Resuscitation
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Comparative Study
Major bleeding complications in cardiopulmonary resuscitation: the place of thrombolytic therapy in cardiac arrest due to massive pulmonary embolism.
Thrombolytic therapy in patients with massive pulmonary embolism (MPE) and prolonged cardiopulmonary resuscitation (CPR) is subject to debate. This study was performed to determine whether (1) thrombolytic treatment increases the risk of bleeding complications, (2) if the risk of bleeding is influenced by the duration of CPR and if (3) thrombolytic therapy improves outcome. ⋯ Although severe bleeding complications tend to occur more frequently in patients undergoing TL, the benefit of this treatment might outweigh the risk of bleeding.
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Mild resuscitative hypothermia has been shown to improve neurological outcome after cardiac arrest presenting with ventricular fibrillation (VF) due to cardiac causes. We describe the experience of inducing mild hypothermia in three patients with non-cardiac causes of arrest and long delays before a return of spontaneous circulation (ROSC). ⋯ All patients survived to discharge from hospital, and neuropsychological examinations revealed good recovery. It is concluded that mild resuscitative hypothermia may be beneficial also in patients with obvious non-coronary causes for cardiac arrest.
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Comparative Study
Comparison of six clinically used external defibrillators in swine.
External defibrillation has long been practiced with two types of monophasic waveforms, and now four biphasic waveforms are also widely available. Although waveforms and clinical dosing protocols differ among defibrillators, no studies have adequately compared performance of the monophasic or the biphasic waveforms. This is the first study to compare defibrillation efficacy among biphasic external defibrillators, and does so as part of a study comparing all commonly available waveforms using their respective manufacturer-provided and clinically used doses. ⋯ Commonly used MDS and MTE waveforms provide markedly dissimilar efficacies. Despite impedance-compensation schemes in biphasic defibrillators, impedance has an impact on their efficacy. At high-impedance, modest efficacy differences exist among clinically available biphasic defibrillators, reflecting differences in both waveforms and manufacturer-provided doses.
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The in-hospital Utstein template for cardiopulmonary resuscitation (CPR) was assessed in four secondary hospitals (334-441 beds) which did not have systematic data collection. ⋯ The in-hospital Utstein template was logical but laborious and it provided tools for resuscitation management evaluation in the study hospitals. For continuous use, a slightly compressed model may be warranted. In the present material, the overall survival rate to hospital discharge was in line with previous reports but there were somewhat less neurologically satisfactory survivors. There is an evident need to improve the outcome of patients suffering CA on the wards. An important step is to reduce the time interval to defibrillation.