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Sample records for expert-led advanced resuscitation

  1. Advanced Cardiac Resuscitation Evaluation (ACRE: A randomised single-blind controlled trial of peer-led vs. expert-led advanced resuscitation training

    Directory of Open Access Journals (Sweden)

    Hughes Thomas C

    2010-01-01

    Full Text Available Abstract Background Advanced resuscitation skills training is an important and enjoyable part of medical training, but requires small group instruction to ensure active participation of all students. Increases in student numbers have made this increasingly difficult to achieve. Methods A single-blind randomised controlled trial of peer-led vs. expert-led resuscitation training was performed using a group of sixth-year medical students as peer instructors. The expert instructors were a senior and a middle grade doctor, and a nurse who is an Advanced Life Support (ALS Instructor. A power calculation showed that the trial would have a greater than 90% chance of rejecting the null hypothesis (that expert-led groups performed 20% better than peer-led groups if that were the true situation. Secondary outcome measures were the proportion of High Pass grades in each groups and safety incidents. The peer instructors designed and delivered their own course material. To ensure safety, the peer-led groups used modified defibrillators that could deliver only low-energy shocks. Blinded assessment was conducted using an Objective Structured Clinical Examination (OSCE. The checklist items were based on International Liaison Committee on Resuscitation (ILCOR guidelines using Ebel standard-setting methods that emphasised patient and staff safety and clinical effectiveness. The results were analysed using Exact methods, chi-squared and t-test. Results A total of 132 students were randomised: 58 into the expert-led group, 74 into the peer-led group. 57/58 (98% of students from the expert-led group achieved a Pass compared to 72/74 (97% from the peer-led group: Exact statistics confirmed that it was very unlikely (p = 0.0001 that the expert-led group was 20% better than the peer-led group. There were no safety incidents, and High Pass grades were achieved by 64 (49% of students: 33/58 (57% from the expert-led group, 31/74 (42% from the peer-led group. Exact

  2. [Advanced resuscitation of adults

    DEFF Research Database (Denmark)

    Lippert, F.K.; Lauritsen, T.L.; Torp-Pedersen, C.

    2008-01-01

    International and European Resuscitation Council (ERC) Guidelines for Resuscitation 2005 implicate major changes in resuscitation, including new universal treatment algorithms. This brief summary of Guidelines 2005 for advanced resuscitation of adult cardiac arrest victims is based upon the ERC...

  3. Cardiopulmonary resuscitation: Advances

    Directory of Open Access Journals (Sweden)

    William Andrés Vargas-Garzón

    2011-06-01

    Full Text Available Reanimation’s guidelines dictated by the AHA (American Heart Association are the strategies to follow in the envi­ronment of any situation related to cardiac arrest. They are acquired after the analysis of the evidence available in reani­mation from higher to less quality, with the best neurological results. After years of observation, was achieved to establish that survival behind cardiac arrest is, in general, low (6%, except that any witness starts immediately cardiopulmonary resuscitation (CPR maneuvers; therefore, medical personal must know and practice these maneuvers. With these con­siderations, it’s necessary to emphasize in the theoretical training of CPR of all health professional and laity, which guarantee everybody be prepared to emergency system ac­tivation, brain’s preservation and defibrillate to recuperate heart and life. The actual approach that combines compres­sions and defibrillation to closed chest, rescue ventilation and cardio tonic drugs. The guidelines AHA 2010, focus on increase frequency and quality of CPR. The objective of this article is to recognize various changes in these guidelines in cardiopulmonary reanimation and promote the continued education’s importance in reanimation.

  4. Neonatal resuscitation: advances in training and practice

    Directory of Open Access Journals (Sweden)

    Sawyer T

    2016-12-01

    Full Text Available Taylor Sawyer, Rachel A Umoren, Megan M Gray Department of Pediatrics, Division of Neonatology, Neonatal Education and Simulation-based Training (NEST Program, University of Washington School of Medicine, Seattle, WA, USA Abstract: Each year in the US, some four hundred thousand newborns need help breathing when they are born. Due to the frequent need for resuscitation at birth, it is vital to have evidence-based care guidelines and to provide effective neonatal resuscitation training. Every five years, the International Liaison Committee on Resuscitation (ILCOR reviews the science of neonatal resuscitation. In the US, the American Heart Association (AHA develops treatment guidelines based on the ILCOR science review, and the Neonatal Resuscitation Program (NRP translates the AHA guidelines into an educational curriculum. In this report, we review recent advances in neonatal resuscitation training and practice. We begin with a review of the new 7th edition NRP training curriculum. Then, we examine key changes to the 2015 AHA neonatal resuscitation guidelines. The four components of the NRP curriculum reviewed here include eSim®, Performance Skills Stations, Integrated Skills Station, and Simulation and Debriefing. The key changes to the AHA neonatal resuscitation guidelines reviewed include initial steps of newborn care, positive-pressure ventilation, endotracheal intubation and use of laryngeal mask, chest compressions, medications, resuscitation of preterm newborns, and ethics and end-of-life care. We hope this report provides a succinct review of recent advances in neonatal resuscitation. Keywords: neonatal resuscitation, Neonatal Resuscitation Program, NRP, simulation, deliberate practice, debriefing, eSIM

  5. Advancements in cardiopulmonary resuscitation: increasing circulation and improving survival.

    Science.gov (United States)

    Ramsay, Philip T; Maxwell, Robert A

    2009-05-01

    Clinicians, as well as lay people, have realized the importance of resuscitative maneuvers throughout recorded history. Cardiopulmonary resuscitation has evolved from a relatively primitive technique to one now dictated by data from evidence based medicine. Recent advancements include changes in life support guidelines, the development of an impedance threshold device, and the initiation of therapeutic hypothermia. We can only expect continued advancements in cardiopulmonary resuscitation through new technology with resultant improved outcomes.

  6. Development of a leadership skills workshop in paediatric advanced resuscitation.

    Science.gov (United States)

    Gilfoyle, Elaine; Gottesman, Ronald; Razack, Saleem

    2007-11-01

    Paediatric residency programs rarely prepare trainees to assume resuscitation team leadership roles despite the recognized need for these skills by specialty accreditation organizations. We conducted a needs-assessment survey of all residents in the McGill Pediatric Residency Program, which demonstrated that most residents had minimal or no experience at leading resuscitation events and felt unprepared to assume this role in the future. We developed an educational intervention (workshop) and evaluated immediate and long term learning outcomes in order to determine whether residents could acquire and retain team leadership skills in pediatric advanced resuscitation. Fifteen paediatric residents participated in a workshop that we developed to fulfill the learning needs highlighted with the needs assessment, as well as the Objectives of Training in Pediatrics from the Royal College of Physicians and Surgeons of Canada. It consisted of a plenary session followed by 2 simulated resuscitation scenarios. Team performance was evaluated by checklist. Residents were evaluated again 6 months later without prior interactive lecture. Learning was also assessed by self-reported retrospective pre/post questionnaire. Checklist score (assigning roles, limitations of team, communication, overall team atmosphere) expressed as % correct: initial workshop scenario 1 vs. scenario 2 (63 vs. 82 p learning in knowledge of tasks, impact and components of communication, avoidance of fixation errors and overall leadership performance (p leadership skills following an educational intervention as shown by both observational checklist scores and self-reported survey. The six-month follow-up evaluation demonstrated skill retention beyond the initial intervention. A control group suggested that these results were due to completion of the first workshop.

  7. Advanced Life Support Providers Have Poor Knowledge of When to Administer Resuscitation Drugs

    DEFF Research Database (Denmark)

    Johnsen, Josephine; Glerup Lauridsen, Kasper; Løfgren, Bo

    2017-01-01

    Background: Advanced life support (ALS) including resuscitation drugs improves return of spontaneous circulation after cardiac arrest. Resuscitation drugs are recommended to be administered at predefined time-points depending on whether the cardiac rhythm is shockable or non-shockable. Timing...... to administer drugs during shockable rhythm only. Similar, only one third knew when to administer drugs during non-shockable rhythm only. Knowledge on when to administer drugs in case of rhythm transition was poor (Figure 1).Conclusion: Advanced life support providers have poor knowledge of when to administer...... resuscitation drugs. Future studies should address methods to improve learning and skill retention of resuscitation drug administration.Author Disclosures: J. Johnsen: None. K.G. Lauridsen: None. B. Løfgren: None....

  8. The association between religiosity and resuscitation status preference among patients with advanced cancer.

    Science.gov (United States)

    Delgado-Guay, Marvin O; Chisholm, Gary; Williams, Janet; Bruera, Eduardo

    2015-10-01

    The potential influence of patient religious and spiritual beliefs on the approach to end-of-life care and resuscitation status preferences is not well understood. The aim of this study was to assess the association between religiosity and resuscitation preferences in advanced-cancer patients. We performed a secondary analysis of a randomized controlled trial that evaluated the influence of physician communication style on patient resuscitation preferences. All patients completed the Santa Clara Strength of Religious Faith Questionnaire-Short Form (SCSRFQ-SF) and expressed their resuscitation preferences. We determined the frequency of resuscitation preferences and its association with intensity of religiosity. A total of 78 patients completed the study. The median age was 54 years, with a range of 18-78. Some 46 (59%) were women; 57 patients (73%) were Caucasian, 15 (19%) African American, and 5 (7%) Hispanic. A total of 46 patients (56%) were Protestant and 13 (17%) Catholic. Some 53 of 60 patients who chose Do Not Resuscitate status (DNR) (88%) and 16 of 18 patients who refused DNR (89%) for a video-simulated patient were highly religious (p = 0.64). When asked about a DNR for themselves after watching the videos, 43 of 48 who refused DNR (90%) and 26 of 30 patients who chose DNR (87%) were highly religious (p = 0.08). The Spearman correlation coefficient for patients choosing DNR for themselves and intensity of religiosity was r = -0.16 (p = 0.16). Some 30 patients (38%) who chose DNR for the video patient refused DNR for themselves, and 42 who chose DNR for both the video patient and themselves (54%) were highly religious (p = NS). There was no significant association between intensity of patient religiosity and DNR preference for either the video patient or the patients themselves. Other beliefs and demographic factors likely impact end-of-life discussions and resuscitation status preferences.

  9. The effect of the Advanced Paediatric Life Support course on perceived self-efficacy and use of resuscitation skills.

    NARCIS (Netherlands)

    Turner, N.M.; Dierselhuis, M.P.; Draaisma, J.M.T.; Cate, O.T. ten

    2007-01-01

    BACKGROUND: Perceived self-efficacy is a predictor of behaviour and therefore an important dimension of resuscitation training which may have consequences for patient care. The Advanced Paediatric Life Support (APLS) course makes use of techniques which would be expected to increase self-efficacy.

  10. Electronic learning in advanced resuscitation training: The perspective of the candidate.

    Science.gov (United States)

    Lockey, Andrew S; Dyal, Laura; Kimani, Peter K; Lam, Jenny; Bullock, Ian; Buck, Dominic; Davies, Robin P; Perkins, Gavin D

    2015-12-01

    Studies have shown that blended approaches combining e-learning with face-to-face training reduces costs whilst maintaining similar learning outcomes. The preferences in learning approach for healthcare providers to this new style of learning have not been comprehensively studied. The aim of this study is to evaluate the acceptability of blended learning to advanced resuscitation training. Participants taking part in the traditional and blended electronic advanced life support (e-ALS) courses were invited to complete a written evaluation of the course. Participants' views were captured on a 6-point Likert scale and in free text written comments covering the content, delivery and organisation of the course. Proportional-odds cumulative logit models were used to compare quantitative responses. Thematic analysis was used to synthesise qualitative feedback. 2848 participants from 31 course centres took part in the study (2008-2010). Candidates consistently scored content delivered face-to-face over the same content delivered over the e-learning platform. Candidates valued practical hands on training which included simulation highly. Within the e-ALS group, a common theme was a feeling of "time pressure" and they "preferred the face-to-face teaching". However, others felt that e-ALS "suited their learning style", was "good for those recertifying", and allowed candidates to "use the learning materials at their own pace". The e-ALS course was well received by most, but not all participants. The majority felt the e-learning module was beneficial. There was universal agreement that the face-to-face training was invaluable. Individual learning styles of the candidates affected their reaction to the course materials. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making.

    Science.gov (United States)

    Waldron, Nicholas; Johnson, Claire E; Saul, Peter; Waldron, Heidi; Chong, Jeffrey C; Hill, Anne-Marie; Hayes, Barbara

    2016-10-06

    Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated 'Goals of Patient Care' (GOPC) form and process; (ii) an education video and resources for teaching advance CPR decision-making and communication. A multidisciplinary group of health professionals and policy-makers with experience in systems development, education and research provided critical feedback. Three key themes emerged from the focus groups and the literature, which identified a structure for the intervention: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it. The themes informed the development of a video to provide education about advance CPR decision-making framework, improving communication and contextualising relevant clinical issues. Critical feedback assisted in refining the video and further guided development and evolution of a medical GOPC approach to discussing and recording medical treatment and advance care plans. Through an iterative process of consultation and review, video-based education and an expanded GOPC form and approach were developed to address physician and systemic barriers to advance CPR decision-making and documentation. Implementation and evaluation across hospital settings is required to examine utility and determine effect on quality of care.

  12. 'We have to discuss it': cancer patients' advance care planning impressions following educational information about cardiopulmonary resuscitation.

    Science.gov (United States)

    Epstein, A S; Shuk, E; O'Reilly, E M; Gary, K A; Volandes, A E

    2015-12-01

    Most cancer patients desire information about care options at the end of life, including cardiopulmonary resuscitation (CPR). Communicating such care options can be challenging and is part of advance care planning (ACP). Our prior studies with video educational media produced data on patients' categoric preferences (yes/no/unsure) for CPR; however, the thematic underpinnings of these educated preferences in patients treated for advanced cancer aren't well known. Qualitative thematic content analysis of participants' responses in a randomized trial of an educational video (V) or narrative (N) about CPR in patients with advanced gastrointestinal cancers. Responses were independently coded and categorized for thematic content by two reviewers. Of 54 study participants, 26 total (41% of V arm, 56% of N arm) articulated questions, comments, or both. Reviewer analyses demonstrated thematic consensus and resulted in seven distinct themes listed in decreasing order of prevalence: (a) ACP should be started early; (b) educational information about CPR affirmed participants' existing beliefs/knowledge/values about advanced illness; (c) participants were apprehensive about ACP but wanted to discuss it; (d) gaps in knowledge about ACP emerged; (e) CPR information was helpful/acceptable; (f) physicians should be involved in ACP; and (g) medical questions about critical illness arose. Findings identified that while sometimes difficult to discuss, advance care planning is desired, deemed helpful, and ideally begun early by clinicians, and that video education is an appropriate and affirming initiator of discussions. These themes are incorporated into our ongoing research on cancer patient-specific values and education about care options. Copyright © 2015 John Wiley & Sons, Ltd.

  13. Improvements in the quality of advanced life support and patient outcome after implementation of a standardized real-life post-resuscitation feedback system.

    Science.gov (United States)

    Hubner, Pia; Lobmeyr, Elisabeth; Wallmüller, Christian; Poppe, Michael; Datler, Philip; Keferböck, Markus; Zeiner, Sebastian; Nürnberger, Alexander; Zajicek, Andreas; Laggner, Anton; Sterz, Fritz; Sulzgruber, Patrick

    2017-11-01

    Educational aspects in the training of advanced life support (ALS) represent a key role in critical care management of patients with out-of-hospital cardiac arrest (OHCA) and received special attention in guidelines of various international societies. While a positive association of feedback on ALS performance in training conditions is well established, data on the impact of a real-life post-resuscitation feedback on both ALS quality and outcome remain scarce and inconclusive. We aimed to elucidate the impact of a standardized post-resuscitation feedback on quality of ALS and improvements in patient outcome, in a real-life out-of-hospital setting. We prospectively enrolled and analyzed 2209 patients presenting with OHCA receiving resuscitation attempts by the municipal emergency medical service (EMS) of Vienna over a two-year period. A standardized post-resuscitation feedback protocol was delivered to the respective EMS-team to elucidate its impact on the quality of ALS. We observed that both chest compression rates and ratios were in accordance to recommendations of recent guidelines. While interruptions of chest compressions longer than 30s declined during the observation period (-6.5%) rates of the recommended chest compressions during defibrillator-charging periods increased (+8.9%). Since the percentage of ROSC and 30-day survival remained balanced, the frequencies of both survival until hospital discharge (+6.3%) and favorable neurological outcome (+16%) in survivors significantly increased during the observation period. Improvements in the quality of advanced life support as well the patient outcome were observed after the implementation of a standardized post-resuscitation feedback protocol. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. A Randomized Controlled Trial of a Cardiopulmonary Resuscitation Video in Advance Care Planning for Progressive Pancreas and Hepatobiliary Cancer Patients

    Science.gov (United States)

    Volandes, Angelo E.; Chen, Ling Y.; Gary, Kristen A.; Li, Yuelin; Agre, Patricia; Levin, Tomer T.; Reidy, Diane L.; Meng, Raymond D.; Segal, Neil H.; Yu, Kenneth H.; Abou-Alfa, Ghassan K.; Janjigian, Yelena Y.; Kelsen, David P.; O'Reilly, Eileen M.

    2013-01-01

    Abstract Background Cardiopulmonary resuscitation (CPR) is an important advance directive (AD) topic in patients with progressive cancer; however such discussions are challenging. Objective This study investigates whether video educational information about CPR engenders broader advance care planning (ACP) discourse. Methods Patients with progressive pancreas or hepatobiliary cancer were randomized to an educational CPR video or a similar CPR narrative. The primary end-point was the difference in ACP documentation one month posttest between arms. Secondary end-points included study impressions; pre- and post-intervention knowledge of and preferences for CPR and mechanical ventilation; and longitudinal patient outcomes. Results Fifty-six subjects were consented and analyzed. Rates of ACP documentation (either formal ADs or documented discussions) were 40% in the video arm (12/30) compared to 15% in the narrative arm (4/26), OR=3.6 [95% CI: 0.9–18.0], p=0.07. Post-intervention knowledge was higher in both arms. Posttest, preferences for CPR had changed in the video arm but not in the narrative arm. Preferences regarding mechanical ventilation did not change in either arm. The majority of subjects in both arms reported the information as helpful and comfortable to discuss, and they recommended it to others. More deaths occurred in the video arm compared to the narrative arm, and more subjects died in hospice settings in the video arm. Conclusions This pilot randomized trial addressing downstream ACP effects of video versus narrative decision tools demonstrated a trend towards more ACP documentation in video subjects. This trend, as well as other video effects, is the subject of ongoing study. PMID:23725233

  15. Advance directives and do-not-resuscitate orders among patients with terminal cancer in palliative care units in Japan: a nationwide survey.

    Science.gov (United States)

    Kizawa, Yoshiyuki; Tsuneto, Satoru; Hamano, Jun; Nagaoka, Hiroka; Maeno, Takami; Shima, Yasuo

    2013-11-01

    To examine the current status of advance directives (ADs) and do-not-resuscitate (DNR) orders among patients with terminal cancer in palliative care units (PCUs) in Japan. We conducted a retrospective chart review of the last 3 consecutive patients who died in 203 PCUs before November 30, 2010. The percentages of patients who had ADs during the final hospitalization for cardiopulmonary resuscitation, mechanical ventilation, intravenous fluid administration, tube feeding, antibiotic administration, and who had appointed a health care proxy were 47%, 46%, 42%, 19%, 18%, and 48%, respectively. Seventy-six percent of the patients had a DNR order. Of the patients with decision-making capacity, 68% were involved in the DNR decision. These findings may reflect positive changes in patients' attitudes toward ADs, in Japan.

  16. Telemedicine for neonatal resuscitation.

    Science.gov (United States)

    Scheans, Patricia

    2014-01-01

    Maintaining high levels of readiness for neonatal resuscitation in low-risk maternity settings is challenging. The neonatal resuscitation program (NRP) algorithm is a community standard in the United States; yet training is biannual, and exposure to enough critical events to be proficient at timely implementation of the algorithm and the advanced procedures is rare. Evidence supports hands-free leadership to help prevent task saturation and communication to promote patient safety. Telemedicine for neonatal resuscitation involves the addition of remote, expert NRP leadership (a NICU-based neonatal nurse practitioner) via camera link to augment effectiveness of the low-risk birth center team. Unanticipated outcomes to report include faster times to transfer initiation and neuroprotective cooling. The positive impact of remote NRP leadership could lead to use of telemedicine to support teams at birthing centers throughout the United States as well as around the world.

  17. CARDIOPULMONARY RESUSCITATION

    African Journals Online (AJOL)

    practice otv CPR. problems encountered and doctors" perception ol' each other's knowledge of resuscitation. The returned terms were analysed. ... tirst. respiration or heartbeat. (respiration). Normal heart rate (6090/ min). Normal respiratory rate (1220/ min). lHow do you recognise a patient needing CPR? 2'; to methods of ...

  18. [The latest in paediatric resuscitation recommendations].

    Science.gov (United States)

    López-Herce, Jesús; Rodríguez, Antonio; Carrillo, Angel; de Lucas, Nieves; Calvo, Custodio; Civantos, Eva; Suárez, Eva; Pons, Sara; Manrique, Ignacio

    2017-04-01

    Cardiac arrest has a high mortality in children. To improve the performance of cardiopulmonary resuscitation, it is essential to disseminate the international recommendations and the training of health professionals and the general population in resuscitation. This article summarises the 2015 European Paediatric Cardiopulmonary Resuscitation recommendations, which are based on a review of the advances in cardiopulmonary resuscitation and consensus in the science and treatment by the International Council on Resuscitation. The Spanish Paediatric Cardiopulmonary Resuscitation recommendations, developed by the Spanish Group of Paediatric and Neonatal Resuscitation, are an adaptation of the European recommendations, and will be used for training health professionals and the general population in resuscitation. This article highlights the main changes from the previous 2010 recommendations on prevention of cardiac arrest, the diagnosis of cardiac arrest, basic life support, advanced life support and post-resuscitation care, as well as reviewing the algorithms of treatment of basic life support, obstruction of the airway and advanced life support. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  19. Time matters--realism in resuscitation training

    DEFF Research Database (Denmark)

    Krogh, Kristian; Høyer, Christian; Ostergaard, Doris

    2014-01-01

    BACKGROUND: The advanced life support guidelines recommend 2min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation......-based resuscitation training, the recommended 2-min CPR cycles are often deliberately decreased in order to increase the number of scenarios. The aim of this study was to test if keeping 2-min CPR cycles during resuscitation training ensures better adherence to time during resuscitation in a simulated setting......s) or shortened CPR cycles (30-45s instead of 120s) in the scenarios. Adherence to time was measured using the European Resuscitation Council's Cardiac Arrest Simulation Test (CASTest) in retention tests conducted one and 12 weeks after the course. RESULTS: The real-time group adhered significantly...

  20. Introducing systematic dispatcher-assisted cardiopulmonary resuscitation (telephone-CPR) in a non-Advanced Medical Priority Dispatch System (AMPDS): implementation process and costs.

    Science.gov (United States)

    Dami, Fabrice; Fuchs, Vincent; Praz, Laurent; Vader, John-Paul

    2010-07-01

    In order to improve the quality of our Emergency Medical Services (EMS), to raise bystander cardiopulmonary resuscitation rates and thereby meet what is becoming a universal standard in terms of quality of emergency services, we decided to implement systematic dispatcher-assisted or telephone-CPR (T-CPR) in our medical dispatch center, a non-Advanced Medical Priority Dispatch System. The aim of this article is to describe the implementation process, costs and results following the introduction of this new "quality" procedure. This was a prospective study. Over an 8-week period, our EMS dispatchers were given new procedures to provide T-CPR. We then collected data on all non-traumatic cardiac arrests within our state (Vaud, Switzerland) for the following 12 months. For each event, the dispatchers had to record in writing the reason they either ruled out cardiac arrest (CA) or did not propose T-CPR in the event they did suspect CA. All emergency call recordings were reviewed by the medical director of the EMS. The analysis of the recordings and the dispatchers' written explanations were then compared. During the 12-month study period, a total of 497 patients (both adults and children) were identified as having a non-traumatic cardiac arrest. Out of this total, 203 cases were excluded and 294 cases were eligible for T-CPR. Out of these eligible cases, dispatchers proposed T-CPR on 202 occasions (or 69% of eligible cases). They also erroneously proposed T-CPR on 17 occasions when a CA was wrongly identified (false positive). This represents 7.8% of all T-CPR. No costs were incurred to implement our study protocol and procedures. This study demonstrates it is possible, using a brief campaign of sensitization but without any specific training, to implement systematic dispatcher-assisted cardiopulmonary resuscitation in a non-Advanced Medical Priority Dispatch System such as our EMS that had no prior experience with systematic T-CPR. The results in terms of T-CPR delivery

  1. Miniature oxygen resuscitator

    Science.gov (United States)

    Johnson, G.; Teegen, J. T.; Waddell, H.

    1969-01-01

    Miniature, portable resuscitation system is used during evacuation of patients to medical facilities. A carrying case contains a modified resuscitator head, cylinder of oxygen, two-stage oxygen regulator, low pressure tube, and a mask for mouth and nose.

  2. Trauma resuscitation time.

    NARCIS (Netherlands)

    Olden, G.D.J. van; Vugt, A.B. van; Biert, J.; Goris, R.J.A.

    2003-01-01

    Documenting the timing and organisation of trauma resuscitation can be utilised to assess performance standards, and to ensure a high quality of trauma resuscitation procedures. Since there is no European literature available on trauma resuscitation time (TRT) in the emergency room, the aim of this

  3. Resuscitation education: narrowing the gap between evidence-based resuscitation guidelines and performance using best educational practices.

    Science.gov (United States)

    Hunt, Elizabeth A; Fiedor-Hamilton, Melinda; Eppich, Walter J

    2008-08-01

    Recent data from in- and out-of-hospital cardiopulmonary arrests reveal that health care teams frequently deviate from American Heart Association guidelines during resuscitation efforts. These discrepancies between the current state of evidence-based resuscitation guidelines and the quality of basic and advanced life support actually delivered represent a missed opportunity and provide a significant target for optimizing patient outcomes through improved educational effectiveness. This article presents discussion of the quality of resuscitation delivered to patients, a brief history of the development of cardiopulmonary resuscitation and attempts to translate the science of resuscitation to the bedside through effective educational strategies, a review of educational best practices that relate to resuscitation education, and discussion of the role of medical simulation in resuscitation training.

  4. Implementation of the ALERT algorithm, a new dispatcher-assisted telephone cardiopulmonary resuscitation protocol, in non-Advanced Medical Priority Dispatch System (AMPDS) Emergency Medical Services centres.

    Science.gov (United States)

    Stipulante, Samuel; Tubes, Rebecca; El Fassi, Mehdi; Donneau, Anne-Francoise; Van Troyen, Barbara; Hartstein, Gary; D'Orio, Vincent; Ghuysen, Alexandre

    2014-02-01

    Early bystander cardiopulmonary resuscitation (CPR) is a key factor in improving survival from out-of-hospital cardiac arrest (OHCA). The ALERT (Algorithme Liégeois d'Encadrement à la Réanimation par Téléphone) algorithm has the potential to help bystanders initiate CPR. This study evaluates the effectiveness of the implementation of this protocol in a non-Advanced Medical Priority Dispatch System area. We designed a before and after study based on a 3-month retrospective assessment of victims of OHCA in 2009, before the implementation of the ALERT protocol in Liege emergency medical communication centre (EMCC), and the prospective evaluation of the same 3 months in 2011, immediately after the implementation. At the moment of the call, dispatchers were able to identify 233 OHCA in the first period and 235 in the second. Victims were predominantly male (59%, both periods), with mean ages of 64.1 and 63.9 years, respectively. In 2009, only 9.9% victims benefited from bystander CPR, this increased to 22.5% in 2011 (p<0.0002). The main reasons for protocol under-utilisation were: assistance not offered by the dispatcher (42.3%), caller physically remote from the victim (20.6%). Median time from call to first compression, defined here as no flow time, was 253s in 2009 and 168s in 2011 (NS). Ten victims were admitted to hospital after ROSC in 2009 and 13 in 2011 (p=0.09). From the beginning and despite its under-utilisation, the ALERT protocol significantly improved the number of patients in whom bystander CPR was attempted. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  5. Time matters – Realism in resuscitation training

    DEFF Research Database (Denmark)

    Krogh, Kristian; Høyer, Christian Bjerre; Østergaard, Doris

    2014-01-01

    . Methods: This study was designed as a randomised control trial. Fifty-four 4th-year medical students with no prior advanced resuscitation training participated in an extra-curricular one-day advanced life support course. Participants were either randomised to simulation-based training using real-time (120...

  6. Cardiopulmonary Resuscitation (CPR): First Aid

    Science.gov (United States)

    First aid Cardiopulmonary resuscitation (CPR): First aid Cardiopulmonary resuscitation (CPR): First aid By Mayo Clinic Staff Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near ...

  7. Protocol compliance and time management in blunt trauma resuscitation.

    NARCIS (Netherlands)

    Spanjersberg, W.R.; Bergs, E.A.; Mushkudiani, N.; Klimek, M.; Schipper, I.B.

    2009-01-01

    OBJECTIVES: To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. PATIENTS AND METHODS: All

  8. An unsuccessful resuscitation:

    African Journals Online (AJOL)

    resuscitation and the cause of death. They were not too concerned with possible mistakes made during the resuscitation, as long as they had the details. The doctors experienced many difficulties in breaking the bad news, due to the low level of education of the families, emotional and unpredictable responses, not being.

  9. Fluid Resuscitation in Tactical Combat Casualty Care: Yesterday and Today.

    Science.gov (United States)

    Butler, Frank K

    2017-06-01

    The prevailing wisdom for the prehospital fluid resuscitation of trauma victims in hemorrhagic shock in 1992 was to administer 2 L of crystalloid solution as rapidly as possible. A review of the fluid resuscitation literature found that this recommendation was not well supported by the evidence at the time. Prehospital fluid resuscitation strategies were reevaluated in the 1993-1996 Tactical Combat Casualty Care (TCCC) research program. This article reviews the advances in prehospital fluid resuscitation as recommended by the original TCCC Guidelines and modified over the following 2 decades. These advances include hypotensive resuscitation, use of prehospital whole blood or blood components when feasible, and use of Hextend or selected crystalloids when logistical considerations make blood or blood component use not feasible. Published by Elsevier Inc.

  10. Protocol compliance and time management in blunt trauma resuscitation.

    Science.gov (United States)

    Spanjersberg, W R; Bergs, E A; Mushkudiani, N; Klimek, M; Schipper, I B

    2009-01-01

    To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. All victims of severe blunt trauma were consecutively included. Patients with a revised trauma score (RTS) of 12 were resuscitated by a "minor trauma" team and patients with an RTS of less than 12 were resuscitated by a "severe trauma" team. Digital video recordings were used to analyse protocol compliance and time management during initial assessment. From 1 May to 1 September 2003, 193 resuscitations were included. The "minor trauma" team assessed 119 patients, with a mean injury severity score (ISS) of 7 (range 1-45). Overall protocol compliance was 42%, ranging from 0% for thoracic percussion to 93% for thoracic auscultation. The median resuscitation time was 45.9 minutes (range 39.7-55.9). The "severe team" assessed 74 patients, with a mean ISS of 22 (range 1-59). Overall protocol compliance was 53%, ranging from 4% for thoracic percussion to 95% for thoracic auscultation. Resuscitation took 34.8 minutes median (range 21.6-44.1). Results showed the current trauma resuscitation to be ATLS-like, with sometimes very low protocol compliance rates. Timing of secondary survey and radiology and thus time efficiency remains a challenge in all trauma patients. To assess the effect of trauma resuscitation protocols on outcome, protocol adherence needs to be improved.

  11. Leadership of resuscitation teams: "Lighthouse Leadership'.

    Science.gov (United States)

    Cooper, S; Wakelam, A

    1999-09-01

    The purpose of this study was to determine the relationship between leadership behaviour, team dynamics and task performance. This was as an observational study, using video recordings of 20 resuscitation attempts. The Leadership Behaviour Description Questionnaire (LBDQ) was used to measure the level of structure built within the team. Interpersonal behaviour and the tasks of resuscitation were measured with a team dynamics and a task performance scale. The degree to which the leader actively participated, 'hands on', with the tasks of resuscitation, and their previous training in advanced life support (ALS), and experience of resuscitation attempts, were evaluated against the leadership rating. The degree to which the leader built a structure within the team was found to correlate significantly with the team dynamics (P = 0.000) and the task performance (P = 0.013). Where the leaders participated 'hands on' they were less likely to build a structured team (P = 0.005), the team were less dynamic (P = 0.028) and the tasks of resuscitation were performed less effectively (P = 0.099). Experience gained over a 1-year period did not enhance leadership performance, but leaders who had up to 3 years experience were more likely to be effective in this role (P = 0.072). Interestingly, ALS training did not enhance leadership performance per se. However those leaders who had had recent ALS training were more likely not to participate 'hands on' (P = 0.035). There were some notable shortcomings in the performance of the task and some interesting correlations relating to duration of resuscitation, survival rate estimations, the leaders' attitudes and the teams' level of experience. Leaders must build a structure within a resuscitation team in order for them to perform effectively. An emergency leadership training programme is essential to enhance the performance of leaders and their teams.

  12. Cardiac arrest: resuscitation and reperfusion.

    Science.gov (United States)

    Patil, Kaustubha D; Halperin, Henry R; Becker, Lance B

    2015-06-05

    The modern treatment of cardiac arrest is an increasingly complex medical procedure with a rapidly changing array of therapeutic approaches designed to restore life to victims of sudden death. The 2 primary goals of providing artificial circulation and defibrillation to halt ventricular fibrillation remain of paramount importance for saving lives. They have undergone significant improvements in technology and dissemination into the community subsequent to their establishment 60 years ago. The evolution of artificial circulation includes efforts to optimize manual cardiopulmonary resuscitation, external mechanical cardiopulmonary resuscitation devices designed to augment circulation, and may soon advance further into the rapid deployment of specially designed internal emergency cardiopulmonary bypass devices. The development of defibrillation technologies has progressed from bulky internal defibrillators paddles applied directly to the heart, to manually controlled external defibrillators, to automatic external defibrillators that can now be obtained over-the-counter for widespread use in the community or home. But the modern treatment of cardiac arrest now involves more than merely providing circulation and defibrillation. As suggested by a 3-phase model of treatment, newer approaches targeting patients who have had a more prolonged cardiac arrest include treatment of the metabolic phase of cardiac arrest with therapeutic hypothermia, agents to treat or prevent reperfusion injury, new strategies specifically focused on pulseless electric activity, which is the presenting rhythm in at least one third of cardiac arrests, and aggressive post resuscitation care. There are discoveries at the cellular and molecular level about ischemia and reperfusion pathobiology that may be translated into future new therapies. On the near horizon is the combination of advanced cardiopulmonary bypass plus a cocktail of multiple agents targeted at restoration of normal metabolism and

  13. History of neonatal resuscitation. Tales of heroism and desperation.

    Science.gov (United States)

    Raju, T N

    1999-09-01

    Although the history of neonatal resuscitation is as old as medicine itself, today's standards of practice evolved over the past 40 years. Most ancient physicians and midwives did know that stimulation and expansion of lungs was needed to revive the "apparently dead" newborn, but the means of providing these 'therapies' varied from brutal shaking, hitting, swinging, electrocuting, hanging upside-down to applying gentle pressures or squeezing of the chest. It would take centuries of development in physiological concepts and technology for the evolution of a rational approach in resuscitating the newborn infant. Even after great advances in medical science in the 19th century, cardiopulmonary resuscitation techniques remained primitive until the mid-1950s. In this article the author has traced some elements of cardiopulmonary resuscitation techniques and developed an outline of the history of neonatal resuscitation.

