Resuscitation
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Comparative Study
External artifacts by advanced life support providers misleading automated external defibrillators.
The ECG analysis algorithm of automated external defibrillators (AEDs) shows reduced sensitivity and specificity in the presence of external artifacts. Therefore, ECG analyses are preceded by voice prompts. We investigated if advanced life support (ALS) providers follow these prompts, and the consequences if they do not. ⋯ External artifacts were frequently found, sometimes leading to important errors. Consequently, more training is needed, especially for ALS providers.
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The only large-scale report (1988) by the Israeli national ambulance service Magen David Adom (MDA) on the outcome of cardiac arrest victims who underwent cardiopulmonary resuscitation (CPR) by paramedics called for more frequent and more promptly initiated CPR and shorter time to arrival of paramedic care to improve survival. We report the 1987-2007 experience of resuscitation of out-of-hospital cardiac arrest victims who were 'SHL'-Telemedicine subscribers and who underwent CPR by SHL-Telemedicine mobile intensive care units (MICUs) personnel or under their instructions. ⋯ 'SHL'-Telemedicine's policy of bi-monthly contact with its subscribers led to heightened awareness of warning signs and need for rapid summoning of medical assistance in the setting of out-of-hospital sudden cardiac arrest.
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To review the epidemiology, pathophysiology, treatment and prognostication in relation to the post-cardiac arrest syndrome. ⋯ A growing body of knowledge suggests that the individual components of the post-cardiac arrest syndrome are potentially treatable.
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Randomized Controlled Trial Comparative Study
The Medical Emergency Team System and not-for-resuscitation orders: results from the MERIT study.
To examine NFR orders in relation to adverse events and emergency team calls in hospitals with or without a Medical Emergency Team (MET) system during the MERIT study. ⋯ In a cohort of Australian hospitals, most deaths occurred in patients with a previously documented NFR order but NFR orders were uncommon before cardiac arrest calls or unplanned ICU admissions. During the conduct of a cluster randomised controlled trial, more NFR orders were issued by emergency teams in those hospitals that implemented a MET system than in control hospitals. MET allocation, teaching hospital status, number of hospital beds and metropolitan location could only explain less than 50% of variance in NFR orders.
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Comparative Study
Rhythmic abdominal compression CPR ventilates without supplemental breaths and provides effective blood circulation.
Standard chest-compression CPR has an out-of-hospital resuscitation rate of less than 10% and can result in rib fractures or mouth-to-mouth transfer of infection. Recently, we introduced a new CPR method that utilizes only rhythmic abdominal compressions (OAC-CPR). The present study compares ventilation and hemodynamics produced by chest and abdominal compression CPR. ⋯ OAC-CPR generated ventilatory volumes significantly greater than the dead space and produced equivalent, or larger, CPP than with chest compressions. Thus, OAC-CPR ventilates a subject, eliminating the need for mouth-to-mouth breathing, and effectively circulates blood during VF without breaking ribs. Furthermore, this technique is simple to perform, can be administered by a single rescuer, and should reduce bystander reluctance to administer CPR.