Resuscitation
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Comparative Study
Cerebral effects of three resuscitation protocols in uncontrolled haemorrhagic shock: a randomised controlled experimental study.
To compare haemodynamic and cerebral variables during aggressive fluid resuscitation vs. administration of a hypertonic starch solution (HS) combined with either noradrenaline [norepinephrine] or arginine vasopressin in an animal model of uncontrolled haemorrhagic shock. ⋯ Following uncontrolled haemorrhagic shock in this animal model, combination of HS with arginine vasopressin increased CPP and cerebral oxygenation faster than aggressive fluid resuscitation, without re-increasing ICP.
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This was an experimental study performed to investigate cerebral metabolism during hypothermia treatment and rewarming after resuscitation from cardiac arrest (CA). ⋯ After resuscitation from CA there was a risk of cerebral secondary energy failure (reflected as an increased L/P-ratio) but hypothermia treatment seemed to counteract this effect. Cerebral oxygen extraction, measured by SjO(2,) was increased in the hypothermic group probably due to reduced metabolism. Rewarming did not reveal any obvious harmful events.
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Acute life-threatening events in children are medical emergencies requiring immediate intervention. They can be due to cardiac arrest, respiratory arrest or another cause of sudden compromise for example, choking. Internationally, hospital systems are being introduced to reduce preventable acute life-threatening events and, despite having significant resource implications, have not yet been subject to economic analysis. This study presents the additional short-term health service costs of in-hospital acute life-threatening events to inform a cost-effectiveness analysis of prevention strategies. ⋯ The short-term costs of paediatric in-hospital acute life-threatening events, including cardiac arrest, from an NHS perspective, are more expensive than those reported for adults, but similar to other life saving treatments. This new information will serve to improve efficiency in the current resuscitation programme and contribute to cost-effectiveness analysis of prevention strategies.
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Extracorporeal life support (ECLS) has been applied successfully to patients with acute cardiopulmonary failure. However, ECLS remains controversial for traumatized patients who are prone to bleeding. ⋯ Using ECLS to resuscitate traumatic respiratory distress proved to be safe and effective when conventional therapies had been exhausted. Early deployment of ECLS to preserve systemic organ perfusion, aggressive treatment of coexisting injuries and tailored anticoagulation protocols are crucial to a successful outcome.
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Letter Case Reports
Cardiac arrest after air travel successfully treated by presumptive fibrinolysis.
Thromboembolic events should be strongly suspected in cases where medical events occur after prolonged air travel. Pulmonary embolism should be suspected in patients with sudden cardiac arrest. Consequently, patients should be managed according to this eventuality. We report a case of sudden cardiac arrest after air travel in which the patient survived after fibrinolysis was prescribed on a presumptive basis.