  14. The art of providing resuscitation in Greek mythology.

    Science.gov (United States)

    Siempos, Ilias I; Ntaidou, Theodora K; Samonis, George

    2014-12-01

    We reviewed Greek mythology to accumulate tales of resuscitation and we explored whether these tales could be viewed as indirect evidence that ancient Greeks considered resuscitation strategies similar to those currently used. Three compendia of Greek mythology: The Routledge Handbook of Greek Mythology, The Greek Myths by Robert Graves, and Greek Mythology by Ioannis Kakridis were used to find potentially relevant narratives. Thirteen myths that may suggest resuscitation (including 1 case of autoresuscitation) were identified. Methods to attempt mythological resuscitation included use of hands (which may correlate with basic life support procedures), a kiss on the mouth (similar to mouth-to-mouth resuscitation), application of burning torches (which might recall contemporary use of external defibrillators), and administration of drugs (a possible analogy to advanced life support procedures). A careful assessment of relevant myths demonstrated that interpretations other than medical might be more credible. Although several narratives of Greek mythology might suggest modern resuscitation techniques, they do not clearly indicate that ancient Greeks presaged scientific methods of resuscitation. Nevertheless, these elegant tales reflect humankind's optimism that a dying human might be restored to life if the appropriate procedures were implemented. Without this optimism, scientific improvement in the field of resuscitation might not have been achieved.

  15. Are We Successful in Cardiopulmonary Resuscitation?

    Directory of Open Access Journals (Sweden)

    Nalan Kozaci

    2013-08-01

    Full Text Available Purpose: In this study, we aimed to determine the success rate of cardiopulmonary resuscitation performed in the patients with diagnosis of cardiac arrest, and demographic characteristics of these patients. Material and Methods: The patients admitted to Adana Numune Education and Research Hospital, Department of Emergency Medicine between 01.01.2011 and 31.12.2012, and who underwent cardiopulmonary resuscitation were included to this study planned as retrospectively. The age, gender, status of judicial cases, causes and time of cardiac arrest, first observed arrest rhythm, the diseases prior to the arrest, means of arrival to emergency department, duration of cardiopulmonary resuscitation, results of cardiopulmonary resuscitation, the name of the hospitalised clinic, the existence of the operation, and outcome of the patients who underwent cardiopulmonary resuscitation in accordance with current advanced life support protocols were recorded in standard data entry form. Results: A total of 290 patients with completely accessible data were included to the study. Most of these patients were men (65.2%. The mean ages were 61 ± 19 years for men, 67 ± 14 years for women (p = 0.018. The most common diagnosis were ischemic heart disease and heart failure according to the analysis of the patient's medical history. 92 patients (31.7% were brought to the emergency department after death, and all of these patients were unsuccessful following to cardiopulmonary resuscitation. 198 patients (68.3% had cardiac arrest in the emergency department, and we determined that cardiopulmonary resuscitation application of 102 patients were successful. The most common causes of cardiac arrest were myocardial infarction and heart failure. Mostly first observed rhythm in the monitor was asystole. The response rate of cardiopulmonary resuscitation in patients with ventricular fibrillation and ventricular tachycardia was higher. Most patients were hospitalised to the

  16. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

    Science.gov (United States)

    Donnino, Michael W; Andersen, Lars W; Berg, Katherine M; Reynolds, Joshua C; Nolan, Jerry P; Morley, Peter T; Lang, Eddy; Cocchi, Michael N; Xanthos, Theodoros; Callaway, Clifton W; Soar, Jasmeet

    2016-01-01

    For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32 °C and 36 °C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document. Copyright © 2015. Published by Elsevier Ireland Ltd.

  17. A comparison of three neonatal resuscitation devices.

    Science.gov (United States)

    Bennett, Stacie; Finer, Neil N; Rich, Wade; Vaucher, Yvonne

    2005-10-01

    Ventilation during neonatal resuscitation involves the use of self-inflating bags, flow-inflating bags, and T-piece resuscitators. The ability of operators to deliver desired peak inspiratory pressures (PIP), positive end expiratory pressures (PEEP), prolonged inflations and the length of time to transition between different pressures has not been compared for all three of these devices. To compare the ability of neonatal resuscitation personnel to deliver predetermined ventilation interventions using these devices in advance of a clinical trial of neonatal resuscitation. We studied 31 operators (neomatologists, neonatal respiratory therapists, neonatal fellows, a pediatrician, pediatric residents, neonatal nurse practitioners, and neonatal nurses) using a T-piece resuscitator (Neopuff), Fisher and Paykel Healthcare, Auckland, New Zealand), a self-inflating bag (Baby Blue II, Vital Signs, Totowa, NJ), and a flow-inflating bag (Model E191 Anesthesia Associates, San Marcos, CA). The self-inflating bag was tested with and without the manufacturer's PEEP valve. Using a continuous pressure recording system and a neonatal manikin, we evaluated the ability to deliver a consistent PIP of 20 or 40 cmH2O and a PEEP of 5 cmH2O during 30 s of ventilation, the ability to maintain a 5 s inflation at a PIP of 20 cmH2O and the time to transition from a PIP of 20 to 40 cmH2O. Each device was evaluated with and without a qualitative CO2 detector (Pedicap) Nellcor Pleasanton, CA). The T-piece resuscitator delivered the desired PIP more precisely and consistently compared with the self-inflating bag at a target of 20 cmH2O (maximum PIP 20.7 cmH2O, S.D.=0.8 versus 24.7 cmH2O, S.D.=2.8; ppiece resuscitator was significantly less than both the flow-inflating bag and the self-inflating bag (39.7 cmH2O, S.D.=2.1 versus 44 cmH2O, S.D.=3.3 versus 45.3 cmH2O, S.D.=4.7; ppiece resuscitator compared to the self-inflating bag or the flow-inflating bag (5.7 s versus 2.2 s versus 1.8 s; pinflation

  18. Haemostatic resuscitation in trauma

    DEFF Research Database (Denmark)

    Stensballe, Jakob; Ostrowski, Sisse Rye; Johansson, Par I.

    2016-01-01

    PURPOSE OF REVIEW: To discuss the recent developments in and evolvement of next generation haemostatic resuscitation in bleeding trauma. RECENT FINDINGS: Mortality from major trauma is a worldwide problem, and massive haemorrhage remains a major cause of potentially preventable deaths. Development...... of coagulopathy further increases trauma mortality emphasizing that coagulopathy is a key target in the phase of bleeding. The pathophysiology of coagulopathy in trauma reflects at least three distinct mechanisms that may be present isolated or coexist: acute traumatic coagulopathy, coagulopathy associated...... with the lethal triad, and consumptive coagulopathy. The concepts of 'damage control surgery' and 'damage control resuscitation' have been developed to ensure early control of bleeding and coagulopathy to improve outcome in bleeding trauma. Haemostatic resuscitation aims at controlling coagulopathy and consists...

  19. Towards evidence-based resuscitation of the newborn infant.

    Science.gov (United States)

    Manley, Brett J; Owen, Louise S; Hooper, Stuart B; Jacobs, Susan E; Cheong, Jeanie L Y; Doyle, Lex W; Davis, Peter G

    2017-04-22

    Effective resuscitation of the newborn infant has the potential to save many lives around the world and reduce disabilities in children who survive peripartum asphyxia. In this Series paper, we highlight some of the important advances in the understanding of how best to resuscitate newborn infants, which includes monitoring techniques to guide resuscitative efforts, increasing awareness of the adverse effects of hyperoxia, delayed umbilical cord clamping, the avoidance of routine endotracheal intubation for extremely preterm infants, and therapeutic hypothermia for hypoxic-ischaemic encephalopathy. Despite the challenges of performing high-quality clinical research in the delivery room, researchers continue to refine and advance our knowledge of effective resuscitation of newborn infants through scientific experiments and clinical trials. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Resuscitative goals and new strategies in severe trauma patient resuscitation.

    Science.gov (United States)

    Egea-Guerrero, J J; Freire-Aragón, M D; Serrano-Lázaro, A; Quintana-Díaz, M

    2014-11-01

    Traumatic injuries represent a major health problem all over the world. In recent years we have witnessed profound changes in the paradigm of severe trauma patient resuscitation, new concepts regarding acute coagulopathy in trauma have been proposed, and there has been an expansion of specific commercial products related to hemostasis, among other aspects. New strategies in severe trauma management include the early identification of those injuries that are life threatening and require surgical hemostasis, tolerance of moderate hypotension, rational intravascular volume replacement, prevention of hypothermia, correction of acidosis, optimization of oxygen carriers, and identification of those factors required by the patient (fresh frozen plasma, platelets, tranexamic acid, fibrinogen, cryoprecipitates and prothrombin complex). However, despite such advances, further evidence is required to improve survival rates in severe trauma patients. Copyright © 2014 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  1. resuscitation among Nigerian doctors

    African Journals Online (AJOL)

    ABSTRACT. Background: Cardiopulmonary resuscitation (CPR), first described in 1960, is observed to be poorly applied in quality and quantum, hence, the need to ascertain its correct knowledge and practice among Nigerian doctors. Methods: Questionnaires were distributed randomly to doctors in a Nigerian University.

  2. Resuscitation of the Newborn

    African Journals Online (AJOL)

    to insufflate the lungs (this is an application of La Place's law), but more gas will be forced through the escape pres- sure vent and less gas will reach the lungs than in a larger neonate. The resuscitator (Fig. 1) consists of a polypropylene accordion-like bellows (capacity 100 cm') which is attached to a clear polystyrene valve ...

  3. Paediatric and Neonatal Resuscitation

    African Journals Online (AJOL)

    Failure of the circulation for 3-4 minutes will lead to irreversible cerebral damage. Delay, within that time, will lessen the ... airway /breathing/ circulation. The basic principles of resuscitation: These include a SAFE ... units, accident and emergency, theatres, intensive care units and x-ray departments must be trained. This. 47 ...

  4. Hydroxyethyl starch for resuscitation

    DEFF Research Database (Denmark)

    Haase, Nicolai; Perner, Anders

    2013-01-01

    PURPOSE OF REVIEW: Resuscitation with hydroxyethyl starch (HES) is controversial. In this review, we will present the current evidence for the use of HES solutions including data from recent high-quality randomized clinical trials. RECENT FINDINGS: Meta-analyses of HES vs. control fluids show clear...

  5. Resuscitation at the limits of viability--an Irish perspective.

    LENUS (Irish Health Repository)

    Khan, R A

    2012-02-01

    BACKGROUND: Advances in neonatal care continue to lower the limit of viability. Decision making in this grey zone remains a challenging process. OBJECTIVE: To explore the opinions of healthcare providers on resuscitation and outcome in the less than 28-week preterm newborn. DESIGN\\/METHODS: An anonymous postal questionnaire was sent to health care providers working in maternity units in the Republic of Ireland. Questions related to neonatal management of the extreme preterm infant, and estimated survival and long-term outcome. RESULTS: The response rate was 55% (74% obstetricians and 70% neonatologists). Less than 1% would advocate resuscitation at 22 weeks, 10% of health care providers advocate resuscitation at 23 weeks gestation, 80% of all health care providers would resuscitate at 24 weeks gestation. 20% of all health care providers would advocate cessation of resuscitation efforts on 22-25 weeks gestation at 5 min of age. 65% of Neonatologists and 54% trainees in Paediatrics would cease resuscitation at 10 min of age. Obstetricians were more pessimistic about survival and long term outcome in newborns delivered between 23 and 27 weeks when compared with neonatologists. This difference was also observed in trainees in paediatrics and obstetrics. CONCLUSION: Neonatologists, trainees in paediatrics and neonatal nurses are generally more optimistic about outcome than their counterparts in obstetrical care and this is reflected in a greater willingness to provide resuscitation efforts at the limits of viability.

  6. The varying ethical attitudes towards resuscitation in Europe.

    Science.gov (United States)

    Baskett, Peter J F; Lim, Andy

    2004-09-01

    This study was conducted to assess the varying attitudes in Europe towards ethical aspects of resuscitation in Europe. The ethics of resuscitation is a key discussion topic in the European Resuscitation Council Advanced Life Support (ALS) course. A questionnaire was sent to all leading ALS course directors in 20 European countries. All completed the questionnaire. The results were compiled in March 2004. Views were sought on the following ethical aspects:When not to attempt resuscitation Active euthanasia When to abandon resuscitation efforts The diagnosis of death by non physicians Permission for relatives to be with the patient during resuscitation if they wish Teaching on the recently dead Breaking bad news Results: The results reveal a considerable variation in the interpretation of ethical dilemmas within European countries. It is interesting to note that the results do not necessarily conform to traditional beliefs in the characteristic differences between Northern and Southern Europe. The Mediterranean countries do not all have the same attitudes, any more than the Nordic or Central European countries share the same views. There remains a widespread divergence of views on ethical aspects of resuscitation with the countries of Europe that are largely unpredictable according to commonly perceived national characteristics. The trend over the past 6 years is towards a more permissive attitude. For many ethical questions there can be no clear and correct didactic answers.

  7. Resuscitation of avalanche victims: Evidence-based guidelines of the international commission for mountain emergency medicine (ICAR MEDCOM): intended for physicians and other advanced life support personnel.

    Science.gov (United States)

    Brugger, Hermann; Durrer, Bruno; Elsensohn, Fidel; Paal, Peter; Strapazzon, Giacomo; Winterberger, Eveline; Zafren, Ken; Boyd, Jeff

    2013-05-01

    In North America and Europe ∼150 persons are killed by avalanches every year. The International Commission for Mountain Emergency Medicine (ICAR MEDCOM) systematically developed evidence-based guidelines and an algorithm for the management of avalanche victims using a worksheet of 27 Population Intervention Comparator Outcome questions. Classification of recommendations and level of evidence are ranked using the American Heart Association system. If lethal injuries are excluded and the body is not frozen, the rescue strategy is governed by the duration of snow burial and, if not available, by the victim's core-temperature. If burial time ≤35 min (or core-temperature ≥32 °C) rapid extrication and standard ALS is important. If burial time >35 min and core-temperature patent airway) should be transported to a hospital for extracorporeal membrane oxygenation or cardiopulmonary bypass rewarming. Patients in cardiac arrest should receive uninterrupted CPR; with asystole, CPR may be terminated (or withheld) if a patient is lethally injured or completely frozen, the airway is blocked and duration of burial >35 min, serum potassium >12 mmol L(-1), risk to the rescuers is unacceptably high or a valid do-not-resuscitate order exists. Management should include spinal precautions and other trauma care as indicated. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  8. Colloids in Acute Burn Resuscitation.

    Science.gov (United States)

    Cartotto, Robert; Greenhalgh, David

    2016-10-01

    Colloids have been used in varying capacities throughout the history of formula-based burn resuscitation. There is sound experimental evidence that demonstrates colloids' ability to improve intravascular colloid osmotic pressure, expand intravascular volume, reduce resuscitation requirements, and limit edema in unburned tissue following a major burn. Fresh frozen plasma appears to be a useful and effective immediate burn resuscitation fluid but its benefits must be weighed against its costs, and risks of viral transmission and acute lung injury. Albumin, in contrast, is less expensive and safer and has demonstrated ability to reduce resuscitation requirements and possibly limit edema-related morbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Singapore Paediatric Resuscitation Guidelines 2016

    Science.gov (United States)

    Ong, Gene Yong Kwang; Chan, Irene Lai Yeen; Ng, Agnes Suah Bwee; Chew, Su Yah; Mok, Yee Hui; Chan, Yoke Hwee; Ong, Jacqueline Soo May; Ganapathy, Sashikumar; Ng, Kee Chong

    2017-01-01

    We present the revised 2016 Singapore paediatric resuscitation guidelines. The International Liaison Committee on Resuscitation’s Pediatric Taskforce Consensus Statements on Science and Treatment Recommendations, as well as the updated resuscitation guidelines from the American Heart Association and European Resuscitation Council released in October 2015, were debated and discussed by the workgroup. The final recommendations for the Singapore Paediatric Resuscitation Guidelines 2016 were derived after carefully reviewing the current available evidence in the literature and balancing it with local clinical practice. PMID:28741003

  10. Protocolized Resuscitation of Burn Patients.

    Science.gov (United States)

    Cancio, Leopoldo C; Salinas, Jose; Kramer, George C

    2016-10-01

    Fluid resuscitation of burn patients is commonly initiated using modified Brooke or Parkland formula. The fluid infusion rate is titrated up or down hourly to maintain adequate urine output and other endpoints. Over-resuscitation leads to morbid complications. Adherence to paper-based protocols, flow sheets, and clinical practice guidelines is associated with decreased fluid resuscitation volumes and complications. Computerized tools assist providers. Although completely autonomous closed-loop control of resuscitation has been demonstrated in animal models of burn shock, the major advantages of open-loop and decision-support systems are identifying trends, enhancing situational awareness, and encouraging burn team communication. Published by Elsevier Inc.

  11. The role of simulation in teaching pediatric resuscitation: current perspectives

    Directory of Open Access Journals (Sweden)

    Lin Y

    2015-03-01

    Full Text Available Yiqun Lin,1 Adam Cheng2 1KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada; 2KidSIM-ASPIRE Research Program, Department of Pediatrics, Division of Emergency Medicine, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada Abstract: The use of simulation for teaching the knowledge, skills, and behaviors necessary for effective pediatric resuscitation has seen widespread growth and adoption across pediatric institutions. In this paper, we describe the application of simulation in pediatric resuscitation training and review the evidence for the use of simulation in neonatal resuscitation, pediatric advanced life support, procedural skills training, and crisis resource management training. We also highlight studies supporting several key instructional design elements that enhance learning, including the use of high-fidelity simulation, distributed practice, deliberate practice, feedback, and debriefing. Simulation-based training is an effective modality for teaching pediatric resuscitation concepts. Current literature has revealed some research gaps in simulation-based education, which could indicate the direction for the future of pediatric resuscitation research. Keywords: simulation, pediatric resuscitation, medical education, instructional design, crisis resource management, health care

  12. Decisions not to resuscitate in a Swedish university hospital.

    Science.gov (United States)

    Friberg, H; Adolfsson, A; Lundberg, D

    1997-11-01

    Cardiopulmonary resuscitation (CPR) has the potential to save many lives. Used indiscriminately though, it may be harmful and not in the best interest of the patient. An advance directive to refrain from resuscitation in selected patients is probably not uncommon in Sweden, but guidelines ruling this are still generally lacking. This study was performed to evaluate the use and documentation of do-not-resuscitate orders in a Swedish university hospital. Adult inpatients at 7 medical, 3 surgical and 2 neurological wards, a total of 220, were investigated on one specific day by interviewing the physicians and nurses responsible for their care. We found a discrepancy in doctors' and nurses' perception concerning the appropriateness of CPR in selected patients. CPR was judged by doctors to be inappropriate for 45 patients (20%). Out of these 45 patients, only 24 had a written do-not-resuscitate order in their medical record, in most cases noted as a code word or sign only. Rarely were the patient or his/her relatives involved in the decision-making process. We conclude that a decision to refrain from resuscitation is often not made, even when considered medically and ethically justifiable. Also, the use of coded information as a sole indicator for a patient not to be resuscitated is still common practice. The patient or his/her relatives are rarely involved in this decision.

  13. Viscoelastic guidance of resuscitation

    DEFF Research Database (Denmark)

    Stensballe, Jakob; Ostrowski, Sisse R; Johansson, Pär I

    2014-01-01

    PURPOSE OF REVIEW: Bleeding in trauma carries a high mortality and is increased in case of coagulopathy. Our understanding of hemostasis and coagulopathy has improved, leading to a change in the protocols for hemostatic monitoring. This review describes the current state of evidence supporting...... populations. In trauma care, viscoelastic hemostatic assays allows for rapid and timely identification of coagulopathy and individualized, goal-directed transfusion therapy. As part of the resuscitation concept, viscoelastic hemostatic assays seem to improve outcome also in trauma; however, there is a need...

  14. CEASE: a guide for clinicians on how to stop resuscitation efforts.

    Science.gov (United States)

    Torke, Alexia M; Bledsoe, Patricia; Wocial, Lucia D; Bosslet, Gabriel T; Helft, Paul R

    2015-03-01

    Resuscitation programs such as Advanced Cardiac Life Support, Cardiac Life Support, Pediatric Advanced Life Support, and the Neonatal Resuscitation Program offer inadequate guidance to physicians who must ultimately decide when to stop resuscitation efforts. These decisions involve clinical and ethical judgments and are complicated by communication challenges, group dynamics, and family considerations. This article presents a framework, summarized in a mnemonic (CEASE: Clinical Features, Effectiveness, Ask, Stop, Explain), for how to stop resuscitation efforts and communicate that decision to clinicians and ultimately the patient's family. Rather than a decision rule, this mnemonic represents a framework based on best evidence for when physicians are considering stopping resuscitation efforts and provides guidance on how to communicate that decision.

  15. Debriefing after resuscitation.

    Science.gov (United States)

    Couper, Keith; Perkins, Gavin D

    2013-06-01

    Evidence of suboptimal cardiopulmonary resuscitation (CPR) delivery in practice has driven interest in strategies to improve CPR quality. Early data suggest that debriefing may be an effective strategy. In this review, we analyse types of debriefing and the evidence to support their usage. There is a general lack of standardization in terminology and methods used for debriefing that limits evaluation. Debriefing interventions generally take two different formats. Hot debriefing is one where individuals or teams are provided with debriefing immediately after the event. Although perhaps the most widely used and easiest to implement, research evidence for its effectiveness is scant. Cold debriefing, where individuals or teams are provided with feedback sometime after the event, is associated with improvements in process and patient outcomes. Such feedback usually involves the use of objective performance data, such as defibrillator downloads or videotape records. Before and after cohort studies have found that both verbal debriefing in groups and individual written feedback seem to be associated with an improvement in performance. Debriefing is a useful strategy to improve resuscitation performance, but the optimal delivery method remains unclear. Future high-quality research is required to identify the most effective form of debriefing.

  16. EVOLUTION OF KNOWLEDGE DEVELOPMENT IN HUMAN RESUSCITATION

    OpenAIRE

    O. Zabolotina

    2010-01-01

    Study of human resuscitation development history is the first step in understanding modern approaches to cardiopulmonary resuscitation. A significant increase in survival parameters is driven by accumulation of knowledge, expertise, improvement in resuscitation technologies. Development of cardiopulmonary resuscitation structure, development of recommendations approved for study and practical use, addressing these issues at the state level are accompanied with a significant reduction in morta...

  17. Knowledge of cardiopulmonary resuscitation of clinicians at a South ...

    African Journals Online (AJOL)

    Objectives: The objectives of this study were to assess clinicians' knowledge about evaluating possible cardiac arrest patients and recognising cardiac arrest, to assess clinicians' knowledge about appropriate decisions and actions during cardiopulmonary resuscitation (CPR), and to determine which advanced life support ...

  18. 2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

    Science.gov (United States)

    Kleinman, Monica E; Goldberger, Zachary D; Rea, Thomas; Swor, Robert A; Bobrow, Bentley J; Brennan, Erin E; Terry, Mark; Hemphill, Robin; Gazmuri, Raúl J; Hazinski, Mary Fran; Travers, Andrew H

    2018-01-02

    Cardiopulmonary resuscitation is a lifesaving technique for victims of sudden cardiac arrest. Despite advances in resuscitation science, basic life support remains a critical factor in determining outcomes. The American Heart Association recommendations for adult basic life support incorporate the most recently published evidence and serve as the basis for education and training for laypeople and healthcare providers who perform cardiopulmonary resuscitation. © 2017 American Heart Association, Inc.

  19. Do not attempt resuscitation orders at the emergency department of a teaching hospital.

    Science.gov (United States)

    Vancini-Campanharo, Cássia Regina; Vancini, Rodrigo Luiz; Machado Netto, Marcelo Calil; Lopes, Maria Carolina Barbosa Teixeira; Okuno, Meiry Fernanda Pinto; Batista, Ruth Ester Assayag; Góis, Aécio Flávio Teixeira de

    2017-01-01

    To identify factors associated with not attempting resuscitation. A cross-sectional study conducted at the emergency department of a teaching hospital. The sample consisted of 285 patients; in that, 216 were submitted to cardiopulmonary resuscitation and 69 were not. The data were collected by means of the in-hospital Utstein Style. To compare resuscitation attempts with variables of interest we used the χ2 test, likelihood ratio, Fisher exact test, and analysis of variance (pcardiopulmonary resuscitation was considered unjustifiable in 56.5% of cases; in that, 37.7% did not want resuscitation and 5.8% were found dead. Of all patients, 22.4% had suffered a previous cardiac arrest, 49.1% were independent for Activities of Daily Living, 89.8% had positive past medical/surgical history; 63.8% were conscious, 69.8% were breathing and 74.4% had a pulse upon admission. Most events (76.4%) happened at the hospital, the presumed cause was respiratory failure in 28.7% and, in 48.4%, electric activity without pulse was the initial rhythm. The most frequent cause of death was infection. The factors that influenced non-resuscitation were advanced age, history of neoplasm and the initial arrest rhythm was asystole. Advanced age, past history of neoplasia and asystole as initial rhythm were factors that significantly influenced the non-performance of resuscitation. Greater clarity when making the decision to resuscitate patients can positively affect the quality of life of survivors.

  20. Ukraine: Resuscitation of Innovations

    Directory of Open Access Journals (Sweden)

    Poliakova Olha Yu.

    2017-03-01

    Full Text Available The article is aimed at identifying, generalizing and structuring the current problems in the sphere of innovations of Ukraine and development of proposals for their solution. The article analyzes the key indicators of innovation activity of enterprises of Ukraine for the period 2005-2015, carries out the international comparisons using data reports of «Global innovation index – 2016" and «European Innovation Scoreboard 2016», revealing worsening of negative tendencies in the sphere of innovations of Ukraine. The carried out study allowed to formulate three directions under which the key problems in the sphere of innovations of Ukraine and the ways for resuscitation of innovations were structured: financing, innovation activity of enterprises and its State regulation, organizational and infrastructural provision. As a matter of priority, development and approval of an integrated strategy for the development of innovation, science and education of Ukraine have been proposed.

  1. [Which drugs are useful during resuscitation? Which are not?].

    Science.gov (United States)

    Haverkamp, Wilhelm

    2016-03-01

    Cardiopulmonary resuscitation represents a therapeutic challenge. Evidence-based guidelines, which were updated in 2015, give detailed advice on how to treat the patient. Basic life support consists of cardiopulmonary resuscitation (30 chest compressions interrupted briefly to provide to 2 ventilations) and, if ventricular tachyarrhythmia is present, urgent cardiac defibrillation. Administration of drugs is one of the aspects of advanced life support. Vasopressors (adrenaline, vasopressin) aim to optimize coronary and cerebral perfusion. Antiarrhythmic drugs (amiodarone or lidocaine, when amiodarone is not available) are given during cardiac arrest to treat specific cardiac arrhythmias, mainly ventricular fibrillation and ventricular tachycardia. However, even in current guidelines, there is growing ambivalence towards drug treatment in the setting of cardiopulmonary resuscitation. This is mainly due to a paucity of robust clinical data. Most of the studies that have addressed the efficacy and safety of drugs during resuscitation are observational studies; however, a few small randomized controlled studies also exist. Recently, two large randomized controlled studies addressing the efficacy and safety of adrenaline versus placebo and amiodarone or lidocaine versus placebo have started. Both are currently recruiting patients. The hope is that the results of these studies will help to better define the role of drugs administered during cardiopulmonary resuscitation.

  2. Suspended animation for delayed resuscitation.

    Science.gov (United States)

    Safar, Peter J; Tisherman, Samuel A

    2002-04-01

    'Suspended animation for delayed resuscitation' is a new concept for attempting resuscitation from cardiac arrest of patients who currently (totally or temporarily) cannot be resuscitated, such as traumatic exsanguination cardiac arrest. Suspended animation means preservation of the viability of brain and organism during cardiac arrest, until restoration of stable spontaneous circulation or prolonged artificial circulation is possible. Suspended animation for exsanguination cardiac arrest of trauma victims would have to be induced within the critical first 5 min after the start of cardiac arrest no-flow, to buy time for transport and resuscitative surgery (hemostasis) performed during no-flow. Cardiac arrest is then reversed with all-out resuscitation, usually requiring cardiopulmonary bypass. Suspended animation has been explored and documented as effective in dogs in terms of long-term survival without brain damage after very prolonged cardiac arrest. In the 1990s, the Pittsburgh group achieved survival without brain damage in dogs after cardiac arrest of up to 90 min no-flow at brain (tympanic) temperature of 10 degrees C, with functionally and histologically normal brains. These studies used emergency cardiopulmonary bypass with heat exchanger or a single hypothermic saline flush into the aorta, which proved superior to pharmacologic strategies. For the large number of normovolemic sudden cardiac death victims, which currently cannot be resuscitated, more research in large animals is needed.

  3. Time Perception during Neonatal Resuscitation.

    Science.gov (United States)

    Trevisanuto, Daniele; De Bernardo, Giuseppe; Res, Giulia; Sordino, Desiree; Doglioni, Nicoletta; Weiner, Gary; Cavallin, Francesco

    2016-10-01

    To assess the accuracy of time perception during a simulated complex neonatal resuscitation. Participants in 5 neonatal resuscitation program courses were directly involved in a complex simulation scenario. They were asked to assume the role of team leader, assistant 1, or assistant 2. At the end of the scenario, each participant completed a questionnaire on perceived time intervals for key resuscitation interventions. During the scenario, actual times were documented by an external observer and video recorded for later review. In addition, participants were asked to evaluate their self-perceived level of stress and preparation. Health care providers (68 physicians and 40 nurses) were involved in 36 scenarios. Perceived time intervals for the initiation of key resuscitation interventions were shorter than the actual time intervals, regardless of the participant's role in the scenario. Self-assessed levels of stress and preparation did not influence time perception. Health care providers underestimate the passage of time, irrespective of their role in a simulated complex neonatal resuscitation. Participant's self-assessed levels of stress and preparation were not related to the accuracy of their time perception. These findings highlight the importance of assigning a dedicated individual to document interventions and the passage of time during a neonatal resuscitation. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. New multifactorial burn resuscitation formula offers superior predictive reliability in comparison to established algorithms.

    Science.gov (United States)

    Benicke, Markus; Perbix, Walter; Lefering, Rolf; Knam, Friedrich; Ipaktchi, Kyros R; Tannapfel, Andrea; Neugebauer, Edmund A M; Spilker, Gerald

    2009-02-01

    The Parkland-Baxter formula is a widely utilized resuscitation guideline for the initial management of fluid deficits in burn victims. Implementation of resuscitation formulas has helped to reduce the incidence of shock and hypovolemic organ failure such as acute renal failure in the setting of burn trauma. However, it has been shown that indiscriminate implementation of these formulas may inappropriately suit individual patient's requirements. In our experience resuscitation by the Parkland formula often forced corrections in order to reach predefined resuscitation goals. Given these findings we felt the need to refine formula based resuscitation strategies. Reviewing a subset of 81 burn admissions we screened for predictive parameters in addition to total body surface area burned (TBSA burned) and body weight influencing resuscitation volume requirements. Using multivariate linear regression analysis (MRA) various parameters were integrated in a stepwise forward mathematical selection procedure resulting in a modified resuscitation formula. A new formula including body weight, TBSA burned, inhalation injury (IHI), high blood alcohol level (BAL) and a compensating factor for advanced age was set up. The new formula was compared to the original Parkland formula. Both were assessed for predictive reliability (PR(+/-20%)). Using this strategy we were able to improve PR(+/-20%) from 28.4% to 51.9%. Optimal fluid resuscitation of severe burn victims is a complex clinical challenge. Rigid-formula based resuscitation schemes often fail to match all subtleties of current clinical practice but need to provide a reliable starting point for fluid resuscitation. We demonstrate a new multifactorial formula resulting in a better guide to initial fluid resuscitation.

  5. Resuscitation og abdominalkirurgiske aspekter ved damage control-kirurgi

    DEFF Research Database (Denmark)

    Hillingsø, Jens G; Svendsen, Lars Bo; Johansson, Pär I

    2011-01-01

    vicious cycle". Due to this a new resuscitation practice has been defined; damage control resuscitation, consisting of hypotensive resuscitation (restricted use of crystalloids), haemostatic resuscitation (balanced use of blood components) in combination with surgical haemostatic procedures (damage...... control surgery)....

  6. [Basic and advanced resuscitation of children

    DEFF Research Database (Denmark)

    Lauritsen, T.L.; Jensen, Tim; Greisen, G.

    2008-01-01

    and continued with alternating cycles of 15 chest compressions and 2 ventilations. Defibrillation of ventricular fibrillation or pulseless ventricular tachycardia is given as single 4 J per kg(-1) shock in every cycle. Rhythm or pulse is not assessed immediately after defibrillation, but first after two minutes...

  7. Advance Directives and Do Not Resuscitate Orders

    Science.gov (United States)

    ... include receiving pain medicine or dying at home.Organ donation – specifying if you want to donate your organs, ... mind, and give them more control over their death.Even if you are in good health, you ...

  8. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa).

    Science.gov (United States)

    Jacobs, Ian; Nadkarni, Vinay; Bahr, Jan; Berg, Robert A; Billi, John E; Bossaert, Leo; Cassan, Pascal; Coovadia, Ashraf; D'Este, Kate; Finn, Judith; Halperin, Henry; Handley, Anthony; Herlitz, Johan; Hickey, Robert; Idris, Ahamed; Kloeck, Walter; Larkin, Gregory Luke; Mancini, Mary Elizabeth; Mason, Pip; Mears, Gregory; Monsieurs, Koenraad; Montgomery, William; Morley, Peter; Nichol, Graham; Nolan, Jerry; Okada, Kazuo; Perlman, Jeffrey; Shuster, Michael; Steen, Petter Andreas; Sterz, Fritz; Tibballs, James; Timerman, Sergio; Truitt, Tanya; Zideman, David

    2004-11-23

    Outcome after cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress toward international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports of cardiac arrest, international registries have yet to be developed. In April 2002, a task force of the International Liaison Committee on Resuscitation (ILCOR) met in Melbourne, Australia, to review worldwide experience with the Utstein definitions and reporting templates. The task force revised the core reporting template and definitions by consensus. Care was taken to build on previous definitions, changing data elements and operational definitions only on the basis of published data and experience derived from those registries that have used Utstein-style reporting. Attention was focused on decreasing the complexity of the existing templates and addressing logistical difficulties in collecting specific core and supplementary (ie, essential and desirable) data elements recommended by previous Utstein consensus conferences. Inconsistencies in terminology between in-hospital and out-of-hospital Utstein templates were also addressed. The task force produced a reporting tool for essential data that can be used for both quality improvement (registries) and research reports and that should be applicable to both adults and children. The revised and simplified template includes practical and succinct operational definitions. It is anticipated that the revised template will enable better and more accurate completion of all reports of cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage

  9. Resuscitation Resequenced: A Rational Approach to Patients with Trauma in Shock.

    Science.gov (United States)

    Petrosoniak, Andrew; Hicks, Christopher

    2018-02-01

    Trauma resuscitation is a complex and dynamic process that requires a high-performing team to optimize patient outcomes. More than 30 years ago, Advanced Trauma Life Support was developed to formalize and standardize trauma care; however, the sequential nature of the algorithm that is used can lead to ineffective prioritization. An improved understanding of shock mandates an updated approach to trauma resuscitation. This article proposes a resequenced approach that (1) addresses immediate threats to life and (2) targets strategies for the diagnosis and management of shock causes. This updated approach emphasizes evidence-based resuscitation principles that align with physiologic priorities. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Drugs in resuscitation: an update.

