Singap Med J
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Following restoration of pulse after the institution of cardiopulmonary resuscitation, defibrillation and perhaps, the initial resuscitative drugs, there is a greater challenge of maintaining that heartbeat for at least the next 24 hours, which can better ensure a high likelihood of the patient being discharged alive from the hospital. A bundle of procedures, which may need to be administered simultaneously, is required. These include prompt identification and treatment of the cause of cardiac arrest, with early consideration for procedures such as percutaneous coronary interventions and fibrinolytics, and treatment of electrolyte abnormalities. ⋯ Additional benefit is possible with appropriate forms of early goal-directed therapy and achieving therapeutic hypothermia within the first few hours, followed by gradual rewarming and ensuring glycaemic control by maintaining blood sugars within a range of 6-10 mmol /L. All these would be important and need to be continued for at least 24 hours, together with a series of measures to control neurological reactions and monitor neurological responses for best effect. Creation of a bundle that incorporates these various aspects of care would more likely ensure that most patients who achieve return of spontaneous circulation may be discharged alive from the hospital with optimal neurological function.
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Despite years of medical advances, bystander cardiopulmonary resuscitation (CPR) remains the most important factor in the saving of out-of-hospital cardiac arrest victims. However, the prevalence of bystander CPR remains low. New international recommendations, which aim to increase bystander CPR prevalence, allow for hands-only CPR under certain circumstances. More should be done to increase the awareness and training of CPR in Singapore as well as encourage the public to perform bystander CPR.
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Mechanical devices for cardiopulmonary resuscitation have been in use for decades. Significant advances in the understanding of cardiac arrest physiology have led to improvements and new devices. Piston, load distribution band, active compression decompression and the impedance threshold device are discussed.