Resuscitation
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Comparative Study
Does the compression to ventilation ratio affect the quality of CPR: a simulation study.
Experience has shown that better quality CPR leads to a greater chance of a patient surviving a cardiac arrest. Simple CPR techniques, such as using only chest compressions, lead to better skill retention and greater willingness to attempt resuscitation on strangers. However, it is not clear from clinical or experimental studies whether such techniques offer any physiological benefit over more usual 5:1 or 15:2 compression:ventilation ratios. ⋯ The best oxygen delivery was provided by continuous chest compression in the early stages of CPR. After 3-4 min however, hypoxia meant that continuous compressions became worse than the other techniques. Spontaneous gasping by the patient during CPR was able to extend the effectiveness of chest compression only CPR for much longer.
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Recently, a new device for minimally invasive direct cardiac massage (MIDCM) has been developed. In animal models of cardiopulmonary resuscitation MIDCM has been shown to provide better organ perfusion than external chest compressions (ECC) massage. Since this device has been developed to improve cardiopulmonary resuscitation in humans, its use must be simple. Thus, we measured the time required for the insertion of the MIDCM device on human cadavers. ⋯ The MIDCM device can be placed in a few seconds in human cadavers by physicians familiar with chest drain insertion. Theoretical course and training with the device may be useful especially for those who are not familiar with chest drain insertion.
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Synthetic starch solution, such as hydroxyethyl starch (HES), has been used clinically to restore cardiovascular volume in patients with hemorrhagic shock. Several HES solutions are available clinically, but each HES has a broad range of molecular mass fractions. We performed comparative studies of extremely low and high molecular HES to evaluate the effects of these HES solutions on lung lymph filtration during resuscitation. ⋯ There was no significant difference in increased lung lymph flow between low molecular HES and NS. However, lung lymph flow after high molecular HES was significantly less than that after low molecular HES. These data suggest that low molecular HES is as useful a plasma substitute as high molecular HES, but has a possibility to increase lung lymph filtration during the early phase of resuscitation.
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The use of an inspiratory impedance threshold valve (ITV) during cardiopulmonary resuscitation (CPR) should reduce intrathoracic pressure during natural chest recoil or active chest decompression. This might in turn improve venous return and thereby organ blood flow. The haemodynamic effects during both standard CPR and active compression-decompression (ACD)-CPR with and without the ITV, therefore, were studied in a well-established porcine model with cross-over design. ⋯ ACD-CPR caused a similar increase, while adding the ITV to ACD-CPR only tended to increase myocardial blood flow (P=0.077). Varying the technique had no effect on cerebral, kidney or carotid blood flow, coronary perfusion pressure, expired CO(2) concentrations or blood gases. The valve is a promising new tool in CPR, but more independent studies of the device are needed.
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Comparative Study
Optimizing ventilation in conjunction with phased chest and abdominal compression-decompression (Lifestick) resuscitation.
The best method for employment of phased chest and abdominal compression-decompression (Lifestick) cardiopulmonary resuscitation (CPR) has yet to be determined. Of particular concern with using this technique is the combining of ventilation with the phased compressions and decompressions. Twenty domestic swine (50+/-1 kg) were equally divided into four groups. ⋯ Optimizing other forms of basic and advanced cardiac life support through different ventilation methods deserves new consideration, including a re-examination of the current single rescuer recommendation of a 15:2 ratio. Optimal ventilation strategy when using the LS device at 60 compressions per min appears to be 5:1 S. Such data is important for conducting clinical trials with this new CPR adjunct.