Resuscitation
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The need for rescue breaths in bystander CPR has been questioned after several studies have shown that omitting ventilation does not worsen outcome. Chest compression may produce passive tidal volumes large enough to provide adequate ventilation in animal studies, but no recent clinical studies have examined this phenomenon. We measured passive ventilation during optimal chest compression to determine whether compression-only CPR provides adequate gas exchange during cardiac arrest. ⋯ At an advanced stage of cardiac arrest, passive ventilation during compression-only CPR is limited in its ability to maintain adequate gas exchange, with gas transport mechanisms associated with high frequency ventilation perhaps generating a very limited gas exchange. The effectiveness of passive ventilation during the early stages of CPR, when chest and lung compliance is greater, remains to be investigated.
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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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The purpose of this study was to assess the long-term survival after OHCA. ⋯ Long-term survival after out-of-hospital cardiac arrest in a physician-staffed emergency system was comparable to survival after myocardial infarction with 46% being alive after ten years.
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In 2003, the International Liaison Committee on Resuscitation (ILCOR) published the "Utstein Style for Drowning" (USFD) to advance knowledge on the epidemiology, treatment, and outcome prediction after drowning. Applying the USFD and evaluating its data template for outcome analysis, we report here on the largest study published thus far of drowned children (age 0-14) who underwent attempted resuscitation on cardiopulmonary bypass (CPB). ⋯ Most variables relevant for outcome in drowned children can be documented with the use of the USFD. Additional variables not included in the USFD that have emerged from this study and may predict outcome include serum K+ concentration, rewarming speed, and initial cardiac rhythm.
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Several different ventricular fibrillation (VF) analysis features based on ECG have been reported for shock outcome prediction. In this study we investigated the influence of the time from VF onset to shock delivery (VF duration) and the rhythm before onset of VF, on the probability of return of spontaneous circulation (ROSC). We also analysed how these factors relate to the VF analysis feature median slope. ⋯ Based on our findings, detection of VF during ongoing chest compressions might be valuable because VF of short duration was associated with ROSC. Further, the rhythm before VF affects shock outcome with a perfusing rhythm giving the best prospect. The median slope can be used for shock outcome prediction, but not for determining VF duration. A combination could be beneficial and warrants further studies.