Resuscitation
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The Advanced Life Support (ALS) Provider Course trains healthcare professionals in a standardised approach to the management of a cardiac arrest. In the setting of limited resources for healthcare training, it is important that courses are fit for purpose in addressing the needs of both the individual and healthcare system. This study investigated the use of ALS skills in clinical practice after training on an ALS course amongst members of the cardiac arrest team compared to first responders. ⋯ We believe that the ALS course is more appropriately targeted to members of a cardiac arrest team. In our opinion the recently launched Immediate Life Support course, in parallel with training in the recognition and intervention in the early stages of critical illness, are more appropriate for the occasional or first responder to a cardiac arrest.
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Randomized Controlled Trial Clinical Trial
Hypoxia and hypercapnia during respiration into an artificial air pocket in snow: implications for avalanche survival.
Snow avalanche case reports have documented the survival of skiers apparently without permanent hypoxic sequelae, after prolonged complete burial despite there being only a small air pocket on extrication. We investigated the underlying pathophysiological changes in a prospective, randomised 2 x 2 crossover study in 12 volunteers (28 tests) breathing into an artificial air pocket (1- or 2-l volume) in snow. Peripheral SpO(2), ETCO(2), arterialised capillary blood variables, air pocket O(2) and CO(2), snow density, and snow conditions at the inner surface of the air pocket were determined. ⋯ We conclude that the degree of hypoxia following avalanche burial is dependent on air pocket volume, snow density and unknown individual personal characteristics, yet long-term survival is possible with only a small air pocket. Hence, the definition of an air pocket, "any space surrounding mouth and nose with the proviso of free air passages" is validated as the main criterion for triage and management of avalanche victims. Our experimental model will facilitate evaluating the interrelation between volume and inner surface area of an air pocket for survival of avalanche victims, whilst the present findings have laid the basis for future investigation of possible interactions between hypoxia, hypercapnia, and hypothermia (triple H syndrome) in snow burial.
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To describe the outcome in the Utstein style for out of hospital cardiac arrest in Gothenburg, over a period of 19 years. ⋯ In this large Utstein style study of out of hospital cardiac arrest stretching over almost 19 years, we report high survival rates both for patients suffering a bystander-witnessed cardiac arrest, and for the subgroup suffering a bystander-witnessed cardiac arrest with VF as the first recorded rhythm. These high survival rates can in part be explained by the short time intervals from calls being received by the emergency dispatch centre (EDC) to the arrival of the emergency medical service at the scene.
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Case Reports
Revisiting the cardiac versus thoracic pump mechanism during cardiopulmonary resuscitation.
The mechanism of forward blood flow due to external chest compressions during cardiopulmonary resuscitation (CPR) remains controversial, with the main theories being based on either a cardiac, or thoracic pump mechanism. Both potential mechanisms are well investigated by echocardiographic assessment. In the present case, a postoperative complication of cardiac tamponade that was detected by a thoracoabdominal CT-scan, led to cardiac arrest with subsequent successful CPR over 15 min until definitive surgical management was performed. This observation suggests that the thoracic pump mechanism may have been the predominant mechanism of forward blood flow in the present case of a pericardial tamponade.