Resuscitation
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A study was designed to determine which paediatric trauma patients with no detectable vital signs are likely to benefit from cardiopulmonary resuscitation (CPR). ⋯ The overall survival rate of paediatric patients with cardiac arrest secondary to trauma is poor. Trauma patients in whom cardiac arrest is caused by respiratory arrest or by thoracoabdominal trauma in the hospital setting may have a chance of survival if a spontaneous circulation is rapidly restored with effective resuscitative measures.
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Randomized Controlled Trial Clinical Trial
Improved retention of the EMS activation component (EMSAC) in adult CPR education.
This study was undertaken to determine whether using a model-telephone to simulate the emergency medical services activation component (EMSAC) during adult cardiopulmonary resuscitation (CPR) training practice would lead to better retention of this component during end-of-class assessment. In a prospective randomized manner, 233 medical professionals and lay-persons taking American Heart Association (AHA) CPR classes were evaluated for EMSAC retention during CPR skills performance at the end of class. During the assessment correct versus incorrect activation of EMS was noted. ⋯ Previous CPR training did not affect the response (P = 0.18). We conclude that use of the model-telephone improved EMSAC retention significantly overall except in the < 30 year-old age group. We recommend using the model-telephone in future adult CPR classes.
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Comparative Study
Force distribution across the heel of the hand during simulated manual chest compression.
According to most published guidelines of cardiopulmonary resuscitation chest compression is performed on the lower half of the sternum by compressing the sternum with the heel of one hand and the other hand on top of the first. In all guidelines and during CPR training great importance is attributed to exact localisation of the so-called compression point. In a laboratory investigation we assessed the force distribution across the heel of the hand and defined the total breadth in contact with the sternum. ⋯ In all except one anaesthetist the hypothenar part of the heel exerted a significantly higher force compared to the thenar part, independent of whether the right hand or the left hand was in contact. The distance between points of maximal force when the right hand or when the left hand in contact was 2.2 cm corresponding to the breadth of one and a half fingers. To reduce the potential risk of sternal fractures by chest compressions applied too far in a cephalad direction, we recommend use of the right hand in contact if the rescuer kneels at the right side of the patient and vice versa.
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Comparative Study
Comparison of two emergency response systems and their effect on survival from out of hospital cardiac arrest.
The pre-hospital care provided by emergency response systems will have an effect on the outcome of patients who have sustained an out of hospital cardiac arrest. This study compares the results of resuscitation in two centres, one in the UK (Edinburgh) and the other in the USA (Milwaukee), and examines the demographics in both centres. ⋯ When these two effects are accounted for there is no difference in outcome. The importance of early alerting of emergency services and early bystander CPR should not be underestimated.