Resuscitation
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The LUCAS 2 device stores technical data that documents the chest compression process. We analyzed chest wall dimensions and mechanics stored during chest compressions on humans using data gathered with the LUCAS 2 device. ⋯ There was a large variation of the required force to achieve a compression depth of 53 mm. No correlation was seen between chest height and maximum force required to compress the chest 53 mm.
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The accuracy of methods that classify the cardiac rhythm despite CPR artifact could potentially be improved by utilizing continuous ECG data. Our objective is to compare three approaches which use identical ECG features and differ only in their degree of temporal integration: (1) static classification, which analyzes 4-s ECG frames in isolation; (2) "best-of-three averaging," which takes the average of three consecutive static classifications successively; and (3) "adaptive rhythm sequencing," which uses hidden Markov models to model ECG segments as rhythm sequences. ⋯ In a continuous monitoring setting, adaptive rhythm sequencing was significantly more accurate than static rhythm classification during CPR.
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Observational Study
Survival after Public Access Defibrillation in Stockholm, Sweden - A striking success.
In Stockholm, a first responder system and a Public Access Defibrillation (PAD) program has been implemented. Additionally, the number of "unregulated" public Automated External Defibrillators (AEDs) sold "over-the-counter" has increased. The aim of this study was to evaluate the impact on survival from different defibrillation strategies in cases of out-of-hospital cardiac arrest (OHCA) available for PAD. ⋯ In OHCAs available for PAD, 70% of patients survived if a public AED was used. Both the structured AED program as well as the spread of unregulated AEDs was associated with very high survival rates, but the structured approach was more efficient in relation to the number of AEDs used.
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Observational Study
Hemodynamic targets during therapeutic hypothermia after cardiac arrest: A prospective observational study.
In analogy with sepsis, current post-cardiac arrest (CA) guidelines recommend to target mean arterial pressure (MAP) above 65 mmHg and SVO2 above 70%. This is unsupported by mortality or cerebral perfusion data. The aim of this study was to explore the associations between MAP, SVO2, cerebral oxygenation and survival. ⋯ we showed that a MAP range between 76-86 mmHg and SVO2 range between 67% and 72% were associated with maximal survival. Optimal cerebral saturation was achieved with a MAP between 87-101 mmHg and a SVO2 between 70% and 75%. Prospective interventional studies are needed to investigate whether forcing MAP and SVO2 in the suggested range with additional pharmacological support would improve outcome.
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Observational Study
Videographic assessment of cardiopulmonary resuscitation quality in the pediatric emergency department.
To describe the adherence to guidelines for CPR in a tertiary pediatric emergency department (ED) where resuscitations are reviewed by videorecording. ⋯ CPR in a tertiary pediatric ED frequently met recommended parameters for compression rate, pause duration, and compression fraction. Hyperventilation and failure of C:V coordination were very common. Future studies should focus on the impact of training methods on CPR performance as documented by videorecording.