Resuscitation
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Comparative Study
Mortality after trauma intubation without drugs in Scottish emergency departments.
Trauma patients who are intubated without anaesthetic drugs in the pre-hospital phase of care have universally poor outcomes. This study aimed to determine the mortality of trauma patients intubated without drugs in emergency departments in Scotland. ⋯ Trauma patients in Scottish emergency departments who are intubated without drugs have high mortality rates. Outcomes are not universally fatal and aggressive resuscitation efforts may be of benefit to a small number of such patients.
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Bystander basic life support (BLS) is an important part of cardiopulmonary resuscitation (CPR) and improves outcome after out-of-hospital cardiac arrest. However, the general population has poor BLS skills. Several training initiatives could be used to improve this situation and the challenge is to find the most efficient one. ⋯ When assessed after 3 months, a 24 min DVD-based instruction plus subsequent self-training in BLS appears equally effective compared to a 6h BLS course and hence is more efficient.
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Comparative Study
Application of normothermic cardiac arrest algorithms to hypothermic cardiac arrest in a canine model.
International guidelines (2000) do not recommend vasopressor and antiarrhythmic medications during ventricular fibrillation (VF) with a core temperature below 30 degrees C. The efficacy of normothermic AHA algorithms using standard doses of epinephrine (EPI) (adrenaline) followed by amiodarone (AMIO) in hypothermic VF is uncertain. ⋯ In this model of severe hypothermia, the use of standard 2000 protocols for VF resulted in a significant increase of CPP, and, a higher ROSC rate compared to placebo controls. This study suggests that AHA normothermic algorithms may be beneficial in severe hypothermia.
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Comparative Study
Feasibility study of epinephrine administration via laryngeal mask airway using a porcine model.
The laryngeal mask airway (LMA) is gaining wide application as an alternative method of maintaining the airway in situations including general anaesthesia, for difficult airways and pre-hospital resuscitation. During resuscitation, drug administration via an LMA is sometimes warranted when vascular accesses cannot be established immediately. Therefore, we conducted a study on the feasibility of drug administration via the laryngeal mask airway. ⋯ No significant difference was demonstrated comparing the PPE levels for Groups 2 and 4. Further, no differences were noted comparing the mean arterial blood pressure and heart rate between these two groups. In this non-arrest adult porcine model we conclude that epinephrine delivered via a catheter passing through the LMA can provide a similar effect as administration via the tracheal tube.
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Over the last 15 years supraglottic airway devices (SADs), most notably the classic laryngeal mask airway (LMA) have revolutionised airway management in anaesthesia. In contrast for resuscitation, both in and outside hospital, facemask ventilation and tracheal intubation remain the mainstays of airway management. However there is evidence that both these techniques have complications and are often poorly performed by inexperienced personnel. ⋯ This pragmatic review examines recent developments in SAD technology and the relevance of this to the potential for using SADs during resuscitation. In addition to examining research directly related to resuscitation both on bench models and in patients the review also examines evidence from anaesthetic practice. SADS discussed include the classic, intubating and Proseal LMAs, the combitube, the laryngeal tube, laryngeal tube sonda mark I and II and single use laryngeal masks.