Resuscitation
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Ambulance call-takers perform the critical role of prompting callers to initiate and continue cardiopulmonary resuscitation (CPR) for patients with suspected out-of-hospital cardiac arrest (OHCA). This study aimed to identify call-taker strategies to address callers' perceptions of CPR 'inappropriateness' (perceiving the patient as dead and beyond help, or as showing signs of life). ⋯ Call-takers used a combination of linguistic features (minimal/symbolic tokens, deontics) and strategies (providing unscripted statements about the context or a rationale for CPR) to overcome barriers of perceived inappropriateness to CPR.
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Hyperoxemia is common in patients resuscitated after out-of-hospital cardiac arrest (OHCA) admitted to the intensive care unit (ICU) and may increase the risk of mortality. However, the effect of hyperoxemia on functional outcome, specifically related to the timing of exposure to hyperoxemia, remains unclear. ⋯ Very early hyperoxemia after ICU admission is associated with higher risk of poor functional outcome after OHCA. Avoiding hyperoxia in the initial hours after resuscitation should be considered.
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The guidelines for Advanced Life Support issued by the European Resuscitation Council recommend considering drug delivery through intraosseous access if intravenous access to the vascular bed is not feasible or unsuccessful. Emergency prehospital intraosseous cannulation may theoretically lead to an increased risk of long-term complications such as osteomyelitis, osteonecrosis, or compartment syndrome. Such complications have previously been reported in case reports or small sample case series. We systematically investigated long-term complications potentially associated with intraosseous cannulation using validated Danish health registries. ⋯ Long-term complications such as osteomyelitis, osteonecrosis, or compartment syndrome following prehospital intraosseous cannulation and drug delivery occurred in less than 0.1% of the cases. Our findings indicate that prehospital intraosseous cannulation may be safe across age groups.
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Out-of-hospital cardiac arrest is a leading cause of mortality in Europe. Quality cardiopulmonary resuscitation, particularly of chest compressions, is crucial. Real-time audiovisual feedback (RTAVF) devices aim to enhance chest compression quality. Recent studies on these tools have reported improved outcomes for in-hospital but not for out-of-hospital cardiac arrest. This registry-based, retrospective study investigated the use of feedback-devices by emergency medical services personnel to treat out-of-hospital cardiac arrest in Germany and assessed its effect on return of spontaneous circulation (ROSC). ⋯ We could show a minor association between the use of feedback devices and any ROSC, but not for ROSC on hospital admission, in out-of-hospital cardiac arrest patients in a generalized linear mixed model. Further research should address implementation strategies, sustainability and evaluate its effectiveness for other applications.