Resuscitation
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A non-linear mathematical model of the oesophagus was developed to study the effects of non-invasive ventilation variables on the severity of gastric inflation. The model was based on the non-linear physical characteristics of biological tissue. The model simulated oesophageal mechanical function during non-invasive ventilation in cardiac arrest (2:30 ventilations/chest compressions cycles) and respiratory arrest (1:5 ventilations/s) as recommended by the European Resuscitation Council (ERC) in its 2005 guidelines for adult basic and advanced life support. ⋯ The model indicates that the time required for the air trapped in the oesophagus to completely deflate is approximately 2 s. This may be longer than the expiratory time recommended by the 2005 guidelines. Model predictions support the 2005 guidelines regarding the decrease in the tidal volume and in the inspiratory pressure in an effort to minimise gastric inflation.
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Adrenaline (epinephrine) is used during cardiopulmonary resuscitation (CPR) based on animal experiments without supportive clinical data. Clinically CPR was reported recently to have much poorer quality than expected from international guidelines and what is generally done in laboratory experiments. We have studied the haemodynamic effects of adrenaline during CPR with good laboratory quality and with quality simulating clinical findings and the feasibility of monitoring these effects through VF waveform analysis. ⋯ Adrenaline improved haemodynamics during laboratory quality CPR in pigs, but not with quality simulating clinically reported CPR performance.
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Biography Historical Article
The resuscitation greats. Dr. William Cullen and Lord Cathcart.
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Randomized Controlled Trial Multicenter Study
Quality of lay person CPR performance with compression: ventilation ratios 15:2, 30:2 or continuous chest compressions without ventilations on manikins.
The new CPR guidelines emphasise chest compression depth and have increased the compression:ventilation ratio to cause less time intervals without chest compressions. How this change may influence the quality of chest compressions is not documented. Sixty-eight volunteers among travellers at Oslo international airport and a senior citizen centre performed 5 min of CPR on a manikin with compression:ventilation ratios 15:2, 30:2 or continuous chest compressions. ⋯ Number of compressions per minute was 40 +/- 9, 43 +/- 14 and 73 +/- 24 and percent no flow time 49 +/- 13%, 38 +/- 20% and 1 +/- 2%, respectively. In conclusion, continuous chest compressions without ventilations gave significantly more chest compressions per minute, but with decreased compression quality. No flow time for 30:2 was significantly less than for 15:2.
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Randomized Controlled Trial
Incomplete chest wall decompression: a clinical evaluation of CPR performance by trained laypersons and an assessment of alternative manual chest compression-decompression techniques.
Complete chest wall recoil improves hemodynamics during CPR by generating relatively negative intrathoracic pressure, which draws venous blood back to the heart, providing cardiac preload prior to the next chest compression. ⋯ The Hands-Off Technique decreased compression duty cycle but was 46.3 times more likely to provide complete chest wall recoil (OR: 46.3; CI: 16.4-130.3) compared to the Standard Hand Position without differences in accuracy of hand placement, adequate depth of compression, or perceived discomfort with its use. All forms of manual CPR tested (including the Standard Hand Position) in trained laypersons produced an inadequate depth of compression for two-thirds of the time. These data support development and testing of more effective layperson CPR training programmes and more effective means to deliver manual as well as mechanical CPR.