Resuscitation
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Review
Goal-directed hemodynamic optimization in the post-cardiac arrest syndrome: a systematic review.
The treatment recommendations from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science (hosted by the American Heart Association) advocate a goal-directed treatment strategy for hemodynamic optimization after return of spontaneous circulation (ROSC) in post-cardiac arrest care. We performed a systematic review to (1) examine the available evidence for goal-directed hemodynamic support in the post-cardiac arrest syndrome, (2) determine the effect of such a treatment strategy on survival, and (3) define the specific hemodynamic goals, if any, that have been tested in clinical trials of post-cardiac arrest patients. ⋯ To date, no clinical trials have examined hemodynamic optimization in post-cardiac arrest patients. Although clinical acumen may support the concept that hemodynamic derangements after ROSC should be normalized, there is currently no evidence available to indicate the best strategy for goal-directed hemodynamic support. The current study indicates the need for future clinical investigations designed to determine both the efficacy of hemodynamic optimization in post-cardiac arrest patients and the best endpoints to target as part of a goal-directed strategy.
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Randomized Controlled Trial Comparative Study
The effectiveness of cardiopulmonary resuscitation instruction: animation versus dispatcher through a cellular phone.
We developed a cardiopulmonary resuscitation (CPR) instruction programme using motion capture animation integrated into cellular phones. We compared the effectiveness of animation-assisted CPR instruction with dispatcher-assisted instruction in participants with no previous CPR training. ⋯ Audiovisual animated CPR instruction through a cellular phone resulted in better scores in checklist assessment and time interval compliance in participants without CPR skill compared to those who received CPR instructions from a dispatcher; however, the accuracy of important psychomotor skill measures was unsatisfactory in both groups.
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Multicenter Study
Time used for ventilation in two-rescuer CPR with a bag-valve-mask device during out-of-hospital cardiac arrest.
Professional rescuers only deliver chest compressions 39% of the available time before intubation during out-of-hospital cardiac arrest. In manikin-studies lay rescuers need approximately 15s to deliver two ventilations. It is not known how much time professional rescuers use for two ventilations and we hypothesised that the time used for two ventilations with a bag-valve-mask device before tracheal intubation is longer than recommended and that the extended time contributes to the high no flow time. ⋯ Professional rescuers delivered two bag-valve-mask ventilations within the 5-6s as indicated in the 2000 Guidelines, slightly longer than the 3-4s recommended in the 2005 Guidelines. However, only half the pauses were used for two ventilations, and the total time for two ventilations accounted for only 27% of the time without chest compressions. Excessive time for ventilation cannot explain the high no-flow time during CPR by professional rescuers before intubation.
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Multicenter Study
Cardiac arrest patients rarely receive chest compressions before ambulance arrival despite the availability of pre-arrival CPR instructions.
To determine the proportion of out-of-hospital cardiac arrest (OOHCA) patients who received chest compressions, before EMS arrival, from bystanders who called the EMS emergency telephone number (9-1-1) at dispatch centers that provided telephone CPR instructions and to describe barriers to following instructions. ⋯ Few 9-1-1 callers provided chest compressions following telephone CPR instructions that included airway and breathing steps. The majority of callers were unwilling or emotionally or physically unable to follow the instructions.
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Good quality basic life support (BLS) results in better survival. BLS is a core competence of nurses but despite regular refresher training, the quality of BLS is often poor and the reasons for this are not well known. We therefore investigated the relation between BLS quality and some of its potential determinants. ⋯ Male gender, greater self-confidence, recent BLS training and recent CPR were associated with better quality of BLS.