    Science.gov (United States)

    Lee, S W

    2011-08-01

    Drug therapy is recommended after effective cardiopulmonary resuscitation and defibrillation in cardiac arrest. Some drugs appear to have short-term benefits, such as improved survival to hospital, e.g. vasopressor and antiarrhythmics. Hence, they have been included in the cardiac life support algorithm. However, to date, no drug (or combination of drugs) has been shown to improve long-term survival in randomised trials. Hopefully, improvements in post-arrest intensive unit care can translate improved survival in hospitals into better long-term outcomes. This review is an update on drugs during resuscitation, including the choice of agents, dosing, sequence and route. Specific drugs may have benefits in correcting identified causes of collapse. Drug usage during resuscitation is an evolving science, with the use of medications improving as results of clinical studies become available.

  11. Leadership and Teamwork in Trauma and Resuscitation.

    Science.gov (United States)

    Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

    2016-09-01

    Leadership skills are described by the American College of Surgeons' Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. We searched the PubMed database using the keywords "leadership" and then either "trauma" or "resuscitation" as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching followed by simulations. Although programs

  12. Practical Considerations in Sepsis Resuscitation.

    Science.gov (United States)

    Long, Brit; Koyfman, Alex; Modisett, Katharine L; Woods, Christian J

    2017-04-01

    Sepsis is a common condition managed in the emergency department, and the majority of patients respond to resuscitation measures, including antibiotics and i.v. fluids. However, a proportion of patients will fail to respond to standard treatment. This review elucidates practical considerations for management of sepsis in patients who fail to respond to standard treatment. Early goal-directed therapy revolutionized sepsis management. However, there is a paucity of literature that provides a well-defined treatment algorithm for patients who fail to improve with therapy. Refractory shock can be defined as continued patient hemodynamic instability (mean arterial pressure, ≤ 65 mm Hg, lactate ≥ 4 mmol/L, altered mental status) after adequate fluid loading (at least 30 mL/kg i.v.), the use of two vasopressors (with one as norepinephrine), and provision of antibiotics. When a lack of improvement is evident in the early stages of resuscitation, systematically considering source control, appropriate volume resuscitation, adequate antimicrobial coverage, vasopressor selection, presence of metabolic pathology, and complications of resuscitation, such as abdominal compartment syndrome and respiratory failure, allow emergency physicians to address the entire clinical scenario. The care of sepsis has experienced many changes in recent years. Care of the patient with sepsis who is not responding appropriately to initial resuscitation is troublesome for emergency physicians. This review provides practical considerations for resuscitation of the patient with septic shock. When a septic patient is refractory to standard therapy, systematically evaluating the patient and clinical course may lead to improved outcomes. Published by Elsevier Inc.

  13. Advances in defibrillation.

    Science.gov (United States)

    Deakin, Charles D

    2011-06-01

    The place of defibrillation in the chain of survival is paramount and this review covers advances in this aspect of resuscitation over the past 18 months. The main advance is the publication of 2010 European Resuscitation Council guidelines of which defibrillation is a key aspect. Additionally, there have been a number of important articles discussing safety issues with defibrillation, the occurrence of refibrillation following successful cardioversion, prediction of shock success and changes in transthoracic impedance with sequential defibrillation shocks. The focus of these articles is to improve the delivery of defibrillation without interrupting chest compression and aiming to do so at an optimal stage of the resuscitation attempt.

  14. EVOLUTION OF KNOWLEDGE DEVELOPMENT IN HUMAN RESUSCITATION

    Directory of Open Access Journals (Sweden)

    O. Zabolotina

    2010-01-01

    Full Text Available Study of human resuscitation development history is the first step in understanding modern approaches to cardiopulmonary resuscitation. A significant increase in survival parameters is driven by accumulation of knowledge, expertise, improvement in resuscitation technologies. Development of cardiopulmonary resuscitation structure, development of recommendations approved for study and practical use, addressing these issues at the state level are accompanied with a significant reduction in mortality both at the hospital and pre-hospital levels. Key words: children, cardiopulmonary resuscitation, development stages, training of pediatricians. (Pediatric Pharmacology. – 2010; 7(3:25-27

  15. Conflicting perspectives compromising discussions on cardiopulmonary resuscitation.

    LENUS (Irish Health Repository)

    Groarke, J

    2010-09-01

    Healthcare professionals, patients and their relatives are expected to discuss resuscitation together. This study aims to identify the differences in the knowledge base and understanding of these parties. Questionnaires examining knowledge and opinion on resuscitation matters were completed during interviews of randomly selected doctors, nurses and the general public. 70% doctors, 24% nurses and 0% of a public group correctly estimated survival to discharge following in-hospital resuscitation attempts. Deficiencies were identified in doctor and nurse knowledge of ethics governing resuscitation decisions. Public opinion often conflicts with ethical guidelines. Public understanding of the nature of cardiopulmonary arrests and resuscitation attempts; and of the implications of a \\'Do Not Attempt Resuscitation (DNAR)\\' order is poor. Television medical dramas are the primary source of resuscitation knowledge. Deficiencies in healthcare professionals\\' knowledge of resuscitation ethics and outcomes may compromise resuscitation decisions. Educational initiatives to address deficiencies are necessary. Parties involved in discussion on resuscitation do not share the same knowledge base reducing the likelihood of meaningful discussion. Public misapprehensions surrounding resuscitation must be identified and corrected during discussion.

  16. Termination of prehospital resuscitative efforts

    DEFF Research Database (Denmark)

    Mikkelsen, Søren; Schaffalitzky de Muckadell, Caroline; Binderup, Lars Grassmé

    2017-01-01

    BACKGROUND: Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when time-critical decisions to initiate or refrain from resuscitative efforts n...

  17. Trauma patients' rights during resuscitation

    Directory of Open Access Journals (Sweden)

    J.C. Bruce

    2000-09-01

    Full Text Available Doctors and nurses working in hospital emergency departments face ethical and moral conflicts more so than in other health care units. Traditional curricular approaches to health professional education have been embedded in a discriminatory societal context and as such have not prepared health professionals adequately for the ethical realities of their practice. Furthermore, the discourse on ethical theories and ethical principles do not provide clear-cut solutions to ethical dilemmas but rather serve as a guide to ethical decision- making. Within the arena of trauma and resuscitation, fundamental ethical principles such as respect for autonomy, beneficence, non-maleficence and justice cannot be taken as absolutes as these may in themselves create moral conflict. Resuscitation room activities require a balance between what is “ ethically" correct and what is “pragmatically required” . Because of the urgent nature of a resuscitation event, this balance is often under threat, with resultant transgression of patients’ rights. This article explores the sources of ethical and moral issues in trauma care and proposes a culture of human rights to provide a context for preserving and protecting trauma patients’ rights during resuscitation. Recommendations for education and research are alluded to in concluding the article.

  18. Ethical issues in cardiopulmonary resuscitation.

    Science.gov (United States)

    Holm, S; Jørgensen, E O

    2001-08-01

    If patients are to benefit from resuscitation, they must regain consciousness and their full faculties. In recent years, we have acquired important information about the natural history of neurological recovery from circulatory arrest. There are clinical tests that predict the outcome, both during ongoing cardiopulmonary resuscitation (CPR) and in the period after restoration of spontaneous circulation. The ability to predict neurological outcome at this stage offers a basis for certain ethical considerations, which are not exclusively centered on "do-not-attempt-resuscitation" (DNAR)- orders. Instead of being forced to make the decision that "I do not want CPR", the patient should be able to decide that "I want resuscitation to be discontinued, if you predict that I will not recover to a level of neurological function that is acceptable to me". Ideally, no competent patient should be given a DNAR-status without his or her consent. No CPR-attempt should be stopped, and no treatment decision for a patient recovering after CPR should be taken without knowing and assessing the available information. Good ethical decision-making requires reliable facts, which we now know are available.

  19. Improving ATLS performance in simulated pediatric trauma resuscitation using a checklist.

    Science.gov (United States)

    Parsons, Samantha E; Carter, Elizabeth A; Waterhouse, Lauren J; Fritzeen, Jennifer; Kelleher, Deirdre C; Oʼconnell, Karen J; Sarcevic, Aleksandra; Baker, Kelley M; Nelson, Erik; Werner, Nicole E; Boehm-Davis, Deborah A; Burd, Randall S

    2014-04-01

    To develop a checklist for use during pediatric trauma resuscitation and test its effectiveness during simulated resuscitations. Checklists have been used to support a wide range of complex medical activities and have effectively reduced errors and improved outcomes in different medical settings. Checklists have not been evaluated in the domain of trauma resuscitation. A focus group of trauma specialists was organized to develop a checklist for pediatric trauma resuscitation. This checklist was then tested in simulated trauma resuscitations to evaluate its impact on team performance. Resuscitations conducted with and without the checklist were compared using the Advanced Trauma Life Support (ATLS) performance score, designed to measure adherence to ATLS protocol, and surveys of team members' subjective workload. The focus group generated a checklist with 56 items divided into 5 sections corresponding to different phases of trauma resuscitation. In simulation testing, the total ATLS performance score was 4.9 points higher with a checklist than without (P ATLS protocol without increasing the workload of trauma team members.

  20. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa).

    Science.gov (United States)

    Jacobs, Ian; Nadkarni, Vinay; Bahr, Jan; Berg, Robert A; Billi, John E; Bossaert, Leo; Cassan, Pascal; Coovadia, Ashraf; D'Este, Kate; Finn, Judith; Halperin, Henry; Handley, Anthony; Herlitz, Johan; Hickey, Robert; Idris, Ahamed; Kloeck, Walter; Larkin, Gregory Luke; Mancini, Mary Elizabeth; Mason, Pip; Mears, Gregory; Monsieurs, Koenraad; Montgomery, William; Morley, Peter; Nichol, Graham; Nolan, Jerry; Okada, Kazuo; Perlman, Jeffrey; Shuster, Michael; Steen, Petter Andreas; Sterz, Fritz; Tibballs, James; Timerman, Sergio; Truitt, Tanya; Zideman, David

    2004-12-01

    Outcome following cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress toward international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports of cardiac arrest, international registries have yet to be developed. In April 2002 a task force of ILCOR met in Melbourne, Australia, to review worldwide experience with the Utstein definitions and reporting templates. The task force revised the core reporting template and definitions by consensus. Care was taken to build on previous definitions, changing data elements and operational definitions only on the basis of published data and experience derived from those registries that have used Utstein-style reporting. Attention was focused on decreasing the complexity of the existing templates and addressing logistical difficulties in collecting specific core and supplementary (i.e., essential and desirable) data elements recommended by previous Utstein consensus conference. Inconsistencies in terminology between in-hospital and out-of-hospital Utstein templates were also addressed. The task force produced a reporting tool for essential data that can be used for both quality improvement (registries) and research reports and that should be applicable to both adults and children. The revised and simplified template includes practical and succinct operational definitions. It is anticipated that the revised template will enable better and more accurate completion of all reports of cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage, confidentiality, management, and registry

  1. T-piece resuscitator versus self-inflating bag for preterm resuscitation: an institutional experience

    National Research Council Canada - National Science Library

    Jayaram, Archana; Sima, Adam; Barker, Gail; Thacker, Leroy R

    2013-01-01

    ...), flow-inflating bags, and T-piece resuscitators. To compare the effect of type of manual ventilation device on overall response to resuscitation among preterm neonates born at < 35 weeks gestation...

  2. Early Management and Fluid Resuscitation

    Directory of Open Access Journals (Sweden)

    Kaya Yorgancı

    2011-07-01

    Full Text Available Initial management of severely burned patient is similar with a trauma victim. Determination of airway patency, evaluation of respiration and circulation, early recognition of concomitant trauma has vital importance in burn patients. In the early phase, mortality mainly depends on missed or un-treated severe injuries or pathologies, but not burn injury itself.In patients that have TBSA greater than 15 %, fluid resuscitation should be started. In the first 24 hours, crystalloid solutions should be preferred. .Several formulas can guide fluid resuscitation; however the amount of fluid that is given to the patient should be individualized according to the patient’s need. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 7-10

  3. Discordance of Patient-Reported and Clinician-Ordered Resuscitation Status in Patients Hospitalized With Acute Decompensated Heart Failure.

    Science.gov (United States)

    Young, Kathleen A; Wordingham, Sara E; Strand, Jacob J; Roger, Vėronique L; Dunlay, Shannon M

    2017-04-01

    Accurate documentation of preferences for cardiopulmonary resuscitation at hospital admission is critical to ensure that patients receive resuscitation or not in accordance with their wishes. We sought to identify and characterize inconsistencies in patient-reported and clinician-ordered resuscitation status in patients hospitalized with acute decompensated heart failure (ADHF). Southeastern Minnesota residents hospitalized with ADHF were prospectively enrolled into a study that included the administration of face-to-face questionnaires from January 2014 to February 2016. Patient-reported resuscitation status was assessed at enrollment using a validated question. Clinician-ordered resuscitation preferences at hospital admission were abstracted from the electronic medical record. Of the 400 patients administered the questionnaire; 213 (53.3%) stated their resuscitation preference as Full Code, 166 (41.5%) do-not-resuscitate (DNR), and 21 (5.3%) were unsure. In comparison, clinician-ordered resuscitation status was Full Code in 263 (65.8%) patients, DNR in 133 (33.3%), and not documented in four (1.0%). Patient-reported and clinician-ordered resuscitation status was discordant in 20% of patients, of whom 5.6% elected Full Code by questionnaire and had a DNR clinician order, and 14.4% elected DNR by questionnaire but had a Full Code clinician order. Differences in age, comorbidities, health literacy, marital status, completion of advance directives, hospital length of stay, and discharge destination in patients with discordant vs. concordant resuscitation preferences were observed. Patient-reported and clinician-ordered resuscitation preferences were discordant in 20% of patients hospitalized with ADHF. The underlying etiology of these inconsistencies may reflect factors such as patient indecisiveness or patient-clinician miscommunication and requires further exploration. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc

  4. Resuscitating the Baby after Shoulder Dystocia

    Directory of Open Access Journals (Sweden)

    Savas Menticoglou

    2016-01-01

    Full Text Available Background. To propose hypovolemic shock as a possible explanation for the failure to resuscitate some babies after shoulder dystocia and to suggest a change in clinical practice. Case Presentation. Two cases are presented in which severe shoulder dystocia was resolved within five minutes. Both babies were born without a heartbeat. Despite standard resuscitation by expert neonatologists, no heartbeat was obtained until volume resuscitation was started, at 25 minutes in the first case and 11 minutes in the second. After volume resuscitation circulation was restored, there was profound brain damage and the babies died. Conclusion. Unsuspected hypovolemic shock may explain some cases of failed resuscitation after shoulder dystocia. This may require a change in clinical practice. Rather than immediately clamping the cord after the baby is delivered, it is proposed that (1 the obstetrician delay cord clamping to allow autotransfusion of the baby from the placenta and (2 the neonatal resuscitators give volume much sooner.

  5. Fluid Resuscitation in Trauma Cases

    Directory of Open Access Journals (Sweden)

    Ayca Acikalin

    2011-04-01

    Full Text Available Traumatic shock may be defined as a syndrome that begun the insufficient sytemic perfusion causes the tissue hypoxia and vital organ dysfunction. The most important point is to achieve the efficient volume. In this review we tried to discuss the recommended blood and blood products, syntethic blood, isotonic and hypertonic cristalloids and their structures, tenancy areas, advantages and dysadvantages and fluid resuscitation intended to coagulopathy in trauma cases. [Archives Medical Review Journal 2011; 20(2.000: 89-106

  6. Leadership and Teamwork in Trauma and Resuscitation

    Directory of Open Access Journals (Sweden)

    Michael Menchine

    2016-09-01

    Full Text Available Introduction: Leadership skills are described by the American College of Surgeons’ Advanced Trauma Life Support (ATLS course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders.  Methods: We searched the PubMed database using the keywords “leadership” and then either “trauma” or “resuscitation” as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1 how leadership affects patient care; 2 which tools are available to measure leadership; and 3 methods to train physicians to become better leaders. Results: We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs

  7. Leadership and Teamwork in Trauma and Resuscitation

    Science.gov (United States)

    Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

    2016-01-01

    Introduction Leadership skills are described by the American College of Surgeons’ Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. Methods We searched the PubMed database using the keywords “leadership” and then either “trauma” or “resuscitation” as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. Results We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching

  8. History of the evolution of cardiopulmonary resuscitation

    OpenAIRE

    George Karlis; Marianna Korre

    2013-01-01

    Cardiopulmonary resuscitation (CPR) is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, hist...

  9. Descriptive Analysis of Medication Administration During Inpatient Cardiopulmonary Arrest Resuscitation (from the Mayo Registry for Telemetry Efficacy in Arrest Study).

    Science.gov (United States)

    Snipelisky, David; Ray, Jordan; Matcha, Gautam; Roy, Archana; Dumitrascu, Adrian; Harris, Dana; Bosworth, Veronica; Clark, Brooke; Thomas, Colleen S; Heckman, Michael G; Vadeboncoeur, Tyler; Kusumoto, Fred; Burton, M Caroline

    2016-05-15

    Advanced cardiovascular life support guidelines exist, yet there are variations in clinical practice. Our study aims to describe the utilization of medications during resuscitation from in-hospital cardiopulmonary arrest. A retrospective review of patients who suffered a cardiopulmonary arrest from May 2008 to June 2014 was performed. Clinical and resuscitation data, including timing and dose of medications used, were extracted from the electronic medical record and comparisons made. A total of 94 patients were included in the study. Patients were divided into different groups based on the medication combination used during resuscitation: (1) epinephrine; (2) epinephrine and bicarbonate; (3) epinephrine, bicarbonate, and calcium; (4) epinephrine, bicarbonate, and epinephrine drip; and (5) epinephrine, bicarbonate, calcium, and epinephrine drip. No difference in baseline demographics or clinical data was present, apart from history of dementia and the use of calcium channel blockers. The number of medications given was correlated with resuscitation duration (Spearman's rank correlation = 0.50, p resuscitation durations compared to that of the other groups (p resuscitation efforts for in-hospital cardiopulmonary arrests. Increased duration and mortality rates were found in those resuscitations compared with epinephrine alone, likely due to the longer resuscitation duration in the former groups. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Patient Experiences of Trauma Resuscitation.

    Science.gov (United States)

    Kaufman, Elinore J; Richmond, Therese S; Wiebe, Douglas J; Jacoby, Sara F; Holena, Daniel N

    2017-09-01

    Patient satisfaction is an increasingly common feature of quality measurement, and patient-centered care is a key aspect of high-quality clinical care. Incorporating patient preferences in an acute context, such as trauma resuscitation, presents distinct challenges; however, to our knowledge, patients' experiences of trauma resuscitation have not been explored. To describe patient experiences of trauma resuscitation and to identify opportunities to improve patient experience without compromising speed or thoroughness. This qualitative, descriptive study was conducted at an urban, academic, level I trauma center. Semistructured interviews and video observations were conducted from May to December 2015. Interview participants were adult English-speaking patients who had experienced trauma resuscitation and were clinically stable with no alteration in consciousness. We recruited interview participants and conducted video observations until thematic saturation was reached, resulting in 30 interviews and 20 observations. Video observation patients did not overlap with interview participants. The purposive sample included equal numbers of violently and nonviolently injured patients. Data were analyzed for thematic content from June 2015 to April 2016. The main outcomes reported are themes of patient experience. Of 30 interview participants, 25 were men (83.3%), and 21 were black (70.0%). Of 20 video observation patients, 16 were men (80.0%), and 17 were black (85.0%). Salient aspects of patient experience of trauma resuscitation included emotional responses, physical experience, nonclinical concerns, treatment and procedures, trauma team members' interactions, communication, and comfort. Participants drew satisfaction from trauma team members' demeanor, expertise, and efficiency and valued clear clinical communication, as well as words of reassurance. Dissatisfaction stemmed from the perceived absence of these attributes and from participants' emotional or physical

  11. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation

    NARCIS (Netherlands)

    Perkins, Gavin D.; Jacobs, Ian G.; Nadkarni, Vinay M.; Berg, Robert A.; Bhanji, Farhan; Biarent, Dominique; Bossaert, Leo L.; Brett, Stephen J.; Chamberlain, Douglas; de Caen, Allan R.; Deakin, Charles D.; Finn, Judith C.; Gräsner, Jan-Thorsten; Hazinski, Mary Fran; Iwami, Taku; Koster, Rudolph W.; Lim, Swee Han; Ma, Matthew Huei-Ming; McNally, Bryan F.; Morley, Peter T.; Morrison, Laurie J.; Monsieurs, Koenraad G.; Montgomery, William; Nichol, Graham; Okada, Kazuo; Ong, Marcus Eng Hock; Travers, Andrew H.; Nolan, Jerry P.; Aikin, Richard P.; Böttiger, Bernd W.; Callaway, Clifton W.; Castren, Maaret K.; Eisenberg, Mickey S.; Kleinman, Monica E.; Kloeck, David A.; Kloeck, Walter G.; Mancini, Mary E.; Neumar, Robert W.; Ornato, Joseph P.; Paiva, Edison F.; Peberdy, Mary Ann; Soar, Jasmeet; Sierra, Alfredo F.; Stanton, David; Zideman, David A.; Rea, Thomas

    2015-01-01

    Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and

  12. Updates in the American Heart Association guidelines for cardiopulmonary resuscitation and potential applications to veterinary patients.

    Science.gov (United States)

    Maton, Barbara L; Smarick, Sean D

    2012-04-01

    To review the updates in the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and identify potential applications to veterinary patients. Cardiopulmonary arrest is common in veterinary emergency and critical care, and consensus guidelines are lacking. Human resuscitation guidelines are continually evolving as new clinical and experimental studies support updated recommendations. Synthesis of human, experimental animal model, and veterinary literature support the potential for updates and advancement in veterinary CPR practices. This review serves to highlight updates in the AHA guidelines for CPR and evaluate their application to small animal veterinary patients. Interventions identified will be evaluated for trans-species potential, raise questions regarding best resuscitation recommendations, and offer opportunities for further research to continue to advance veterinary CPR. The prognosis for any patient undergoing cardiopulmonary arrest remains guarded. © Veterinary Emergency and Critical Care Society 2012.

  13. Bispectral index monitoring is useless during cardiac arrest patients' resuscitation.

    Science.gov (United States)

    Chollet-Xémard, Charlotte; Combes, Xavier; Soupizet, François; Jabre, Patricia; Penet, Candice; Bertrand, Catherine; Margenet, Alain; Marty, Jean

    2009-02-01

    It has been suggested that out-of-hospital bispectral (BIS) index monitoring during advanced cardiac life support (ACLS) might provide an indication of cerebral resuscitation. The aims of our study were to establish whether BIS values during ACLS might predict return to spontaneous circulation, and whether BIS values on hospital admission might predict survival. This was a prospective observational study in 92 patients with cardiac arrest who received basic life support from a fire-fighter squad and ACLS on arrival of an emergency medical team on the scene. BIS values, electromyographic activity, and signal quality index were recorded throughout resuscitation and out-of-hospital management. Seven patients had recovered spontaneous cardiac activity by the time the medical team arrived on scene. Of the 92 patients, 62 patients died on scene and 30 patients returned to spontaneous cardiac activity and were admitted to hospital. The correlation between BIS values and end-tidal CO(2) during the first minutes of ACLS was poor (r(2)=0.02, P=0.19). Of the 30 admitted patients, 27 died. Three were discharged with no disabilities. There was no significant difference in BIS values on admission between the group of patients who died and the group who survived (P=0.78). Although BIS monitoring during resuscitation was not difficult, it did not predict return to spontaneous cardiac activity, nor survival after admission to intensive care. Its use to monitor cerebral function during ACLS is therefore pointless.

  14. An institutionwide approach to redesigning management of cardiopulmonary resuscitation.

    Science.gov (United States)

    Lighthall, Geoffrey K; Mayette, Michael; Harrison, T Kyle

    2013-04-01

    Despite widespread training in basic life support (BLS) and advanced cardiovascular life support (ACLS) among hospital personnel, the likelihood of survival from in-hospital cardiac arrests remains low. In 2006 a university-affiliated tertiary medical center initiated a cardiopulmonary (CPR) resuscitation redesign project. REDESIGNING THE HOSPITAL'S RESUSCITATION SYSTEM: The CPR Committee developed the interventions on the basis of a large-scale view of the process of delivering BLS and ACLS, identification of key decision nodes and actions, and compartmentalization of specific functions. It was proposed that arrest management follow a steady progression in a two-layer scheme from BLS to ACLS. Handouts describing team structure and specific roles were given to all code team providers and house staff at the start of their month-long rotations. To further increase role clarity and team organization, daily morning and evening meetings of the arrest team were instituted. Site-specific BLS training, on-site ACLS refresher training, and defibrillator training were initiated. Project elements also included use of unannounced mock codes to provide system oversight; preparation and distribution of cognitive aids (printed algorithms, dosing guides, and other checklists to ensure compliance with ACLS protocols), identification of patients who may be unstable or a source of concern, event review and analysis of arrests and other critical events, and a CPR website. A mature hospital-based resuscitation system should include definition of arrest trends and resuscitation needs, development of local methods for approaching the arresting patient, an emphasis on prevention, establishment of training programs tailored to meet specific hospital needs, system examination and oversight, and administrative processes that maximize interaction between all components.

  15. Implementation and execution of military forward resuscitation programs.

    Science.gov (United States)

    Hooper, Timothy J; Nadler, Roy; Badloe, John; Butler, Frank K; Glassberg, Elon

    2014-05-01

    Through necessity, military medicine has been the driver of medical innovation throughout history. The battlefield presents challenges, such as the requirement to provide care while under threat, resource limitation, and prolonged evacuation times, which must be overcome to improve casualty survival. Focus must also be placed on identifying the causes, and timing, of death within the battlefield. By doing so, military medical doctrine can be shaped, appropriate goals set, new concepts adopted, and relevant technologies investigated and implemented. The majority of battlefield casualties still die in the prehospital environment, before reaching a medical treatment facility, and hemorrhage remains the leading cause of potentially survivable death. Many countries have adopted policies that push damage control resuscitation forward into the prehospital setting, while understanding the need for timely medical evacuation. Although these policies vary according to country, the majority share many common principles. These include the need for early catastrophic hemorrhage control at point-of-wounding, judicious use of fluid resuscitation, use of blood products as far forward as possible, and early evacuation to a surgical facility. Some countries place medical providers with the ability, and resources, for advanced resuscitation with the forward fighting units (perhaps at company level), whereas others have established en route resuscitation capabilities. If we are to continue to improve battlefield casualty survival, we must continue to work together and learn from each other. We must also carry on working alongside our civilian colleagues so that the benefits of translational experience are not lost. This review describes several countries current military approaches to prehospital trauma care. These approaches, refined through a decade of experience, merit consideration for integration into civilian prehospital care practice.

  16. Resuscitation, prolonged cardiac arrest, and an automated chest compression device

    DEFF Research Database (Denmark)

    Risom, Martin; Jørgensen, Henrik; Rasmussen, Lars S

    2010-01-01

    The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest.......The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest....

  17. Fuzzy expert system in the prediction of neonatal resuscitation

    Directory of Open Access Journals (Sweden)

    M.A.M. Reis

    2004-05-01

    Full Text Available In view of the importance of anticipating the occurrence of critical situations in medicine, we propose the use of a fuzzy expert system to predict the need for advanced neonatal resuscitation efforts in the delivery room. This system relates the maternal medical, obstetric and neonatal characteristics to the clinical conditions of the newborn, providing a risk measurement of need of advanced neonatal resuscitation measures. It is structured as a fuzzy composition developed on the basis of the subjective perception of danger of nine neonatologists facing 61 antenatal and intrapartum clinical situations which provide a degree of association with the risk of occurrence of perinatal asphyxia. The resulting relational matrix describes the association between clinical factors and risk of perinatal asphyxia. Analyzing the inputs of the presence or absence of all 61 clinical factors, the system returns the rate of risk of perinatal asphyxia as output. A prospectively collected series of 304 cases of perinatal care was analyzed to ascertain system performance. The fuzzy expert system presented a sensitivity of 76.5% and specificity of 94.8% in the identification of the need for advanced neonatal resuscitation measures, considering a cut-off value of 5 on a scale ranging from 0 to 10. The area under the receiver operating characteristic curve was 0.93. The identification of risk situations plays an important role in the planning of health care. These preliminary results encourage us to develop further studies and to refine this model, which is intended to implement an auxiliary system able to help health care staff to make decisions in perinatal care.

  18. How we developed a comprehensive resuscitation-based simulation curriculum in emergency medicine.

    Science.gov (United States)

    Dagnone, Jeffrey Damon; McGraw, Robert; Howes, Daniel; Messenger, David; Bruder, Eric; Hall, Andrew; Chaplin, Timothy; Szulewski, Adam; Kaul, Tom; O'Brien, Terrence

    2016-01-01

    Over the past decade, simulation-based education has emerged as a new and exciting adjunct to traditional bedside teaching and learning. Simulation-based education seems particularly relevant to emergency medicine training where residents have to master a very broad skill set, and may not have sufficient real clinical opportunities to achieve competence in each and every skill. In 2006, the Emergency Medicine program at Queen's University set out to enhance our core curriculum by developing and implementing a series of simulation-based teaching sessions with a focus on resuscitative care. The sessions were developed in such as way as to satisfy the four conditions associated with optimum learning and improvement of performance; appropriate difficulty of skill, repetitive practice, motivation, and immediate feedback. The content of the sessions was determined with consideration of the national training requirements set out by the Royal College of Physicians & Surgeons of Canada. Sessions were introduced in a stepwise fashion, starting with a cardiac resuscitation series based on the AHA ACLS guidelines, and leading up to a more advanced resuscitation series as staff became more adept at teaching with simulation, and as residents became more comfortable with this style of learning. The result is a longitudinal resuscitation curriculum that begins with fundamental skills of resuscitation and crisis resource management (CRM) in the first 2 years of residency and progresses through increasingly complex resuscitation cases where senior residents are expected to play a leadership role. This paper documents how we developed, implemented, and evaluated this resuscitation-based simulation curriculum for Emergency Medicine postgraduate trainees, with discussion of some of the challenges encountered.

  19. Damage control resuscitation: lessons learned.

    Science.gov (United States)

    Giannoudi, M; Harwood, P

    2016-06-01

    Damage control resuscitation describes an approach to the early care of very seriously injured patients. The aim is to keep the patient alive whilst avoiding interventions and situations that risk worsening their situation by driving the lethal triad of hypothermia, coagulopathy and acidosis or excessively stimulating the immune-inflammatory system. It is critical that the concepts and practicalities of this approach are understood by all those involved in the early management of trauma patients. This review aims to summarise this and discusses current knowledge on the subject. Damage control resuscitation forms part of an overall approach to patient care rather than a specific intervention and has evolved from damage control surgery. It is characterised by early blood product administration, haemorrhage arrest and restoration of blood volume aiming to rapidly restore physiologic stability. The infusion of large volumes of crystalloid is no longer appropriate, instead the aim is to replace lost blood and avoid dilution and coagulopathy. In specific situations, permissive hypotension may also be of benefit, particularly in patients with severe haemorrhage from an arterial source. As rapid arrest of haemorrhage is so important, team-based protocols that deliver patients rapidly but safely, via CT scan where appropriate, to operating theatres or interventional radiology suites form a critical part of this process. Given that interventions are so time dependent in the severely injured, it is likely that by further improving trauma systems and protocols, improvements in outcome can still be made. Further research work in this area will allow us to target these approaches more accurately to those patients who can benefit most.

  20. Teamwork and Leadership in Cardiopulmonary Resuscitation

    National Research Council Canada - National Science Library

    Hunziker, Sabina; Johansson, Anna C; Tschan, Franziska; Semmer, Norbert K; Rock, Laura; Howell, Michael D; Marsch, Stephan

    2011-01-01

    .... Resuscitation teams often deviate from algorithms of CPR. Emerging evidence suggests that in addition to technical skills of individual rescuers, human factors such as teamwork and leadership affect adherence to algorithms and hence the outcome of CPR...

  1. Fluid resuscitation for critically ill patients

    Directory of Open Access Journals (Sweden)

    Fei-hu ZHOU

    2017-04-01

    Full Text Available Fluid overload is frequently found in patients with intravenous fluid resuscitation, and recent studies showed the potential risks of fluid overload for organ failure and mortality. To avoid volume overload and its associated complications, strategies to identify fluid responsiveness are necessary. Apart from the amount of fluid utilized for resuscitation, the type of fluid used also impacts patient outcome. In recent years, there has also been an increasing focus on comparing various resuscitation fluids with respect to both benefits and risks. In this article, through analyzing the impact of fluid overload on patient outcome, we describe the differences in static and dynamic estimates of fluid responsiveness, and review the current literature regarding choice of intravenous fluids for resuscitation in critically ill patients to help clinicians to make appropriative decision on intravenous fluids prescription and to optimize patient outcome. DOI: 10.11855/j.issn.0577-7402.2017.02.04

  2. The Evolving Science of Trauma Resuscitation.

    Science.gov (United States)

    Harris, Tim; Davenport, Ross; Mak, Matthew; Brohi, Karim

    2018-02-01

    This review summarizes the evolution of trauma resuscitation from a one-size-fits-all approach to one tailored to patient physiology. The most dramatic change is in the management of actively bleeding patients, with a balanced blood product-based resuscitation approach (avoiding crystalloids) and surgery focused on hemorrhage control, not definitive care. When hemostasis has been achieved, definitive resuscitation to restore organ perfusion is initiated. This approach is associated with decreased mortality, reduced duration of stay, improved coagulation profile, and reduced crystalloid/vasopressor use. This article focuses on the tools and methods used for trauma resuscitation in the acute phase of trauma care. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. A case of survival after cardiac arrest and 3½ hours of resuscitation.

    Science.gov (United States)

    Nusbaum, Derek M; Bassett, Scott T; Gregoric, Igor D; Kar, Biswajit

    2014-04-01

    Although survival rates after cardiac arrest remain low, new techniques are improving patients' outcomes. We present the case of a 40-year-old man who survived a cardiac arrest that lasted approximately 3½ hours. Resuscitation was performed with strict adherence to American Heart Association/American College of Cardiology Advanced Cardiac Life Support guidelines until bedside extracorporeal membrane oxygenation could be placed. A hypothermia protocol was initiated immediately afterwards. The patient had a full neurologic recovery and was bridged from dual ventricular assist devices to a total artificial heart. On hospital day 160, he underwent orthotopic heart and cadaveric kidney transplantation. On day 179, he was discharged from the hospital in ambulatory condition. To our knowledge, this is the only reported case in which a patient survived with good neurologic outcomes after a resuscitation that lasted as long as 3½ hours. Documented cases of resuscitation with good recovery after prolonged arrest give hope for improved overall outcomes in the future.

