Current opinion in critical care
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Ventricular fibrillation is the primary rhythm in many cardiac arrest patients. Since the late 1980s, the surface electrocardiogram of ventricular fibrillation has been subjected to analysis to obtain reliable information about the likelihood of successful countershock and to estimate the duration of cardiac arrest. Considerable efforts were made in the past 2 years to further improve the predictive power of rescue shock measures. ⋯ Recent results question the ventricular fibrillation feature analysis as a reliable tool to estimate the duration of human cardiac arrest. Animal and clinical studies confirmed that ventricular fibrillation waveform analysis contains information to reliably predict the countershock success rate and further improved countershock outcome prediction. Prospective clinical studies are highly warranted to demonstrate that ventricular fibrillation waveform analysis definitely improves survival after cardiac arrest.
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Curr Opin Crit Care · Jun 2008
ReviewImproving cardiopulmonary resuscitation quality to ensure survival.
There is correlation between quality of bystander cardiopulmonary resuscitation and patient survival. Recent developments in defibrillator technology enable recording of cardiopulmonary resuscitation quality, and have shown quality of professional cardiopulmonary resuscitation far from guidelines' levels for factors such as chest compression depth and rate, ventilation rate, and pauses in chest compressions. The effects of cardiopulmonary resuscitation quality factors on patient survival are presently under scrutiny. ⋯ Cardiopulmonary resuscitation quality affects survival after cardiac arrest. Reporting cardiopulmonary resuscitation quality data should be standard in all studies of cardiac arrest as effects of studied interventions can depend on or influence cardiopulmonary resuscitation quality. These data are also valuable in quality improvement processes both in-hospital and out-of-hospital.
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Tissue hypoperfusion is a common pathophysiologic process leading to multiple-organ dysfunction and death. An important goal of hemodynamic monitoring is the early detection of inadequate tissue perfusion and oxygenation. The use of simple, noninvasive monitoring techniques has the advantage of facilitating earlier initiation of therapy. Near-infrared spectroscopy has emerged in recent years as a tool for monitoring peripheral oxygenation (StO2) in various tissues, including muscle. Here, we review our current knowledge about the applicability, usefulness, and limitations of near-infrared spectroscopy as a technique to evaluate muscle oxygenation in acutely ill patients. ⋯ Near-infrared spectroscopy provides a noninvasive measure of muscle oxygen metabolism and microvascular dysfunction in critically ill patients. It may be useful to guide the management of critically ill patients.
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To discuss the advantages and disadvantages of various methods of airway management during cardiopulmonary resuscitation. The role of ventilation during out-of-hospital cardiopulmonary resuscitation is also discussed. ⋯ Supraglottic airway devices are a logical alternative to tracheal intubation when cardiopulmonary resuscitation is undertaken by individuals who are not highly skilled and experienced intubators. By teaching laypeople compression-only cardiopulmonary resuscitation, it is hypothesized that rates of bystander cardiopulmonary resuscitation, and therefore survival after out-of-hospital cardiac arrest, will increase.
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Cardiac arrest of patients during anesthesia has been the driving force behind the development of this specialty. Safer procedures, new anesthetics, and technical improvements such as monitoring devices and ventilators have successfully reduced intraoperative mortality. Nevertheless, modern technology itself creates specific risks; and causes, diagnosis, and management of anesthesia-related cardiac arrest differ considerably from situations encountered elsewhere. ⋯ The anesthetic environment has become much safer than it was 50 years ago. For a successful management of cardiac arrest during operative procedures, not only individual knowledge and skills but also institutional safety culture have to be implemented into education, training, and everyday practice of this specialty.