Resuscitation
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During cardiopulmonary resuscitation (CPR), advanced life support (ALS) providers have been shown to deliver inadequate CPR with long intervals without chest compressions. Several changes made to the 2005 CPR Guidelines were intended to reduce unnecessary interruptions. We have evaluated if quality of CPR performed by the Oslo Emergency Medical System (EMS) improved after implementation of the modified 2005 CPR Guidelines, and if any such improvement would result in increased survival. ⋯ Quality of CPR improved after implementation of the modified 2005 Guidelines with only a weak trend towards improved survival to hospital discharge.
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We sought to evaluate the in-hospital fate of patients with ST segment elevation myocardial infarction (STEMI) diagnosed already in the prehospital phase by physican equipped ambulances. ⋯ In patients with STEMI already diagnosed in the prehospital phase the ischemic time is short, accuracy of the diagnosis is high and reperfusion therapy is performed in over 82%. Inhospital mortality was not different between prehospital fibrinolysis and primary PCI.
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To evaluate the use of a structured training programme in emergency care in Pakistan through the completion of logbooks documenting actual resuscitation attempts. ⋯ Resuscitation logbooks can be used to assess which skills are used in emergency care. This analysis provides some evidence that the skills taught during the ESS-EMCH programme are used by the trained health workers. Individually held and completed logbooks should continue to act as a feedback and audit mechanism to measure outcomes, in conjunction with other methods of evaluating the impact of the training component of this programme.
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Safety precautions during defibrillation and cardioversion are generally taken very seriously. The actual hazard for bystanders and rescuers, however, has rarely been investigated. Recently, continuing chest compressions during defibrillation has been suggested to improve outcome from cardiac arrest. This article is to review reports on electric shocks to persons other than patients and to discuss the pertinent biomedical principles. ⋯ External electric therapy is likely to be safer than traditionally assumed, especially with self-adhesive thoracic electrodes. Sound clinical experiments are urgently needed before safety measures are revised.
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Controlled Clinical Trial
Diffusion and perfusion MRI of the brain in comatose patients treated with mild hypothermia after cardiac arrest: a prospective observational study.
Outcome for resuscitated cardiac arrest (CA) patients is poor. The 1-year survival rate with favourable neurological outcome (CPC 1-2) after out-of-hospital CA is reported to be 4%. Among resuscitated patients treated within an ICU, approximately 50% regain consciousness, whereas the other 50% remain comatose before they die. Induced hypothermia significantly improves the neurological outcome and survival in patients with primary CA who remain comatose after return of spontaneous circulation. ⋯ Diffusion and perfusion MRI are potentially helpful tools for the evaluation of ischaemic brain damage in resuscitated comatose patients treated with hypothermia after CA.