Resuscitation
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Randomized Controlled Trial
Self-learning training versus instructor-led training for basic life support: A cluster randomised trial.
To compare the effectiveness of two basic life support (BLS) training interventions. ⋯ There was no statistically significant difference in practical skills or willingness to act when comparing self-learning training with instructor-led training six months after training in BLS. However, directly after the intervention, practical skills were better when the training was led by an instructor.
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Supraglottic airway devices (SGDs) are widely used during the resuscitation of out-of-hospital cardiac arrest (OHCA). The effect of SGDs on carotid blood flow (CBF) as resuscitation time passes is controversial. We assessed the effects of endotracheal intubation (ETI) and 3 types of SGD placement on CBF over time in prolonged resuscitation through an experimental porcine cardiac arrest study. ⋯ SGD placement was associated with decreased carotid blood flow during cardiopulmonary resuscitation in an experimental porcine model. As time passed during prolonged resuscitation, reduction in CBF was aggravated after the transition to SGD placement compared to the reduction after the transition to ETI. This study was approved by the study institution IACUC 16-0140-S1A0.
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Multicenter Study
Cost effectiveness and quality of life analysis of extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest.
The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest (ECPR) has increased exponentially. ECPR is a resource intensive service and its cost effectiveness has yet to be demonstrated. We sought to complete a cost analysis with modelling of cost effectiveness and quality of life outcomes. We sought to complete a cost analysis with modelling of cost effectiveness and quality of life outcomes of patients who have undergone ECPR. ⋯ ECMO support for refractory cardiac arrests is cost effective and compares favourably to accepted cost effectiveness thresholds.
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Multicenter Study
The response to patient deterioration in the UK National Health Service - a survey of acute hospital policies.
The assessment of acute-illness severity in adult non-pregnant patients in the United Kingdom is based on early warning score (EWS) values that determine the urgency and nature of the response to patient deterioration. This study aimed to describe, and identify variations in, the expected clinical response outlined in 'deteriorating patient' policies/guidelines in acute NHS hospitals. ⋯ The 'deteriorating patient' policies of the hospitals studied varied in their contents and often omitted precise instructions for staff. We recommend that individual hospitals review these documents, and that research and/or consensus are used to develop a national algorithm regarding the response to patient deterioration.
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Post-resuscitation care of out-of-hospital cardiac arrest (OHCA) patients often involves inter-hospital transfer (IHT). We aimed to determine the association between IHT and outcomes of OHCA. ⋯ IHT should be considered when treating OHCA patients in LVEDs.