Resuscitation
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Comparative Study
Rapid cardiac ultrasound of inpatients suffering PEA arrest performed by nonexpert sonographers.
Cardiac arrest presenting as pulseless electrical activity (PEA) currently has a very low survival rate. Many of the conditions underlying PEA (cardiac tamponade, hypovolemia, and pulmonary embolus) are associated with specific cardiac ultrasound findings. The aim of this study was to evaluate a rapid cardiac ultrasound assessment performed by trained nonexpert sonographers integrated into the ACLS response system at a major medical center. ⋯ Rapid cardiac sonography can be successfully integrated in the ACLS response. Nonexpert sonographers may be able to provide useful interpretive information when sufficiently trained.
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Automated external defibrillators (AEDs) are currently not recommended for use in children under 1 year of age. We report the first description of successful AED defibrillation in an infant using a 50 J shock and provide rationale for employing these life-saving devices in infants at risk for sudden cardiac death.
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Comparative Study
Independent evaluation of a defibrillation outcome predictor for out-of-hospital cardiac arrested patients.
We evaluated the ability of a previously derived outcome predictor to discriminate between ECG segments corresponding to return of spontaneous circulation (ROSC) or not in validation data from 136 patients with cardiac arrest. The new data used for validation were totally independent from the predictor derivation data used in the original study. ⋯ Outcome predictor performance was reproducible. As in the present study, future testing should be performed on totally independent data not included in the design of the outcome predictor to get a reliable impression of expected performance.
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Comparative Study
Use of an impedance threshold device improves short-term outcomes following out-of-hospital cardiac arrest.
An impedance threshold device (ITD) has been developed for the treatment of cardiac arrest to augment circulation to the heart and brain during cardiopulmonary resuscitation (CPR). The ITD has ventilation timing lights that flash at 12 min(-1) to discourage excessive ventilation rates. ⋯ The ITD was used safely and effectively in a large, diverse EMS system and markedly improved short-term survival for adult patients in non-traumatic cardiac arrest.
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Lung inflation is the most important, and most difficult step in newborn resuscitation. A wide variety of devices are used to achieve lung inflation, but there are relatively few data to guide clinicians in their choice of device. ⋯ These data do not support use of 240-ml or 500-ml self-inflating bags for resuscitation of newborn term infants. A variable pressure T piece blow-off system may be the easiest device to use for newborn resuscitation and the most reliable at delivering desired pressures for set times.