Resuscitation
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To describe the epidemiology and survival from out-of-hospital cardiac arrest. ⋯ The trends in occurrence and survival following out-of-hospital cardiac arrest in Perth, WA, are similar to those found elsewhere. There is an opportunity to strengthen the chain of survival by reducing the response time interval and increasing the use of bystander cardiopulmonary resuscitation (CPR). First-responder programs and public access defibrillation will need to be considered in the light of local demographics, location and the epidemiologic features of out-of-hospital cardiac arrest.
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Variables for reporting outcome of pre-hospital cardiac arrest have been delineated in the Utstein style template. The primary outcome statistic is survival to hospital discharge (SHD). The template allows comparisons of pre-hospital care systems and has been used to determine the benefit of pre-hospital interventions. Post-resuscitation care has not been standardized and in-hospital events that affect SHD are not considered in the template. ⋯ In-hospital care and medical decision making are not considered in the Utstein template and can have a significant effect on reported survival statistics. When assessing the benefit of pre-hospital interventions, it may be preferable to consider survival to hospital admission as the primary outcome statistic until such time as post-resuscitation care after hospital admission is rigidly standardized.
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Advances in diagnosis, techniques, therapeutic interventions, organisation of perinatal care, and socio-economic factors have all contributed to the survival after resuscitation and intensive care of neonates with extremely low birth weight and gestational age. While morbidity during the first years of life in those infants does not increase, at school age multiple dysfunctions may become apparent. What are the limits of intensive care for the newborn? Is it right to use extreme technical and economic measures for neonates with a borderline chance of survival? What is justifiable for the neonate, the family, the society and how does legislation interfere in a decision process which involves starting, stopping or continuing intensive care? A short historical overview for the care of the newborn is given, followed by the outcome after resuscitation and treatment of the very low birth weight infant. Published management strategies and recommendations are discussed.
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Randomized Controlled Trial Clinical Trial
Mild hypothermia induced by a helmet device: a clinical feasibility study.
To test the feasibility and the speed of a helmet device to achieve the target temperature of 34 degrees C in unconscious after out of hospital cardiac arrest (CA). ⋯ Mild hypothermia induced by a helmet device was feasible, easy to perform, inexpensive and effective, with no increase in complications.
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Transthoracic impedance (TTI) is an important determinant of success in defibrillation. Low TTI increases transmyocardial current and therefore increases the chance of depolarising a critical mass of myocardium. A major component of TTI occurs at the paddle-skin interface and is minimised by pressure applied to the defibrillation paddles. ⋯ Only 14% could achieve > or =12 kg force on both paddles for defibrillation. Men achieved more force than women (10.7 vs. 8.1 kg force; P<0.01), and there was a correlation between maximum force achieved and operator height (r2=0.27) and dominant hand-grip strength (r2=0.34). The ERC recommendation of 12 kg paddle force is not achievable by the majority of defibrillator operators.