Resuscitation
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Comparative Study
Outcome prediction for guidance of initial resuscitation protocol: Shock first or CPR first.
Ventricular fibrillation (VF) is treated optimally with a defibrillation shock shortly after patient collapse, but may benefit from initial cardiopulmonary resuscitation (CPR) if the shock is delayed. An objective measure of potential responsiveness to defibrillation could help decide optimal initial therapy. ⋯ Both call-to-shock interval and a real-time ECG analysis are predictive of patient outcome. The ECG analysis is more predictive of neurologically intact survival. Moreover, the ECG analysis is dependent only upon the patient's condition at the time of treatment, with no need for knowledge of the response interval, which may be difficult to estimate at the time of treatment.
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We reported previously that therapeutic hypothermia with extracorporeal lung and heart assist (ECLHA) improved neurological outcome after 15 min cardiac arrest (CA) in dogs, although 45 min was needed to achieve hypothermia. We now investigate whether rapidly induced hypothermia with ECLHA (RHE) would result in a better outcome than slowly induced hypothermia with ECLHA (SHE) in dogs. ⋯ Rapid hypothermic induction might be an important factor to improve neurological outcomes in prolonged CA models.
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Review Comparative Study
Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review.
Pre-hospital insertion of chest tubes or decompression of air within the pleural space is one of the controversial topics in emergency medical care of trauma patients. While a wide variety of opinions exist medical personnel on the scene require guidance in situations when tension pneumothorax or progressive pneumothorax is suspected. To ensure evidence based decisions we performed a systematic review of the current literature with respect to the diagnostic accuracy in the pre-hospital setting to identify patients with (tension) pneumothorax, the efficacy and safety of performing pleural decompression in the field and the choice of method and technique for the procedure. The evidence found is presented and discussed and recommendations are drawn from the authors' perspective.
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Randomized Controlled Trial
Hypertonic saline during CPR: Feasibility and safety of a new protocol of fluid management during resuscitation.
In experimental studies infusion of hypertonic saline during cardiopulmonary resuscitation (CPR) increased resuscitation success rate and improved myocardial and cerebral reperfusion during CPR. We tested the feasibility and the safety of this new therapeutic measure in a randomised, preclinical pilot study. ⋯ HHS after CA is feasible and safe and might improve short term survival after CPR. However, whether giving HHS could be a useful measure to increase resuscitation success after out-of-hospital CA requires a larger preclinical trial.
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To determine the out-of-hospital cardiac arrest survival rate, and prevalence of modifiable factors associated with survival, in Detroit, Michigan, over a 6-month period of time in 2002. ⋯ In this urban setting, out-of-hospital cardiac arrest is an almost uniformly fatal event.