  4. Are We Successful in Cardiopulmonary Resuscitation?

    OpenAIRE

    Nalan Kozaci; Mehmet Oguzhan Ay; Ferhat Icme; Abdulkadir Akturk; Salim Satar

    2013-01-01

    Purpose: In this study, we aimed to determine the success rate of cardiopulmonary resuscitation performed in the patients with diagnosis of cardiac arrest, and demographic characteristics of these patients. Material and Methods: The patients admitted to Adana Numune Education and Research Hospital, Department of Emergency Medicine between 01.01.2011 and 31.12.2012, and who underwent cardiopulmonary resuscitation were included to this study planned as retrospectively. The age, gender, status o...

  5. Amitriptyline Intoxication Responded to Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    Güldem Turan

    2012-04-01

    Full Text Available The most severe effects in amitriptiline intoxications are related with central nervous system and cardiovascular system. Amitriptiline intoxication especially with high doses has severe cardiac effects and can result in cardiac arrest. Most favorable responses can be achieved with efficient and prolonged cardiopulmonary resuscitation. We wanted to present a case ingested high dose of amitriptiline for attempt to suicide and responded to prolonged cardiopulmonary resuscitation.

  6. Providing immediate neonatal care and resuscitation at birth beside the mother: parents' views, a qualitative study.

    Science.gov (United States)

    Sawyer, Alexandra; Ayers, Susan; Bertullies, Sophia; Thomas, Margaret; Weeks, Andrew D; Yoxall, Charles W; Duley, Lelia

    2015-09-18

    The aims of this study were to assess parents' views of immediate neonatal care and resuscitation at birth being provided beside the mother, and their experiences of a mobile trolley designed to facilitate this bedside care. Qualitative study with semistructured interviews. Results were analysed using thematic analysis. Large UK maternity hospital. Mothers whose baby received initial neonatal care in the first few minutes of life at the bedside, and their birth partners, were eligible. 30 participants were interviewed (19 mothers, 10 partners and 1 grandmother). 5 babies required advanced neonatal resuscitation. 5 themes were identified: (1) Reassurance, which included 'Baby is OK', 'Having baby close', 'Confidence in care', 'Knowing what's going on' and 'Dad as informant'; (2) Involvement of the family, which included 'Opportunity for contact', 'Family involvement' and 'Normality'; (3) Staff communication, which included 'Communication' and 'Experience'; (4) Reservations, which included 'Reservations about witnessing resuscitation', 'Negative emotions' and 'Worries about the impact on staff' and (5) Experiences of the trolley, which included 'Practical issues' and 'Comparisons with standard resuscitation equipment'. Families were positive about neonatal care being provided at the bedside, and felt it gave reassurance about their baby's health and care. They also reported feeling involved as a family. Some parents reported experiencing negative emotions as a result of witnessing resuscitation of their baby. Parents were positive about the trolley. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  7. Haemostatic resuscitation in trauma: the next generation.

    Science.gov (United States)

    Stensballe, Jakob; Ostrowski, Sisse R; Johansson, Pär I

    2016-12-01

    To discuss the recent developments in and evolvement of next generation haemostatic resuscitation in bleeding trauma. Mortality from major trauma is a worldwide problem, and massive haemorrhage remains a major cause of potentially preventable deaths. Development of coagulopathy further increases trauma mortality emphasizing that coagulopathy is a key target in the phase of bleeding. The pathophysiology of coagulopathy in trauma reflects at least three distinct mechanisms that may be present isolated or coexist: acute traumatic coagulopathy, coagulopathy associated with the lethal triad, and consumptive coagulopathy. The concepts of 'damage control surgery' and 'damage control resuscitation' have been developed to ensure early control of bleeding and coagulopathy to improve outcome in bleeding trauma. Haemostatic resuscitation aims at controlling coagulopathy and consists of a ratio driven strategy aiming at 1 : 1 : 1, using tranexamic acid according to CRASH-2, and applying haemostatic monitoring enabling a switch to a goal-directed approach when bleeding slows. Haemostatic resuscitation is the mainstay of trauma resuscitation and is associated with improved survival. The next generation of haemostatic resuscitation aims at applying a ratio 1 : 1 : 1 driven strategy while using antifibrinolytics, haemostatic monitoring and avoiding critical fibrinogen deficiency by substitution.

  8. Cardiac arrest leadership: in need of resuscitation?

    Science.gov (United States)

    Robinson, Philip S; Shall, Emma; Rakhit, Roby

    2016-12-01

    Leadership skills directly correlate with the quality of technical performance of cardiopulmonary resuscitation (CPR) and clinical outcomes. Despite an improved focus on non-technical skills in CPR training, the leadership of cardiac arrests is often variable. To assess the perceptions of leadership and team working among members of a cardiac arrest team and to evaluate future training needs. Cross-sectional survey of 102 members of a cardiac arrest team at an Acute Hospital Trust in the UK with 892 inpatient beds. Responses sought from doctors, nurses and healthcare assistants to 12 rated statements and 4 dichotomous questions. Of 102 responses, 81 (79%) were from doctors and 21 (21%) from nurses. Among specialist registrars 90% agreed or strongly agreed that there was clear leadership at all arrests compared with between 28% and 49% of nurses and junior doctors respectively. Routine omission of key leadership tasks was reported by as many as 80% of junior doctors and 50% of nurses. Almost half of respondents reported non-adherence with Advanced Life Support (ALS) guidelines. Among junior members of the team, 36% felt confident to lead an arrest and 75% would welcome further dedicated cardiac arrest leadership training. Leadership training is integrated into the ALS (Resus Council, UK) qualification. However, this paper found that in spite of this training; standards of leadership are variable. The findings suggest a pressing need for further dedicated cardiac arrest leadership training with a focus on improving key leadership tasks such as role assignment, team briefing and debriefing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. The Art of Providing Resuscitation in Greek Mythology

    National Research Council Canada - National Science Library

    Siempos, Ilias I; Ntaidou, Theodora K; Samonis, George

    2014-01-01

    BACKGROUND:We reviewed Greek mythology to accumulate tales of resuscitation and we explored whether these tales could be viewed as indirect evidence that ancient Greeks considered resuscitation strategies...

  10. Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation.

    Science.gov (United States)

    Yeung, Joyce H Y; Ong, G J; Davies, Robin P; Gao, Fang; Perkins, Gavin D

    2012-09-01

    This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed. Forty advanced life-support providers leading a cardiac arrest team in a standardized cardiac-arrest simulation were videotaped. Background data were collected, including age (in yrs), sex, whether they had received any leadership training in the past, whether they were part of a professional group, the most recent advanced life-support course (in months) they had undergone, advanced life-support instructor/provider status, and whether they had led in any cardiac arrest situation in the preceding 6 months. Participants were scored using the Cardiac Arrest Simulation test score and Leadership Behavior Description Questionnaire for leadership skills. Process-focused quality of cardiopulmonary resuscitation data were collected directly from manikin and video recordings. Primary outcomes were complex technical skills (measured as Cardiac Arrest Simulation test score, preshock pause, and hands-off ratio). Secondary outcomes were simple technical skills (chest-compression rate, depth, and ventilation rate). Univariate linear regressions were performed to examine how leadership skills affect quality of cardiopulmonary resuscitation and bivariate correlations elicited factors affecting team-leadership skills.Teams led by leaders with the best leadership skills performed higher quality cardiopulmonary resuscitation with better technical performance (R = 0.75, p Leadership skills were not significantly associated with more simple technical skills such as chest-compression rate, depth, and ventilation rate. Prior training in team leader skills was independently associated with better leadership behavior. There is an association between team leadership skills and cardiac arrest simulation test score, preshock pause, and hands off ratio. Developing leadership

  11. Outcomes of In–Hospital Cardiopulmonary Resuscitation in Patients with CKD

    Science.gov (United States)

    Adil, Malik M.; Kaleem, Umar M.; Zafar, Taqi T.; Khan, Abdus Salam; Holley, Jean L.; Nally, Joseph V.

    2016-01-01

    Background and objectives Advance care planning, including code/resuscitation status discussion, is an essential part of the medical care of patients with CKD. There is little information on the outcomes of cardiopulmonary resuscitation in these patients. We aimed to measure cardiopulmonary resuscitation outcomes in these patients. Design, setting, participants, & measurements Our study is observational in nature. We compared the following cardiopulmonary resuscitation–related outcomes in patients with CKD with those in the general population by using the Nationwide Inpatient Sample (2005–2011): (1) survival to hospital discharge, (2) discharge destination, and (3) length of hospital stay. All of the patients were 18 years old or older. Results During the study period, 71,961 patients with CKD underwent in–hospital cardiopulmonary resuscitation compared with 323,620 patients from the general population. Unadjusted in–hospital mortality rates were higher in patients with CKD (75% versus 72%; P<0.001) on univariate analysis. After adjusting for age, sex, and potential confounders, patients with CKD had higher odds of mortality (odds ratio, 1.24; 95% confidence interval, 1.11 to 1.34; P≤0.001) and length of stay (odds ratio, 1.11; 95% confidence interval, 1.07 to 1.15; P=0.001). Hospitalization charges were also greater in patients with CKD. There was no overall difference in postcardiopulmonary resuscitation nursing home placement between the two groups. In a separate subanalysis of patients ≥75 years old with CKD, higher odds of in-hospital mortality were also seen in the patients with CKD (odds ratio, 1.10; 95% confidence interval, 1.02 to 1.17; P=0.01). Conclusions In conclusion, we observed slightly higher in-hospital mortality in patients with CKD undergoing in–hospital cardiopulmonary resuscitation. PMID:27445163

  12. Persisting effect of community approaches to resuscitation

    DEFF Research Database (Denmark)

    Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen

    2014-01-01

    BACKGROUND: On the Danish island of Bornholm an intervention was carried out during 2008-2010 aiming at increasing out-of-hospital cardiac arrest (OHCA) survival. The intervention included mass media focus on resuscitation and widespread educational activities. The aim of this study was to compare....... There was no significant change in all-rhythm 30-day survival for non-EMS witnessed OHCAs with presumed cardiac aetiology (6.7% [95% CI 3-13] in the follow-up period; vs. 4.6% [95% CI 1-12], p=0.76). CONCLUSION: In a 3-year follow-up period after an intervention engaging laypersons in resuscitation through mass education...... in BLS combined with a media focus on resuscitation, we observed a persistent significant increase in the bystander BLS rate for all OHCAs with presumed cardiac aetiology. There was no significant difference in 30-day survival....

  13. Liver laceration related to cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Halil Beydilli

    2016-06-01

    Full Text Available Cardiopulmonary resuscitation (CPR is recognized as a medical procedure performed to maintain vital functions of a person whose cardiac and respiratory functions have stopped. Chest compression is the most essential component of CPR and it is performed on the lower half of the sternum. During CPR, many complications may occur because of chest compressions, especially chest injuries including sternum and rib fractures. Rarely tracheal injury, rupture of the stomach, or liver or spleen injury may also occur as complications.In this study, we present two cases of liver injury caused by resuscitation. With this article, we want to emphasize the importance of making correct chest compressions. Keywords: Resuscitation complications, Emergency service, Liver laceration, Autopsy

  14. Decision to resuscitate or not in patients with chronic diseases

    DEFF Research Database (Denmark)

    Saltbæk, Lena; Tvedegaard, Erling

    2012-01-01

    Do-not-resuscitate (DNR) decisions are frequently made without informing the patients. We attempt to determine whether patients and physicians wish to discuss the DNR decision, who they think, should be the final decision maker and whether they agree on the indication for cardiopulmonary resuscit...... resuscitation (CPR) in case of cardiac arrest....

  15. Resuscitation Guideline 2000: What is the level of Awareness and ...

    African Journals Online (AJOL)

    BACKGROUND: Cardiopulmonary resuscitation was officially instituted in 1960. In 1992, the American Heart Association released the first set of resuscitation guidelines. Following a general consensus by experts drawn from various resuscitation councils worldwide, a new set of evidence based guidelines was released in ...

  16. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

    Science.gov (United States)

    Perkins, Gavin D; Jacobs, Ian G; Nadkarni, Vinay M; Berg, Robert A; Bhanji, Farhan; Biarent, Dominique; Bossaert, Leo L; Brett, Stephen J; Chamberlain, Douglas; de Caen, Allan R; Deakin, Charles D; Finn, Judith C; Gräsner, Jan-Thorsten; Hazinski, Mary Fran; Iwami, Taku; Koster, Rudolph W; Lim, Swee Han; Huei-Ming Ma, Matthew; McNally, Bryan F; Morley, Peter T; Morrison, Laurie J; Monsieurs, Koenraad G; Montgomery, William; Nichol, Graham; Okada, Kazuo; Eng Hock Ong, Marcus; Travers, Andrew H; Nolan, Jerry P

    2015-09-29

    Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome. © 2014 by the American Heart

  17. Inflammatory response to trauma: implications for coagulation and resuscitation.

    Science.gov (United States)

    Pierce, Albert; Pittet, Jean-François

    2014-04-01

    Recent studies have changed our understanding of the timing and interactions of the inflammatory processes and coagulation cascade following severe trauma. This review highlights this information and correlates its impact on the current clinical approach for fluid resuscitation and treatment of coagulopathy for trauma patients. Severe trauma is associated with a failure of multiple biologic emergency response systems that includes imbalanced inflammatory response, acute coagulopathy of trauma, and endovascular glycocalyx degradation with microcirculatory compromise. These abnormalities are all interlinked and related. Recent observations show that after severe trauma: proinflammatory and anti-inflammatory responses are concomitant, not sequential and resolution of the inflammatory response is an active process, not a passive one. Understanding these interrelated processes is considered extremely important for the development of future therapies for severe trauma in humans. Traumatic injuries continue to be a significant cause of mortality worldwide. Recent advances in understanding the mechanisms of end-organ failure, and modulation of the inflammatory response has important clinical implications regarding fluid resuscitation and treatment of coagulopathy.

  18. Hemostatic resuscitation for acute traumatic coagulopathy

    Directory of Open Access Journals (Sweden)

    Scalea Thomas M

    2011-01-01

    Full Text Available Abstract Trauma resuscitation paradigms have changed considerably over the last twenty years. Originally, the goal was to normalize a blood pressure as quickly as possible. Large volume crystalloid resuscitation was used to accomplish this. Standard therapy was that any patient with suspected bleeding received a two liter crystalloid bolus as initial therapy. It was often repeated and blood transfusion therapy was used relatively late. Fresh frozen plasma and platelets were also used relatively late, often after patients had received ten units of red cells. Dilutional anemia was relatively common. Patients with large volume blood loss often died from what was termed, "the bloody vicious cycle," of hypothermia, acidosis and coagulopathy.

  19. Family Presence During Resuscitation: A Double-Edged Sword.

    Science.gov (United States)

    Hassankhani, Hadi; Zamanzadeh, Vahid; Rahmani, Azad; Haririan, Hamidreza; Porter, Joanne E

    2017-03-01

    To illuminate the meaning of the lived experiences of resuscitation team members with the presence of the patient's family during resuscitation in the cultural context of Iran. An interpretative phenomenology was used to discover the lived experiences of the nurses and physicians of Tabriz hospitals, Iran, with family presence during resuscitation (FPDR). A total of 12 nurses and 9 physicians were interviewed over a 6-month period. The interviews were audio recorded and semistructured, and were transcribed verbatim. Van Manen's technique was used for data analysis. Two major themes and 10 subthemes emerged, including destructive presence (cessation of resuscitation, interference in resuscitation, disruption to the resuscitation team's focus, argument with the resuscitation team, and adverse mental image in the family) and supportive presence (trust in the resuscitation team, collaboration with the resuscitation team, alleviating the family's concern and settling their nerves, increasing the family's satisfaction, and reducing conflict with resuscitation team members). Participants stated that FPDR may work as a double-edged sword for the family and resuscitation team, hurting or preserving quality. It is thus recommended that guidelines be created to protect patients' and families' rights, while considering the positive aspects of the phenomenon for hospitals. A liaison support person would act to decrease family anxiety levels and would be able to de-escalate any potentially aggressive or confrontational events during resuscitation. Well-trained and expert cardiopulmonary resuscitation team members do not have any stress in the presence of family during resuscitation. Resuscitation events tend to be prolonged when family members are allowed to be present. © 2017 Sigma Theta Tau International.

  20. 2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: An ILCOR advisory statement.

    Science.gov (United States)

    Idris, Ahamed H; Bierens, Joost J L M; Perkins, Gavin D; Wenzel, Volker; Nadkarni, Vinay; Morley, Peter; Warner, David S; Topjian, Alexis; Venema, Allart M; Branche, Christine M; Szpilman, David; Morizot-Leite, Luiz; Nitta, Masahiko; Løfgren, Bo; Webber, Jonathon; Gräsner, Jan-Thorsten; Beerman, Stephen B; Youn, Chun Song; Jost, Ulrich; Quan, Linda; Dezfulian, Cameron; Handley, Anthony J; Hazinski, Mary Fran

    2017-09-01

    Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely. In particular, measurement of cardiopulmonary resuscitation elements and neurological outcomes reporting have advanced substantially. The purpose of this report is to provide updated guidelines for reporting data from studies of resuscitation from drowning. An international group with scientific expertise in the fields of drowning research, resuscitation research, emergency medical services, public health, and development of guidelines met in Potsdam, Germany, to determine the data that should be reported in scientific articles on the subject of resuscitation from drowning. At the Utstein-style meeting, participants discussed data elements in detail, defined the data, determined data priority, and decided how data should be reported, including scoring methods and category details. The template for reporting data from drowning research was revised extensively, with new emphasis on measurement of quality of resuscitation, neurological outcomes, and deletion of data that have proved to be less relevant or difficult to capture. The report describes the consensus process, rationale for selecting data elements to be reported, definitions and priority of data, and scoring methods. These guidelines are intended to improve the clarity of scientific communication and the comparability of scientific investigations. Copyright © 2017 European Resuscitation Council, American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.

  1. T-piece resuscitator versus self-inflating bag for preterm resuscitation: an institutional experience.

    Science.gov (United States)

    Jayaram, Archana; Sima, Adam; Barker, Gail; Thacker, Leroy R

    2013-07-01

    Manual ventilation in the delivery room is provided with devices such as self-inflating bags (SIBs), flow-inflating bags, and T-piece resuscitators. To compare the effect of type of manual ventilation device on overall response to resuscitation among preterm neonates born at piece was used for 159 neonates. There was no significant difference between the 1-min and 5-min Apgar scores between SIB and T-piece (P = .77 and P = .11, respectively), nor were there significant differences in secondary outcomes. The rate of rise of Apgar score was higher, by 0.47, with T-piece, compared to SIB (95% CI 0.08-0.87, P = .02). Although some manikin studies favor T-piece for providing reliable and consistent pressures, our experience did not indicate significant differences in effectiveness of resuscitation between the T-piece and SIB in preterm resuscitations.

  2. [CPR--guidelines 2000. New international guidelines for cardiopulmonary resuscitation].

    Science.gov (United States)

    Gervais, H W

    2001-03-01

    The "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. An International Consensus an Science" are the first true international CPR guidelines in the history of resuscitation medicine. Experts from major international resuscitation organizations (International Liaison Committee on Resuscitation, ILCOR) achieved a consensus of recommendations which had to pass a rigorous review procedure applying the tools of evidence-based medicine: all proposed guidelines or guideline changes had to be based on critically appraised pieces of evidence which had to be integrated into a final class of recommendations. The most important changes compared to previous recommendations from either the European Resuscitation Council or the American Heart Association are presented and commented upon.

  3. Cardiopulmonary resuscitation and do-not-resuscitate orders: a guide for clinicians.

    Science.gov (United States)

    Loertscher, Laura; Reed, Darcy A; Bannon, Michael P; Mueller, Paul S

    2010-01-01

    The do-not-resuscitate order, introduced nearly a half century ago, continues to raise questions and controversy among health care providers and patients. In today's society, the expectation and availability of medical interventions, including at the end of life, have rendered the do-not-resuscitate order particularly relevant. The do-not-resuscitate order is the only order that requires patient consent to prevent a medical procedure from being performed; therefore, informed code status discussions between physicians and patients are especially important. Epidemiologic studies have informed our understanding of resuscitation outcomes; however, patient, provider, and institutional characteristics account for great variability in the prevalence of do-not-resuscitate orders. Specific strategies can improve the quality of code status conversations and enhance end-of-life care planning. In this article, we review the history, epidemiology, and determinants of do-not-resuscitate orders, as well as frequently encountered questions and recommended strategies for discussing this important topic with patients. Copyright 2010. Published by Elsevier Inc.

  4. A SOF Damage Control Resuscitation Cocktail

    Science.gov (United States)

    2015-05-01

    include Hextend for volume resuscitation and tissue perfusion, fibrinogen concentrate for hemostasis , and tranexamic acid for hemostasis . These...for hemostasis , and tranexamic acid for hemostasis . These components are tested in a combat-relevant swine polytrauma model of hemorrhagic shock with

  5. Resuscitation in hip fractures: a systematic review.

    Science.gov (United States)

    Rocos, Brett; Whitehouse, Michael R; Kelly, Michael B

    2017-05-04

    To evaluate the evidence for the resuscitation of patients with hip fracture in the preoperative or perioperative phase of their treatment and its impact on mortality. We searched MEDLINE, EMBASE, CENTRAL and PROSPERO databases using a systematic search strategy for randomised trials and observational studies investigating the fluid resuscitation of any patient with hip fracture. No language limits were applied to the search, which was complemented by manually screening the reference lists of appropriate studies. Mortality at 1 week, 30 days and 1 year following surgery. Two hundred and ninety-eight citations were identified, and 12 full manuscripts were reviewed; no studies satisfied the inclusion criteria. The background literature showed that the mortality for these patients at 30 days is approximately 8.5% and that bone cement implantation syndrome is insufficient to explain this. The literature was explored to define the need for an interventional investigation into the preoperative resuscitation of patients with hip fracture. Patients with hip fracture show similar physiological disturbance to major trauma patients. Nineteen per cent of patients presenting with hip fracture are hypoperfused and 50% show preoperative anaemia suggesting that under resuscitation is a common problem that has not been investigated. A properly conducted interventional trial could improve the outcome of these vulnerable patients. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Outcome of Cardiopulmonary Resuscitation in the

    African Journals Online (AJOL)

    ABSTRACT. The purpose of this study is to evaluate the demographic characteristics of patients Who suffered cardiac arrest in our ICUs and to identify thOse factors influencing outcome after resuscitation following cardiac arrest. We reviewed the records of all patients who underwent CPR in the two ICUs at the ...

  7. Quality of survival after cardiopulmonary resuscitation

    NARCIS (Netherlands)

    de Vos, R.; de Haes, H. C.; Koster, R. W.; de Haan, R. J.

    1999-01-01

    BACKGROUND: Outcome of cardiopulmonary resuscitation (CPR) can be poor, in terms of life expectancy and quality of life. OBJECTIVES: To determine the impact of patient characteristics before, during, and after CPR on these outcomes, and to compare results of the quality-of-life assessment with

  8. An unsuccessful resuscitation: The families' and doctors ...

    African Journals Online (AJOL)

    ... should be organised after the initial shock, when further questions can be asked and abnormal grief reactions identified. Bereavement counselling should be available and community-based resources should be identified in this regard. Debriefing should also be available for staff involved in unsuccessful resuscitations.

  9. Knowledge and practice of cardiopulmonary resuscitation among ...

    African Journals Online (AJOL)

    Background: Cardiopulmonary resuscitation (CPR), first described in 1960, is observed to be poorly applied in quality and quantum, hence, the need to ascertain its correct knowledge and practice among Nigerian doctors. Methods: Questionnaires were distributed randomly to doctors in a Nigerian University Teaching ...

  10. Resuscitation Training at Rwanda Military Hospital

    African Journals Online (AJOL)

    Learning the C-A-Bs: Resuscitation Training at Rwanda Military Hospital. Kathryn Norgang1, Auni Idi Muhire1, Sarah Howrath1. 1Rwanda Military Hospital, Rwanda. Background. There is a lack of trained staff to respond to critically ill patients and cardiac and respiratory arrests in a health facility in Rwanda. This lack of ...

  11. Acute posthypoxic myoclonus after cardiopulmonary resuscitation

    NARCIS (Netherlands)

    Bouwes, Aline; van Poppelen, Daniel; Koelman, Johannes H. T. M.; Kuiper, Michael A.; Zandstra, Durk F.; Weinstein, Henry C.; Tromp, Selma C.; Zandbergen, Eveline G. J.; Tijssen, Marina A. J.; Horn, Janneke

    2012-01-01

    Background: Acute posthypoxic myoclonus (PHM) can occur in patients admitted after cardiopulmonary resuscitation (CPR) and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of

  12. Creating advocates for family presence during resuscitation.

    Science.gov (United States)

    Agard, Marcia

    2008-06-01

    Research suggests that family presence at the bedside during resuscitation is beneficial for both family members and staff Education of health care personnel will help them communicate effectively with and guide distraught family members during a code. Tools to implement a family presence protocol are provided.

  13. Resuscitation of the Newborn: AN IMPROVED NEONATAL ...

    African Journals Online (AJOL)

    Insufflatory resuscitation of a newborn baby that has not breathed presents many problems. These are dependent not only on the size and prematurity of the neonate, but on the amount of fluid which is present in the alveoli of the lungs, and the absence of the functional residual capacity (FRC). Before adequate gaseous ...

  14. Anaesthetists' knowledge of cardiopulmonary resuscitation | Ogboli ...

    African Journals Online (AJOL)

    Background: Cardio-Pulmonary Resuscitation (CPR) is an integral part of an anaesthetist's knowledge and practice. In Nigeria, these skills are taught mainly during medical school and postgraduate training. Objectives: The study sought to assess the knowledge of anaesthetists about CPR. Methodology: A structured ...

  15. Iatrogenic burns injury complicating neonatal resuscitation ...

    African Journals Online (AJOL)

    La blessure dans les membres inférieurs a une surface d'environ 4%. Cette communication souligne la mauvaise méthode traditionnelle de la réanimation chez des nouveau nés. Keywords: Asphyxia, Burns, Newborn, Perinatal care, Resuscitation, Traditional medical practice. West African Journal of Medicine Vol.

  16. An unsuccessful resuscitation: The families' and doctors ...

    African Journals Online (AJOL)

    Background: The objective was to elicit families' experience of the death of a family member at the Elsies River Community Health Centre, their feelings towards the staff involved in the resuscitation and their opinions about how things could be improved. The study also elicited the doctors' experiences of communicating ...

  17. The development of pediatric fluid resuscitation: an interview with Dr. Frederic A. 'Fritz' Berry.

    Science.gov (United States)

    Berry, Fritz

    2014-02-01

    Dr. Frederic A. 'Fritz' Berry (1935), Professor Emeritus of Anesthesiology and Pediatrics at the University of Virginia, has played a pioneering role in the development of pediatric anesthesiology through training generations of anesthesiologists. He identifies his early advocacy of balanced electrolyte solution for perioperative fluid resuscitation as his defining contribution. Based on his clinical experiences, he pushed to extend the advances in adult fluid resuscitation into pediatric practice. He imparted these and other insights to his colleagues although textbooks, book chapters, original journal publications, and decades of Refresher Course Lectures at the American Society of Anesthesiologists' annual meetings. A model educator, clinician, and researcher, he shaped the careers of hundreds of physicians-in-training while advancing the field of pediatric anesthesiology. © 2013 John Wiley & Sons Ltd.

  18. The significance of clinical experience on learning outcome from resuscitation training-a randomised controlled study

    DEFF Research Database (Denmark)

    Jensen, Morten Lind; Lippert, Freddy; Hesselfeldt, Rasmus

    2008-01-01

    CONTEXT: The impact of clinical experience on learning outcome from a resuscitation course has not been systematically investigated. AIM: To determine whether half a year of clinical experience before participation in an Advanced Life Support (ALS) course increases the immediate learning outcome ...... but statistically significant impact on the retention of learning, but not on the immediate learning outcome Udgivelsesdato: 2008/12/4......CONTEXT: The impact of clinical experience on learning outcome from a resuscitation course has not been systematically investigated. AIM: To determine whether half a year of clinical experience before participation in an Advanced Life Support (ALS) course increases the immediate learning outcome...... and retention of learning. MATERIALS AND METHODS: This was a prospective single blinded randomised controlled study of the learning outcome from a standard ALS course on a volunteer sample of the entire cohort of newly graduated doctors from Copenhagen University. The outcome measurement was ALS...

  19. Dilemmas in decision-making about resuscitation--a focus group study of older people.

    Science.gov (United States)

    Vandrevala, Tushna; Hampson, Sarah E; Daly, Tom; Arber, Sara; Thomas, Hilary

    2006-04-01

    Cardiopulmonary resuscitation (CPR) may be used by default on patients suffering a cardiac arrest in hospital in the UK unless there is an order that specifies otherwise in the patient's notes. Guidelines recommend that the decision involves competent and willing patients or, in the case of incapacitation, their families. In practice, patient autonomy is often compromised. Ideally, discussion of preferences for end-of-life care should take place prior to hospitalisation. The majority of research on this topic has been conducted on hospitalised patients, so little is known about the views of older, but healthy, people about resuscitation decision-making. The present study was designed to address this gap. A series of eight focus groups involving a total of 48 participants over the age of 65 was conducted to explore people's views about the factors guiding resuscitation decision-making. A qualitative analysis, which emphasised the dilemmatic nature of resuscitation decision-making, identified two broad thematic dilemmas that subsumed six specific themes which contribute to resolving the dilemmas: quality of life (medical condition, mental versus physical incapacity, age and ageing, and burden), and the involvement of others (doctors and families) versus loss of autonomy. The dilemma underlying quality of life is that an acceptable quality of life after CPR cannot be assured. The dilemma underlying the involvement of others is that individual autonomy may be lost. The themes and subthemes provide the basis for guiding these difficult discussions in advance of serious illness.

  20. Doctors' attitudes regarding not for resuscitation orders.

    Science.gov (United States)

    Sritharan, Gaya; Mills, Amber C; Levinson, Michele R; Gellie, Anthea L

    2017-12-01

    Objectives The aims of the present study were to investigate doctors' attitudes regarding the discussion and writing of not for resuscitation (NFR) orders and to identify potential barriers to the completion of these orders. Methods A questionnaire-based convenience study was undertaken at a tertiary hospital. Likert scales and open-ended questions were directed to issues surrounding the discussion, timing, understanding and writing of NFR orders, including legal and personal considerations. Results Doctors thought the presence of an NFR order both should and does alter care delivered by nursing staff, particularly delivery of pain relief, nursing observations and contacting the medical emergency team. Eighty-five per cent of doctors believed they needed somebody else's consent to write an NFR order (seeking of consent is not a requirement in most Australian jurisdictions). Conclusion There are complex barriers to the writing and implementation of NFR orders, including doctors' knowledge around the need for consent when cardiopulmonary resuscitation is likely to be futile or excessively burdensome. Doctors also believed that NFR orders result in changes to goals-of-care, suggesting a confounding of NFR orders with palliative care. Furthermore, doctors are willing to write NFR orders where there is clear medical indication and the patient is imminently dying, but are otherwise reliant on patients and family to initiate discussion. What is known about the topic? Hospitalised elderly patients, in the absence of an NFR order, are known to have poor survival and outcomes following resuscitation. Further, Australian data on the prevalence of NFR forms show that only a minority of older in-patients have a written NFR order in their history. In Australian hospitals, NFR orders are completed by doctors. What does this paper add? To our knowledge, the present study is the first in Australia to qualitatively analyse doctors' reasons to writing NFR orders. The open-text nature

  1. Outcomes of cardiopulmonary resuscitation in the emergency department

    Directory of Open Access Journals (Sweden)

    Seyed Hossein Ojaghi Haghighi

    2017-06-01

    Full Text Available Objective: Cardiopulmonary resuscitation (CPR is a lifesaving technique useful in the prevention of death or delaying it in a person with cardiac arrest. In this regard, demographic information about patients who need CPR is vital. Methods: In this cross-sectional study patients with cardiopulmonary arrest or arrhythmias admitted to Imam Reza and Sina educational hospitals of Tabriz University of Medical Sciences from 22 December 2013 to 21 December 2014 entered the study. Demographic information such as age, sex, cardiopulmonary resuscitation time, the place of cardiopulmonary arrest (outside or inside the hospital, the duration of resuscitation process, success or failure of the resuscitation process and the mechanism of cardiopulmonary arrest were obtained. Results: From a total of 354 cases of cardiopulmonary resuscitation, 281 cases (79% were unsuccessful and 73 cases (21% were successful. The average age of patients was 59 ± 22 years. The average time of the resuscitation process was 31 ± 12 minutes. There was a significant difference between the mean of age and resuscitation time in patients who had experienced successful or unsuccessful resuscitation (P = 0.0001. There was a significant relationship between sex and the success rate of resuscitation (P = 0.0001. In addition, a significant relationship between the success of the resuscitation operation and the ward of resuscitation was observed (P = 0.0001. Conclusion: The most common mechanism leading to cardiopulmonary arrest among patients was asystole. In this regard, no significant difference was observed between successful and unsuccessful resuscitation processes. It was also observed that the success of resuscitation from 8 am to 4 pm was more than any other time period.

  2. Mitigating hyperventilation during cardiopulmonary resuscitation.

    Science.gov (United States)

    Nikolla, Dhimitri; Lewandowski, Tyler; Carlson, Jestin

    2016-03-01

    Although multiple airway management and ventilation strategies have been proposed during cardiac arrest, the ideal strategy is unknown. Current strategies call for advanced airways, such as endotracheal intubation and supraglottic airways. These may facilitate hyperventilation which is known to adversely affect cardiopulmonary physiology. We provide a summary of conceptual models linking hyperventilation to patient outcomes and identify methods for mitigating hyperventilation during cardiac arrest. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Analysis and classification of errors made by teams during neonatal resuscitation.

    Science.gov (United States)

    Yamada, Nicole K; Yaeger, Kimberly A; Halamek, Louis P

    2015-11-01

    The Neonatal Resuscitation Program (NRP) algorithm serves as a guide to healthcare professionals caring for neonates transitioning to extrauterine life. Despite this, adherence to the algorithm is challenging, and errors are frequent. Information-dense, high-risk fields such as air traffic control have proven that formal classification of errors facilitates recognition and remediation. This study was performed to determine and characterize common deviations from the NRP algorithm during neonatal resuscitation. Audiovisual recordings of 250 real neonatal resuscitations were obtained between April 2003 and May 2004. Of these, 23 complex resuscitations were analyzed for adherence to the contemporaneous NRP algorithm and scored using a novel classification tool based on the validated NRP Megacode Checklist. Seven hundred eighty algorithm-driven tasks were observed. One hundred ninety-four tasks were completed incorrectly, for an average error rate of 23%. Forty-two were errors of omission (28% of all errors) and 107 were errors of commission (72% of all errors). Many errors were repetitive and potentially clinically significant: failure to assess heart rate and/or breath sounds, improper rate of positive pressure ventilation, inadequate peak inspiratory and end expiratory pressures during ventilation, improper chest compression technique, and asynchronous PPV and CC. Errors of commission, especially when performing advanced life support interventions such as positive pressure ventilation, intubation, and chest compressions, are common during neonatal resuscitation and are sources of potential harm. The adoption of error reduction strategies capable of decreasing cognitive and technical load and standardizing communication - strategies common in other industries - should be considered in healthcare. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Communication during trauma resuscitation: do we know what is happening?

