Resuscitation
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Patients with unexpected in-hospital cardiac arrest often have an abnormal clinical observation prior to the arrest. Previous studies have suggested that a medical emergency team responding to such patients may decrease in-hospital mortality from cardiac arrest, but the association between any abnormal clinical observation and subsequent increased mortality has not been studied prospectively. The aim of this study was to determine the predictive value of selected abnormal clinical observations in a ward population for subsequent in-hospital mortality. ⋯ Six abnormal clinical observations are associated with a high risk of mortality for in-hospital patients. These observations should be included as criteria for the early identification of patients at higher risk of unexpected in-hospital cardiac arrest.
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Multicenter Study Clinical Trial Controlled Clinical Trial
A prospective, multicenter pilot study to evaluate the feasibility and safety of using the CoolGard System and Icy catheter following cardiac arrest.
Cardiac arrest causes devastating neurological morbidity and mortality. Mild/moderate hypothermia is neuroprotective after global cerebral ischemia. More rapid controlled attainment of the target temperature may increase efficacy. ⋯ In comatose survivors of cardiac arrest, hypothermia via endovascular methods is safe and feasible, and target temperatures can be achieved and controlled rapidly and precisely. More studies are needed to assess the efficacy of rapid endovascular hypothermia after cardiac arrest.
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The timing and use of norepinephrine (noradrenaline) (NE) in septic shock remain a matter of controversy. ⋯ Early and exclusive use of NE in hyperdynamic septic shock achieved a stable MAP >75 mmHg in all patients. Survival compared favorably with that predicted by illness severity scores.
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In general automated external defibrillators (AED) are handled easily, but some untrained lay rescuers may have major problems with the use of such products. This may result in delayed shock delivery and delay in basic life support (BLS) after use of the AED. To study the effect of voice prompts and design solutions we tested the time from the first shock to the initiation of BLS for six defibrillators available in Austria. ⋯ We demonstrated that there are significant differences between AEDs, concerning important operational outcomes like time to first shock and the start of BLS. Further research and development is urgently required to optimise user-friendliness and operational outcomes.
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Immediate accessibility to automated external defibrillators (AED) is recommended for highly frequented public areas. In train terminals and metro stations electromagnetic interference (EMI) is present. In preparation for a public access defibrillation (PAD) programme in this environment possible effects on AED safety and accuracy were studied. ⋯ Shock advisory systems of some AED models are susceptible to electromagnetic interference, especially in terminals with 15 kV 16 2/3 Hz ac power supplies. Interference is minimized, if patient position is parallel and electrode cables are perpendicular to overhead line. The choice of AED model for train or metro stations depends on its lack of susceptibility to typical electromagnetic interference.