Resuscitation
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Therapeutic hypothermia improves outcomes in resuscitated cardiac arrest patients, but prior application rates are less than 30%. We sought to evaluate self-reported physician adoption, predictors of adoption, and barriers to use among Canadian emergency and critical care physicians. A web-based modified Dillman questionnaire asked all physicians on the membership lists of the Canadian Association of Emergency Physicians and the Canadian Critical Care Forum physicians to report their experience with therapeutic hypothermia using the Pathman framework of changing physician behaviour. ⋯ Common barriers included: lack of awareness of recommended practice (31%), perceptions of poor prognosis (25%), too much work required to cool (20%) and staffing shortages (20%). Therapeutic hypothermia after cardiac arrest has not been universally adopted. Adoption might be improved through protocol implementation, education about benefits and prognosis, and strategies to make administration easier.
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Case Reports
Imaging the human microcirculation during cardiopulmonary resuscitation in a hypothermic victim of submersion trauma.
The microcirculation is essential for delivery of oxygen and nutrients to tissue. However, the human microvascular response to cardiopulmonary resuscitation (CPR) is unknown. We report on the first use of sidestream dark field imaging to assess the human microcirculation during CPR with a mechanical chest compression/decompression device (mCPR). mCPR was able to provide microvascular perfusion. ⋯ However, indices of microvascular perfusion were low and improved vastly after return of spontaneous circulation. Microvascular perfusion was relatively independent from blood pressure. The microcirculation may be a useful monitor for determining the adequacy of CPR.
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The use of emergency cardiopulmonary bypass (ECPB) resuscitation after cardiac arrest may offer hope for survival when standard ACLS therapies fail. However, whether cooling adds benefit to ECPB is unknown and we lack an ECPB rodent model for experimental studies. We sought to (a) develop a 72 h survival rodent model using ECPB to treat asphyxial cardiac arrest and (b) use this new model to evaluate early mild and moderate hypothermia versus normothermia during ECPB resuscitation. ⋯ A rodent model of ECPB is feasible and useful for resuscitation studies. The addition of early mild and moderate hypothermia to ECPB resuscitation significantly improves survival compared with normothermic ECPB in rats.
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Acute lung injury (ALI) develops in various clinical situations and is associated with high morbidity and mortality and therapeutic hypothermia (HT) has been studied to attenuate the ALI. However, the optimal method of rewarming has not been determined. We determined the effect of speed of rewarming and the administration of anti-inflammatory or anti-oxidant agents on ALI in an intestinal ischemia and reperfusion (I/R) model treated with HT. ⋯ Gradual rewarming and administration of dexamethasone improved survival and attenuated ALI after intestinal I/R injury treated with HT in rats.