Resuscitation
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Demonstrate minimally invasive rapid body core and brain cooling in a large animal model. ⋯ GLV cooling times are comparable to those for cardiopulmonary bypass. Heat and CO(2) removal can be independently controlled by changing the mix of lavage and gas ventilation. Due to VDtherm of approximately 6 ml/kg in dogs, efficient V-lav is >18 ml/kg. GLV cooling power appears more limited by PFC flows than lavage residence times. Concurrent gas ventilation may mitigate heat-diffusion limitations in liquid breathing, perhaps via bubble-induced turbulence.
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To determine whether the quality of expired air given during mouth-to-mouth ventilation differs between one- and two-person basic life support. ⋯ Trainees in basic life support should be informed that symptoms of hypocarbia may occur in prolonged mouth-to-mouth ventilation, when acting in a two-man team. We would advise rescuers using these protocols to change places every 5 min to avoid these symptoms. These findings add further weight to the recommendations that all resuscitation should be carried out using 15:2 compression:ventilation ratio.
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The difficulties inherent in the 'Look, Listen and Feel' method of identifying respiratory arrest prompted the authors to develop a simple mechanical breathing indicator that can show clearly, at a glance, whether or not a patient is breathing. The novel indicator was designed to be highly visible so that its interpretation should be obvious to medical personnel and the lay public, and yet sufficiently simple so that it could be easily and inexpensively incorporated into the type of pocket rescue masks currently in use. The indicator needs no power source, works indoors and outdoors and does not interfere with the delivery of rescue breaths during resuscitation. ⋯ The authors found that the indicator responded to peak inspiratory flow rates of between 15 and 120 l/min, inspiratory pressures as low as 0.18 cm H(2)O with no supplemental oxygen flowing to the mask and 0.22 cm H(2)O with supplemental oxygen flowing at 9 l/min, minute ventilation volumes between 7.1 and 21.8 l/min, tidal volumes between 0.36 and 2.92 l and a respiratory rate range of 7-24 breaths per min. The authors conclude that the new indicator, when attached to a pocket rescue mask, is sensitive enough to identify clearly and reliably those patients at the scene of collapse who have stopped breathing. Additionally it may assist rescuers in timing the delivery of assisted rescue breaths in those patients with poor respiratory effort.
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To investigate the factors which influence decision making by experienced emergency physicians when they decide whether to (a) pronounce 'life extinct' in adult patients with non traumatic cardiac arrest while in the ambulance, or (b) bring them into the resuscitation room in the Emergency Department for further assessment/management. ⋯ The reasoning behind decisions made when a patient arrives at the Emergency Department in cardiac arrest is multifactorial. Strict guidelines would be difficult to construct since individuals vary in the importance they attach to different factors.
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The mechanism of forward blood flow during cardiopulmonary resuscitation (CPR) remains controversial. We hypothesized that, if the heart acts as a pump, the proximal descending thoracic aorta would be distended during compression by forward blood flow, and would be constricted or remained unchanged if blood flow is generated by increased intrathoracic pressure. Fourteen patients with nontraumatic cardiac arrest underwent transesophageal echocardiography to verify changes in the descending thoracic aorta during standard manual CPR. ⋯ The deformation ratio of the descending thoracic aorta proximal to the maximal compression site remained unchanged during compression and relaxation (1.0+/-0.88 vs. 1.0+/-0.9, P=0.345). The cross-sectional area of the descending thoracic aorta proximal to the maximal compression site increased 15% on average during compression compared with relaxation in 12 of 14 patients. In conclusion, deformation of the aorta at the maximal compression site and increase in the cross-sectional area of the proximal aorta suggests that cardiac pumping is the dominant mechanism in generating forward blood flow during CPR in humans.