Resuscitation
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Randomized Controlled Trial Comparative Study Clinical Trial
Carbon dioxide levels during pre-hospital active compression--decompression versus standard cardiopulmonary resuscitation.
In a prospective randomised study we investigated end-tidal carbon dioxide levels during standard versus active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) assuming that the end-tital carbon dioxide reflects cardiac output during resuscitation. In each group 60 patients with out-of-hospital cardiac arrest were treated either with the standard or the ACD method. End-tidal CO2 (p(et)CO2, mmHg) was assessed with a side-stream capnometer following intubation and then every 2 min up to 10 min or restoration of spontaneous circulation (ROSC). ⋯ However, CO2 was significantly higher in patients who were admitted to hospital as compared to patients declared dead at the scene. All of the admitted patients had a p(et)CO2 of at least 15 mmHg no later than 2 min following intubation, none of the dead patients ever exceeded 15.5 mmHg. From these data we conclude that capnometry adds valuable information to the estimation of a patient's prognosis in the field (threshold, 15 mmHg), but we could not detect any difference in p(et)CO2 between ACD and standard CPR.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of standard and a modified method of two resuscitator adult cardiopulmonary resuscitation: description of a new system for research into advanced life support skills.
The study compares two methods of Advanced Life Support by a pair of resuscitators using a bag-valve-mask (BVM) technique. Standard two resuscitator cardiopulmonary resuscitation (CPR) was compared with a modified method of two resuscitator CPR. During the modified CPR one resuscitator held the face mask while the other resuscitator alternates between squeezing the self inflating bag and performing simulated cardiac compressions. ⋯ Modified CPR produced a greater tidal volume (TV) (P < 0.001), a slower respiratory rate (RR) (P < 0.001) and a faster compression rate (CR) (P < 0.01) (means with (S. D.): modified CPR: TV 990 (220) ml, RR 6 (1) min(-1), CR 82 (8) min(-1); standard CPR: TV 570 (190) ml, RR 10 (2) min(-1), CR 65 (11) min(-1)). A new method for the simultaneous computerised recording of simulated cardiac compressions together with mask pressure and expired gas composition in anaesthetised patients is described.
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Randomized Controlled Trial Clinical Trial
The study of the effectiveness of chest compressions using the CPR-plus.
Effective cardiopulmonary resuscitation (CPR) requires a high level of skill from both healthcare professionals and the lay public. Inadequate chest compressions are a common cause of ineffective CPR. The CPR-plus is a non-invasive, hand-held, simple to use CPR adjunct designed to assist the rescuer to monitor and modify the compression technique during CPR, hopefully resulting in improved rescuer performance and more effective CPR. ⋯ The average number of correctly applied compressions was significantly better when the CPR-plus was used: 138.35/150 versus 110.70/150 (p = 0.0001). Improvements in techniques associated with the use of the CPR-plus also included a reduction in excessive application of pressure and incorrect hand position. The device provided reassurance of satisfactory compressions and an indication of impending fatigue in the rescuer.
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Randomized Controlled Trial Clinical Trial
Tracheal intubation via the laryngeal mask airway: a viable alternative to direct laryngoscopy for nursing staff during cardiopulmonary resuscitation.
Eight nurses with no previous experience of advanced airway management were randomly assigned to be taught tracheal intubation either by direct laryngoscopy or via a laryngeal mask. Once competent in the technique using a manikin, they attempted a maximum of ten intubations on anaesthetised patients. ⋯ Intubation in under 30 s was successful via the laryngeal mask in 60% of patients (42/70) compared to 39% (27/70) when using a laryngoscope (P = 0.11). It appears that non-medical personnel can be successfully taught to intubate the trachea using the laryngeal mask as a conduit, for those circumstances where a cuffed tracheal tube is considered essential during resuscitation.
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Randomized Controlled Trial Clinical Trial
Effectiveness of mask ventilation in a training mannikin. A comparison between the Oxylator EM100 and the bag-valve device.
The demands for an optimal ventilation apparatus are that it can be easily handled, achieves a sufficiently high ventilation volume, and minimizes gastric inflation. Our aim was therefore to carry out a study in a training mannikin to find out whether the Oxylator EM100, compared with the bag, obtains improved ventilation and a decrease in gastric inflation. In a randomized crossover study, 72 subjects were selected (24 physicians, 44 nurses and 4 auxiliary nurses), chosen from the operating theatre, emergency department and intensive care unit of two hospitals. ⋯ Of most importance is a significant lowering of gastric inflation and less so a marked increase in ventilatory volume. Our trial procedure with a relatively high lung compliance and a high oesophageal sphincter opening simulated favorable conditions. Owing to a large in vivo variability of these magnitudes, a direct testing in real patients with circulatory arrest is indicated.