Current opinion in critical care
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Challenged by the continued high mortality rates for patients in cardiac arrest, the American Heart Association and the European Resuscitation Council developed a new set of guidelines in 2000 to help advance several new and promising cardiopulmonary resuscitation (CPR) techniques and devices. This is the first time these organizations have taken such a bold move, in part because of the poor results with standard closed-chest cardiac massage. The new techniques, interposed abdominal counterpulsation and active compression decompression CPR, each provide greater blood flow to the vital organs in animal models of CPR and lead to higher blood pressures in patients in cardiac arrest. ⋯ However, no studies on the automated mechanical compression devices have showed an improvement in hemodynamic variables or survival in comparison with standard CPR. Taken together, these new technologies represent an important step forward in the evolution of CPR from a pair of hands to devices designed to enhance CPR efficiency. Each of these advances is described, and the recent literature about each of them is reviewed.
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Controversy still exists concerning the strategy of targeting so-called supranormal levels of oxygen delivery as a means of improving outcome from high-risk surgery. The pathogenesis of postoperative morbidity is not fully defined; however, it seems likely that the gastrointestinal tract plays a pivotal role, particularly as a source of endotoxin, which is a potent stimulator of the inflammatory response. Delayed recovery of gastrointestinal function also is a major contributor to postoperative morbidity. Demonstration of a significant reduction in gut ischemia, endotoxemia, postoperative inflammatory response, and morbidity in a high-risk general surgical population as a result of perioperative hemodynamic optimization would be a highly worthwhile study.
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Curr Opin Crit Care · Jun 2001
ReviewTechnologic advances and program initiatives in public access defibrillation using automated external defibrillators.
Widespread provision of early defibrillation following cardiac arrest holds major promise for improved survival from ventricular fibrillation. The critical element in predicting a successful outcome is the rapidity with which defibrillation is achieved. A worldwide awareness of this potential and its advocacy by such organizations as the American Heart Association have been pivotal in the evolution of initiatives to make defibrillation more widely and more rapidly available. ⋯ New low-energy waveforms with biphasic morphology have been shown to be more effective in terminating ventricular fibrillation and may do so with less myocardial injury. Placement of AEDs in a variety of nontraditional settings such as police cars, aircraft and airport terminals, and gambling casinos has been shown to yield an impressive number of survivors of cardiac arrest in ventricular fibrillation. Questions yet to be answered center on the appropriate disposition of AEDs in public access defibrillation settings, training and retraining issues, device maintenance, and collection of accurate data to document benefit and to identify areas of needed improvement or expansion of AED availability.