Resuscitation
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It has been suggested that the laryngeal mask has a role to play in the management of the airway during resuscitation both from cardiac arrest and possibly major trauma. Should it be introduced for this purpose, there will be a need to provide training for a very large number of paramedical staff. Currently training in advanced airway management techniques involves live patient practice in theatres; clearly this system is already reaching a limit as paramedics in training often have some difficulty in reaching the prescribed number of procedures. This paper describes experience with a possible alternative utilising only classroom teaching.
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Since its introduction into clinical practice in 1988, the laryngeal mask airway (LMA) has fundamentally changed the airway management of patients undergoing routine anaesthesia. Currently in the UK, the LMA is used in > 50% of surgical procedures where an endotracheal tube (ETT) would formerly have been used. It seems timely to review the role of this device in resuscitation and its potential role in the pre-hospital arena.
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Based upon an anecdotal report of successful resuscitation using a toilet plunger, Cohen and co-workers have developed and investigated a hand-held suction cup as an adjunct to standard manual CPR. This new method, called active compression-decompression cardiopulmonary resuscitation, utilizes a device which is placed over the mid-sternum, approximately 1-2 inches above the lower rib cage border. Active compression-decompression cardiopulmonary resuscitation is then performed in accordance with American Heart Association guidelines at a rate equal to 80-100/min using a 50% duty cycle and compression depth of 1.5-2.0 inches. ⋯ Improved resuscitation success has also been documented in human subjects after in-hospital and pre-hospital cardiac arrest. Active compression-decompression cardiopulmonary resuscitation is a simple method which utilizes a hand held suction cup as an interface between rescuer and victim during closed chest circulatory support. This method allows for standard manual cardiopulmonary resuscitation with the addition of active chest wall decompression and appears to be a beneficial adjunct to standard manual cardiopulmonary resuscitation.
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Comparative Study
Prediction of failure to survive following in-hospital cardiopulmonary resuscitation: comparison of two predictive instruments.
The purpose of this study is to compare two clinical predictive rules, the pre-arrest-morbidity (PAM) index and the prognosis-after-resuscitation (PAR) score, which predict failure to survive following in-hospital cardiopulmonary resuscitation (CPR). The study population consisted of 274 consecutive adult patients who underwent CPR at University College Hospital in Galway, Ireland over a 2-year period. The PAM and PAR scores were calculated from the most recent data available for each variable prior to cardiac arrest. ⋯ The PAR score also had a greater area under the ROC curve, although this difference was not statistically significant (P = 0.07). In summary, the PAR score performed better than the PAM index in the identification of patients who are unlikely to survive following CPR. Although further confirmation is necessary, it may provide useful prognostic information to physicians and patients involved with decisions about do-not-resuscitate orders.