    Science.gov (United States)

    Bergs, Engelbert A G; Rutten, Frans L P A; Tadros, Tamer; Krijnen, Pieta; Schipper, Inger B

    2005-08-01

    Verbal communication is essential for teamwork and leadership in high-intensity performances like trauma resuscitation. We evaluated communication during multidisciplinary trauma resuscitation. The main trauma room of a level one trauma centre was equipped with a digital video recording system. Resuscitations were consecutively and prospectively enrolled. Patients with revised trauma score (RTS)=12 were resuscitated by a 'minor trauma team' and patients with RTSresuscitations were included, 12 were lost for evaluation. The 'major trauma team' resuscitated 74 patients (ISS:21.4). Communication was audible in 56% and understandable in 44% during the primary survey. The 'minor trauma team' assessed 119 patients (ISS:7.4). Communication was audible in 43% and understandable in 33%. Communication during trauma resuscitation was found to be sub optimal. This is potentially harmful for trauma victims. Professionals and institutions should be aware that communication is not self-evident. Introduction of an aviation-like communication feedback system could help to optimise trauma care.

  5. Interruptions of Trauma Resuscitations for Radiographic Procedures.

    Science.gov (United States)

    Itakura, Kaoru S; Pillsbury, McKinsey M; Rodriguez, Robert M

    2015-08-01

    Although x-ray studies provide important diagnostic information during trauma resuscitations, they may also lead to significant interruptions in care. We sought to determine the frequency and duration of interruptions for chest x-ray studies (CXR) and pelvic x-ray studies (PXR) and the frequency of lead apron use among providers who exited trauma rooms during resuscitation. Using a convenience sampling method, we conducted a prospective, observational study from August 2013 to March 2014, enrolling adult trauma patients at a Level I trauma center who received CXR and PXR in the first 30 min of evaluation. An observer stood outside resuscitation rooms and recorded the time elapsed from the first provider exiting the room to the last provider returning. We recorded how many exiting providers wore lead aprons and whether unused aprons were available. Of the 156 trauma cases observed, 67.3% were of male patients with a mean age of 52 years (interquartile range [IQR] 34-67 years); 97.4% (184/189) of radiographs resulted in interruptions of trauma evaluation. Mean and median interruption times were 67 s and 50 s, respectively (IQR 25-95) for CXR; 37 s and 27 s, respectively (IQR 16-43) for PXR; and 160 s and 180 s, respectively (IQR 120-180) for combined CXR/PXR. A mean of 3.5 providers (IQR 3-5) left the immediate bedside and exited the room during x-ray studies. Most (91%) providers leaving the room were not wearing lead aprons, and extra aprons were available in the room 91% (167/184) of the time. Radiographic procedures often result in interruptions of trauma resuscitations despite the availability of lead aprons. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Survival after in-hospital Cardiopulmonary Resuscitation

    OpenAIRE

    M Adib Hajbaghery; Akbari, H.; GA Mousavi

    2005-01-01

    Background: During recent years, cardiopulmonary resuscitation (CPR) in hospital has received much attention. However, the survival rate of CPR in Iran’s hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. Methods: A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and unt...

  7. Leadership and Teamwork in Trauma and Resuscitation

    OpenAIRE

    Michael Menchine; Elizabeth Burner; Sanjay Arora; Kenji Inaba; Demetrios Demetriades; Bertrand Yersin

    2016-01-01

    I ntroduction: Leadership skills are described by the American College of Surgeons’ ATLS course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. D...

  8. Survival after in-hospital Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    M Adib Hajbaghery

    2005-05-01

    Full Text Available Background: During recent years, cardiopulmonary resuscitation (CPR in hospital has received much attention. However, the survival rate of CPR in Iran’s hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. Methods: A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and until defibrillation, duration and result of CPR, frequency of tracheal intubations and time served for it were collected in a checklist. Results: In six months study, 206 cases of cardiopulmonary resuscitation attempted. The survival rate was similar for both sexes. Short-term survival observed in19.9% of cases and only 5.3% survived to discharge. Conclusions: Duration of CPR, time of the first defibrillation, response time and the location of cardiac arrest are the key predictors of survival to hospital discharge and in-hospital CPR strategies require improvement. This study promotes a national study on post CPR survival for accurate data on our performance in attention to chain of survival. KeyWords: Cardiopulmonary Resuscitation (CPR, Survival rate, Iran

  9. Impact of Training Frequency on Nurses' Pediatric Resuscitation Skills.

    Science.gov (United States)

    Ciurzynski, Susan M; Gottfried, Julie Albright; Pietraszewski, Julie; Zalewski, Melinda

    The ideal time frame for frequency of resuscitation skills training has yet to be determined. Results obtained from this performance improvement project using hands-on practice sessions suggest that 6 months may be an adequate time frame for retention of resuscitation skills. Professional development educators may want to consider 6-month retraining intervals for low-volume/high-risk skills such as cardiopulmonary resuscitation to optimize nurses' proficiency in these life-saving competencies.

  10. Cardiopulmonary resuscitation : the history and evidence behind modern management

    OpenAIRE

    Tua, Carl;

    2014-01-01

    Resuscitation following cardiac arrest involves a life-saving set of skills which are practised by healthcare workers and trained laypersons throughout the world. Various associations and groups, such as the European Resuscitation Council (ERC) and the American Heart Association have training programmes on resuscitation techniques using standardized algorithms. There are different protocols for different situations, using various pieces of equipment and with a range of...

  11. Some Medicolegal Aspects of the Russian Cardiopulmonary Resuscitation Protocol

    Directory of Open Access Journals (Sweden)

    V. A. Kuksinsky

    2006-01-01

    Full Text Available The purpose of the study was to analyze the Russian legislation to identify the medicolegal aspects of cardiopulmonary resuscitation, which are most significant for an intensive care anesthesiologist. Statutory acts concerning human health care, including those pertinent to cardiopulmonary resuscitation and those providing for the responsibility of medical workers in some cases were analyzed. A number of discrepancies in various legal acts concerning human death verification and resuscitative measures were identified. The analysis has revealed the aspects of cardiopulmonary resuscitation, which are, from the point of view of legislation, most important for the physician.

  12. Ethical aspects of cardiopulmonary resuscitation in premature neonates: where do we stand?

    Science.gov (United States)

    Van Reempts, P J; Van Acker, K J

    2001-12-01

    Advances in diagnosis, techniques, therapeutic interventions, organisation of perinatal care, and socio-economic factors have all contributed to the survival after resuscitation and intensive care of neonates with extremely low birth weight and gestational age. While morbidity during the first years of life in those infants does not increase, at school age multiple dysfunctions may become apparent. What are the limits of intensive care for the newborn? Is it right to use extreme technical and economic measures for neonates with a borderline chance of survival? What is justifiable for the neonate, the family, the society and how does legislation interfere in a decision process which involves starting, stopping or continuing intensive care? A short historical overview for the care of the newborn is given, followed by the outcome after resuscitation and treatment of the very low birth weight infant. Published management strategies and recommendations are discussed.

  13. Effect of methylene blue on resuscitation after haemorrhagic shock.

    Science.gov (United States)

    Jeroukhimov, I; Weinbroum, A; Ben-Avraham, R; Abu-Abid, S; Michowitz, M; Kluger, Y

    2001-10-01

    To compare prehospital hypotensive resuscitation with volume resuscitation, and find out whether reagents that inhibit free-oxygen radical formation, such as methylene blue, can improve resuscitation and survival. Randomised controlled trial. Animal laboratory, Israel. 48 adult male Wistar rats. After 30 minutes of controlled haemorrhage, rats were subjected to 60 minutes of uncontrolled haemorrhage with simultaneous resuscitation. Hartmann's solution alone, or with blood or with a bolus of methylene blue were infused to maintain the mean arterial pressure (MAP) at 80 or 40 mm Hg. Then haemorrhage was stopped and Hartmann's solution plus whole blood were infused to obtain a MAP that was within normal limits. Volumes of shed blood and resuscitation fluids, MAP, packed cell volume, blood pH and base deficit, and survival. During uncontrolled haemorrhage. a MAP of 80 mm Hg could not be reached in animals resuscitated with Hartmann's solution alone, and all died. All the rats given Hartmann's solution with a bolus of methylene blue or with whole blood achieved a higher MAP. MAP of 40 mm Hg was attained in all animals regardless of the resuscitation fluid. Only 15 of 24 animals resuscitated to a MAP of 80 mm Hg survived, compared with 22 survivors of the 24 rats resuscitated to a MAP of 40 mm Hg (p <0.04). Methylene blue or whole blood drastically reduced the volumes of shed blood and of fluids required, and moderated the reduction in packed cell volume, particularly during hypotensive resuscitation. Hypotensive protocols should be used to improve survival. Methylene blue given with the electrolyte solutions could negate their detrimental effects during resuscitation.

  14. Resuscitation skills of pediatric residents and effects of Neonatal Resuscitation Program training.

    Science.gov (United States)

    Gunay, Ilker; Agin, Hasan; Devrim, Ilker; Apa, Hursit; Tezel, Basak; Ozbas, Sema

    2013-08-01

    The Neonatal Resuscitation Program (NRP) is an effective tool in decreasing mortality and morbidity due to birth asphyxia. The aim of the study was to assess the skill and knowledge level of pediatric residents in a teaching hospital and the effects of NRP training. Subjects consisted of pediatric residents of Dr Behcet Uz Hospital, Izmir, Turkey. They were assessed on practice exam scenarios and NRP provider course flow charts. Teams with two members were formed randomly. Each resident was evaluated on a 100 point scale covering all resuscitation steps and interventions. Exam scores were analyzed for two major parameters: resident participation in NRP training (never, within the last 6 months, and ≥6 months previously) and being a senior (>18 months residency). A total of 49 residents enrolled in the study (94.2% of the target group). Twenty-one residents had NRP training (42.9%). Junior residents comprised 46.9% of the study group. The mean skill score was 72.1, and it was significantly higher for senior residents and residents who attended the NRP course (P training significantly increases the resuscitation knowledge and skill of pediatric residents, although this can be achieved by being a senior. Residents should undergo training as soon as possible to achieve a higher level of quality in resuscitating babies. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

  15. Resuscitation debriefing for nurses at the Accident and Emergency ...

    African Journals Online (AJOL)

    Two of the nurses had no recollection of any emotions, while one stated that, after an unsuccessful resuscitation, she or he “felt terribly traumatised and heartsore after the death of the child”, and another stated that, after a successful resuscitation, she or he “felt good, extremely good, because something was done to help ...

  16. Neonatal resuscitation – knowledge and practice of nurses in ...

    African Journals Online (AJOL)

    2008-11-04

    Nov 4, 2008 ... special care baby unit within the last 5 years while only 14.0% had attended neonatal resuscitation training course within the last 5 years. Similarly ... Frequent and intensive courses on neonatal resuscitation are highly desired. SAJCH MARCH .... knowledge, experience and comfort level. Appl Nurs Res ...

  17. Resuscitation of thermal injuries in the United Kingdom and Ireland.

    Science.gov (United States)

    Baker, R H J; Akhavani, M A; Jallali, N

    2007-01-01

    The purpose of this study was to examine the consistency of burns resuscitation practice throughout UK and Ireland. Twenty-six Burns Units were identified via the National Burn Bed Bureau and surveyed via a postal questionnaire. Twenty-three units returned a completed questionnaire, covering all of the units treating children and 17 out of 20 units that treat adults. Nearly all of the Burns Units commence fluid resuscitation at 10% total body surface area of burn in children and 15% total body surface area of burn in adults. The estimated resuscitation volume is calculated using the Parkland or the Muir and Barclay formula in 76% and 11% of units, respectively. The most commonly used resuscitation fluid is Hartmann's solution. No unit uses blood as a first line fluid. Resuscitation is discontinued after 24h in 35% of units and after 36 h in 30% of units. Approximately half of the units do not routinely change the type of intravenous fluid administered after the initial period of resuscitation. This survey illustrates that resuscitation of thermally injured patients in UK and Ireland Burns Units is fairly consistent with a shift towards crystalloid resuscitation.

  18. Neonatal Resuscitation: Knowledge And Practice Of Nurses In ...

    African Journals Online (AJOL)

    Background. Appropriate resuscitation techniques are crucial to the survival of newborn infants. Objective. To assess knowledge of nurses in western Nigeria about neonatal resuscitation. Method. A cross-sectional survey of the nurses attached to secondary health facilities in western Nigeria was done using a ...

  19. ORIGINAL ARTICLES Family-witnessed resuscitation in emergency ...

    African Journals Online (AJOL)

    patients in their 2000 and 2005 Guidelines for Cardiopulmonary. Resuscitation and Emergency Cardiac Care.12 The AHA encourages family presence at the resuscitation, and recommends this in all AHA adult and paediatric life support courses. Methods. We studied the attitudes of emergency doctors working in Gauteng.

  20. The Level of Awareness of Cardio-Pulmonary Resuscitation (CPR ...

    African Journals Online (AJOL)

    Resuscitation is one of the most evolving areas of modern medicine. For the past forty years newer techniques are developed in order to improve the outcome of resuscitation. The study is aimed at finding the level of knowledge amongst radiographers practising in Nigeria because radiographers use materials that ...

  1. Cardiopulmonary resuscitation: state of the art in 2011

    African Journals Online (AJOL)

    2011-02-21

    Feb 21, 2011 ... The science of cardiopulmonary resuscitation (CPR) is dynamic and ever changing as new evidence continuously comes to light. Modern CPR dates back to 1966, when the first consensus statement was released. The International Liaison Committee on Resuscitation. (ILCOR) was founded in 1992.

  2. Optimal oxygenation during and after cardiopulmonary resuscitation.

    Science.gov (United States)

    Neumar, Robert W

    2011-06-01

    Reversal of tissue hypoxia, particularly in the heart and brain, is a fundamental goal of cardiopulmonary resuscitation. However, a growing body of evidence suggests that hyperoxia, especially after return of spontaneous circulation (ROSC), may worsen outcomes. The purpose of this review is to describe the current evidence supporting the concept of controlled oxygenation during and after cardiac arrest. Animal studies over the last two decades have built a compelling case that arterial hyperoxemia during the first hour after ROSC causes increased oxidative damage, increased neuronal death, and worse neurologic function. However, human data are limited. The only prospective randomized clinical trial comparing different inspired oxygen concentrations in post-cardiac arrest patients was underpowered to detect a difference in survival or neurologic outcome. More recently a retrospective analysis of data from a multicenter registry found that initial arterial hyperoxemia (paO2 ≥ 300 mmHg) was associated with increased mortality and worse functional outcome in patients admitted to the ICU after cardiac arrest. The existing evidence, though limited, has contributed to new guidelines for oxygen therapy in patients resuscitated from cardiac arrest. The benefit of supplemental oxygen during cardiopulmonary resuscitation remains uncertain. However, in patients who achieve ROSC after cardiac arrest, available evidence supports adjusting inspired oxygen content to avoid arterial hyperoxemia while providing adequate arterial oxyhemoglobin saturation. This strategy is likely to be most effective when initiated as soon as possible after ROSC and appears to be most important during the first hour. Definitive clinical trials are needed to determine the ultimate impact on outcome.

  3. Cardiopulmonary resuscitation-from the patient's perspective.

    Science.gov (United States)

    Wee, S; Chang, Z Y; Lau, Y H; Wong, Yky; Ong, Cym

    2017-05-01

    With increasing emphasis on patient autonomy, patients are encouraged to be more involved in end-of-life issues, including the use of extraordinary efforts to prolong their lives. Being able to make anticipatory decisions is seen to promote autonomy, empower patients and optimise patient care. To facilitate shared decision-making, patients need to have a clear and accurate understanding of cardiopulmonary resuscitation (CPR). This study aims to understand the knowledge and perspectives of the local community regarding resuscitation options and end-of-life decision-making and to explore ways to improve the quality of end-of-life discussions. An interviewer-administered survey was conducted with a prospectively recruited group of surgical patients admitted postoperatively to the day surgery ward of a single tertiary institution in Singapore from April to May 2015. The survey, modelled after two validated questionnaires, measured patients' knowledge, attitudes and preferences regarding CPR in a series of 18 questions. Fifty-one out of 67 (76.1%) patients completed the survey. Results indicated that 80.4% (n=41) of participants correctly understood the purpose of CPR, but 64.7% (n=33) did not know of any possible complications of CPR. Less than half (n=21, 41.2%) of participants had thought about life support measures they wanted for themselves. Most of the participants agreed that they should personally be involved in making end-of-life decisions (n=44, 86.3%). Many patients had a poor knowledge of CPR and other resuscitation measures and the majority overestimated the success rate of CPR. However, a majority were receptive to improving their knowledge and keen to discuss end-of-life issues with physicians.

  4. Evaluation of the Augmented Infant Resuscitator: A Monitoring Device for Neonatal Bag-Valve-Mask Resuscitation.

    Science.gov (United States)

    Bennett, Desmond J; Itagaki, Taiga; Chenelle, Christopher T; Bittner, Edward A; Kacmarek, Robert M

    2017-08-31

    Annually, 6 million newborns require bag-valve-mask resuscitation, and providing live feedback has the potential to improve the quality of resuscitation. The Augmented Infant Resuscitator (AIR), a real-time feedback device, has been designed to identify leaks, obstructions, and inappropriate breath rates during bag-valve-mask resuscitation. However, its function has not been evaluated. The resistance of the AIR was measured by attaching it between a ventilator and a ventilator tester. To test the device's reliability in training and clinical-use settings, it was placed in-line between a ventilation bag or ventilator and a neonatal manikin and a clinical lung model simulator. The lung model simulator simulated neonates of 3 sizes (2, 4, and 6 kg). Leaks, obstructions, and respiratory rate alterations were introduced. At a flow of 5 L/min, the pressure drop across the AIR was only 0.38 cm H2O, and the device had almost no effect on ventilator breath parameters. During the manikin trials, it was able to detect all leaks and obstructions, correctly displaying an alarm 100% of the time. During the simulated clinical trials, the AIR performed best on the 6-kg neonatal model, followed by the 4-kg model, and finally the 2-kg model. Over all 3 clinical models, the prototype displayed the correct indicator 73.5% of the time, and when doing so, took 1.6 ± 0.9 seconds. The AIR is a promising innovation that has the potential to improve neonatal resuscitation. It introduces only marginal resistance and performs well on neonatal manikins, but its firmware should be improved before clinical use.

  5. Resuscitation of canine and feline neonates.

    Science.gov (United States)

    Traas, A M

    2008-08-01

    Fetal depression following dystocia and Cesarean section has two primary causes; the first (and often most important) cause is hypoxia, and the second is depression from anesthetic agents given to the dam. Resuscitation efforts should be provided in the following order: warmth, airway, breathing, circulation, and drugs. Adequate time should be allowed for correction of hypoxia using ventilatory and circulatory support before drugs are used, with the exception of drugs given to reverse anesthetic and analgesic agents that were given to the dam prior to delivery of the neonates.

  6. Cardiopulmonary resuscitation: how far have we come?

    Science.gov (United States)

    Whitcomb, John J; Blackman, Virginia Schmied

    2007-01-01

    In the 43 years since it was first described, cardiopulmonary resuscitation (CPR) has grown from an obscure medical theory to a basic first aid skill taught to adults and is now the near-universal technique used in CPR instruction. This article provides insight into the history of CPR. We explore the phenomenon of sudden cardiac arrest, the historical roots of CPR, current practice data and recommendations, and the society's role in the development of this life-saving technique. We conclude with a review of CPR's economic impact on the healthcare system and the ethical and policy issues surrounding CPR.

  7. Post-resuscitation myocardial microcirculatory dysfunction is ameliorated with eptifibatide.

    Science.gov (United States)

    Kern, Karl B; Sasaoka, Taro; Higashi, Haruhiko; Hilwig, Ronald W; Berg, Robert A; Zuercher, Mathias

    2011-01-01

    The post-cardiac arrest syndrome includes a decline in myocardial microcirculation function. Inhibition of the platelet IIb/IIIa glycoprotein receptor has improved myocardial microvascular function post-percutaneous coronary intervention. Therefore, we evaluated such inhibition with eptifibatide for its effect on myocardial microcirculation function post-cardiac arrest and resuscitation. Four groups of swine were studied in a prospective, randomized, blinded, placebo-controlled protocol including; eptifibatide administered during CPR (Group 1, n=5), after resuscitation (Group 2, n=4), during and after resuscitation (Group 3, n=5), or placebo (Group 4, n=10). CPR was initiated following 12min of untreated VF. Those successfully resuscitated were studied during a 4-h post-resuscitation period. Coronary flow reserve, a measure of microcirculation function (in the absence of coronary obstruction), as well as parameters of left ventricular systolic and diastolic function, were measured pre-arrest and serially post-resuscitation. Coronary flow reserve was preserved during the post-resuscitation period, indicating normal microcirculatory function in the eptifibatide-treated animals, but not in the placebo-treated group. However, LV function declined equally in both groups during the first 4h after cardiac arrest. Inhibition of platelet IIb/IIIa glycoprotein receptors with eptifibatide post-resuscitation prevented myocardial microcirculation dysfunction. Left ventricular dysfunction post-resuscitation was not improved with eptifibatide, and perhaps transiently worse at 30min post-resuscitation. Post-cardiac arrest ventricular dysfunction may require a multi-modality treatment strategy for successful prevention or amelioration. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  8. Rabbit model of uncontrolled hemorrhagic shock and hypotensive resuscitation

    Directory of Open Access Journals (Sweden)

    J.B. Rezende-Neto

    2010-12-01

    Full Text Available Clinically relevant animal models capable of simulating traumatic hemorrhagic shock are needed. We developed a hemorrhagic shock model with male New Zealand rabbits (2200-2800 g, 60-70 days old that simulates the pre-hospital and acute care of a penetrating trauma victim in an urban scenario using current resuscitation strategies. A laparotomy was performed to reproduce tissue trauma and an aortic injury was created using a standardized single puncture to the left side of the infrarenal aorta to induce hemorrhagic shock similar to a penetrating mechanism. A 15-min interval was used to simulate the arrival of pre-hospital care. Fluid resuscitation was then applied using two regimens: normotensive resuscitation to achieve baseline mean arterial blood pressure (MAP, 10 animals and hypotensive resuscitation at 60% of baseline MAP (10 animals. Another 10 animals were sham operated. The total time of the experiment was 85 min, reproducing scene, transport and emergency room times. Intra-abdominal blood loss was significantly greater in animals that underwent normotensive resuscitation compared to hypotensive resuscitation (17.1 ± 2.0 vs 8.0 ± 1.5 mL/kg. Antithrombin levels decreased significantly in normotensive resuscitated animals compared to baseline (102 ± 2.0 vs 59 ± 4.1%, sham (95 ± 2.8 vs 59 ± 4.1%, and hypotensive resuscitated animals (98 ± 7.8 vs 59 ± 4.1%. Evidence of re-bleeding was also noted in the normotensive resuscitation group. A hypotensive resuscitation regimen resulted in decreased blood loss in a clinically relevant small animal model capable of reproducing hemorrhagic shock caused by a penetrating mechanism.

  9. Guidelines for the use of do-not-resuscitate orders in Dutch hospitals.

    Science.gov (United States)

    Haverkate, I; van Delden, J J; van Nijen, A B; van der Wal, G

    2000-08-01

    To determine the prevalence and analyze the content of guidelines for the use of do-not-resuscitate (DNR) orders in Dutch hospitals. Cross-sectional descriptive study. A questionnaire was mailed to the directors of patient care at all 143 Dutch hospitals. Directors were asked whether their hospitals had guidelines for the use of DNR orders and to provide copies of the guidelines if they did. The content of the guidelines was analyzed with regard to basic assumptions about nonresuscitation, definitions, persons involved in decision-making, advance directives, starting discussions about nonresuscitation, notation, evaluation, and other aspects. Of the 143 hospital directors surveyed, 95% responded. Sixty percent of the hospitals had guidelines for the use of DNR orders and provided copies. The assumption "always resuscitate, unless" was mentioned in 66% of guidelines. In 93% it was stated that patients should be involved in decision-making about nonfutile resuscitation. In 38% it was stated that in principle, living wills were respected in cases of incompetence. The role of proxies was mainly to discuss decisions (58% of guidelines), not to make them. The most frequently mentioned moment for starting a discussion about nonresuscitation was the onset of clinical deterioration of the patient (41%). It is promising that 60% of Dutch hospitals have developed guidelines for the use of DNR orders. However, current guidelines can be improved in many respects.

  10. Are European Resuscitation Council recommendations for paddle force achievable during defibrillation?

    Science.gov (United States)

    Sado, D M; Deakin, C D; Petley, G W

    2001-12-01

    Transthoracic impedance (TTI) is an important determinant of success in defibrillation. Low TTI increases transmyocardial current and therefore increases the chance of depolarising a critical mass of myocardium. A major component of TTI occurs at the paddle-skin interface and is minimised by pressure applied to the defibrillation paddles. The International Liaison Committee on Resuscitation (ILCOR) 2000 guidelines recommend that 'firm force' should be applied to both paddles, whereas previous European Resuscitation Council (ERC) 1992 guidelines were more precise, recommending that 12 kg of force should to be applied. We assessed whether defibrillator operators are capable of achieving 12 kg paddle force. Fifty advanced life support-trained doctors and nurses attempted to achieve 12 kg paddle force while simulating defibrillation on a resuscitation doll. The median value of the maximum pressures obtainable was 10.1 (max 16.0; min 5.0) kg force. Only 14% could achieve > or =12 kg force on both paddles for defibrillation. Men achieved more force than women (10.7 vs. 8.1 kg force; Pdefibrillator operators.

  11. Mental practice: a simple tool to enhance team-based trauma resuscitation.

    Science.gov (United States)

    Lorello, Gianni R; Hicks, Christopher M; Ahmed, Sana-Ara; Unger, Zoe; Chandra, Deven; Hayter, Megan A

    2016-03-01

    Effective trauma resuscitation requires the coordinated efforts of an interdisciplinary team. Mental practice (MP) is defined as the mental rehearsal of activity in the absence of gross muscular movements and has been demonstrated to enhance acquiring technical and procedural skills. The role of MP to promote nontechnical, team-based skills for trauma has yet to be investigated. We randomized anaesthesiology, emergency medicine, and surgery residents to two-member teams randomly assigned to either an MP or control group. The MP group engaged in 20 minutes of MP, and the control group received 20 minutes of Advanced Trauma Life Support (ATLS) training. All teams then participated in a high-fidelity simulated adult trauma resuscitation and received debriefing on communication, leadership, and teamwork. Two blinded raters independently scored video recordings of the simulated resuscitations using the Mayo High Performance Teamwork Scale (MHPTS), a validated team-based behavioural rating scale. The Mann-Whitney U-test was used to assess for between-group differences. Seventy-eight residents provided informed written consent and were recruited. The MP group outperformed the control group with significant effect on teamwork behaviour as assessed using the MHPTS: r=0.67, p<0.01. MP leads to improvement in team-based skills compared to traditional simulation-based trauma instruction. We feel that MP may be a useful and inexpensive tool for improving nontechnical skills instruction effectiveness for team-based trauma care.

  12. Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST)

    NARCIS (Netherlands)

    Waalewijn, R. A.; Tijssen, J. G.; Koster, R. W.

    2001-01-01

    The objective of this study was to analyze the functioning of the first two links of the chain of survival: 'access' and 'basic cardiopulmonary resuscitation (CPR)'. In a prospective study, all bystander witnessed circulatory arrests resuscitated by emergency medical service (EMS) personnel, were

  13. Outcomes of In-Hospital Cardiopulmonary Resuscitation Among Patients With Cancer.

    Science.gov (United States)

    Zafar, Waleed; Ghafoor, Irum; Jamshed, Arif; Gul, Sabika; Hafeez, Haroon

    2017-04-01

    To review all episodes where an emergency code was called in a cancer-specialized hospital in Pakistan and to assess survival to discharge among patients who received a cardiopulmonary resuscitation (CPR). We reviewed demographic and clinical data related to all "code blue" calls over 3 years. Multivariate logistic regression analyses were used to test the association of clinical characteristics with the primary outcome of survival to discharge. A total of 646 code blue calls were included in the analysis. The CPR was performed in 388 (60%) of these calls. For every 20 episodes of CPR among patients with cancer of all ages, only 1 resulted in a patient's survival to discharge, even though in 52.2% episodes there was a return of spontaneous circulation. No association was found between the type of rhythm at initiation of CPR and likelihood of survival to discharge. The proportion of patients with advanced cancer surviving to discharge after in-hospital CPR in a low-income country was in line with the reported international experience. Most patients with cancer who received in-hospital CPR did not survive to discharge and did not appear to benefit from resuscitation. Advance directives by patients with cancer limiting aggressive interventions at end of life and proper documentation of these directives will help in provision of care that is humane and consonant with patients' wishes for a dignified death. Patients' early appreciation of the limited benefits of CPR in advanced cancer is likely to help them formulate such advance directives.

  14. Providing immediate neonatal care and resuscitation at birth beside the mother: parents’ views, a qualitative study

    Science.gov (United States)

    Sawyer, Alexandra; Ayers, Susan; Bertullies, Sophia; Thomas, Margaret; Weeks, Andrew D; Yoxall, Charles W; Duley, Lelia

    2015-01-01

    Objectives The aims of this study were to assess parents’ views of immediate neonatal care and resuscitation at birth being provided beside the mother, and their experiences of a mobile trolley designed to facilitate this bedside care. Design Qualitative study with semistructured interviews. Results were analysed using thematic analysis. Setting Large UK maternity hospital. Participants Mothers whose baby received initial neonatal care in the first few minutes of life at the bedside, and their birth partners, were eligible. 30 participants were interviewed (19 mothers, 10 partners and 1 grandmother). 5 babies required advanced neonatal resuscitation. Results 5 themes were identified: (1) Reassurance, which included ‘Baby is OK’, ‘Having baby close’, ‘Confidence in care’, ‘Knowing what's going on’ and ‘Dad as informant’; (2) Involvement of the family, which included ‘Opportunity for contact’, ‘Family involvement’ and ‘Normality’; (3) Staff communication, which included ‘Communication’ and ‘Experience’; (4) Reservations, which included ‘Reservations about witnessing resuscitation’, ‘Negative emotions’ and ‘Worries about the impact on staff’ and (5) Experiences of the trolley, which included ‘Practical issues’ and ‘Comparisons with standard resuscitation equipment’. Conclusions Families were positive about neonatal care being provided at the bedside, and felt it gave reassurance about their baby's health and care. They also reported feeling involved as a family. Some parents reported experiencing negative emotions as a result of witnessing resuscitation of their baby. Parents were positive about the trolley. PMID:26384723

  15. Crystalloids and colloids in critical patient resuscitation.

    Science.gov (United States)

    Garnacho-Montero, J; Fernández-Mondéjar, E; Ferrer-Roca, R; Herrera-Gutiérrez, M E; Lorente, J A; Ruiz-Santana, S; Artigas, A

    2015-01-01

    Fluid resuscitation is essential for the survival of critically ill patients in shock, regardless of the origin of shock. A number of crystalloids and colloids (synthetic and natural) are currently available, and there is strong controversy regarding which type of fluid should be administered and the potential adverse effects associated with the use of these products, especially the development of renal failure requiring renal replacement therapy. Recently, several clinical trials and metaanalyses have suggested the use of hydroxyethyl starch (130/0.4) to be associated with an increased risk of death and kidney failure, and data have been obtained showing clinical benefit with the use of crystalloids that contain a lesser concentration of sodium and chlorine than normal saline. This new information has increased uncertainty among clinicians regarding which type of fluid should be used. We therefore have conducted a review of the literature with a view to developing practical recommendations on the use of fluids in the resuscitation phase in critically ill adults. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  16. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support.

    Science.gov (United States)

    2006-05-01

    This publication presents the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of the pediatric patient and the 2005 American Academy of Pediatrics/AHA guidelines for CPR and ECC of the neonate. The guidelines are based on the evidence evaluation from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American Heart Association in Dallas, Texas, January 23-30, 2005. The "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" contain recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. The evidence evaluation process that was the basis for these guidelines was accomplished in collaboration with the International Liaison Committee on Resuscitation (ILCOR). The ILCOR process is described in more detail in the "International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations." The recommendations in the "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" confirm the safety and effectiveness of many approaches, acknowledge that other approaches may not be optimal, and recommend new treatments that have undergone evidence evaluation. These new recommendations do not imply that care involving the use of earlier guidelines is unsafe. In addition, it is important to note that these guidelines will not apply to all rescuers and all victims in all situations. The leader of a resuscitation attempt may need to adapt application of the guidelines to unique circumstances. The following are the major pediatric advanced life support changes in the 2005 guidelines: There is further caution about the use of endotracheal tubes. Laryngeal mask airways are acceptable when used by experienced

  17. Comparison of powered and conventional air-purifying respirators during simulated resuscitation of casualties contaminated with hazardous substances.

    Science.gov (United States)

    Schumacher, J; Gray, S A; Weidelt, L; Brinker, A; Prior, K; Stratling, W M

    2009-07-01

    Advanced life support of patients contaminated with chemical, biological, radiological or nuclear (CBRN) substances requires adequate respiratory protection for medical first responders. Conventional and powered air-purifying respirators may exert a different impact during resuscitation and therefore require evaluation. This will help to improve major incident planning and measures for protecting medical staff. A randomised crossover study was undertaken to investigate the influence of conventional negative pressure and powered air-purifying respirators on the simulated resuscitation of casualties contaminated with hazardous substances. Fourteen UK paramedics carried out a standardised resuscitation algorithm inside an ambulance vehicle, either unprotected or wearing a conventional or a powered respirator. Treatment times, wearer mobility, ease of communication and ease of breathing were determined and compared. In the questionnaire, volunteers stated that communication and mobility were similar in both respirator groups while breathing resistance was significantly lower in the powered respirator group. There was no difference in mean (SD) treatment times between the groups wearing respiratory protection and the controls (245 (19) s for controls, 247 (17) s for conventional respirators and 250 (12) s for powered respirators). Powered air-purifying respirators improve the ease of breathing and do not appear to reduce mobility or delay treatment during a simulated resuscitation scenario inside an ambulance vehicle with a single CBRN casualty.

