Resuscitation
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Review Case Reports
Cardiac arrest during surgery and ventilation in the prone position: a case report and systematic review.
We present a case report of successful resuscitation following cardiac arrest in a patient undergoing surgery in the prone position. A systematic review of the literature identified 22 further cases. ⋯ Management of prone cardiac arrest may be improved by identification of high-risk patients, careful patient positioning, use of invasive monitoring and placement of self-adhesive defibrillator paddles. Suitable techniques for cardiopulmonary resuscitation including methods for chest compression, defibrillation and the management of air embolism are discussed.
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Randomized Controlled Trial Clinical Trial
An automated voice advisory manikin system for training in basic life support without an instructor. A novel approach to CPR training.
Twenty-four paramedic students with previous basic life support training were randomised, performing cardiopulmonary resuscitation (CPR) on a manikin for 3 min without any feedback followed by 3 min of CPR with audio feedback from the manikin after a 2-min break, or vice versa. A computer recorded information on timing, ventilation flow rates and volumes and all movements of the sternum of the manikin. The software allowed acceptable limits to be set for all ventilation and compression/release variables giving appropriate on-line audio feedback according to these settings from among approximately 40 pre-recorded messages. ⋯ There were no problems with the median compression rate, sternal release during decompressions, or the hand position, even before feedback. There were no significant differences in any variables with and without feedback for the students who started with feedback, or between the audio feedback periods of the two groups. It is concluded that this automated voice advisory manikin system, a novel approach to basic CPR training, caused an immediate improvement in the skills performance of paramedic students.
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Case Reports
Successful transdiaphragmatic cardiac resuscitation through midline abdominal incision in patient with flail chest.
This case report describes a transdiaphragmatic approach through an already present vertical midline abdominal incision for performing internal cardiac compressions in a 30-year-old male road accident victim. The patient had a flail chest with haemopneumothorax and haemoperitoneum. Exploratory laparotomy followed by splenectomy was performed under general anaesthesia but the patient developed a witnessed cardiac arrest in postoperative period. Successful resuscitation using internal cardiac compression by a transdiaphragmatic approach through the midline abdominal incision that was not extended proximally is described.
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The Guidelines 2000 for cardiopulmonary resuscitation recommend shock delivery to victims in ventricular fibrillation within 5 min of call receipt by the Emergency Medical Services. In an effort to achieve this goal, in some parts of the United States, police officers have been trained to use automated external defibrillators (AEDs). We undertook a 3-year pilot evaluation of the use of AEDs by City of London police (CPOL) officers. ⋯ Two (15%) of these victims survived to hospital discharge. This study has confirmed the feasibility of training police officers in the UK to use AEDs as first responders. The call received to arrival on scene interval should be reduced by improvements in communication between LAS and CPOL.