Resuscitation
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Although modern defibrillators are nearly always successful in terminating ventricular fibrillation (VF), multiple defibrillation attempts are usually required to achieve return of spontaneous circulation (ROSC). This is potentially deleterious as cardiopulmonary resuscitation (CPR) must be discontinued during each defibrillation attempt which causes deterioration in the heart muscle and reduces the chance of ROSC from later defibrillation attempts. In this work defibrillation outcomes are predicted prior to electrical shocks using a neural network model to analyse VF time series in an attempt to avoid defibrillation attempts that do not result in ROSC. ⋯ Pre-shock VF ECG time series can be classified according to the defibrillation conversion to a return of spontaneous circulation (ROSC) or No-ROSC.
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To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts. ⋯ Survival to discharge from hospital in all cases of OHCA was 6.2% but 20.5% in witnessed, presumed cardiac aetiology in VF. The decision to withhold resuscitation was based upon presumed prolonged anoxia in the majority of cases.
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Outcome following cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress toward international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports of cardiac arrest, international registries have yet to be developed. ⋯ It is anticipated that the revised template will enable better and more accurate completion of all reports of cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage, confidentiality, management, and registry implementation are acknowledged and potential solutions offered. Uniform collection and tracking of registry data should enable better continuous quality improvement within every hospital, EMS system, and community.
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The forensic records were reviewed of 1823 deaths referred to Edinburgh City Mortuary for autopsy over a 15-month period, 2000-2001; 499 cases (343 males, 156 females) that received CPR prior to death were studied. Rib fractures were found in 29%, sternal fracture in 14%, and 11% of cases showed external chest wall bruising or abrasion. More females sustained rib fractures than males (37% versus 26%; P <0.05). ⋯ The incidence of rib fractures increased with age (P <0.001). There was no significant difference in the number of left or right ribs fractured (P=0.631). This study incorporates all cases of in and out-of-hospital CPR and does not discriminate for the CPR provider or technique employed, therefore, providing a current and representative overview of the incidence of rib and sternal fractures in non-survivors of CPR.