Resuscitation
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The external pumping action in CPR should generate sufficient flow and pressure, but the pump must also be 'primed' by ongoing venous return. Different additions to standard CPR are in use just for this purpose. Active decompression of the thorax (ACD-CPR) to 'suck in' venous blood has proven successful, but, theoretically, compression of venous reservoirs in the abdomen should be even more effective. We compared different techniques for improved CPR with specific attention to the pulmonary circulation. We did our comparisons 'in silico' rather than 'in vivo' in a well-evaluated computer model. ⋯ IAC-CPR outperforms the other techniques in achieving good aortic pressure and cardiac output. However, abdominal pressure should be limited.
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Editorial Comment
Drowning: more hope for patients, less hope for guidelines.