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.
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Randomized Controlled Trial Clinical Trial
Magnesium in cardiac arrest (the magic trial).
The prognosis of out of hospital cardiac arrest (OHCA) is dismal. Recent reports indicate that high dose magnesium may improve survival. A prospective randomized double blind placebo controlled trial was conducted at the emergency department (ED) of Royal Perth Hospital, a University teaching hospital. ⋯ In this study, the use of high dose magnesium as first line drug therapy for OHCA was not associated with a significantly improved survival. Early defibrillation remains the single most important treatment for ventricular fibrillation (VF). Further studies are required to evaluate the role of magnesium in cardiac and cerebral resuscitation.
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Randomized Controlled Trial Clinical Trial
Improved retention of the EMS activation component (EMSAC) in adult CPR education.
This study was undertaken to determine whether using a model-telephone to simulate the emergency medical services activation component (EMSAC) during adult cardiopulmonary resuscitation (CPR) training practice would lead to better retention of this component during end-of-class assessment. In a prospective randomized manner, 233 medical professionals and lay-persons taking American Heart Association (AHA) CPR classes were evaluated for EMSAC retention during CPR skills performance at the end of class. During the assessment correct versus incorrect activation of EMS was noted. ⋯ Previous CPR training did not affect the response (P = 0.18). We conclude that use of the model-telephone improved EMSAC retention significantly overall except in the < 30 year-old age group. We recommend using the model-telephone in future adult CPR classes.
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Randomized Controlled Trial Clinical Trial
Quality of mechanical, manual standard and active compression-decompression CPR on the arrest site and during transport in a manikin model.
The quality of mechanical CPR (M-CPR) was compared with manual standard CPR (S-CPR) and active compression-decompression CPR (ACD-CPR) performed by paramedics on the site of a cardiac arrest and during manual and ambulance transport. Each technique was performed 12 times on manikins using teams from a group of 12 paramedic students with good clinical CPR experience using a random cross-over design. Except for some lost ventilations the CPR effort using the mechanical device adhered to the European Resuscitation Council guidelines, with an added time requirement of median 40 s for attaching the device compared with manual standard CPR. ⋯ On the stairs, 68% of S-CPR compressions and 100% of ACD-CPR compressions were too weak. In conclusion, when evaluated on a manikin, in comparison with manual standard and ACD-CPR, mechanical CPR adhered more closely to ERC guidelines. This was particularly true when performing CPR during transport on a stretcher.
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Randomized Controlled Trial Clinical Trial
Active compression-decompression cardiopulmonary resuscitation in standing position over the patient: pros and cons of a new method.
Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) has been introduced to improve outcome of CPR after cardiac arrest. Usually, ACD-CPR is performed with the rescuer kneeling beside the patient (ACD-B), but ACD-CPR with the rescuer in standing position (ACD-S) has been taught and applied in some centres in addition to conventional ACD-CPR (ACD-B). The aim of this randomised and cross-over study was to evaluate the new technique of ACD-S and to compare it with conventional ACD-B. ⋯ Compression forces decreased in ACD-S from 55.1 to 48.9 kp (P = 0.002) and in ACD-B from 52.8 to 47.0 kp (P = 0.069). We conclude that ACD-CPR in standing position can be considered equal to ACD-B in view of maximal duration of CPR, exhaustion of the rescuers and decompression forces. The decrease of compression forces in ACD-S and ACD-B as well as the difference between compression forces in ACD-S and ACD-B seem to be of no clinical relevance, and exhaustion was judged to be similar despite oxygen consumption being higher in ACD-S than in ACD-B.