Resuscitation
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An important predictor of outcomes from out-of-hospital cardiac arrest (OOHCA) is bystander resuscitation, but in industrialised nations this is undertaken only in 15-50%. To explore reasons for this low response rate we analysed bystander perceptions during the victim's collapse, and methods used to assess cardiac arrest. ⋯ In this sample of interviewed bystanders of OOHCA, almost half of the arrests were not detected. This might be a reason for the low rate of bystander resuscitation. Common bystander perceptions of arrest presence included "bluish skin colour" and abnormal breathing of the victim. These findings indicate that improvement of perception capabilities should be incorporated as a major learning objective into lay basic life support training. In addition, information regarding skin colour may be of value in dispatch protocols.
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Randomized Controlled Trial Multicenter Study Comparative Study
Alternating providers during continuous chest compressions for cardiac arrest: every minute or every two minutes?
Studies have shown that the quality of chest compressions for cardiac arrest decreases markedly after only a brief time. This is thought to be an important contributor to an adverse outcome of resuscitation, which has led to recommendations to alternate chest compression providers. This study compared alternating rescuers every 1 min versus every 2 min in a manikin simulation. ⋯ Power calculations with these results show that an unfeasibly large number of scenarios would be needed to definitively demonstrate the superiority of one of the scenarios. It seems reasonable to alternate chest compression providers every 2 min, to prevent the loss of effective compressions due to fatigue and to minimise interruptions of chest compressions. The ideal time to do this would be during the rhythm and pulse check as dictated by current guidelines.
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Comparative Study
Subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest: a prospective computed tomography study.
Aneurysmal subarachnoid haemorrhage (SAH) is a relatively common cause of out-of-hospital cardiac arrest (OHCA). Early identification of SAH-induced OHCA with the use of brain computed tomography (CT) scan obtained immediately after resuscitation may help emergency physicians make therapeutic decision as quickly as they can. ⋯ Aneurysmal SAH causes OHCA more frequently than had been believed. Immediate brain CT scan may particularly be useful in excluding SAH-induced OHCA from thrombolytic trial enrollment, for whom the use of thrombolytics is contraindicated. The low VF incidence suggests that VF by itself may not be a common cause of SAH-induced OHCA.
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Early and accurate prediction of survival to hospital discharge following resuscitation after cardiac arrest (CA) is a major challenge. Our aim was to investigate the levels of ischemia-modified albumin (IMA) and malondialdehyde (MDA) in CA patients and whether IMA levels are valuable early marker of post-cardiopulmonary resuscitation prognosis in CA patients. ⋯ In conclusion, though the result may not be applied clinically in every patient, the ischemia-modified albumin may be a valuable prognostic marker in cardiac arrest patients following CPR.