Resuscitation
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In-hospital cardiopulmonary resuscitation (CPR) has seen a steady increase in the application of technology and techniques since the introduction of closed cardiac massage in 1960. Despite this progress, there has not been a demonstrated improvement in survival rates after in-hospital cardiac arrest over the last 40 years. Identification of prognostic factors associated with survival after a resuscitation attempt can help physician decisions and patients' end-of-life choices in a pre-arrest situation. ⋯ Survival after in-hospital cardiopulmonary arrest is poor and can be estimated by using clinical variables. If validated in a large prospective trial, this score could help physicians in attempting resuscitation, patients and families in making end-of-life decisions and hospitals in resource allocation.
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Comparative Study
Percutaneous transcricoid jet ventilation compared with surgical cricothyroidotomy in a sheep airway salvage model.
We developed a large animal model of the "cannot intubate/cannot ventilate" (CNI/V) scenario to compare percutaneous transcricoid manual jet ventilation (MJV) with surgical cricothyroidotomy (SC). ⋯ Using a realistic model of CNI/V we found no difference in respiratory or hemodynamic variables between MJV and SC. Adequate ventilation and perfusion was maintained solely by MJV for up to 20 min.
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Randomized Controlled Trial Clinical Trial
A pilot randomised trial of thrombolysis in cardiac arrest (The TICA trial).
The outcome after out of hospital cardiac arrest is dismal. Thrombolysis during CPR has been advocated. Our hypothesis was that early administration of bolus thrombolysis could lead to improved survival from out of hospital cardiac arrest. ⋯ In this pilot study, we found the use of early bolus tenecteplase for OHCA to be feasible, and that it appears to increase the rate of ROSC. Larger studies are required to determine if this translates into a survival benefit. Appropriate patient selection for OHCA studies remains problematic.