Resuscitation
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The guidelines for Advanced Life Support issued by the European Resuscitation Council recommend considering drug delivery through intraosseous access if intravenous access to the vascular bed is not feasible or unsuccessful. Emergency prehospital intraosseous cannulation may theoretically lead to an increased risk of long-term complications such as osteomyelitis, osteonecrosis, or compartment syndrome. Such complications have previously been reported in case reports or small sample case series. We systematically investigated long-term complications potentially associated with intraosseous cannulation using validated Danish health registries. ⋯ Long-term complications such as osteomyelitis, osteonecrosis, or compartment syndrome following prehospital intraosseous cannulation and drug delivery occurred in less than 0.1% of the cases. Our findings indicate that prehospital intraosseous cannulation may be safe across age groups.
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Observational Study
Visual detection of pulselessness by carotid artery sonography - A prospective observational study among medical students.
This cross-sectional study aimed to determine whether medical students with little to no ultrasound experience could correctly distinguish between 'pulsation present' and 'no pulsation present' after a short introductory video on the subject using ultrasound videos of the common carotid artery (CCA). ⋯ Medical students seem to be able to detect the absence of a pulse with a high degree of accuracy using 2D ultrasound of the CCA in a controlled study setting, using different ultrasound modes. The results of this study suggest that a combination of Color Doppler and B-mode may be useful when evaluating the CCA during CPR to answer the question 'pulsation present' or 'no pulsation present'.
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Ambulance call-takers perform the critical role of prompting callers to initiate and continue cardiopulmonary resuscitation (CPR) for patients with suspected out-of-hospital cardiac arrest (OHCA). This study aimed to identify call-taker strategies to address callers' perceptions of CPR 'inappropriateness' (perceiving the patient as dead and beyond help, or as showing signs of life). ⋯ Call-takers used a combination of linguistic features (minimal/symbolic tokens, deontics) and strategies (providing unscripted statements about the context or a rationale for CPR) to overcome barriers of perceived inappropriateness to CPR.
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Bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) has increased in Singapore, Japan, and South Korea following the implementation of several public health, bystander-focused interventions, such as dispatcher-assisted CPR and community CPR training. It is unclear whether bystander CPR prevalence will continue on this trajectory over time. This study aimed to investigate the temporal trends of bystander CPR prevalence over a ten-year period in these three Asian countries. ⋯ This study investigated the trend of bystander CPR over 10 years in three Asian countries. Although the proportion of bystander CPR has increased, it has now plateaued between 50-60 %. Further research is necessary to identify the contributing factors and advance beyond this "invisible ceiling".
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Observational Study
The impact of gasping versus apnea on initial heart rate and response to positive pressure ventilation in the delivery room following interruption of placental blood flow.
The impact and/or significance of gasping or apnea on cardio-respiratory status at birth remains unclear. ⋯ Apneic (12.3 %) versus gasping infants (5.7 %) were 7.2-fold more likely to die in the first 24 h (p = 0.01) and 2.8-fold more likely to die (p = 0.047) by 7 days. Initial HR was higher in gasping versus apneic infants (122 vs 105 bpm) (p = 0.01). Time to initiate breathing after starting PPV was significantly shorter in gasping versus apneic infants. No differences in applied peak inflation pressure, tidal volume, end tidal CO2, or resuscitation duration were noted. Of infants who died versus survivors, a HR < 100 bpm was observed more often in both gasping and apneic infants (p = 0.01) CONCLUSIONS: Infants who present with gasping versus apnea are less likely to die; apneic infants are more likely to die within the initial 24 h. Gasping versus apneic infants had a higher initial HR, were less likely to have a HR < 100 bmp and initiated spontaneous respiratory effort sooner after PPV. These findings are consistent with experimental and adult observations that suggest gasping appears critical to survival if PPV is initiated in a timely manner.