Singap Med J
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Survivors of successful resuscitated cardiac arrest have a high incidence of severe neurological deficits. The pathophysiology of cerebral injury is thought to be multifactorial, and therapeutic mild hypothermia is one of the strategies that have been shown to minimise this complication. ⋯ Finally, unresolved issues are discussed as we outline the ongoing prospective clinical trial underway in Singapore in order to evaluate its safety and efficacy in our local population. We advocate further research into this topic, as it has great potential to improve the outcomes of comatose resuscitated patients of cardiac arrest.
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Defibrillation may be needed in witnessed and unwitnessed cardiac arrests. Cardiopulmonary resuscitation (CPR) must be initiated and defibrillation administered without delay. Every shock cycle includes 1-2 minutes of CPR followed by rhythm analysis. ⋯ Monitoring electrodes and pacemaker locations should be considered during paddle/pad placement. AED skills should be imparted to a wide variety of community groups. More efforts will be made to increase the availability of AEDs in public, residential, commercial and industrial facilities.
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Nurses are usually the first caregivers for cardiac arrest patients in an in-hospital environment, and subsequently partner with doctors in the further resuscitation of patients. The skills of basic life support are crucial for their practice. ⋯ The components of the LSCN programme have evolved over the years, taking into consideration the modifications to resuscitation guidelines. The LSCN programme is gradually including a larger proportion of nurses in the emergency and critical care environments as well as those in the general ward.
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Bystander cardiopulmonary resuscitation (CPR) is important for survival from out-of-hospital cardiac arrest (OHCA). However, recent research indicates that the quality of CPR is an important and often overlooked factor affecting survival. Individual factors, training, awareness, technique and rescuer fatigue may influence the quality of CPR. ⋯ Locally, limited information is available regarding the quality of CPR being performed for OHCA. Strategies to improve the quality of CPR include research, training, education as well as incorporating appropriate technologies that measure and feedback the quality of CPR. These technologies are at the heart of recent advances, as they now make it feasible to provide routine feedback to rescuers providing CPR, through the integration of feedback devices into training equipment, defibrillators and standalone CPR assist devices.
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The main emphasis in the Advanced Cardiac Life Support (ACLS) guidelines are in the areas of good quality chest compressions, ensuring normoventilation, removal of atropine from the cardiac arrest algorithm, removal of the use of the endotracheal route for drug administration, and renewed focus on the care provided after return of spontaneous circulation. In addition, the need for monitoring of quality of the various care procedures is emphasised. While the various ACLS procedures are being carried out, there is a need to minimise interruptions to chest compressions for maintenance of coronary perfusion pressures. In addition, the resuscitation team needs to continually look out for reversible causes of the cardiac arrest.