Resuscitation
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The aim of our study was to compare poly(ADP-ribose) polymerase (PARP) activity levels in a porcine model of hemorrhagic shock and resuscitation. ⋯ In our model of porcine hemorrhagic shock, PARP activity levels increased during hemorrhagic shock. However, this increase in PARP activity levels was transient as they returned to baseline regardless of resuscitation strategy. Interestingly, PARP activity levels were significantly higher during hemorrhagic shock in non-survivors compared to survivors. These findings suggest that PARP activity may be a part of initial pathways leading from hemorrhagic shock to death.
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To examine survival rates for paediatric trauma patients requiring cardiopulmonary resuscitation (CPR) in the pre-hospital setting, and to identify characteristics that may be associated with survival. ⋯ This study confirms the poor outcome for children requiring pre-hospital CPR following trauma. However, the results are better in this physician-attended group than in other studies where physicians were not present. They also suggest that cardiac arrest associated with trauma in children has a better outcome than in adults. In common with adults treated in this system, those patients with hypovolaemic cardiac arrest did not survive (Ann Emerg Med 2006;48:240-4). A large proportion of the survivors suffered hypoxic or asphyxial injuries. Targeted aggressive out-of-hospital resuscitation in certain patient groups can produce good outcomes.
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Systemic and microvascular hemodynamic responses to transfusion of oxygen using functional and non-functional packed fresh red blood cells (RBCs) from hemorrhagic shock were studied in the hamster window chamber model to determine the significance of RBCs on rheological and oxygen transport properties. Moderate hemorrhagic shock was induced by arterial controlled bleeding of 50% of the blood volume, and a hypovolemic state was maintained for 1h. Volume restitution was performed by infusion of the equivalent of 2.5 units of packed cells, and the animals were followed for 90 min. ⋯ Functional capillary density (FCD) was substantially higher for transfusion versus HES, and the presence of MetHb in the fresh RBC did not change FCD or microvascular hemodynamics. Oxygen delivery and extraction were significantly lower for resuscitation with HES and MetRBC compared to OxyRBC. Incomplete re-establishment of perfusion after resuscitation with HES could also be a consequence of the inappropriate restoration of blood rheological properties which unbalance compensatory mechanisms, and appear to be independent of the reduction in oxygen carrying capacity.
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Emergency preservation and resuscitation (EPR) is a new approach for resuscitation of exsanguination cardiac arrest (CA) victims to buy time for surgical hemostasis. EPR uses a cold aortic flush to induce deep hypothermic preservation, followed by resuscitation with cardiopulmonary bypass (CPB). We previously reported that 20 min of EPR was feasible with intact outcome. ⋯ In conclusion, we have shown that 60 min of EPR after exsanguination CA is associated with survival and favorable neurological outcome, while 75 min of EPR results in significant mortality and neurological damage in survivors. Surprisingly, extracerebral lesions predominated at 75-min EPR group. This model should serve as a screening model both for testing new pharmacological adjuncts to improve survival after exsanguination CA, and for elucidating the underlying mechanisms of ischemia/reperfusion injury.
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Due to motion artifact in the ECG caused by chest compressions automatic external defibrillators (AEDs) have difficulty recognizing ventricular fibrillation (VF) during cardiopulmonary resuscitation (CPR). Frequent interruption of CPR is required for artifact-free ECG interpretation, but these interruptions reduce the efficacy of CPR. We developed a motion artifact reduction system (MARS), based on adaptive noise cancellation techniques, for use during CPR. We hypothesized that this system would allow for automated rhythm discrimination during uninterrupted CPR. ⋯ Motion artifact reduction by adaptive noise cancellation allows for recognition of VF during uninterrupted automated CPR, while this is rarely possible based on the raw ECG. Incorporation of this signal processing strategy may obviate the need for interruptions in chest compression and thus enhance CPR efficacy.