Resuscitation
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Randomized Controlled Trial Comparative Study
Comparison of times of intervention during pediatric CPR maneuvers using ABC and CAB sequences: a randomized trial.
The proposed introduction of the CAB (circulation, airway, breathing) sequence for cardiopulmonary resuscitation has raised some perplexity within the pediatric community. We designed a randomized trial intended to verify if and how much timing of intervention in pediatric cardiopulmonary resuscitation is affected by the use of the CAB vs. the ABC (airway, breathing, circulation) sequence. ⋯ Compared to ABC the CAB sequence prompts shorter time of intervention both in diagnosing respiratory or cardiac arrest and in starting ventilation or chest compression. However, this does not necessarily entail prompter resumption of spontaneous circulation and significant reduction of neurological sequelae, an issue that requires further studies.
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Comparative Study
Differences in outcomes between ICU attending and senior resident physician led medical emergency team responses.
Although rapid response systems (RRS) have been shown to decrease the incidence of cardiac arrest (CA), there are no studies evaluating optimal staffing. We hypothesize that there are no outcome differences between ICU physician and senior resident led events. ⋯ Resident-led RRS may have similar outcomes to attending intensivist led events. Prospective studies are needed to determine the ideal team composition.
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Mild hypothermia (MH) decreases infarct size and mortality in experimental reperfused myocardial infarction, but may potentiate ischaemia-induced left ventricular (LV) diastolic dysfunction. ⋯ We conclude that (i) an acute loss of end-diastolic LV compliance is a major component of acute cardiac pump failure during experimental myocardial infarction, and that (ii) MH does not potentiate this diastolic LV failure, but stabilizes haemodynamics and improves systemic oxygen supply/demand imbalance by reducing demand.
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The ventricular fibrillation (VF) waveform is dynamic and predicts defibrillation success. Quantitative waveform measures (QWMs) quantify these changes. Coronary perfusion pressure (CPP), a surrogate for myocardial perfusion, also predicts defibrillation success. The relationship between QWM and CPP has been preliminarily explored. We sought to further delineate this relationship in our porcine model and to determine if it is different between animals with/without ROSC (return of spontaneous circulation). ⋯ There is a linear relationship between QWM and CPP during chest compressions in our porcine cardiac arrest model that is different between animals with/without ROSC.
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Clinical Trial
A low tilt waveform in the transthoracic defibrillation of ventricular arrhythmias during cardiac arrest.
Most commercially available defibrillators utilise a high tilt waveform. Work in atrial fibrillation has shown improved defibrillation success using low tilt waveforms. We hypothesise that a novel low tilt biphasic waveform will be non-inferior to a standard tilt waveform whilst delivering lower energy for the defibrillation of ventricular arrhythmias. ⋯ The low tilt waveform used in this study demonstrated first shock success rates in keeping with a commercially available high tilt defibrillator which could result in less myocardial damage due to reduced energy requirements.