  18. Implementation of an in situ qualitative debriefing tool for resuscitations.

    Science.gov (United States)

    Mullan, Paul C; Wuestner, Elizabeth; Kerr, Tarra D; Christopher, Daniel P; Patel, Binita

    2013-07-01

    Multiple guidelines recommend debriefing of resuscitations to improve clinical performance. We implemented a novel standardized debriefing program using a Debriefing In Situ Conversation after Emergent Resuscitation Now (DISCERN) tool. Following the development of the evidence-based DISCERN tool, we conducted an observational study of all resuscitations (intubation, CPR, and/or defibrillation) at a pediatric emergency department (ED) over one year. Resuscitation interventions, patient survival, and physician team leader characteristics were analyzed as predictors for debriefing. Each debriefing's participants, time duration, and content were recorded. Thematic content of debriefings was categorized by framework approach into Team Emergency Assessment Measure (TEAM) elements. There were 241 resuscitations and 63 (26%) debriefings. A higher proportion of debriefings occurred after CPR (pDebriefing participants always included an attending and nurse; the median number of staff roles present was six. Median intervals (from resuscitation end to start of debriefing) & debriefing durations were 33 (IQR 15, 67) and 10 min (IQR 5, 12), respectively. Common TEAM themes included co-operation/coordination (30%), communication (22%), and situational awareness (15%). Stated reasons for not debriefing included: unnecessary (78%), time constraints (19%), or other reasons (3%). Debriefings with the DISCERN tool usually involved higher acuity resuscitations, involved most of the indicated personnel, and lasted less than 10 min. Future studies are needed to evaluate the tool for adaptation to other settings and potential impacts on education, quality improvement programming, and staff emotional well-being. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  19. Speaking Up and Sharing Information Improves Trainee Neonatal Resuscitations

    Science.gov (United States)

    Katakam, Lakshmi I; Trickey, Amber W; Thomas, Eric J

    2012-01-01

    Objectives To identify teamwork behaviors associated with improving efficiency and quality of simulated resuscitation training. Methods Secondary analysis of a randomized controlled trial of trainees undergoing neonatal resuscitation training was performed. Trainees at a large academic center (n=100) were randomized to receive standard curriculum (n=36) versus supplemental team training curriculum (n=62). A two-hour team training session focused on communication skills and team behaviors served as the intervention. Outcomes of interest included resuscitation duration, time required to complete a simulated newborn resuscitation, and performance score, determined by evaluation of each of the team’s steps during simulated resuscitation scenarios. Results The teamwork behaviors assertion and sharing information were associated with shorter resuscitation duration and higher performance scores. Each additional use of assertion (per minute) was associated with a duration reduction of 41 s (95%CI: −71.5 to −10.2) and an increase in performance score of 1.6% (95%CI: 0.4 to 2.7). Each additional use of sharing information (per minute) was associated with a 14 s reduction in duration (95%CI: −30.4 to 2.9) and a 0.8% increase in performance score (95%CI: 0.05 to 1.5). Conclusions Teamwork behaviors of assertion and sharing information are two important mediators of efficiency and quality of resuscitations. PMID:23007245

  20. Capnography during cardiopulmonary resuscitation: Current evidence and future directions

    Directory of Open Access Journals (Sweden)

    Bhavani Shankar Kodali

    2014-01-01

    Full Text Available Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 . Most recent Advanced Cardiac Life Support (ACLS guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR. Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 and cardiac output that can indicate the return of spontaneous circulation (ROSC. Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS in refractory cardiac arrest (RCA. There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

  1. Code status and resuscitation options in the electronic health record.

    Science.gov (United States)

    Bhatia, Haresh L; Patel, Neal R; Choma, Neesha N; Grande, Jonathan; Giuse, Dario A; Lehmann, Christoph U

    2015-02-01

    The advance discussion and documentation of code-status is important in preventing undesired cardiopulmonary resuscitation and related end of life interventions. Code-status documentation remains infrequent and paper-based, which limits its usefulness. This study evaluates a tool to document code-status in the electronic health records at a large teaching hospital, and analyzes the corresponding data. Encounter data for patients admitted to the Medical Center were collected over a period of 12 months (01-APR-2012-31-MAR-2013) and the code-status attribute was tracked for individual patients. The code-status data were analyzed separately for adult and pediatric patient populations. We considered 131,399 encounters for 83,248 adult patients and 80,778 encounters for 55,656 pediatric patients in this study. 71% of the adult patients and 30% of the pediatric patients studied had a documented code-status. Age and severity of illness influenced the decision to document code-status. Demographics such as gender, race, ethnicity, and proximity of primary residence were also associated with the documentation of code-status. Absence of a recorded code-status may result in unnecessary interventions. Code-status in paper charts may be difficult to access in cardiopulmonary arrest situations and may result in unnecessary and unwanted interventions and procedures. Documentation of code-status in electronic records creates a readily available reference for care providers. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Capnography during cardiopulmonary resuscitation: Current evidence and future directions.

    Science.gov (United States)

    Kodali, Bhavani Shankar; Urman, Richard D

    2014-10-01

    Capnography continues to be an important tool in measuring expired carbon dioxide (CO2). Most recent Advanced Cardiac Life Support (ACLS) guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR). Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO2 (PETCO2) and cardiac output that can indicate the return of spontaneous circulation (ROSC). Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO2 values can guide the initiation of extracorporeal life support (ECLS) in refractory cardiac arrest (RCA). There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

  3. Do Radiologists Want/Need Training in Cardiopulmonary Resuscitation?

    Energy Technology Data Exchange (ETDEWEB)

    Schellhammer, F. [St. Katharinen Hospital, Frechen (Germany). Dept. of Radiology

    2003-03-01

    Purpose: Prompt and effective cardiopulmonary resuscitation (CPR) decreases morbidity and mortality following cardiopulmonary arrest. Radiologists are frequently confronted with severely ill patients, who may deteriorate at any time. Furthermore, they have to be aware of life-threatening reactions towards contrast media. This study was designed to assess experience and self-estimation of German-speaking radiologists in CPR and cardiac defibrillation (CD). Material and Methods: 650 German-speaking radiologists were audited by a specially designed questionnaire, which was sent via e-mail. The answers were expected to be re-mailed within a 2-month period. Results: The response rate was 12.6%. 72.8% of the responders had performed at least 1 CPR (range 9.5 {+-} 13.1) and 37% at least 1 CD. 67.9% had had opportunities to attend training courses, which had been utilized by 41.8% of them. The last training of the responders was more than 2 years ago in 69.2% and more than 5 years ago in 37%. Of all responders 75.6% expressed the need for further education. Conclusion: The small response rate indicates the small importance of CPR in the subpopulation surveyed. The vast majority of the responders, however, showed interest in basic and advanced life support and advocated regular updates. It seems reasonable that radiological Dept. themselves should organize courses in order to cope with their specific situations.

  4. Comparison of training in neonatal resuscitation using self inflating bag and T-piece resuscitator.

    Science.gov (United States)

    Mathai, S S; Adhikari, K M; Rajeev, A

    2015-01-01

    Both the self inflating bag and the T-piece resuscitator are recommended for neonatal resuscitation, but many health care workers are unfamiliar with using the latter. A prospective, comparative, observational study was done to determine the ease and effectiveness of training of health care personnel in the two devices using infant training manikins. 100 health care workers, who had no prior formal training in neonatal resuscitation, were divided into small groups and trained in the use of the two devices by qualified trainers. Assessment of cognitive skills was done by pre and post MCQs. Psychomotor skill was assessed post training on manikins using a 10-point objective score. Acceptance by users was ascertained by questionnaire. Assessments were also done after 24 h and 3 months. Comparison was done by Chi square and paired t-tests. Pre-training cognitive tests increased from 3.77 (+1.58) to 6.99 (+1.28) on day of training which was significant. Post training assessment of psychomotor skills showed significantly higher initial scores for the T-piece group (7.07 + 2.57) on day of training. Reassessment after 24 h showed significant improvement in cognitive scores (9.89 + 1.24) and psychomotor scores in both groups (8.86 + 1.42 for self inflating bag and 9.70 + 0.57 for T-piece resuscitator). After 3-6 months the scores in both domains showed some decline which was not statistically significant. User acceptability was the same for both devices. It is equally easy to train health care workers in both devices. Both groups showed good short term recall and both devices were equally acceptable to the users.

  5. Comparison of training in neonatal resuscitation using self inflating bag and T-piece resuscitator

    Science.gov (United States)

    Mathai, S.S.; Adhikari, K.M.; Rajeev, A.

    2014-01-01

    Background Both the self inflating bag and the T-piece resuscitator are recommended for neonatal resuscitation, but many health care workers are unfamiliar with using the latter. A prospective, comparative, observational study was done to determine the ease and effectiveness of training of health care personnel in the two devices using infant training manikins. Methods 100 health care workers, who had no prior formal training in neonatal resuscitation, were divided into small groups and trained in the use of the two devices by qualified trainers. Assessment of cognitive skills was done by pre and post MCQs. Psychomotor skill was assessed post training on manikins using a 10-point objective score. Acceptance by users was ascertained by questionnaire. Assessments were also done after 24 h and 3 months. Comparison was done by Chi square and paired t-tests. Results Pre-training cognitive tests increased from 3.77 (+1.58) to 6.99 (+1.28) on day of training which was significant. Post training assessment of psychomotor skills showed significantly higher initial scores for the T-piece group (7.07 + 2.57) on day of training. Reassessment after 24 h showed significant improvement in cognitive scores (9.89 + 1.24) and psychomotor scores in both groups (8.86 + 1.42 for self inflating bag and 9.70 + 0.57 for T-piece resuscitator). After 3–6 months the scores in both domains showed some decline which was not statistically significant. User acceptability was the same for both devices. Conclusion It is equally easy to train health care workers in both devices. Both groups showed good short term recall and both devices were equally acceptable to the users. PMID:25609858

  6. Availability and Utilization of Cardiac Resuscitation Centers

    Directory of Open Access Journals (Sweden)

    Bryn E. Mumma

    2014-11-01

    Full Text Available Introduction: The American Heart Association (AHA recommends regionalized care following out-of-hospital cardiac arrest (OHCA at cardiac resuscitation centers (CRCs. Key level 1 CRC criteria include 24/7 percutaneous coronary intervention (PCI capability, therapeutic hypothermia capability, and annual volume of ≥40 patients resuscitated from OHCA. Our objective was to characterize the availability and utilization of resources relevant to post-cardiac arrest care, including level 1 CRCs in California. Methods: We combined data from the AHA, the California Office of Statewide Health Planning and Development (OSHPD, and surveys to identify CRCs. We surveyed emergency department directors and nurse managers at all 24/7 PCI centers identified by the AHA to determine their post-OHCA care capabilities. The survey included questions regarding therapeutic hypothermia use and specialist availability and was pilot-tested prior to distribution. Cases of OHCA were identified in the 2011 OSHPD Patient Discharge Database using a “present on admission” diagnosis of cardiac arrest (ICD-9-CM code 427.5. We defined key level 1 CRC criteria as 24/7 PCI capability, therapeutic hypothermia, and annual volume ≥40 patients admitted with a “present on admission” diagnosis of cardiac arrest. Our primary outcome was the proportion of hospitals meeting these criteria. Descriptive statistics and 95% CI are presented. Results: Of the 333 acute care hospitals in California, 31 (9.3%, 95% CI 6.4-13% met level 1 CRC criteria. These hospitals treated 25% (1937/7780; 95% CI 24-26% of all admitted OHCA patients in California in 2011. Of the 125 hospitals identified as 24/7 PCI centers by the AHA, 54 (43%, 95% CI 34-52% admitted ≥40 patients following OHCA in 2011. Seventy (56%, 95% CI 47-65% responded to the survey; 69/70 (99%, 95% CI 92-100% reported having a therapeutic hypothermia protocol in effect by 2011. Five percent of admitted OHCA patients (402/7780; 95% CI

  7. [Data from automated external defibrillators provide important information on the quality of in-hospital resuscitation].

    Science.gov (United States)

    Vestergård, Lone Due; Løfgren, Bo; Krarup, Niels Henrik Vinther; Holm, Tina; Andersen, Lone Kærslund

    2014-09-01

    International guidelines recommend monitoring the outcome following in-hospital cardiac arrest. Using data from automatic external defibrillators (AED) prospectively collected during a three-year period in a regional hospital, we evaluated the treatment quality of resuscitation. Time to defibrillation was acceptable, but quality of chest compressions did not comply with current international recommendations. AED use led to a high fraction of time with no chest compressions. Survival to discharge was 11%. Consequently, training in basic and advanced life support of hospital staff has been modified.

  8. Resuscitation of preterm infants: delivery room interventions and their effect on outcomes.

    LENUS (Irish Health Repository)

    O'Donnell, Colm P F

    2012-12-01

    Despite advances in neonatal care, the rate of oxygen dependence at 36 weeks\\' postmenstrual age or bronchopulmonary dysplasia has not fallen. Neonatologists are increasingly careful to apply ventilation strategies that are gentle to the lung in the neonatal intensive care unit. However, there has not been the same emphasis applying gentle ventilation strategies immediately after birth. A lung-protective strategy should start immediately after birth to establish a functional residual capacity, reduce volutrauma and atelectotrauma, facilitate gas exchange, and improve oxygenation during neonatal transition. This article discusses techniques and equipment recommended by international resuscitation guidelines during breathing assistance in the delivery room.

  9. Definitive studies on pole-top resuscitation. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Gordon, A.S.; Ridolpho, P.F.; Cole, J.E.

    1983-02-01

    This report summarizes the history of the application of cardiopulmonary resuscitation to the electric shock victim located at the top of a utility pole. This dramatic and urgent situation requires that rescue be attempted with procedures which are thoroughly understood and effective. Questions related to the use of resuscitation and precordial thump at the pole top were subjected to experimental testing, both in animals and in humans. Results of this study clearly demonstrate the advantages of postponing resuscitation until the victim has been lowered to the ground. The author concludes with seven recommendations for emergency treatment at the scene.

  10. Ethics and medico legal aspects of "Not for Resuscitation"

    Directory of Open Access Journals (Sweden)

    Naveen Sulakshan Salins

    2010-01-01

    Full Text Available Not for resuscitation in India still remains an abstract concept with no clear guidelines or legal frame work. Cardiopulmonary resuscitation is a complex medical intervention which is often used inappropriately in hospitalized patients and usually guided by medical decision making rather than patient-directed choices. Patient autonomy still remains a weak concept and relatives are expected to make this big decision in a short time and at a time of great emotional distress. This article outlines concepts around ethics and medico legal aspects of not for resuscitation, especially in Indian setting.

  11. Quality of resuscitation by first responders using the 'public access resuscitator': a randomized manikin study.

    Science.gov (United States)

    Taelman, Dries G; Huybrechts, Sofie A M; Peersman, Wim; Calle, Paul A; Monsieurs, Koenraad G

    2014-12-01

    The CAREvent Public Access Resuscitator (PAR) is an electronic, oxygen-driven cardiopulmonary resuscitation (CPR) device allowing volume-controlled ventilation with a face mask and guiding the rescuer through the resuscitation with voice prompts and visual indications. We hypothesized that 1 year after initial training, the efficacy of ventilation skills (primary outcome) and compression skills (secondary outcome) by first responders using the PAR would be superior compared with CPR with only a face mask. Seventy-one first responders were randomized to a group using the PAR (n=35) and a control group using only a face mask (n=36). CPR skills were assessed immediately after training and after 3, 7 and 12 months using a Skill Reporter manikin. Differences between groups over time and the interaction between time and groups were assessed using repeated measures models. Results are reported as mean values and number of participants with good ventilation or compression skills. Twelve months after training, there were more PAR users with adequate tidal volume than face mask users. Other ventilations skills did not differ between groups. There were more PAR users with an adequate number of compressions and with good hand position. Skill decay over 12 months did not differ between groups, except for hand position, where no decline was observed in the PAR group. Compared with the face mask, PAR improved tidal volume, compressions per minute and hand position in a manikin setting.

  12. A description of the "event manager" role in resuscitations: A qualitative study of interviews and focus groups of resuscitation participants.

    Science.gov (United States)

    Taylor, Katherine L; Parshuram, Christopher S; Ferri, Susan; Mema, Briseida

    2017-06-01

    Communication during resuscitation is essential for the provision of coordinated, effective care. Previously, we observed 44% of resuscitation communication originated from participants other than the physician team leader; 65% of which was directed to the team, exclusive of the team leader. We called this outer-loop communication. This institutional review board-approved qualitative study used grounded theory analysis of focus groups and interviews to describe and define outer-loop communication and the role of "event manager" as an additional "leader." Participants were health care staff involved in the medical management of resuscitations in a quaternary pediatric academic hospital. The following 3 domains were identified: the existence and rationale of outer-loop communication; the functions fulfilled by outer-loop communication; and the leadership and learning of event manager skills. The role was recognized by all team members and evolved organically as resuscitation complexity increased. A "good" manager has similar qualities to a "good team leader" with strong nontechnical skills. Event managers were not formally identified and no specific training had occurred. "Outer-loop" communication supports resuscitation activities. An event manager gives direction to the team, coordinates activities, and supports the team leader. We describe a new role in resuscitation in light of structural organizational theory and cognitive load with a view to incorporating this structure into resuscitation training. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Immediate defibrillation or defibrillation after cardiopulmonary resuscitation.

    Science.gov (United States)

    Koike, Soichi; Tanabe, Seizan; Ogawa, Toshio; Akahane, Manabu; Yasunaga, Hideo; Horiguchi, Hiromasa; Matsumoto, Shinya; Imamura, Tomoaki

    2011-01-01

    This study aimed to determine whether short cardiopulmonary resuscitation (CPR) by emergency medical services before defibrillation (CPR first) has a better outcome than immediate defibrillation followed by CPR (shock first) in patients with ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT) out-of-hospital cardiac arrest. We analyzed a national database between 2006 and 2008, and included patients aged 18 years or more who had witnessed cardiac arrests and whose first recorded rhythm was VF/pulseless VT. Those study subjects were divided into five groups in accordance with the CPR/defibrillation intervention sequence. Each group was subdivided into call-to-response intervals of attempted defibrillation did not present a better outcome compared with shock first as measured by either one-month survival or neurologically favorable one-month survival, after adjusting for potential confounders. Further studies are required to determine whether CPR first has an advantage over shock first.

  14. Review of commonly used age-based weight estimates for paediatric drug dosing in relation to the pharmacokinetic properties of resuscitation drugs.

    Science.gov (United States)

    Carasco, Clare Francesca; Fletcher, Penny; Maconochie, Ian

    2016-05-01

    To study which weight estimate calculation used in paediatric resuscitation results in optimal drug dosing; Advanced Paediatric and Life Support (APLS) or the UK Resuscitation Council age-based formula. Commonly used drugs used in paediatric resuscitation were selected and a literature search conducted for each drug's pharmacokinetic properties, concentrating on the volume of distribution (Vd). Hydrophobic drugs have a higher Vd than hydrophilic drugs as they distribute preferentially to fat mass (FM). The larger the Vd, the higher the initial dose required to achieve therapeutic plasma concentrations. Actual body weight (ABW) estimates are a good indicator of Vd for hydrophobic drugs as they correlate well with FM. Ideal body weight (IBW) estimates may be a better indicator of Vd for hydrophilic drugs, as they correlate better with lean body mass. This highlights potential variation between ABW and IBW, which may result in toxic or sub-therapeutic dosing. The new APLS formulae give higher estimates of expected weight for a wider age range. This may be a more accurate reflection of ABW due to increasing prevalence of obesity in children. The UK Resuscitation Council's formula appears to result in a lower estimate of weight, which may relate more closely to IBW. The main drugs used in paediatric resuscitation are hydrophilic, thus the APLS formulae may result in too much being given. Therefore the UK Resuscitation Council's single formula may be preferred. In addition, a single formula may minimize error in the context of a child of unknown weight requiring administration of emergency resuscitation drugs. © 2015 The British Pharmacological Society.

  15. External validation of scoring instruments for evaluating pediatric resuscitation.

    Science.gov (United States)

    Levy, Arielle; Donoghue, Aaron; Bailey, Benoit; Thompson, Nathan; Jamoulle, Olivier; Gagnon, Robert; Gravel, Jocelyn

    2014-12-01

    Although many methods have been proposed to assess clinical performance during resuscitation, robust and generalizable metrics are still lacking. Further research is necessary to develop validated clinical performance assessment tools and show an improvement in outcomes after training. We aimed to establish evidence for validity of a previously published scoring instrument--the Clinical Performance Tool (CPT)--designed to evaluate clinical performance during simulated pediatric resuscitations. This was a prospective experimental trial performed in the simulation laboratory of a pediatric tertiary care facility, with a pretest/posttest design that assessed residents before and after pediatric advanced life support (PALS) certification. Thirteen postgraduate year 1 (PGY1) and 11 PGY3 pediatric residents completed 5 simulated pediatric resuscitation scenarios each during 2 consecutive sessions; between the 2 sessions, they completed a full PALS certification course. All sessions were video recorded. Sessions were scored by raters using the CPT; total scores were expressed as a percentage of maximum points possible for each scenario. Validity evidence was established and interpreted according to Messick's framework. Evidence regarding relations to other variables was assessed by calculating differences in scores between pre-PALS and post-PALS certification and PGY1 and PGY3 using a repeated-measures analysis of variance test. Internal structure evidence was established by assessing interrater reliability using intraclass correlation coefficients (ICCs) for each scenario, a G-study, and a variance component analysis of individual measurement facets (scenarios, raters, and occasions) and associated interactions. Overall scores for the entire study cohort improved by 10% after PALS training. Scores improved by 9.9% (95% confidence interval [CI], 4.5-15.4) for the pulseless nonshockable arrest (ICC, 0.85; 95% CI, 0.74-0.92), 14.6% (95% CI, 6.7-22.4) for the pulseless

  16. Sustained inflations: comparing three neonatal resuscitation devices.

    Science.gov (United States)

    Klingenberg, Claus; Dawson, Jennifer A; Gerber, Angela; Kamlin, C Omar F; Davis, Peter G; Morley, Colin J

    2011-01-01

    Some national resuscitation guidelines advocate using sustained initial inflations (2-3 s) for babies requiring resuscitation. Inflation times ≥10 s have been used for preterm infants. This study examines the ability of operators of varying experience to provide a sustained inflation using three different manual ventilation devices. We compared a self-inflating bag, a flow-inflating bag and a pressure-limited T-piece device. Fifty clinical staff members from five professional groups gave a sustained inflation with a target peak pressure of 30 cm H2O and target duration of 10 s to an internal leak-free manikin. We measured peak inflating pressure (PIP) and mean inflating pressure (MIP) during the sustained inflation, and the duration of inflating pressure (IP) >20 and 25 cm H2O. Median (IQR) duration of IP >25 cm H2O was: self-inflating bag 2.5 s (0.8-5.7), flow-inflating bag 10.6 s (8.4-12.9) and the T-piece 10.7 s (8.9-11.9). There was a weak correlation between experience using a self-inflating bag and longer inflation times (R = 0.290, p = 0.041). When compared with the T-piece, the flow-inflating bag had lower mean MIP (27.0 ± 1.8 vs. 28.8 ± 2.0 cm H2O) and higher mean PIP (32.3 ± 3.7 vs. 29.8 ± 1.8 cm H2O). There were no differences in performance between operator groups. The T-piece provided consistent PIP during a single 10 s sustained inflation with less variation in pressure compared with the flow-inflating bag. Sustained inflations >3 s were difficult to achieve with a self-inflating bag. Copyright © 2011 S. Karger AG, Basel.

  17. Reversible myocardial dysfunction after cardiopulmonary resuscitation.

    Science.gov (United States)

    Ruiz-Bailén, Manuel; Aguayo de Hoyos, Eduardo; Ruiz-Navarro, Silvia; Díaz-Castellanos, Miguel Angel; Rucabado-Aguilar, Luis; Gómez-Jiménez, Francisco Javier; Martínez-Escobar, Sergio; Moreno, Rafael Melgares; Fierro-Rosón, Javier

    2005-08-01

    Myocardial stunning frequently has been described in patients with an acute coronary syndrome. Recently, it has also been described in critically ill patients without ischaemic heart disease. It is possible that the most severe form of any syndrome, leading to cardio-respiratory arrest, may cause myocardial stunning. Myocardial stunning appears to have been demonstrated in experimental studies, though this phenomenon has not been sufficiently studied in human models. The aim of the present work has been to study and describe the possible development of myocardial dysfunction in patients resuscitated after cardio-respiratory arrest, in the absence of acute or previous coronary artery disease. Descriptive study of a case series. The intensive care unit (ICU) of a provincial hospital. The study period was from April 1999 to June 2001. All patients admitted to the ICU with critical, non-coronary artery pathology, with no past history of cardiac disease, and those who were resuscitated after cardio-respiratory arrest, were included in the study. Transthoracic and transoesophageal echocardiography was used to assess left ventricular ejection fraction (LVEF) and disturbances of segmental contractility. This study was carried out within the first 24h after admission, during the first week, during the second or third week, after 1 month, and between 3 and 6 months. Twenty-nine patients with a median age of 65 years (range 24--76) were included in the study. Twelve patients died. Twenty patients developed myocardial dysfunction; the initial LVEF in these patients was 0.28 (0.12--0.51), showing improvement over time in the patients who survived. All of these patients presented disturbances of segmental contractility which also became normal over time. After successful CPR, reversible myocardial dysfunction, consisting of systolic myocardial dysfunction and disturbances of segmental contractility, may occur.

  18. Effects of the administration of 2,3-butanedione monoxime during conventional cardiopulmonary resuscitation on ischaemic contracture and resuscitability in a pig model of out-of-hospital cardiac arrest.

    Science.gov (United States)

    Lee, Byung Kook; Jeung, Kyung Woon; Choi, Sung Soo; Park, Sang Wook; Yun, Seong Woo; Lee, Sung Min; Kim, Nan Yeol; Heo, Tag; Min, Yong Il

    2015-02-01

    Ischaemic contracture compromises the haemodynamic effectiveness of cardiopulmonary resuscitation and resuscitability. 2,3-Butanedione monoxime (BDM) reduced ischaemic contracture by inhibiting actin-myosin crossbridge formation in an isolated heart model. We investigated the effects of BDM on ischaemic contracture and resuscitation outcomes in a pig model of out-of-hospital cardiac arrest (OHCA). After 15min of untreated ventricular fibrillation, followed by 8min of basic life support, 16 pigs were randomised to receive either 2mlkg(-1) of BDM solution (25gl(-1)) or 2mlkg(-1) of saline during advanced cardiac life support (ACLS). During the ACLS, the control group showed an increase in left ventricular (LV) wall thickness from 10.0mm (10.0-10.8) to 13.0mm (13.0-13.0) and a decrease in LV chamber area from 8.13cm(2) (7.59-9.29) to 7.47cm(2) (5.84-8.43). In contrast, the BDM group showed a decrease in the LV wall thickness from 10mm (9.0-10.8) to 8.5mm (7.0-9.8) and an increase in the LV chamber area from 9.86cm(2) (7.22-12.39) to 12.15 cm(2) (8.02-14.40). Mixed model analyses of the LV wall thickness and LV chamber area revealed significant group effects and group-time interactions. Spontaneous circulation was restored in four (50%) animals in the control group and in eight (100%) animals in the BDM group (p=0.077). All the resuscitated animals survived during an intensive care period of 4h. BDM administered during cardiopulmonary resuscitation reversed ischaemic contracture in a pig model of OHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. In-hospital cardiopulmonary resuscitation: prearrest morbidity and outcome

    NARCIS (Netherlands)

    de Vos, R.; Koster, R. W.; de Haan, R. J.; Oosting, H.; van der Wouw, P. A.; Lampe-Schoenmaeckers, A. J.

    1999-01-01

    BACKGROUND: Considerations about the application of cardiopulmonary resuscitation (CPR) should include the expected probability of survival. The survival probability after CPR may be more accurately estimated by the occurrence in time of the prearrest morbidity of patients. OBJECTIVE: To identify

  20. Resuscitation and coagulation in the severely injured trauma patient

    Science.gov (United States)

    Midwinter, Mark J.; Woolley, Tom

    2011-01-01

    Developments in the resuscitation of the severely injured trauma patient in the last decade have been through the increased understanding of the early pathophysiological consequences of injury together with some observations and experiences of recent casualties of conflict. In particular, the recognition of early derangements of haemostasis with hypocoagulopathy being associated with increased mortality and morbidity and the prime importance of tissue hypoperfusion as a central driver to this process in this population of patients has led to new resuscitation strategies. These strategies have focused on haemostatic resuscitation and the development of the ideas of damage control resuscitation and damage control surgery continuum. This in turn has led to a requirement to be able to more closely monitor the physiological status, of major trauma patients, including their coagulation status, and react in an anticipatory fashion. PMID:21149355

  1. Striving for good nursing care: nurses' experiences of do not resuscitate orders within oncology and hematology care.

    Science.gov (United States)

    Pettersson, Mona; Hedström, Mariann; Höglund, Anna T

    2014-12-01

    Within oncology and hematology care, patients are sometimes considered to have such a poor prognosis that they can receive a do not resuscitate order from the physician responsible, stipulating that neither basic nor advanced coronary pulmonary rescue be performed in the event of a cardiac arrest. Studies on do not resuscitate decisions within oncology and hematology units, focusing on the specific role of the nurse in relation to these decisions, are scarce. The aim of this study was to investigate hematology and oncology nurses' experiences and perceptions of do not resuscitate orders, in order to achieve a deeper understanding of the nurses' specific role in these decisions. A qualitative, descriptive methodology with individual semi-structured interviews was used. A total of 15 nurses from eight hematology/oncology wards in four hospitals in Sweden were interviewed individually. In accordance with national regulations, an ethical review was not required for this study. The research followed international guidelines for empirical research, as outlined in the Helsinki Declaration. The nurses strived for good nursing care through balancing harms and goods and observing integrity and quality of life as important values. Experienced hindrances for good care were unclear and poorly documented decisions, uninformed patients and relatives, and disagreements among the caregivers and family. The nurses expressed a need for an ongoing discussion on do not resuscitate decisions, including all concerned parties. In order to provide good nursing care, nurses need clear and well-documented do not resuscitate orders, and patients and relatives need to be well informed and included in the decisions. To increase the understanding for each other's opinions within the medical team, regular ethical discussions are required. © The Author(s) 2014.

  2. Resuscitation in hip fractures:A systematic review

    OpenAIRE

    Rocos, Brett; Whitehouse, Michael R.; Kelly, Michael B

    2017-01-01

    To evaluate the evidence for the resuscitation of patients with hip fracture in the preoperative or perioperative phase of their treatment and its impact on mortality.DESIGN: We searched MEDLINE, EMBASE, CENTRAL and PROSPERO databases using a systematic search strategy for randomised trials and observational studies investigating the fluid resuscitation of any patient with hip fracture. No language limits were applied to the search, which was complemented by manually screening the reference l...

  3. The Level Of Knowlege Guidelines Cardiopulmonary Resuscitation For Nurses

    OpenAIRE

    Lukešová, Ludmila

    2012-01-01

    The goal of this thesis is to determine the level of theoretical knowledge of the procedures of cardiopulmonary resuscitation of selected non-medical staff members in VFN in Prague. The work is subdivided into a theoretical and a practical part. In the first part I comment on the history of cardiopulmonary resuscitation, the basic and widespread vital support to adults and children and the didactics of CPR. In the second- practical part I compare the theoretical knowledge of CPR of selected n...

  4. Cardiopulmonary resuscitation: from the beginning to the present day.

    Science.gov (United States)

    Ristagno, Giuseppe; Tang, Wanchun; Weil, Max Harry

    2009-01-01

    Cardiac arrest represents a dramatic event that can occur suddenly and often without premonitory signs, characterized by sudden loss of consciousness and breathing after cardiac output ceases and both coronary and cerebral blood flows stop. Restarting of the blood flow by cardiopulmonary resuscitation potentially re-establishes some cardiac output and organ blood flows. This article summarizes the major events that encompass the history of cardiopulmonary resuscitation, beginning with ancient history and evolving into the current American Heart Association's commitment to save hearts.

  5. Do resuscitation-related injuries kill infants and children?

    Science.gov (United States)

    Matshes, Evan W; Lew, Emma O

    2010-06-01

    Occasionally, individuals accused of inflicting fatal injuries on infants and young children will claim some variant of the "CPR defense," that is, they attribute the cause of injuries found at autopsy to their "untrained" resuscitative efforts. A 10-year (1994-2003) historical fixed cohort study of all pediatric forensic autopsies at the Miami-Dade County Medical Examiner Department was undertaken. To be eligible for inclusion in the study, children had to have died of atraumatic causes, with or without resuscitative efforts (N(atraumatic) = 546). Of these, 382 had a history of cardiopulmonary resuscitation (CPR; average age of 4.17 years); 248 had CPR provided by trained individuals only; 133 had CPR provided by both trained and untrained individuals; 1 had CPR provided by untrained individuals only. There was no overlap between these 3 distinct groups. Twenty-two findings potentially attributable to CPR were identified in 19:15 cases of orofacial injuries compatible with attempted endotracheal intubation; 4 cases with focal pulmonary parenchymal hemorrhage; 1 case with prominent anterior mediastinal emphysema; and 2 cases with anterior chest abrasions. There were no significant hollow or solid thoracoabdominal organ injuries. There were no rib fractures. The estimated relative risk of injury subsequent to resuscitation was not statistically different between the subset of decedents whose resuscitative attempts were made by trained individuals only, and the subset who received CPR from both trained and untrained individuals. In the single case of CPR application by an untrained individual only, no injuries resulted. The remaining 164 children dying from nontraumatic causes and who did not undergo resuscitative efforts served as a control group; no injuries were identified. This study indicates that in the pediatric population, injuries secondary to resuscitative efforts are infrequent or rare, pathophysiologically inconsequential, and predominantly orofacial in

  6. Prolonged Cardiopulmonary Resuscitation Process and Lower Frequency of Medical Staff Visit Predicts Independently In-hospital Resuscitation Success in the Elderly Population

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    Jui-Chen Tsai

    2012-09-01

    Conclusion: Although the initial resuscitation success rate was not affected by age, a longer time interval between the last medical staffs’ visit and the onset of resuscitation did result in a worse success rate in elderly patients. Our data suggest that more frequent staff visits to the elderly population during hospitalization could alter initial resuscitation results.

  7. Analysis of neonatal resuscitation using eye tracking: a pilot study.

    Science.gov (United States)

    Law, Brenda Hiu Yan; Cheung, Po-Yin; Wagner, Michael; van Os, Sylvia; Zheng, Bin; Schmölzer, Georg

    2017-08-19

    Visual attention (VA) is important for situation awareness and decision-making. Eye tracking can be used to analyse the VA of healthcare providers. No study has examined eye tracking during neonatal resuscitation. To test the use of eye tracking to examine VA during neonatal resuscitation. Six video recordings were obtained using eye tracking glasses worn by resuscitators during the first 5 min of neonatal resuscitation. Videos were analysed to obtain (i) areas of interest (AOIs), (ii) time spent on each AOI and (iii) frequency of saccades between AOIs. Five videos were of acceptable quality and analysed. Only 35% of VA was directed at the infant, with 33% at patient monitors and gauges. There were frequent saccades (0.45/s) and most involved patient monitors. During neonatal resuscitation, VA is often directed away from the infant towards patient monitors. Eye tracking can be used to analyse human performance during neonatal resuscitation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Ethical dilemmas of recording and reviewing neonatal resuscitation.

