Resuscitation
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Multicenter Study
Epidemiology and survival rate of out-of-hospital cardiac arrest in north-east Italy: The F.A.C.S. study. Friuli Venezia Giulia Cardiac Arrest Cooperative Study.
The results of the first epidemiological, prospective, multicentric study on cardiac arrest in a geographical Italian region are reported. On 708 consecutive cardiac arrests, 438 underwent cardiopulmonary resuscitation (CPR). Of these, 344 were identified of cardiac aetiology. ⋯ Overall, the highest probability of survival was achieved when CPR interventions were started within the first minutes after collapse. Basic Life Support (BLS) manoeuvres began after 9 min of untreated cardiac arrest were still followed by a ROSC, but none of these patients survived. The incidence of prehospital cardiac arrest in our population was estimated to be in proportion of 0.95/1000 per year with a survival rate of 6.7%.
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Effect of DC shock on serum levels of total creatine kinase, MB-creatine kinase mass and troponin T.
After successful resuscitation from cardiac arrest, it is important to identify whether the event has been triggered by a myocardial infarction, since this determines subsequent investigations and management. Previous studies have shown that biochemical indices of infarction become elevated after resuscitation in patients without myocardial infarction. This can lead to overdiagnosis of myocardial infarction in the post-arrest setting. ⋯ MB-CK levels become significantly elevated in individuals receiving high energy shocks, probably due to release of small quantities of the CK-MB isoform from skeletal muscle. The negligible troponin T levels seen after high energy cardioversion indicate that significant myocardial injury does not occur. Electrical injury is not likely to account for the elevated troponin T levels seen after out-of-hospital resuscitation in patients without myocardial infarction.
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Randomized Controlled Trial Clinical Trial
The study of the effectiveness of chest compressions using the CPR-plus.
Effective cardiopulmonary resuscitation (CPR) requires a high level of skill from both healthcare professionals and the lay public. Inadequate chest compressions are a common cause of ineffective CPR. The CPR-plus is a non-invasive, hand-held, simple to use CPR adjunct designed to assist the rescuer to monitor and modify the compression technique during CPR, hopefully resulting in improved rescuer performance and more effective CPR. ⋯ The average number of correctly applied compressions was significantly better when the CPR-plus was used: 138.35/150 versus 110.70/150 (p = 0.0001). Improvements in techniques associated with the use of the CPR-plus also included a reduction in excessive application of pressure and incorrect hand position. The device provided reassurance of satisfactory compressions and an indication of impending fatigue in the rescuer.
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Assuming that a lay person performing cardiopulmonary resuscitation (CPR) will also use an automatic external defibrillator (AED) wherever available, we tried to estimate the maximal attainable benefit of public access defibrillation in some centres in Belgium. ⋯ It is concluded that in our EMS system, laymen reach a substantial number of VF/VT victims many minutes before the arrival of the professional EMS teams. Therefore, a substantial increase in the number of survivors could be expected if lay responders were prepared to use an AED.