure rates with facemask and LTS-D may indicate that additional training is required to perform airway management adequately with these devices. High-level trials are needed to confirm these results in cardiac arrest patients.
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Randomized Controlled Trial Comparative Study
Comparing three CPR feedback devices and standard BLS in a single rescuer scenario: a randomised simulation study.
Efficiently performed basic life support (BLS) after cardiac arrest is proven to be effective. However, cardiopulmonary resuscitation (CPR) is strenuous and rescuers' performance declines rapidly over time. Audio-visual feedback devices reporting CPR quality may prevent this decline. We aimed to investigate the effect of various CPR feedback devices on CPR quality. ⋯ While we found differences between the investigated CPR feedback devices, overall BLS quality was suboptimal in all groups. Surprisingly, effective compression was not improved by any CPR feedback device compared to standard BLS. All feedback devices caused substantial delay in starting CPR, which may worsen outcome.
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To describe differences over time in outcome, physical and cognitive function among survivors of cardiac arrest treated with hypothermia and to examine survivors' life satisfaction 6 months after cardiac arrest as well as gender differences. ⋯ Cardiac arrest survivors are satisfied with life as a whole despite a severe illness that has impaired their physical and cognitive function, which seemed to improve over time. Predicting patients' functional outcome in early stages is difficult, and the CPC score alone is not sufficient to assess patients' function. It is a need to reach a consensus to which instruments best reflect physical and cognitive function as well as to specify a rehabilitation plan.
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Physician Orders for Life-Sustaining Treatment (POLST) has become a common means of documenting patient treatment preferences. In addition to orders either for Attempt Resuscitation or Do Not Attempt Resuscitation, for patients not in cardiopulmonary arrest, POLST provides three levels of treatment: Full Treatment, Limited Interventions, and Comfort Measures Only. Oregon has an electronic registry for POLST forms completed in the state. We used registry data to examine the different combinations of treatment orders. ⋯ The most common order combinations were DNR/Comfort Measures Only, DNR/Limited Interventions and Attempt Resuscitation/Full Treatment. These three makes sense to health professionals. However, other order combinations that require interpretation at the time of a crisis were completed for about 10% of Registrants. These combinations need further investigation.