    Science.gov (United States)

    den Boer, Maria C; Houtlosser, Mirjam; van Zanten, Henriëtte Anje; Foglia, Elizabeth E; Engberts, Dirk P; Te Pas, Arjan B

    2018-01-20

    Neonatal resuscitation is provided to approximately 3% of neonates. Adequate ventilation is often the key to successful resuscitation, but this can be difficult to provide. There is increasing evidence that inappropriate respiratory support can have severe consequences. Several neonatal intensive care units have recorded and reviewed neonatal resuscitation procedures for quality assessment, education and research; however, ethical dilemmas sometimes make it difficult to implement this review process. We reviewed the literature on the development of recording and reviewing neonatal resuscitation and have summarised the ethical concerns involved. Recording and reviewing vital physiological parameters and video imaging of neonatal resuscitation in the delivery room is a valuable tool for quality assurance, education and research. Furthermore, it can improve the quality of neonatal resuscitation provided. We observed that ethical dilemmas arise as the review process is operating in several domains of healthcare that all have their specific moral framework with requirements and conditions on issues such as consent, privacy and data storage. These moral requirements and conditions vary due to local circumstances. Further research on the ethical aspects of recording and reviewing is desirable before wider implementation of this technique can be recommended. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Cardiopulmonary Resuscitation Training for Medical Students in Anesthesiology Rotation in Ardabil Medical University (Iran

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    Kh Isazadehfar

    2009-11-01

    Full Text Available Background and purpose: Cardiopulmonary resuscitation (CPR training for undergraduate medical students has been noted to be poor in the past. Attempts have been made The aim of this study is to determine effect of CPR training in the anesthetic ward to improve knowledge and practice undergraduate medical student of CPR.Methods: A 12 month Educational experimental study with self control was done on all undergraduate medical student (n=30 at the medical university of Ardabil in 2006-2007. During I month of program allthis students have undergone CPR training including basic life support (BLS , advanced cardiac life support (ACLS and practical skills. Data were collected via questionnaire, demographic, pre/post knowledge and practice.Results: After training the acceptable score (good and very good about knowledge of BLS, ACLS and practical skill significantly increased %6.7 to %50 (p=0.0001 , %13.3 to %53.4 (p=0.001 and %3.3 to %100 (p=0.001 respectively. A significant relationship between knowledge of ACLS and practical skills was shown (p=0.005.Conclusion: The CPR training course in anesthetic ward leads to a significant increased in skills and knowledge. Adding this course to undergraduate curriculum of medical students especially in operaticallywards (e.g. Anesthetic ward is essential.Keywords: CARDIOPULMONARY RESUSCITATION; TRAINING; BASIC LIFE SUPPORT; ADVANCED CARDIAC LIFE SUPPORT

  10. Family support liaison in the witnessed resuscitation: A phenomenology study.

    Science.gov (United States)

    Hassankhani, Hadi; Zamanzade, Vahid; Rahmani, Azad; Haririan, Hamidreza; Porter, Joanne E

    2017-09-01

    Family-witnessed resuscitation remains controversial among clinicians from implementation to practice and there are a number of countries, such as Iran, where that is considered a low priority. To explore the lived experience of resuscitation team members with the presence of the patient's family during resuscitation. The hermeneutic phenomenology. The emergency departments and critical care units of 6 tertiary hospitals in Tabriz, Iran. There were potentially 380 nurses and physicians working in the emergency departments and acute care settings of 6 tertiary hospitals in Tabriz. A purposive sample of these nurses and physicians was used to recruit participants who had at least 2 years of experience, had experienced an actual family witnessed resuscitation event, and wanted to participate. The sample size was determined according to data saturation. Data collection ended when the data were considered rich and varied enough to illuminate the phenomenon, and no new themes emerged following the interview of 12 nurses and 8 physicians. Semi-structured, face- to- face interviews were held with the participants over a period of 6 months (April 2015 to September 2015), and Van Manen's method of data analysis was adopted. Three main themes emerged from the data analysis, including 'Futile resuscitation', 'Family support liaison', and 'Influence on team's performance'. A further 9 sub-themes emerged under the 3 main themes, which included 'futile resuscitation in end-stage cancer patients', 'when a patient dies', 'young patients', 'care of the elderly', 'accountable person', 'family supporter', 'no influence', 'positive influence', and 'negative influence'. Participants noted both positive and negative experiences of having family members present during cardiopulmonary resuscitation. Welltrained and expert resuscitation team members are less likely to be stressed in the presence of family. A family support liaison would act to decrease family anxiety levels and to de

  11. Resuscitation of the trauma patient: tell me a trigger for early haemostatic resuscitation please!

    Science.gov (United States)

    Reed, Matthew J; Lone, Nazir; Walsh, Timothy S

    2011-03-01

    The management of trauma-related coagulopathy and haemorrhage is changing from a reactive strategy to a proactive early intervention with blood products and haemostatic agents. Although major haemorrhage and massive transfusion are associated with higher mortality, the pattern of this association with modern trauma care is poorly described. In addition, early predictors of massive transfusion, which might trigger a proactive haemostatic resuscitation strategy, are not currently available. We review recent literature relating to predictors of massive transfusions and the relationship between transfusion and mortality.

  12. Cardiac arrest in the toilet: clinical characteristics and resuscitation profiles.

    Science.gov (United States)

    Inamasu, Joji; Miyatake, Satoru

    2013-03-01

    The great majority of non-traumatic cardiac arrests (CA) occur at home. The toilet is a closed and private room where CA occurs frequently. However, due to the feelings of privacy that are associated with this room, the circumstances and causes of CA in the toilet have rarely been investigated. A retrospective study was conducted to clarify clinical characteristics and resuscitation profiles of patients sustaining CA in the toilet. Among 907 CA patients treated during a 4-year period, 101 (11 %) sustained CA in the toilet. While the collapse was witnessed in only 10 % of these patients, return of spontaneous circulation (ROSC) was achieved in 41 %. However, the long-term survival rate was 1 %. Multivariate regression analysis revealed that a history of cardiac diseases was predictive of CA in the toilet (odds ratio 3.045; 95 % confidence interval 1.756-5.282) but that there was no correlation with advanced age. The frequency of CA in the toilet may be influenced moderately by seasonal/circadian variations. The 101 patients were classified into four subgroups according to mode of discovery of CA. The frequency of ROSC was highest in those who collapsed in the presence of caregivers and lowest in those whose collapse were discovered later by family members being worried that the patient stayed in the toilet "too long." Imaging studies revealed life-threatening extra-cardiac lesions responsible for CA, such as subarachnoid hemorrhage and aortic dissection, in 23 % of the patient cohort. The rarity of long-term survival among individuals sustaining CA in the toilet is mainly due to the delay in discovering the individual who collapsed. Although a history of cardiac diseases is a risk factor, predicting who may sustain CA in the toilet remains difficult due to etiological heterogeneity.

  13. Do-not-resuscitate order: The experiences of iranian cardiopulmonary resuscitation team members

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    Abdolghader Assarroudi

    2017-01-01

    Full Text Available Background: One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR. This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order. Methods: CPR team members were interviewed, and data were analyzed using a conventional content analysis method. Results: Three categories and six subcategories emerged: “The dilemma between revival and suffering” with the subcategories of “revival likelihood” and “death as a cause for comfort;” “conflicting situation” with the subcategories of “latent decision” and “ambivalent order;” and “low-quality CPR” with the subcategories of “team member demotivation” and “disrupting CPR performance.” Conclusion: There is a need for the development of a contextual guideline, which is required for respecting the rights of patients and their families and providing legal support to health-care professionals during CPR.

  14. Providing immediate neonatal care and resuscitation at birth beside the mother: clinicians' views, a qualitative study.

    Science.gov (United States)

    Yoxall, Charles W; Ayers, Susan; Sawyer, Alexandra; Bertullies, Sophia; Thomas, Margaret; D Weeks, Andrew; Duley, Lelia

    2015-09-30

    The aims of this study were to assess clinicians' views and experiences of providing immediate neonatal care at birth beside the mother, and of using a mobile trolley designed to facilitate this bedside care. Qualitative interview study with semistructured interviews. The results were analysed using thematic analysis. A large UK maternity unit. Clinicians (n=20) from a range of disciplines who were present when the trolley was used to provide neonatal care at birth at the bedside. Five clinicians provided/observed advanced resuscitation by the bedside. Five themes were identified: (1) Parents' involvement, which included 'Contact and involvement', 'Positive emotions for parents' and 'Staff communication'; (2) Reservations about neonatal care at birth beside the mother, which included 'Impact on clinicians' and 'Impact on parents'; (3) Practical challenges in providing neonatal care at the bedside, which included 'Cord length' and 'Caesarean section'; (4) Comparison of the trolley with usual resuscitation equipment and (5) Training and integration of bedside care into clinical routine, which included 'Teething problems' and 'Training'. Overall, most clinicians were positive about providing immediate neonatal care at the maternal bedside, particularly in terms of the clinicians' perceptions of the parents' experience. Clinicians also perceived that their close proximity to parents improved communication. However, there was some concern about performing more intensive interventions in front of parents. Providing immediate neonatal care and resuscitation at the bedside requires staff training and support. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Providing immediate neonatal care and resuscitation at birth beside the mother: clinicians’ views, a qualitative study

    Science.gov (United States)

    Yoxall, Charles W; Ayers, Susan; Sawyer, Alexandra; Bertullies, Sophia; Thomas, Margaret; D Weeks, Andrew; Duley, Lelia

    2015-01-01

    Objectives The aims of this study were to assess clinicians’ views and experiences of providing immediate neonatal care at birth beside the mother, and of using a mobile trolley designed to facilitate this bedside care. Design Qualitative interview study with semistructured interviews. Results The results were analysed using thematic analysis. Setting A large UK maternity unit. Participants Clinicians (n=20) from a range of disciplines who were present when the trolley was used to provide neonatal care at birth at the bedside. Five clinicians provided/observed advanced resuscitation by the bedside. Results Five themes were identified: (1) Parents’ involvement, which included ‘Contact and involvement’, ‘Positive emotions for parents’ and ‘Staff communication’; (2) Reservations about neonatal care at birth beside the mother, which included ‘Impact on clinicians’ and ‘Impact on parents’; (3) Practical challenges in providing neonatal care at the bedside, which included ‘Cord length’ and ‘Caesarean section’; (4) Comparison of the trolley with usual resuscitation equipment and (5) Training and integration of bedside care into clinical routine, which included ‘Teething problems’ and ‘Training’. Conclusions Overall, most clinicians were positive about providing immediate neonatal care at the maternal bedside, particularly in terms of the clinicians’ perceptions of the parents’ experience. Clinicians also perceived that their close proximity to parents improved communication. However, there was some concern about performing more intensive interventions in front of parents. Providing immediate neonatal care and resuscitation at the bedside requires staff training and support. PMID:26423852

  16. Hypothermia Modulates Arrhythmia Substrates During Different Phases of Resuscitation From Ischemic Cardiac Arrest.

    Science.gov (United States)

    Piktel, Joseph S; Cheng, Aurelia; McCauley, Matthew; Dale, Zack; Nassal, Michelle; Maleski, Danielle; Pawlowski, Gary; Laurita, Kenneth R; Wilson, Lance D

    2017-11-17

    We designed an innovative porcine model of ischemia-induced arrest to determine dynamic arrhythmia substrates during focal infarct, global ischemia from ventricular tachycardia or fibrillation (VT/VF) and then reperfusion to determine the effect of therapeutic hypothermia (TH) on dynamic arrhythmia substrates and resuscitation outcomes. Anesthetized adult pigs underwent thoracotomy and regional plunge electrode placement in the left ventricle. Subjects were then maintained at either control (CT; 37°C, n=9) or TH (33°C, n=8). The left anterior descending artery (LAD) was occluded and ventricular fibrillation occurred spontaneously or was induced after 30 minutes. Advanced cardiac life support was started after 8 minutes, and LAD reperfusion occurred 60 minutes after occlusion. Incidences of VF/VT and survival were compared with ventricular ectopy, cardiac alternans, global dispersion of repolarization during LAD occlusion, and LAD reperfusion. There was no difference in incidence of VT/VF between groups during LAD occlusion (44% in CT versus 50% in TH; P=1s). During LAD occlusion, ectopy was increased in CT and suppressed in TH (33±11 ventricular ectopic beats/min versus 4±6 ventricular ectopic beats/min; P=0.009). Global dispersion of repolarization and cardiac alternans were similar between groups. During LAD reperfusion, TH doubled the incidence of cardiac alternans compared with CT, with a marked increase in VF/VT (100% in TH versus 17% in CT; P=0.004). Ectopy and global dispersion of repolarization were similar between groups during LAD reperfusion. TH alters arrhythmia substrates in a porcine translational model of resuscitation from ischemic cardiac arrest during the complex phases of resuscitation. TH worsens cardiac alternans, which was associated with an increase in spontaneous VT/VF during reperfusion. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  17. Hypothermia and postconditioning after cardiopulmonary resuscitation reduce cardiac dysfunction by modulating inflammation, apoptosis and remodeling.

    Directory of Open Access Journals (Sweden)

    Patrick Meybohm

    Full Text Available BACKGROUND: Mild therapeutic hypothermia following cardiac arrest is neuroprotective, but its effect on myocardial dysfunction that is a critical issue following resuscitation is not clear. This study sought to examine whether hypothermia and the combination of hypothermia and pharmacological postconditioning are cardioprotective in a model of cardiopulmonary resuscitation following acute myocardial ischemia. METHODOLOGY/PRINCIPAL FINDINGS: Thirty pigs (28-34 kg were subjected to cardiac arrest following left anterior descending coronary artery ischemia. After 7 minutes of ventricular fibrillation and 2 minutes of basic life support, advanced cardiac life support was started according to the current AHA guidelines. After successful return of spontaneous circulation (n = 21, coronary perfusion was reestablished after 60 minutes of occlusion, and animals were randomized to either normothermia at 38 degrees C, hypothermia at 33 degrees C or hypothermia at 33 degrees C combined with sevoflurane (each group n = 7 for 24 hours. The effects on cardiac damage especially on inflammation, apoptosis, and remodeling were studied using cellular and molecular approaches. Five animals were sham operated. Animals treated with hypothermia had lower troponin T levels (p<0.01, reduced infarct size (34+/-7 versus 57+/-12%; p<0.05 and improved left ventricular function compared to normothermia (p<0.05. Hypothermia was associated with a reduction in: (i immune cell infiltration, (ii apoptosis, (iii IL-1beta and IL-6 mRNA up-regulation, and (iv IL-1beta protein expression (p<0.05. Moreover, decreased matrix metalloproteinase-9 activity was detected in the ischemic myocardium after treatment with mild hypothermia. Sevoflurane conferred additional protective effects although statistic significance was not reached. CONCLUSIONS/SIGNIFICANCE: Hypothermia reduced myocardial damage and dysfunction after cardiopulmonary resuscitation possible via a reduced rate of apoptosis

  18. Human factors in resuscitation: Lessons learned from simulator studies

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    Hunziker S

    2010-01-01

    Full Text Available Medical algorithms, technical skills, and repeated training are the classical cornerstones for successful cardiopulmonary resuscitation (CPR. Increasing evidence suggests that human factors, including team interaction, communication, and leadership, also influence the performance of CPR. Guidelines, however, do not yet include these human factors, partly because of the difficulties of their measurement in real-life cardiac arrest. Recently, clinical studies of cardiac arrest scenarios with high-fidelity video-assisted simulations have provided opportunities to better delineate the influence of human factors on resuscitation team performance. This review focuses on evidence from simulator studies that focus on human factors and their influence on the performance of resuscitation teams. Similar to studies in real patients, simulated cardiac arrest scenarios revealed many unnecessary interruptions of CPR as well as significant delays in defibrillation. These studies also showed that human factors play a major role in these shortcomings and that the medical performance depends on the quality of leadership and team-structuring. Moreover, simulated video-taped medical emergencies revealed that a substantial part of information transfer during communication is erroneous. Understanding the impact of human factors on the performance of a complex medical intervention like resuscitation requires detailed, second-by-second, analysis of factors involving the patient, resuscitative equipment such as the defibrillator, and all team members. Thus, high-fidelity simulator studies provide an important research method in this challenging field.

  19. New perspectives of volemic resuscitation in polytrauma patients: a review.

    Science.gov (United States)

    Bedreag, Ovidiu Horea; Papurica, Marius; Rogobete, Alexandru Florin; Sarandan, Mirela; Cradigati, Carmen Alina; Vernic, Corina; Dumbuleu, Corina Maria; Nartita, Radu; Sandesc, Dorel

    2016-01-01

    Nowadays, fluid resuscitation of multiple trauma patients is still a challenging therapy. Existing therapies for volume replacement in severe haemorrhagic shock can lead to adverse reactions that may be fatal for the patient. Patients presenting with multiple trauma often develop hemorrhagic shock, which triggers a series of metabolic, physiological and cellular dysfunction. These disorders combined, lead to complications that significantly decrease survival rate in this subset of patients. Volume and electrolyte resuscitation is challenging due to many factors that overlap. Poor management can lead to post-resuscitation systemic inflammation causing multiple organ failure and ultimately death. In literature, there is no exact formula for this purpose, and opinions are divided. This paper presents a review of modern techniques and current studies regarding the management of fluid resuscitation in trauma patients with hemorrhagic shock. According to the literature and from clinical experience, all aspects regarding post-resuscitation period need to be considered. Also, for every case in particular, emergency therapy management needs to be rigorously respected considering all physiological, biochemical and biological parameters.

  20. Design of a Functional Training Prototype for Neonatal Resuscitation

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    Sivaramakrishnan Rajaraman

    2014-11-01

    Full Text Available Birth Asphyxia is considered to be one of the leading causes of neonatal mortality around the world. Asphyxiated neonates require skilled resuscitation to survive the neonatal period. The project aims to train health professionals in a basic newborn care using a prototype with an ultimate objective to have one person at every delivery trained in neonatal resuscitation. This prototype will be a user-friendly device with which one can get trained in performing neonatal resuscitation in resource-limited settings. The prototype consists of a Force Sensing Resistor (FSR that measures the pressure applied and is interfaced with Arduino® which controls the Liquid Crystal Display (LCD and Light Emitting Diode (LED indication for pressure and compression counts. With the increase in population and absence of proper medical care, the need for neonatal resuscitation program is not well addressed. The proposed work aims at offering a promising solution for training health care individuals on resuscitating newborn babies under low resource settings.

  1. Analysis of Medication Errors in Simulated Pediatric Resuscitation by Residents

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    Evelyn Porter

    2014-07-01

    Full Text Available Introduction: The objective of our study was to estimate the incidence of prescribing medication errors specifically made by a trainee and identify factors associated with these errors during the simulated resuscitation of a critically ill child. Methods: The results of the simulated resuscitation are described. We analyzed data from the simulated resuscitation for the occurrence of a prescribing medication error. We compared univariate analysis of each variable to medication error rate and performed a separate multiple logistic regression analysis on the significant univariate variables to assess the association between the selected variables. Results: We reviewed 49 simulated resuscitations . The final medication error rate for the simulation was 26.5% (95% CI 13.7% - 39.3%. On univariate analysis, statistically significant findings for decreased prescribing medication error rates included senior residents in charge, presence of a pharmacist, sleeping greater than 8 hours prior to the simulation, and a visual analog scale score showing more confidence in caring for critically ill children. Multiple logistic regression analysis using the above significant variables showed only the presence of a pharmacist to remain significantly associated with decreased medication error, odds ratio of 0.09 (95% CI 0.01 - 0.64. Conclusion: Our results indicate that the presence of a clinical pharmacist during the resuscitation of a critically ill child reduces the medication errors made by resident physician trainees.

  2. Effect of a pharmacologically induced decrease in core temperature in rats resuscitated from cardiac arrest

    Science.gov (United States)

    Targeted temperature management is recommended to reduce brain damage after resuscitation from cardiac arrest in humans although the optimal target temperature remains controversial. 1 4 The American Heart Association (AHA) and the International Liaison Committee on Resuscitation...

  3. In-hospital resuscitation evaluated by in situ simulation: a prospective simulation study

    DEFF Research Database (Denmark)

    Mondrup, Frederik; Brabrand, Mikkel; Folkestad, Lars

    2011-01-01

    ABSTRACT: BACKGROUND: : Interruption in chest compressions during cardiopulmonary resuscitation can be characterized as no flow ratio (NFR) and the importance of minimizing these pauses in chest compression has been highlighted recently. Further, documentation of resuscitation performance has been...

  4. Complications of cardiopulmonary resuscitation in non-traumatic cases and factors affecting complications

    Directory of Open Access Journals (Sweden)

    Umit Kaldırım

    2016-09-01

    It has been shown that during cardiopulmonary resuscitation, severe injuries can occur due to thoracic compression. Only a positive correlation with the duration of cardiopulmonary resuscitation was found in our study.

  5. Delayed recovery of spontaneous circulation following cessation of cardiopulmonary resuscitation in an older patient: a case report.

    Science.gov (United States)

    Huang, Yili; Kim, Sijun; Dharia, Amishi; Shalshin, Aleksander; Dauer, Jan

    2013-03-12

    This report describes the apparent 'resurrection' of a patient in an emergency department setting. Befittingly named the 'Lazarus phenomenon', the recovery of spontaneous circulation after cessation of cardiopulmonary resuscitation is an extremely rare occurrence that was first described in 1982 and has been mentioned only 38 times in the medical literature. Our patient's case is remarkable in that it helps illustrate many of the mechanisms of this rare phenomenon. It also serves as a reminder of our limitations in determining when to terminate cardiopulmonary resuscitation and suggests that cessation of cardiopulmonary resuscitation should be approached with more care. An 89-year-old Caucasian woman with a medical history of hypertension, atrial fibrillation, hypothyroidism, aortic insufficiency, lymphedema and hypoxia secondary to partial lung resection presented to our hospital after a witnessed fall unassociated with head trauma or loss of consciousness. On examination, our patient was saturating at 85 percent and exhibited a decreased range of motion of the upper extremities and left hip. Radiographic images revealed a left femoral neck and left distal radius fracture. Our patient was stabilized on 100 percent fraction of inspired oxygen and was awaiting transfer to an in-patient unit when, at 3:30 a.m., she went into cardiac arrest. An advanced cardiac life support protocol was initiated, at which time our patient was intubated and administered epinephrine, vasopressin and sodium bicarbonate. Our patient remained unresponsive and asystolic so cardiopulmonary resuscitation was abandoned at 3:48 a.m. After five minutes a ventricular contraction was noted at 3:51 a.m. This progressed to sinus rhythm with a pulse at 3:53 a.m. Our patient was stabilized on norepinephrine and moved to our Intensive Care Unit. At 10:55 a.m., however, our patient again arrested and, despite resuscitative efforts, was pronounced dead at 11:03 a.m. Our patient's case clearly

  6. Recent Advances in Managing Acute Pancreatitis.

    Science.gov (United States)

    Janisch, Nigeen; Gardner, Timothy

    2015-01-01

    This article will review the recent advances in managing acute pancreatitis. Supportive care has long been the standard of treatment for this disease despite extensive, but ultimately unsuccessful, efforts to develop disease-specific pharmacologic therapies. The primary interventions center on aggressive fluid resuscitation, initiation of early enteral nutrition, targeted antibiotic therapy, and the management of complications. In this article, we will detail treatment of acute pancreatitis with a focus on intravenous fluid resuscitation, enteral feeding, and the current evidence behind the use of antibiotics and other pharmacologic therapies.

  7. Initial resuscitation and management of pediatric septic shock.

    Science.gov (United States)

    Martin, K; Weiss, S L

    2015-04-01

    The pediatric sepsis syndrome remains a common cause of morbidity, mortality, and health care utilization costs worldwide. The initial resuscitation and management of pediatric sepsis is focused on 1) rapid recognition of abnormal tissue perfusion and restoration of adequate cardiovascular function; 2) eradication of the inciting invasive infection, including prompt administration of empiric broad-spectrum antimicrobial medications; and 3) supportive care of organ system dysfunction. Efforts to improve early and aggressive initial resuscitation and ongoing management strategies have improved outcomes in pediatric severe sepsis and septic shock, though many questions still remain as to the optimal therapeutic strategies for many patients. In this article, we will briefly review the definitions, epidemiology, clinical manifestations, and pathophysiology of sepsis and provide an extensive overview of both current and novel therapeutic strategies used to resuscitate and manage pediatric patients with severe sepsis and septic shock.

  8. The AED in resuscitation: it's not just about the shock.

    Science.gov (United States)

    Page, Richard L

    2011-01-01

    The automated external defibrillator (AED), in combination with effective cardiopulmonary resuscitation (CPR), is a critical part of the American Heart Association's "Chain of survival." Newer guidelines have simplified resuscitation and emphasized the importance of CPR in providing rapid and deep compressions with minimal interruptions; in fact, CPR should resume immediately after the shock given by the AED, without the delay entailed in checking for pulse or rhythm conversion. Our experience with the AED aboard aircraft, showing 40% long-term survival with the AED in ventricular fibrillation, demonstrated the safety and efficacy of the device. Despite this and other reports of successful AED deployment, AEDs are not yet available at all public locations. Prospective research, as undertaken by the Resuscitation Outcomes Consortium, will be the key to future refinements of the guidelines and enhanced survival with use of the AED in sudden cardiac arrest.

  9. Role of the family support person during resuscitation.

    Science.gov (United States)

    Cottle, Elita-Mae; James, Jayne Elizabeth

    This article discusses family witnessed resuscitation and describes the need for a healthcare professional to be available to support the family before and during this experience. Careful explanation and emotional support are required during the event and if cardiopulmonary resuscitation is unsuccessful, further explanation and support will be required. A family support person is usually a nurse but could also be a hospital chaplain or social worker. The chaplain's background and ability to interpret medical information, combined with the emotional and spiritual support he or she can offer, make the chaplain suitable for this role. However, for some patients and families a chaplain's involvement might not be appropriate. The authors suggest that further research and evidence-based guidance should be developed to maximise the benefits of a family support person's presence during witnessed resuscitation.

  10. Moral distress in the resuscitation of extremely premature infants.

    Science.gov (United States)

    Molloy, Jennifer; Evans, Marilyn; Coughlin, Kevin

    2015-02-01

    To increase our understanding of moral distress experienced by neonatal registered nurses when directly or indirectly involved in the decision-making process of resuscitating infants who are born extremely premature. A secondary qualitative analysis was conducted on a portion of the data collected from an earlier study which explored the ethical decision-making process among health professionals and parents concerning resuscitation of extremely premature infants. A regional, tertiary academic referral hospital in Ontario offering a perinatal program. A total of 15 registered nurses were directly or indirectly involved in the resuscitation of extremely premature infants. Interview transcripts of nurses from the original study were purposefully selected from the original 42 transcripts of health professionals. Inductive content analysis was conducted to identify themes describing factors and situations contributing to moral distress experienced by nurses regarding resuscitation of extremely premature infants. Ethical approval was obtained from the research ethics review board for both the initial study and this secondary data analysis. Five themes, uncertainty, questioning of informed consent, differing perspectives, perceptions of harm and suffering, and being with the family, contribute to the moral distress felt by nurses when exposed to neonatal resuscitation of extremely premature infants. An interesting finding was the nurses' perceived lack of power and influence in the neonatal resuscitation decision-making process. Moral distress continues to be a significant issue for nursing practice, particularly among neonatal nurses. Strategies are needed to help mediate the moral distress experienced by nurses, such as debriefing sessions, effective communication, role clarification, and interprofessional education and collaboration. © The Author(s) 2014.

  11. Recent developments in the management of patients resuscitated from cardiac arrest.

    Science.gov (United States)

    Jentzer, Jacob C; Clements, Casey M; Murphy, Joseph G; Scott Wright, R

    2017-06-01

    Cardiac arrest is the leading cause of death in Europe and the United States. Many patients who are initially resuscitated die in the hospital, and hospital survivors often have substantial neurologic dysfunction. Most cardiac arrests are caused by coronary artery disease; patients with coronary artery disease likely benefit from early coronary angiography and intervention. After resuscitation, cardiac arrest patients remain critically ill and frequently suffer cardiogenic shock and multiorgan failure. Early cardiopulmonary stabilization is important to prevent worsening organ injury. To achieve best patient outcomes, comprehensive critical care management is needed, with primary goals of stabilizing hemodynamics and preventing progressive brain injury. Targeted temperature management is frequently recommended for comatose survivors of cardiac arrest to mitigate the neurologic injury that drives outcomes. Accurate neurologic assessment is central to managing care of cardiac arrest survivors and should combine physical examination with objective neurologic testing, with the caveat that delaying neurologic prognosis is essential to avoid premature withdrawal of supportive care. A combination of clinical findings and diagnostic results should be used to estimate the likelihood of functional recovery. This review focuses on recent advances in care and specific cardiac intensive care strategies that may improve morbidity and mortality for patients after cardiac arrest. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. The Force-Displacement Relationship in Commonly Used Resuscitation Manikins: Not Very Human

    DEFF Research Database (Denmark)

    Thomsen, Jakob E; Stærk, Mathilde; Løfgren, Bo

    2017-01-01

    (Laerdal) and CPR Anytime® Infant (inflatable; American Heart Association) and five adult manikins: Mini Anne (inflatable), Little Anne®, Resusci Anne, Resusci Anne Advanced(Laerdal) and Ambu® Man (Ambu). Infant manikins required a force of 57 N and 34 N to compress the chest 3 cm. The force required...... to compress the adult manikins to a depth of 5 cm ranged from 195 N to 543 N. The force-displacement curve is shown in the Figure.Conclusions: Four out of five adult resuscitation manikins and one infant manikin had a nearly linear force-displacement curve different from the human chest. The Mini Anne......Introduction: Manikins are widely used for CPR training and designed to simulate a human in cardiac arrest. Previous studies show a non-linear force-displacement relationship in the human chest. This may not be the case for resuscitation manikins. The aim of this study was to investigate the force...

  13. Neonatal Resuscitation Training: Implications of Course Construct and Discipline Compartmentalization on Role Confusion and Role Ambiguity.

    Science.gov (United States)

    Jnah, Amy J; Newberry, Desi M; Trembath, Andrea N; Robertson, Tracey; Downing, April; Greene, Miriam; Sewell, Kerry

    2016-06-01

    The Neonatal Resuscitation Program's (NRP's) Sixth Edition introduced simulation-based training (SBT) into neonatal life support training. SBT offers neonatal emergency response teams a safe, secure environment to rehearse coordinated neonatal resuscitations. Teamwork and communication training can reduce tension and anxiety during neonatal medical emergencies. To discuss the implications of variability in number and type of simulation scenario, number and type of learners who comprise a course, and their influence upon scope of practice, role confusion, and role ambiguity. Relevant articles from MEDLINE, CINAHL, EMBASE, Google Scholar, the World Health Organization, the American Heart Association, and NRP were included in this integrative review of the literature. Purposeful synergy of optimal SBT course construct with teamwork and communication can resist discipline compartmentalization, role confusion, and role ambiguity. Five key themes were identified and coined the "5 Rights" of NRP SBT. These "5 Rights" can guide healthcare institutions with planning, implementation, and evaluation of NRP SBT courses. NRP SBT can facilitate optimal team function and reduce errors when teams of learners and varied scenarios are woven into the course construct. The simulated environment must be realistic and fully equipped to encourage knowledge transfer and attainment of the NRP's key behavioral outcomes. Investigation of teamwork and communication training with NRP SBT, course construct, discipline compartmentalization, and behavioral and clinical outcomes is indicated. Investigation of outcomes of SBT using a team-teaching model, combining basic and advanced practice NRP instructors, is indicated.

  14. Cellular edema regulates tissue capillary perfusion after hemorrhage resuscitation.

    Science.gov (United States)

    Zakaria, El Rasheid; Li, Na; Matheson, Paul J; Garrison, Richard N

    2007-10-01

    Hemorrhage-induced activation of endothelial cell Na+/H+ -exchanger results in cellular swelling, which physically impedes capillary filling and compromises gut perfusion. We hypothesized that correction of the vascular volume deficit by conventional resuscitation does not improve capillary filling unless cellular swelling is prevented. Also, we hypothesized that adjunctive direct peritoneal resuscitation (DPR) with topical peritoneal dialysis solution (Delflex; Fresenius USA, Inc., Ogden, Ut) enhances capillary filling and gut perfusion by mechanisms that are independent of the Na+/H+ function. In vivo intravital videomicroscopy and Doppler velocimeter were used by us to measure microvascular diameter and flow, capillary filling (index of functional capillary density, FCD), and endothelial cell function in the terminal ileum of anesthetized rats. Rats were bled to 50% mean arterial pressure for 60 min and resuscitated with the shed blood plus 2 volumes of saline (conventional resuscitation). Prevention of endothelial cell swelling was achieved with topical amiloride (specific Na+/H+ inhibitor) in the tissue bath before hemorrhage or simultaneously with conventional resuscitation. DPR was simulated by instillation of Delflex in the tissue bath as adjunctive to conventional resuscitation. Sham no hemorrhage group and a simulated DPR group that received topical amiloride treatment served as controls. Conventional resuscitation from hemorrhagic shock restored and maintained central hemodynamics but caused progressive and persistent intestinal vasoconstriction and hypoperfusion associated with low FCD and endothelial cell dysfunction. Prevention of endothelial cell swelling when combined with conventional resuscitation, preserved endothelial cell function, and restored local intestinal microvascular variables to near-prehemorrhage levels. Simulated adjunctive DPR produced rapid, sustained, and generalized vasodilation associated with restoration of endothelial cell

  15. Blood Transfusion Strategies for Hemostatic Resuscitation in Massive Trauma.

    Science.gov (United States)

    McGrath, Caroline

    2016-03-01

    Massive transfusion practices were transformed during the 1970s without solid evidence supporting the use of component therapy. A manual literature search was performed for all references to the lethal triad, acute or early coagulopathy of trauma, fresh whole blood, and component transfusion therapy in massive trauma, and damage control resuscitation. Data from recent wars suggest traditional component therapy causes a nonhemostatic resuscitation worsening the propagation of the lethal triad hastening death. These same studies also indicate the advantage of fresh whole blood over component therapy even when administered in a 1:1:1 replacement ratio. Published by Elsevier Inc.

  16. Hæmostatisk resuscitation til blødende traumepatienter

    DEFF Research Database (Denmark)

    Stensballe, Jakob; Johansson, Pär I; Steinmetz, Jacob

    2016-01-01

    Trauma haemorrhage is a common reversible cause of death. Haemostatic resuscitation focuses on replacing the lost blood with transfusions equivalent to whole blood as early as possible. In Denmark, the optimal ratio for transfusions in massive bleeding is four packs of red blood cells, four packs...... of plasma and one pool of platelets (equal to ratio 1:1:1 in USA). Haemostatic resuscitation also includes a restricted use of crystalloids, early tranexamic acid, and a goal-directed transfusion therapy by using viscoelastic haemostatic assays to detect coagulopathy and the need for additional transfusions...

  17. Emergency Medical Technicians Are Often Consulted on Termination of Resuscitation, and Will Terminate Resuscitation Based on Controversial Single Factors

    DEFF Research Database (Denmark)

    Mygind-Klausen, Troels; Glerup Lauridsen, Kasper; Bødtker, Henrik

    2016-01-01

    Introduction: Many out-of-hospital cardiopulmonary resuscitation (CPR) attempts have to be terminated. Previous studies have investigated knowledge on abandoning resuscitation among physicians. In the prehospital setting emergency medical technicians (EMTs) may be involved in the decision...... on abandoning CPR but this is sparsely investigated. Aim: To investigate if EMTs are involved in termination of CPR, their self-assessed competence and knowledge of guidelines on termination of CPR according to European Resuscitation Council guidelines 2015. In addition, to evaluate single factors...... that according to an EMT should lead to termination of CPR. Methods: This was a pilot-study including EMTs from a Danish Emergency Medical Service. Data was collected using a structured questionnaire. All responses were collected anonymously. Results: In total, 50 EMTs (male: 88%, median age: 38, response rate...

  18. Comparison of continuous compression with regular ventilations versus 30:2 compressions-ventilations strategy during mechanical cardiopulmonary resuscitation in a porcine model of cardiac arrest.

