Resuscitation
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Randomized Controlled Trial Multicenter Study Comparative Study
Advanced life support cardiac arrest scenario test evaluation.
The cardiac arrest scenario test (CASTest) is a central component of the assessment strategy on the Advanced Life Support Course. The aim of this study was to establish equivalence between the four different CASTest scenarios and investigate the impact of profession, candidate order and course centre on the pass rate. ⋯ The CASTest assessment scenarios used during ALS testing appear equivalent in terms of difficulty. In contrast, the professional background of the candidate and centre at which the assessment is performed do significantly influence the likelihood of passing the assessment. Further evaluation of the reasons for differences between course centres is required.
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More than 160,000 people suffer sudden cardiac death each year in the US. It is estimated that ventricular fibrillation (VF) is the initial rhythm in approximately 30% of these cases. Ventricular fibrillation that does not respond to the first few defibrillation attempts is associated with mortality rates of up to 97%. ⋯ While no significant detrimental effects directly related to low dose beta-blockade during VF have been reported in the studies reviewed, concerns relating to possible loss of myocardial contractility and hypotension remain. To this day, high quality human trials are lacking. Preliminary human studies are needed to assess the effects of beta-blockers in the treatment of cardiac arrest from ventricular fibrillation or pulseless VT further.
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Review Case Reports
Acute respiratory failure leading to emergency intubation: an unusual manifestation of Munchausen's syndrome.
Munchausen's syndrome is a contrived psychiatric disorder, in which patients present with an intentionally produced or feigned illness with the aim to assume the sick role and to gain medical attention. Patients may even seek the application of invasive procedures, sometimes with serious risk to life. ⋯ This case report may contribute to the awareness among emergency physicians of Munchausen's syndrome as a differential diagnosis of respiratory failure. Recognition of this psychiatric disease is not only important for correct medical diagnosis and treatment, but also essential in protecting the patients from unnecessary invasive and aggressive medical procedures.
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Questions remain about the optimal timing and method for treating ventricular fibrillation (VF) during out-of-hospital cardiac arrest, and a variety of treatment protocols are used. Detailed description of rescue shock outcomes during actual patient care under different protocols would allow rational comparison of treatment strategies. The purpose of this study is to describe rescue shock outcomes in a single system using a specific defibrillation protocol. ⋯ Witnessed collapse and an initial rhythm other than asystole were associated with an increased likelihood of rescue shock success. There is a small but real incremental gain in ROSC and ROEA from delivering three rescue shocks in rapid succession. The greater incidence of rescue shock success with later rescue shocks suggests that VF responds favorably to ongoing resuscitation.
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Mechanical chest compression may be necessary to make coronary intervention possible during resuscitation. We report our experience using the Lund University Cardiac Arrest System (LUCAS, Jolife, Lund, Sweden) which is a gas-driven sternal compression device that incorporates a suction cup for active decompression. During the last 13 months LUCAS has been used in our catheterisation laboratory to maintain adequate organ perfusion pressure in 13 patients with cardiac arrest or severe hypotension and bradycardia (male/female ratio 1.6, mean age 59+/-19). ⋯ In two cases we found inadequate flow in the anterior descending artery, and in one case the invasive measurements revealed inadequate coronary perfusion pressure. There were no excessive intra-thoracic or intra-abdominal injuries. We conclude that the LUCAS device is suitable during cardiac catheterisation and intervention, and the device ensures an adequate systemic blood pressure in most patients without life-threatening injuries.