Resuscitation
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Randomized Controlled Trial
Impact of adding video communication to dispatch instructions on the quality of rescue breathing in simulated cardiac arrests--a randomized controlled study.
Both ventilations and compressions are important for victims of prolonged cardiopulmonary resuscitation (CPR) and asphyxial arrest. Dispatch assistance increases bystander CPR, but the quality of dispatcher-assisted CPR (DA-CPR), especially rescue breathing, remains unsatisfactory. This study was conducted to assess the impact of adding interactive video communication to dispatch instructions on the quality of rescue breathing in simulated cardiac arrests. ⋯ Adding video communication to dispatch instructions improved the quality of bystander rescue breathing, including higher proportion of airway opened, and larger volume of ventilation delivered, in simulated cardiac arrests.
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The response of recurrent episodes of ventricular fibrillation (VF) to defibrillation shocks has not been systematically studied. We analyzed outcomes from countershocks delivered for VF during advanced life support (ALS) care of patients with out-of-hospital cardiac arrest. ⋯ Repeated refibrillation is common in patients with VF cardiac arrest. The likelihood of countershocks to terminate VF declines for repeated episodes of VF, yet shocks that terminate these episodes result increasingly in a sustained organized rhythm.
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To explore the use of pre-hospital heart rate variability (HRV) as a predictor of clinical outcomes such as hospital admission, intensive care unit (ICU) admission and mortality. We also implemented an automated pre-analysis signal processing algorithm and multiple principal component analysis (PCA) for outcomes. ⋯ With signal processing techniques, it is feasible to filter and analyze ambulance ECG data for HRV. We found a combination of HRV parameters and traditional 'vital signs' to have an association with clinical outcomes in pre-hospital patients. This may have potential as a triage tool for ambulance patients.
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To investigate the effect of therapeutic hypothermia in the prognostic value of the pituitary-adrenal axis in comatose patients after cardiac arrest. ⋯ In comatose patients resuscitated from cardiac arrest, the pituitary-adrenal axis is activated particularly in those dying in the ICU, irrespective of therapeutic hypothermia. Hence, activation of the axis may be a marker of fatal cerebral damage. There is no firm evidence for relative adrenal insufficiency associated with death and a transiently blunted cortisol response to ACTH in non-survivors may be attributed to higher baseline values.
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We have observed consistent hemodynamic patterns after restoration of spontaneous circulation (ROSC) after ventricular fibrillation (VF) cardiac arrest. We sought to characterize the time-course of these patterns, and to determine whether these differed based on duration of the VF insult. ⋯ There are two distinct phases of hemodynamic change after resuscitation of VF. The first phase is a brief hyperdynamic phase. The second phase is either stabilization or cardiovascular collapse. When VF is brief, blood pressures often return to normal without exogenous support. When VF was prolonged animals were rescued with exogenous pressor. Healthcare providers should be prepared to provide pressor support for patients having ROSC after prolonged VF.