Resuscitation
-
Comparative Study
Increased survival after EMS witnessed cardiac arrest. Observations from the Resuscitation Outcomes Consortium (ROC) Epistry-Cardiac arrest.
Out of hospital cardiac arrest (OHCA) is common and lethal. It has been suggested that OHCA witnessed by EMS providers is a predictor of survival because advanced help is immediately available. We examined EMS witnessed OHCA from the Resuscitation Outcomes Consortium (ROC) to determine the effect of EMS witnessed vs. bystander witnessed and unwitnessed OHCA. ⋯ Immediate application of prehospital care for OHCA may improve survival. Efforts should be made to educate patients to access 9-1-1 for prodromal symptoms.
-
The American Heart Association (AHA) released guidelines to improve survival rates from out-of-hospital cardiac arrest in 2005. We sought to identify what barriers delayed the implementation of these guidelines in EMS agencies. ⋯ Many barriers contributed to delays in the implementation of the 2005 AHA guidelines in EMS agencies. These identified barriers should be proactively addressed prior to the 2010 Guidelines to facilitate rapid translation of science into clinical practice.
-
Randomized Controlled Trial Comparative Study
A randomized trial of the capability of elderly lay persons to perform chest compression only CPR versus standard 30:2 CPR.
Early cardiopulmonary resuscitation (CPR) improves survival after cardiac arrest, but there is a discrepancy between the age group normally attending CPR-classes and the age group most likely to witness a cardiac arrest. We wanted to study if elderly lay persons could perform 10min of CPR on a realistic manikin with continuous chest compressions (CCC) and conventional CPR (30:2). ⋯ Lay people in the age group 50-76 were able to perform CPR with acceptable quality for 10min and we found only very slight temporal quality deterioration. This makes training programs for the elderly meaningful to improve survival after cardiac arrest.
-
Review
On coenrollment in clinical resuscitation studies: review and experience from randomized trials.
Patients with acute life-threatening illness are candidates for enrollment in multiple trials. Whether patients are enrolled in multiple trials has implications for patient safety, trial enrollment duration, and study validity. ⋯ There is no regulatory prohibition on coenrollment of patients in more than one study. Randomized trials of interventions for a variety of clinical conditions have allowed coenrollment without any reported deleterious impact on either study. Guidelines for coenrollment are proposed.
-
Comparative Study
Esophageal temperature after out-of-hospital cardiac arrest: an observational study.
Out-of-hospital cardiac arrest (OHCA) is a significant cause of death and severe neurological disability. The only post-return of spontaneous circulation (ROSC) therapy shown to increase survival is mild therapeutic hypothermia (MTH). The relationship between esophageal temperature post OHCA and outcome is still poorly defined. ⋯ Following OHCA all patients have esophageal temperatures below normal in the pre-hospital phase and on arrival in the Emergency Department. Patients who achieve ROSC following OHCA and survive to hospital discharge are warmer on arrival in ICU and take longer to reach target MTH temperatures compared to patients who die in hospital. The mechanisms of action underlying esophageal temperature and survival from OHCA remain unclear and further research is warranted to clarify this relationship.