Resuscitation
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This cross-sectional study aimed to determine whether medical students with little to no ultrasound experience could correctly distinguish between 'pulsation present' and 'no pulsation present' after a short introductory video on the subject using ultrasound videos of the common carotid artery (CCA). ⋯ Medical students seem to be able to detect the absence of a pulse with a high degree of accuracy using 2D ultrasound of the CCA in a controlled study setting, using different ultrasound modes. The results of this study suggest that a combination of Color Doppler and B-mode may be useful when evaluating the CCA during CPR to answer the question 'pulsation present' or 'no pulsation present'.
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Most preterm infants breathe spontaneously at birth. Despite this, the majority have a face mask immediately applied for breathing support. Face mask application may inhibit spontaneous breathing in newborn infants. We wished to determine whether selectively applying a mask to give positive pressure ventilation (PPV) for apnoea or bradycardia only compared to routinely applying a mask for continuous positive airway pressure (CPAP) resulted in fewer preterm infants receiving PPV in the delivery room (DR). ⋯ Selectively applying a face mask for PPV only did not result in fewer preterm infants receiving PPV in the DR.
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Limited evidence supports guidelines to perform chest compressions at the lower half of the sternum. Imaging studies suggest this location may obstruct blood flow. Our primary aim was to compare the highest arterial line systolic blood pressure (SBP) during lower-half-of-sternum chest compressions (CC) versus those left-of-sternum, where the left ventricle is more likely located. Secondarily, we compared the highest end-tidal CO2 (ETCO2). ⋯ In our pilot, retrospective, observational study of select ED cardiac arrest patients, left-of-sternum chest compressions are associated with higher SBP than lower-half-of-sternum compressions, while ETCO2 was similar.
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The impact and/or significance of gasping or apnea on cardio-respiratory status at birth remains unclear. ⋯ Apneic (12.3 %) versus gasping infants (5.7 %) were 7.2-fold more likely to die in the first 24 h (p = 0.01) and 2.8-fold more likely to die (p = 0.047) by 7 days. Initial HR was higher in gasping versus apneic infants (122 vs 105 bpm) (p = 0.01). Time to initiate breathing after starting PPV was significantly shorter in gasping versus apneic infants. No differences in applied peak inflation pressure, tidal volume, end tidal CO2, or resuscitation duration were noted. Of infants who died versus survivors, a HR < 100 bpm was observed more often in both gasping and apneic infants (p = 0.01) CONCLUSIONS: Infants who present with gasping versus apnea are less likely to die; apneic infants are more likely to die within the initial 24 h. Gasping versus apneic infants had a higher initial HR, were less likely to have a HR < 100 bmp and initiated spontaneous respiratory effort sooner after PPV. These findings are consistent with experimental and adult observations that suggest gasping appears critical to survival if PPV is initiated in a timely manner.