Resuscitation
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of exertion required to perform standard and active compression-decompression cardiopulmonary resuscitation.
Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) utilizes a hand-held suction device with a pressure gauge that enables the operator to compress as well as actively decompress the chest. This new CPR method improves hemodynamic and ventilatory parameters when compared with standard CPR. ACD-CPR is easy to perform but may be more labor intensive. The purpose of this study was to quantify and compare the work required to perform ACD and standard CPR. ⋯ Approximately 25% more work is required to perform ACD-CPR compared with standard CPR. Both methods require subanaerobic energy expenditure and can therefore be sustained for a sufficient length of time by most individuals to optimize resuscitation efforts. Due to the slightly higher work requirement, ACD-CPR may be more difficult to perform compared with standard CPR for long periods of time, particularly by individuals unaccustomed to the workload requirement of CPR, in general.
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To compare and contrast outcomes following cardiac arrest managed in two Accident and Emergency departments, and to identify factors which might account for such differences. ⋯ Patients suffering out-of-hospital cardiac arrests in Edinburgh have a significantly better chance of being admitted to a ward. There is a trend favouring better survival to discharge in Edinburgh, but with the numbers investigated this does not achieve statistical significance. Amongst those factors which contribute to survival there are fewer witnessed arrests, less bystander CPR and slower ambulance response times in those brought to GRI. There is a need to investigate the environment in which patients collapse, to train the public in CPR, and to review the efficiency and resourcing of the ambulance service.
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To audit the outcome from pre-hospital cardiac arrest managed by ambulance personnel, and to assess their proficiency by analysing the time to initiate basic and advanced cardiac life support, the compliance with national guidelines, and the overall success of resuscitation. ⋯ The survival from pre-hospital cardiac arrest in this community is worse than the national average. There is no single explanation for this. Better community CPR training, greater efficiency at the scene through additional personnel, and stricter compliance with national ACLS guidelines, facilitated by extended refresher training, are all required if outcome is to be improved.
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Comparative Study
Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest.
To evaluate the influence of quality of bystander cardiopulmonary resuscitation (CPR) on outcome in prehospital cardiac arrest we consecutively included patients with prehospital cardiac arrest treated by paramedics in a community run ambulance system in Oslo, Norway from 1985 to 1989. Good CPR was defined as palpable carotid or femoral pulse and intermittent chest expansion with inflation attempts. Outcome measure was hospital discharge rate. ⋯ There were no differences in paramedic response interval between the groups, but the mean interval from start of unconsciousness to initiation of CPR (arrest-CPR interval) was significantly shorter in the group receiving good bystander CPR (2.5 min, 95% confidence interval (CI): 1.7-3.3 min) than no good CPR (6.6 min, CI: 5.2-8.0 min) or no bystander CPR (7.8 min, CI: 7.2-8.4 min). Bystanders started CPR more frequently in public than in the patient's home (58 vs. 34%, P < 0.0005). Good bystander CPR was associated with a shorter arrest-CPR interval and improved hospital discharge rate as compared to no good BCPR or no BCPR.
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The administration of ATP-MgCl2 may be of benefit in the treatment of shock by improving cellular metabolic function during resuscitation. Prior studies have reported data from hemorrhage models in which heparinized shed blood is returned both during shock and in resuscitation. The purpose of this study was to test the effects of ATP-MgCl2 therapy upon blood pressure and survival in an animal model of hemorrhagic shock utilizing crystalloid (Lactated Ringer's) resuscitation. ⋯ Blood pressure was monitored throughout the procedure and survival time was noted. Post-resuscitation MAP was increased in animals treated with ATP-MgCl2. ATP-MgCl2 added to resuscitation significantly improved 72-h survival over that of control (LR) animals, and animals treated with MgCl2 alone.