Current opinion in critical care
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Curr Opin Crit Care · Jun 2005
Delaying shock for cardiopulmonary resuscitation: does it save lives?
Out-of-hospital cardiac arrest claims more than 450,000 lives annually in North America. Many communities have dedicated significant resources to provide rapid defibrillator response for patients in ventricular fibrillation. In spite of these efforts, mortality from out-of-hospital cardiac arrest has not improved significantly. Emerging evidence suggests some patients in ventricular fibrillation arrest may be harmed by immediate defibrillation. ⋯ Current guidelines call for rapid defibrillation as the most important 'link' in the 'chain of survival'. For most ventricular fibrillation patients who have professional rescuers arrive after 5-8 minutes of ventricular fibrillation, however, immediate defibrillation is likely to be ineffective. Counterintuitively, these patients may benefit from a period of chest compressions prior to being shocked.
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Despite a more widespread knowledge of basic cardiopulmonary resuscitation maneuvers in the community, the survival rate for patients with cardiac arrest has remained essentially unchanged in the past 30 years. Over the past few decades, many different compression-ventilation ratios have been studied in terms of best coronary and cerebral oxygen delivery, restoration of spontaneous circulation, and neurologic outcome. This article summarizes the recent evidence presented at the International Consensus on Resuscitation Science in January 2005. ⋯ The optimal compression-ventilation ratio is still unknown and the best tradeoff between oxygenation and organ perfusion during cardiopulmonary resuscitation is probably different for each patient and scenario. A discrepancy between what is recommended by the current guidelines and the 'real world' of cardiopulmonary resuscitation has resulted in a near flat survival rate from cardiac arrest in the past few years.
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Central venous pressure is a very common clinical measurement, but it is frequently misunderstood and misused. As with all hemodynamic measurements, it is important to understand its basic principles. ⋯ The clinical application of central venous pressure measurement requires a good understanding of the concept of the interaction of the function of the heart with the function of the return of blood to the heart.