Resuscitation
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Although early care in out-of-hospital cardiac arrest has been improved over the past decades, survival remains poor and neurological performance after survival is often impaired. Consequently, new therapies are needed to improve outcome. ⋯ Both therapies can restore coronary and pulmonary perfusion in cardiac arrest patients and, additionally, fibrinolysis might prevent microthrombi to the brain. In this review, the rationale, safety and efficacy of reperfusion therapy in patients with out-of-hospital cardiac arrest will be discussed.
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Semi-automatic defibrillation requires pauses in chest compressions during ECG analysis and charging, and prolonged pre-shock compression pauses reduce the chance of a return of spontaneous circulation (ROSC). We hypothesised that pauses are shorter for manual defibrillation by trained rescuers, but with an increased number of inappropriate shocks given for a non-VF/VT rhythm. ⋯ Manual defibrillation resulted in shorter pauses in chest compressions, but a higher frequency of inappropriate shocks. A higher formal level of education did not prevent inappropriate shocks. Trial registrationhttp://www.clinicaltrials.gov/ (NCT00138996 and NCT00228293).
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To investigate the potential for finding an alternative for the 'pulse check' during CPR, we studied the use of thoracic impedance measured via the defibrillator pads for circulation assessment during CPR. ⋯ We have shown that the circulation-related information found in the impedance signal may be used for circulatory assessment, especially the recognition of restoration of spontaneous circulation after cardiac arrest.
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Emergency medical dispatchers are the entry points to the emergency medical services (EMS). The overall performances of the dispatchers are imperative determinants of the emergency medical services dispatching system. There is little data on the cultural and language impacts on emergency medical dispatch. ⋯ Most callers were found to be emotional stable and cooperative with dispatcher's interrogations when calling for cardiac arrest victims in this Mandarin speaking population. The dispatchers have shown satisfactory interview skills in approaching emergency calls and a good ability to identify OHCA. There is a low rate of T-CPR offered to the callers in the investigation. Efforts should be made to address the deficiencies in order to maximise the function of the EMS.
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The duration of untreated ventricular fibrillation (VF) is of paramount importance for CPR success. Moreover, therapeutic interventions taking into account the interval between cardiac arrest onset and initiation of CPR improve outcome. This study was performed to investigate whether VF feature analysis could be used to estimate the duration of VF in patients with out-of-hospital cardiac arrest. ⋯ The correlation between VF ECG features and cardiac arrest times was investigated using Pearson's correlation coefficient in a subset of 40 patients with reliably estimated downtimes and artefact-free initial VF tracings. No significant correlation (p<.05) between any of the VF ECG features and downtime could be found. The duration of cardiac arrest could not be estimated reliably from human VF ECG single feature analysis.