    Science.gov (United States)

    Yang, Zhengfei; Liu, Qingyu; Zheng, Guanghui; Liu, Zhifeng; Jiang, Longyuan; Lin, Qing; Chen, Rui; Tang, Wanchun

    2017-09-01

    A compression-ventilation (C:V) ratio of 30:2 is recommended for adult cardiopulmonary resuscitation (CPR) by the current American Heart Association (AHA) guidelines. However, continuous chest compression (CCC) is an alternative strategy for CPR that minimizes interruption especially when an advanced airway exists. In this study, we investigated the effects of 30:2 mechanical CPR when compared with CCC in combination with regular ventilation in a porcine model. Sixteen male domestic pigs weighing 39±2 kg were utilized. Ventricular fibrillation was induced and untreated for 7 min. The animals were then randomly assigned to receive CCC combined with regular ventilation (CCC group) or 30:2 CPR (VC group). Mechanical chest compression was implemented with a miniaturized mechanical chest compressor. At the same time of beginning of precordial compression, the animals were mechanically ventilated at a rate of 10 breaths-per-minute in the CCC group or with a 30:2 C:V ratio in the VC group. Defibrillation was delivered by a single 150 J shock after 5 min of CPR. If failed to resuscitation, CPR was resumed for 2 min before the next shock. The protocol was stopped if successful resuscitation or at a total of 15 min. The resuscitated animals were observed for 72 h. Coronary perfusion pressure, end-tidal carbon dioxide and carotid blood flow in the VC group were similar to those achieved in the CCC group during CPR. No significant differences were observed in arterial blood gas parameters between two groups at baseline, VF 6 min, CPR 4 min and 30, 120 and 360 min post-resuscitation. Although extravascular lung water index of both groups significantly increased after resuscitation, no distinct difference was found between CCC and VC groups. All animals were successfully resuscitated and survived for 72 h with favorable neurologic outcomes in both groups. However, obviously more numbers of rib fracture were observed in CCC animals in comparison with VC animals. There was no

  19. Duration of Prehospital Resuscitation Efforts After Out-of-Hospital Cardiac Arrest.

    Science.gov (United States)

    Nagao, Ken; Nonogi, Hiroshi; Yonemoto, Naohiro; Gaieski, David F; Ito, Noritoshi; Takayama, Morimasa; Shirai, Shinichi; Furuya, Singo; Tani, Sigemasa; Kimura, Takeshi; Saku, Keijiro

    2016-04-05

    During out-of-hospital cardiac arrest, it is unclear how long prehospital resuscitation efforts should be continued to maximize lives saved. Between 2005 and 2012, we enrolled 282 183 adult patients with bystander-witnessed out-of-hospital cardiac arrest from the All-Japan Utstein Registry. Prehospital resuscitation duration was calculated as the time interval from call receipt to return of spontaneous circulation in cases achieving prehospital return of spontaneous circulation or from call receipt to hospital arrival in cases not achieving prehospital return of spontaneous circulation. In each of 4 groups stratified by initial cardiac arrest rhythm (shockable versus nonshockable) and bystander resuscitation (presence versus absence), we calculated minimum prehospital resuscitation duration, defined as the length of resuscitation efforts in minutes required to achieve ≥99% sensitivity for the primary end point, favorable 30-day neurological outcome after out-of-hospital cardiac arrest. Prehospital resuscitation duration to achieve prehospital return of spontaneous circulation ranged from 1 to 60 minutes. Longer prehospital resuscitation duration reduced the likelihood of favorable neurological outcome (adjusted odds ratio, 0.84; 95% confidence interval, 0.838-0.844). Although the frequency of favorable neurological outcome was significantly different among the 4 groups, ranging from 20.0% (shockable/bystander resuscitation group) to 0.9% (nonshockable/bystander resuscitation group; Pprehospital resuscitation duration did not differ widely among the 4 groups (40 minutes in the shockable/bystander resuscitation group and the shockable/no bystander resuscitation group, 44 minutes in the nonshockable/bystander resuscitation group, and 45 minutes in the nonshockable/no bystander resuscitation group). On the basis of time intervals from the shockable arrest groups, prehospital resuscitation efforts should be continued for at least 40 minutes in all adults with

  20. Multicenter observational prehospital resuscitation on helicopter study.

    Science.gov (United States)

    Holcomb, John B; Swartz, Michael D; DeSantis, Stacia M; Greene, Thomas J; Fox, Erin E; Stein, Deborah M; Bulger, Eileen M; Kerby, Jeffrey D; Goodman, Michael; Schreiber, Martin A; Zielinski, Martin D; O'Keeffe, Terence; Inaba, Kenji; Tomasek, Jeffrey S; Podbielski, Jeanette M; Appana, Savitri N; Yi, Misung; Wade, Charles E

    2017-07-01

    Earlier use of in-hospital plasma, platelets, and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT). We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter. Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from January to November 2015. Five helicopter systems had plasma and/or RBCs, whereas the other four helicopter systems used only crystalloid resuscitation. All patients meeting predetermined high-risk criteria were analyzed. Patients receiving PHT were compared with patients not receiving PHT. Our primary analysis compared mortality at 3 hours, 24 hours, and 30 days, using logistic regression to adjust for confounders and site heterogeneity to model patients who were matched on propensity scores. Twenty-five thousand one hundred eighteen trauma patients were admitted, 2,341 (9%) were transported by helicopter, of which 1,058 (45%) met the highest-risk criteria. Five hundred eighty-five of 1,058 patients were flown on helicopters carrying blood products. In the systems with blood available, prehospital median systolic blood pressure (125 vs 128) and Glasgow Coma Scale (7 vs 14) was significantly lower, whereas median Injury Severity Score was significantly higher (21 vs 14). Unadjusted mortality was significantly higher in the systems with blood products available, at 3 hours (8.4% vs 3.6%), 24 hours (12.6% vs 8.9%), and 30 days (19.3% vs 13.3%). Twenty-four percent of eligible patients received a PHT. A median of 1 unit of RBCs and plasma were transfused prehospital. Of patients receiving PHT, 24% received only plasma, 7% received only RBCs, and 69% received both. In the propensity score matching analysis (n = 109), PHT was not significantly associated with mortality

  1. Pediatric advanced life support and sedation of pediatric dental patients

    OpenAIRE

    Kim, Jongbin

    2016-01-01

    Programs provided by the Korea Association of Cardiopulmonary Resuscitation include Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Korean Advanced Life Support (KALS). However, programs pertinent to dental care are lacking. Since 2015, related organizations have been attempting to develop a Dental Advanced Life Support (DALS) program, which can meet the needs of the dental environment. Generally, for initial management of emergency ...

  2. Nitroglycerin Attenuates Vasoconstriction of HBOC-201 during Hemorrhagic Shock Resuscitation

    Science.gov (United States)

    2010-01-01

    Noack E. Nitric oxide (NO) formation from nitrovasodilators occurs independently of hemoglobin or non-heme iron . Eur 1 Pharmacol 1987;142:465-9...gen monitoring during hemorrhagic shock and resuscitation: a comparison or lactated Ringer’s solution, hypertonic saline dextran , and HBOC-201.1

  3. First resuscitation of critical burn patients: progresses and problems.

    Science.gov (United States)

    Sánchez-Sánchez, M; García-de-Lorenzo, A; Asensio, M J

    2016-03-01

    Currently, the aim of the resuscitation of burn patients is to maintain end-organ perfusion with fluid intake as minimal as possible. To avoid excess intake, we can improve the estimation using computer methods. Parkland and Brooke are the commonly used formulas, and recently, a new, an easy formula is been used, i.e. the 'Rule of TEN'. Fluid resuscitation should be titrated to maintain the urine output of approximately 30-35 mL/h for an average-sized adult. The most commonly used fluids are crystalloid, but the phenomenon of creep flow has renewed interest in albumin. In severely burn patients, monitoring with transpulmonary thermodilution together with lactate, ScvO2 and intraabdominal pressures is a good option. Nurse-driven protocols or computer-based resuscitation algorithms reduce the dependence on clinical decision making and decrease fluid resuscitation intake. High-dose vitamin C, propranolol, the avoidance of excessive use of morphine and mechanical ventilation are other useful resources. Copyright © 2016 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  4. Cardiopulmonary resuscitation: biomedical and biophysical analysis (Chapter XXX)

    DEFF Research Database (Denmark)

    Noordergraaf, G.J; Ottesen, Johnny T.; Scheffer, G.J.

    2004-01-01

    The evolution of the human in caring for others is reflected in the development of cardiopulmonary resuscitation (CPR). Superstition, divine intervention and finally science have contributed to the development of a technique which may allow any person to save another’s life. Fully 50% of the firs...

  5. Abstract: Magnitude and Outcome of Resuscitation Activities at ...

    African Journals Online (AJOL)

    Abstract: Magnitude and Outcome of Resuscitation Activities at Rwanda Military Hospital for the Period of April 2013-September 2013. ... Lack of compliance with drug administration guidelines was noted, particularly in the lack of initiating administration of specific drugs, despite the drug being available (59%). Conclusion

  6. Assessment of knowledge on neonatal resuscitation amongst health ...

    African Journals Online (AJOL)

    Conclusion: Health providers, as the key personnel in the management of neonatal resuscitation, in this survey seem to have inadequate training and knowledge on this subject. Increasing the duration and quality of formal training should be considered during the pre-service medical education to ensure acceptable ...

  7. Rapid Resuscitation with Small Volume Hypertonic Saline Solution ...

    African Journals Online (AJOL)

    The data were entered into a computer data base and analysed. Results: Forty five patients were enrolled and resuscitated with 250 mls 7.5% HSS. Among the studied patients, 88.9% recovered from shock immediately after being infused with 7.5% HSS. Of patients with a single injury, 96.6% recovered from shock whereas ...

  8. Epidemiology of admissions in a pediatric resuscitation room.

    Science.gov (United States)

    Claudet, Isabelle; Bounes, Vincent; Fédérici, Sonia; Laporte, Eve; Pajot, Christine; Micheau, Pascale; Grouteau, Erick

    2009-05-01

    Describe the epidemiology of a pediatric resuscitation room (PRR). A prospective study was performed in a pediatric emergency department (PED) from June 17, 2004 to March 19, 2006. Collected data were date and time of admission in the unit and, in the PRR, age and sex, geographical origin, mode of transportation, PED referral mode, diagnosis, evolution, and resuscitation techniques. Statistical analysis included a univariate analysis of hypothetical links between variables and their relation to the risk of death or transfer to the pediatric intensive care unit, then a multivariate analysis by logistical regression where the dependant variable was this risk. Three hundred sixty-one patients totaled 370 admissions. The male-female ratio was 1.3. Mean (SD) age was 5.5 (5.2) years. A quarter of the population was recommended for admission by a physician. Main causes were cardiocirculatory (32%), neurological (26%), respiratory (23%), and traumas (18%), and 17% were hospitalized in an intensive care unit and 4 died. Sixteen technical resuscitation procedures were performed. Children from 0 to 2 years old were more often admitted for cardiocirculatory insufficiency (P management, the teaching and knowledge of the different diagnosis admitted in the PRR and their resuscitation technical procedures warranty a serener approach of those stressful situations.

  9. National neonatal resuscitation training program in Nigeria (2008 ...

    African Journals Online (AJOL)

    2014-08-05

    Aug 5, 2014 ... Nigeria were conducted eight months after the primary training, to evaluate the post-training neonatal resuscitation activities. Results: Over the period of study, 357 doctors and 370 .... During the training workshop, the participants had didactic lectures conducted in modules, as well as hands‑on skills.

  10. Gastroschisis in a developing country: poor resuscitation is a more ...

    African Journals Online (AJOL)

    Gastroschisis in a developing country: poor resuscitation is a more significant predictor of mortality than postnatal transfer time. ... Background: The time from birth to the first paediatric surgical consultation of neonates with gastroschisis is a predictor of mortality in developing countries. This is contrary to findings in the ...

  11. Voice advisory manikin versus instructor facilitated training in cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Isbye, Dan L; Høiby, Pernilla; Rasmussen, Maria B

    2008-01-01

    for Resuscitation 2005) was assessed in a 2 min test before randomisation to either IF training in groups of 8 or individual VAM training. Immediately after training and after 3 months, CPR performance was assessed in identical 2 min tests. Laerdal PC Skill Reporting System 2.0 was used to collect data. To quantify...

  12. Cultural Resuscitation and Nation-Building: An Examination of ...

    African Journals Online (AJOL)

    Mrs Afam

    sentimental attachment to western values seem to be eroding Nigerian cultural values even in the post colonial ... are to yield results. Key words: Cultural Resuscitation, Nation-building, Nigeria and Ughievwen ..... Intelligence Assessment Report on Jeremi Clan, Sobo Sub-Tribe, 1932 compiled by. S.E. Johnson, CSO.

  13. Magnitude and Outcome of Resuscitation Activities at Rwanda ...

    African Journals Online (AJOL)

    Methods. The purpose of this project was to analyze the frequency, obstacles, and outcomes of patient resus- citation following cardiac and/or respiratory arrest. A form was developed to record all actions taken during resuscitation including: response time, staff presence, and equipment and medications used. Collection of ...

  14. Outcome of Cardiopulmonary Resuscitation in the Intensive Care ...

    African Journals Online (AJOL)

    The purpose of this study is to evaluate the demographic characteristics of patients who suffered cardiac arrest in our ICUs and to identify those factors influencing outcome after resuscitation following cardiac arrest. We reviewed the records of all patients who underwent CPR in the two ICUs at the Georg-August University ...

  15. Family presence during cardiopulmonary resuscitation and invasive procedures in children

    Directory of Open Access Journals (Sweden)

    Cristiana Araujo G. Ferreira

    2014-03-01

    Full Text Available Objective: To identify literature evidences related to actions to promote family's presence during cardiopulmonary resuscitation and invasive procedures in children hospitalized in pediatric and neonatal critical care units. Data sources : Integrative literature review in PubMed, SciELO and Lilacs databases, from 2002 to 2012, with the following inclusion criteria: research article in Medicine, or Nursing, published in Portuguese, English or Spanish, using the keywords "family", "invasive procedures", "cardiopulmonary resuscitation", "health staff", and "Pediatrics". Articles that did not refer to the presence of the family in cardiopulmonary resuscitation and invasive procedures were excluded. Therefore, 15 articles were analyzed. Data synthesis : Most articles were published in the United States (80%, in Medicine and Nursing (46%, and were surveys (72% with healthcare team members (67% as participants. From the critical analysis, four themes related to the actions to promote family's presence in invasive procedures and cardiopulmonary resuscitation were obtained: a to develop a sensitizing program for healthcare team; b to educate the healthcare team to include the family in these circumstances; c to develop a written institutional policy; d to ensure the attendance of family's needs. Conclusions: Researches on these issues must be encouraged in order to help healthcare team to modify their practice, implementing the principles of the Patient and Family Centered Care model, especially during critical episodes.

  16. Retention of Cardiopulmonary Resuscitation Skills in Nigerian Secondary School Students

    Science.gov (United States)

    Onyeaso, Adedamola Olutoyin

    2016-01-01

    Background/Objective: For effective bystander cardiopulmonary resuscitation (CPR), retention of CPR skills after the training is central. The objective of this study was to find out how much of the CPR skills a group of Nigerian secondary school students would retain six weeks after their first exposure to the conventional CPR training. Materials…

  17. LETTER TO THE EDITOR: Paediatric and Neonatal Resuscitation ...

    African Journals Online (AJOL)

    Resuscitation: Saving lives is the primary responsibility of secondary care services. Many patients arrive in hospitals when they are acutely ill and are hoping for rescue treatment that will save their lives, but also deal with the primary cause of the acute illness. It is therefore important that all staff involved in the care of such ...

  18. Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Bistra Iordanova

    2017-08-01

    Full Text Available Greater than 50% of patients successfully resuscitated from cardiac arrest have evidence of neurological disability. Numerous studies in children and adults, as well as in animal models have demonstrated that cerebral blood flow (CBF is impaired after cardiac arrest. Stages of cerebral perfusion post-resuscitation include early hyperemia, followed by hypoperfusion, and finally either resolution of normal blood flow or protracted hyperemia. At the level of the microcirculation the blood flow is heterogeneous, with areas of no flow, low flow, and increased flow. CBF directed therapies in animal models of cardiac arrest improved neurological outcome, and therefore, the alterations in CBF after cardiac arrest likely contribute to the development of hypoxic ischemic encephalopathy. Current intensive care after cardiac arrest is centered upon maintaining systemic oxygenation, normal blood pressure values for age, maintaining general homeostasis, and avoiding hyperthermia. Assessment of CBF and oxygenation is not routinely performed after cardiac arrest. Currently available and underutilized techniques to assess cerebral perfusion include transcranial doppler, near-infrared spectroscopy, and arterial spin labeling magnetic resonance imaging. Limited clinical studies established the role of CBF and oxygenation monitoring in prognostication after cardiac arrest and few studies suggest that guiding critical care post-resuscitation to mean arterial pressures above the minimal autoregulatory range might improve outcome. Important knowledge gaps thus remain in cerebral monitoring and CBF and oxygen goal-directed therapies post-resuscitation from cardiac arrest.

  19. Page 1 SAMJFoRUM -~----- BOOKS RESUSCITATION OF BABIES ...

    African Journals Online (AJOL)

    This little paperback is meant to be used as a template for the development of locally agreed policies for resuscitation of babies at birth, and it should be a real help to anyone concerned with that. Much of the content could be incorporated verbatim. It starts with a brief ctiscussion of general principles and the physiology of.

  20. A National Survey of Cardiopulmonary Resuscitation Training for the Deaf.

    Science.gov (United States)

    Beck, Kenneth H.; Tomasetti, James A.

    1983-01-01

    Responses to a national survey by regional directors of the American Heart Association, American National Red Cross, and continuing education programs for the deaf indicated that little is done to train the deaf in cardiopulmonary resuscitation and that communication barriers and inadequate training resources are major reasons. (Author)

  1. A Wireless Text Messaging System Improves Communication for Neonatal Resuscitation.

    Science.gov (United States)

    Hughes Driscoll, Colleen A; Schub, Jamie A; Pollard, Kristi; El-Metwally, Dina

    Handoffs for neonatal resuscitation involve communicating critical delivery information (CDI). The authors sought to achieve ≥95% communication of CDI during resuscitation team requests. CDI included name of caller, urgency of request, location of delivery, gestation of fetus, status of amniotic fluid, and indication for presence of the resuscitation team. Three interventions were implemented: verbal scripted handoff, Spök text messaging, and Engage text messaging. Percentages of CDI communications were analyzed using statistical process control. Following implementation of Engage, the communication of all CDI, except for indication, was ≥95%; communication of indication occurred 93% of the time. Control limits for most CDI were narrower with Engage, indicating greater reliability of communication compared to the verbal handoff and Spök. Delayed resuscitation team arrival, a countermeasure, was not higher with text messaging compared to verbal handoff ( P = 1.00). Text messaging improved communication during high-risk deliveries, and it may represent an effective tool for other delivery centers.

  2. Management of foetal asphyxia by intrauterine foetal resuscitation

    Directory of Open Access Journals (Sweden)

    S Velayudhareddy

    2010-01-01

    Full Text Available Management of foetal distress is a subject of gynaecological interest, but an anaesthesiologist should know about resuscitation, because he should be able to treat the patient, whenever he is directly involved in managing the parturient patient during labour analgesia and before an emergency operative delivery. Progressive asphyxia is known as foetal distress; the foetus does not breathe directly from the atmosphere, but depends on maternal circulation for its oxygen requirement. The oxygen delivery to the foetus depends on the placental (maternal side, placental transfer and foetal circulation. Oxygen transport to the foetus is reduced physiologically during uterine contractions in labour. Significant impairment of oxygen transport to the foetus, either temporary or permanent may cause foetal distress, resulting in progressive hypoxia and acidosis. Intrauterine foetal resuscitation comprises of applying measures to a mother in active labour, with the intention of improving oxygen delivery to the distressed foetus to the base line, if the placenta is functioning normally. These measures include left lateral recumbent position, high flow oxygen administration, tocolysis to reduce uterine contractions, rapid intravenous fluid administration, vasopressors for correction of maternal hypotension and amnioinfusion for improving uterine blood flow. Intrauterine Foetal Resuscitation measures are easy to perform and do not require extensive resources, but the results are encouraging in improving the foetal well-being. The anaesthesiologist plays a major role in the application of intrauterine foetal resuscitation measures.

  3. Starch safety in resuscitation – when will we ever learn?

    African Journals Online (AJOL)

    systematic review exist.[19] High-quality reviews are reliable if the underlying trials are unbiased, and if adequate patient numbers have accrued. ... sepsis, and may increase the need for dialysis in resuscitation. With these caveats, and in the absence of adequately powered studies to confirm safety in other situations, it is ...

  4. Team communication patterns in emergency resuscitation: a mixed methods qualitative analysis.

    Science.gov (United States)

    Calder, Lisa Anne; Mastoras, George; Rahimpour, Mitra; Sohmer, Benjamin; Weitzman, Brian; Cwinn, A Adam; Hobin, Tara; Parush, Avi

    2017-12-01

    In order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. The objective of this study is to understand how teams communicate during resuscitation; specifically to assess for a shared mental model (organized understanding of a team's relationships) and information needs. We triangulated 3 methods to evaluate resuscitation team communication at a tertiary care academic trauma center: (1) interviews; (2) simulated resuscitation observations; (3) live resuscitation observations. We interviewed 18 resuscitation team members about shared mental models, roles and goals of team members and procedural expectations. We observed 30 simulated resuscitation video recordings and documented the timing, source and destination of communication and the information category. We observed 12 live resuscitations in the emergency department and recorded baseline characteristics of the type of resuscitations, nature of teams present and type and content of information exchanges. The data were analyzed using a qualitative communication analysis method. We found that resuscitation team members described a shared mental model. Respondents understood the roles and goals of each team member in order to provide rapid, efficient and life-saving care with an overall need for situational awareness. The information flow described in the interviews was reflected during the simulated and live resuscitations with the most responsible physician and charting nurse being central to team communication. We consolidated communicated information into six categories: (1) time; (2) patient status; (3) patient history; (4) interventions; (5) assistance and consultations; 6) team members present. Resuscitation team members expressed a shared mental model and prioritized situational awareness. Our findings support a need for cognitive aids to

  5. Treatment with lipid therapy to resuscitate a patient suffering from toxicity due to local anesthetics

    Directory of Open Access Journals (Sweden)

    Manuel Monti

    2014-06-01

    Full Text Available Recently, although without a universal recognition, the use of lipid emulsions as a rescue therapy for the bupivacaine cardiac toxicity has been proposed. In this article we report a successful resuscitation of a patient after the injection of bupivacaine in emergency room and a commented review of the related literature. The patient is a 73 years old man that, after a subcutaneous injection of bupivacaine (0.5%, i.e. 0.5 mL/h, developed circulatory arrest. After the failure of the initial treatment based on the advanced life support protocol, we have successfully performed a therapy with lipid emulsion. The bupivacaine intravascular injection, together with its interaction with amitriptyline and carbamazepine, could lead to cardiac depression, severe arrhythmias, hypotension, and/or cardiac arrest. In the case of failure of traditional life support treatment, intravenous lipid emulsion proves to be the best therapy to treat bupivacaine systemic toxicity.

  6. Advanced life support for cardiac arrest beyond the algorithm

    DEFF Research Database (Denmark)

    Rudolph, Søren Steemann; Isbye, Dan Lou; Pfeiffer, Peter

    2018-01-01

    circulation fails in most cases, but in some circumstances the patient may benefit from additional interventional approaches, in which case transport to hospital with ongoing cardiopulmonary resuscitation is indicated. This paper has summarized treatments outside the ALS algorithm, which may be beneficial......In an advanced emergency medical service all parts of the advanced life support (ALS) algorithm can be provided. This evidence-based algorithm outlines resuscitative efforts for the first 10-15 minutes after cardiac arrest, whereafter the algorithm repeats itself. Restoration of spontaneous......, but are not supported by firm scientific evidence....

  7. Resuscitation and post resuscitation care of the very old after out-of-hospital cardiac arrest is worthwhile

    DEFF Research Database (Denmark)

    Winther-Jensen, Matilde; Kjaergaard, Jesper; Hassager, Christian

    2015-01-01

    BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. OBJECTIVES: We aimed to investigate mortality, neurological outcome and post resuscitation care...

  8. Resuscitation on television: realistic or ridiculous? A quantitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical drama.

    Science.gov (United States)

    Harris, Dylan; Willoughby, Hannah

    2009-11-01

    Patients' preferences for cardiopulmonary resuscitation (CPR) relate to their perception about the likelihood of success of the procedure. There is evidence that the lay public largely base their perceptions about CPR on their experience of the portrayal of CPR in the media. The medical profession has generally been critical of the portrayal of CPR on medical drama programmes although there is no recent evidence to support such views. To compare the patient characteristics, cause and success rates of cardiopulmonary resuscitation (CPR) on medical television drama with published resuscitation statistics. Observational study. 88 episodes of television medical drama were reviewed (26 episodes of Casualty, Casualty, 25 episodes of Holby City, 23 episodes of Grey's Anatomy and 14 episodes of ER) screened between July 2008 and April 2009. The patient's age and sex, medical history, presumed cause of arrest, use of CPR and immediate and long term survival rate were recorded. Immediate survival and survival to discharge following CPR. There were a total of 76 cardio-respiratory arrests and 70 resuscitation attempts in the episodes reviewed. The immediate success rate (46%) did not differ significantly from published real life figures (p=0.48). The resuscitation process appeared to follow current guidelines. Survival (or not) to discharge was rarely shown. The average age of patients was 36 years and contrary to reality there was not an age related difference in likely success of CPR in patients less than 65 compared with those 65 and over (p=0.72). The most common cause of cardiac arrest was trauma with only a minor proportion of arrests due to cardio-respiratory causes such as myocardial infarction. Whilst the immediate success rate of CPR in medical television drama does not significantly differ from reality the lack of depiction of poorer medium to long term outcomes may give a falsely high expectation to the lay public. Equally the lay public may perceive that the

  9. Predicting medical professionals' intention to allow family presence during resuscitation: A cross sectional survey.

    Science.gov (United States)

    Lai, Meng-Kuan; Aritejo, Bayu Aji; Tang, Jing-Shia; Chen, Chien-Liang; Chuang, Chia-Chang

    2017-05-01

    Family presence during resuscitation is an emerging trend, yet it remains controversial, even in countries with relatively high acceptance of family presence during resuscitation among medical professionals. Family presence during resuscitation is not common in many countries, and medical professionals in these regions are unfamiliar with family presence during resuscitation. Therefore, this study predicted the medical professionals' intention to allow family presence during resuscitation by applying the theory of planned behaviour. A cross-sectional survey. A single medical centre in southern Taiwan. Medical staffs including physicians and nurses in a single medical centre (n=714). A questionnaire was constructed to measure the theory of planned behaviour constructs of attitudes, subjective norms, perceived behavioural control, and behavioural intentions as well as the awareness of family presence during resuscitation and demographics. In total, 950 questionnaires were distributed to doctors and nurses in a medical centre. Among the 714 valid questionnaires, only 11 participants were aware of any association in Taiwan that promotes family presence during resuscitation; 94.7% replied that they were unsure (30.4%) or that their unit did not have a family presence during resuscitation policy (74.8%). Regression analysis was performed to predict medical professionals' intention to allow family presence during resuscitation. The results indicated that only positive attitudes and subjective norms regarding family presence during resuscitation and clinical tenure could predict the intention to allow family presence during resuscitation. Because Family presence during resuscitation practice is not common in Taiwan and only 26.19% of the participants agreed to both items measuring the intention to allow family presence during resuscitation, we recommend the implementation of a family presence during resuscitation education program that will enhance the positive beliefs

  10. Critical care considerations in the management of the trauma patient following initial resuscitation

    Directory of Open Access Journals (Sweden)

    Shere-Wolfe Roger F

    2012-09-01

    Full Text Available Abstract Background Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust the ongoing resuscitative needs of the patient and address potential complications. In this review, we address ongoing resuscitation in the intensive care unit along with potential complications in the trauma patient after initial resuscitation. Complications such as abdominal compartment syndrome, transfusion related patterns of acute lung injury and metabolic consequences subsequent to post-trauma resuscitation are presented. Methods A non-systematic literature search was conducted using PubMed and the Cochrane Database of Systematic Reviews up to May 2012. Results and conclusion Polytrauma patients with severe shock from hemorrhage and massive tissue injury present major challenges for management and resuscitation in the intensive care setting. Many of the current recommendations for “damage control resuscitation” including the use of fixed ratios in the treatment of trauma induced coagulopathy remain controversial. A lack of large, randomized, controlled trials leaves most recommendations at the level of consensus, expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients.

  11. Critical care considerations in the management of the trauma patient following initial resuscitation

    Science.gov (United States)

    2012-01-01

    Background Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust the ongoing resuscitative needs of the patient and address potential complications. In this review, we address ongoing resuscitation in the intensive care unit along with potential complications in the trauma patient after initial resuscitation. Complications such as abdominal compartment syndrome, transfusion related patterns of acute lung injury and metabolic consequences subsequent to post-trauma resuscitation are presented. Methods A non-systematic literature search was conducted using PubMed and the Cochrane Database of Systematic Reviews up to May 2012. Results and conclusion Polytrauma patients with severe shock from hemorrhage and massive tissue injury present major challenges for management and resuscitation in the intensive care setting. Many of the current recommendations for “damage control resuscitation” including the use of fixed ratios in the treatment of trauma induced coagulopathy remain controversial. A lack of large, randomized, controlled trials leaves most recommendations at the level of consensus, expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients. PMID:22989116

  12. Adherence to AHA Guidelines When Adapted for Augmented Reality Glasses for Assisted Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial.

    Science.gov (United States)

    Siebert, Johan N; Ehrler, Frederic; Gervaix, Alain; Haddad, Kevin; Lacroix, Laurence; Schrurs, Philippe; Sahin, Ayhan; Lovis, Christian; Manzano, Sergio

    2017-05-29

    The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) are nowadays recognized as the world's most authoritative resuscitation guidelines. Adherence to these guidelines optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite their availability, suboptimal quality of CPR is still common. Currently, the median hospital survival rate after pediatric in-hospital cardiac arrest is 36%, whereas it falls below 10% for out-of-hospital cardiac arrest. Among emerging information technologies and devices able to support caregivers during resuscitation and increase adherence to AHA guidelines, augmented reality (AR) glasses have not yet been assessed. In order to assess their potential, we adapted AHA Pediatric Advanced Life Support (PALS) guidelines for AR glasses. The study aimed to determine whether adapting AHA guidelines for AR glasses increased adherence by reducing deviation and time to initiation of critical life-saving maneuvers during pediatric CPR when compared with the use of PALS pocket reference cards. We conducted a randomized controlled trial with two parallel groups of voluntary pediatric residents, comparing AR glasses to PALS pocket reference cards during a simulation-based pediatric cardiac arrest scenario-pulseless ventricular tachycardia (pVT). The primary outcome was the elapsed time in seconds in each allocation group, from onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, as well as the time intervals between defibrillation attempts and drug doses, shock doses, and number of shocks. All these outcomes were assessed for deviation from AHA guidelines. Twenty residents were randomized into 2 groups. Time to first defibrillation attempt (mean: 146 s) and adherence to AHA guidelines in terms of time to other

  13. [Diagnostic and resuscitative aspects of pediatric nerve agent intoxication].

    Science.gov (United States)

    Ben-Abraham, Ron; Hadad, Eran; Sokolov, Tali; Weinbroum, Avi

    2002-08-01

    Chemical warfare and the use of nerve agents are still a threat to the civilian population in the 21st century. Modern history of chemical warfare began in 1915 in the battle of Ypres when German troops used chlorine against the French army. Since then, the arsenal of such agents has included asphyxiates, burn-causing and nerve paralytic agents. Nerve gases are considered the most dangerous of all chemical weapons with little known about the treatment of the civilian population especially children. Management of the civilian population injured by these agents may be a tremendous challenge, especially in children, due to lack of previous data regarding pediatric resuscitation. This review emphasizes resuscitation issues of the child who suffers from multiple trauma and nerve agent poisoning, mainly based on data from reports concerning episodic civilian exposure to organophosphates.

  14. Hemostatic resuscitation with plasma and platelets in trauma

    DEFF Research Database (Denmark)

    Johansson, Pär I; Oliveri, Roberto S; Ostrowski, Sisse R

    2012-01-01

    Continued hemorrhage remains a major contributor of mortality in massively transfused patients and controversy regarding the optimal management exists although recently, the concept of hemostatic resuscitation, i.e., providing large amount of blood products to critically injured patients in an im......Continued hemorrhage remains a major contributor of mortality in massively transfused patients and controversy regarding the optimal management exists although recently, the concept of hemostatic resuscitation, i.e., providing large amount of blood products to critically injured patients...... in an immediate and sustained manner as part of an early massive transfusion protocol has been introduced. The aim of the present review was to investigate the potential effect on survival of proactive administration of plasma and/or platelets (PLT) in trauma patients with massive bleeding....

  15. Functional systemic approach to the resuscitation and intensive care

    Directory of Open Access Journals (Sweden)

    Sadchikov D.V.

    2014-09-01

    Full Text Available Functional systemic approach to the resuscitation and intensive care may be considered as a direct correlation between analysis and synthesis, induction and deduction, and, in general, between the formal and dialectical categories. The realization of this system should be started with the interaction and formation of the final beneficial result. Therefore the experience assessment on the basis of functional systematic approach will enable us to formulate more precisely the subject and methods of resuscitation from the philosophical point of view taking into consideration the interaction of the human life integrity with death phenomenon as fixed in ontogenesis and will allow to methodically justify the distinguishing of functional systems and standard processes both in sanogenesis and thanatogenesis.

  16. Cardiorespiratory monitoring during neonatal resuscitation for direct feedback and audit

    Directory of Open Access Journals (Sweden)

    Jeroen Johannes van Vonderen

    2016-04-01

    Full Text Available Neonatal resuscitation is one of the most frequently performed procedures and it is often successful if the ventilation applied is adequate. Over the last decade, interest in seeking objectivity in evaluating the infant’s condition at birth or the adequacy and effect of the interventions applied has markedly increased. Clinical parameters such as heart rate, colour and chest excursions are difficult to interpret and can be very subjective and subtle. The use of ECG, pulse oximetry, capnography and respiratory function monitoring can add objectivity to the clinical assessment. These physiological parameters, with or without the combination of video recordings, can be used directly to guide care, but can also be used later for audit and teaching purposes. Further studies are needed to investigate whether this will improve the quality of delivery room management. In this review we will give an update of the current developments in monitoring neonatal resuscitation.

  17. Ruptured subcapsular liver haematoma following mechanically-assisted cardiopulmonary resuscitation.

    Science.gov (United States)

    Joseph, John R; Freundlich, Robert Edward; Abir, Mahshid

    2016-02-02

    A 64-year-old man with a history of ascending aortic surgery and pulmonary embolus presented with shortness of breath. He rapidly decompensated, prompting intubation, after which he lost pulses. Manual resuscitation was initiated immediately, with subsequent use of a LUCAS-2 mechanical compression device. The patient was given bolus thrombolytic therapy and regained pulses after 7 min of CPR. Compressions were reinitiated with the LUCAS-2 twice more during resuscitation over the subsequent hour for brief episodes of PEA. After confirmation of massive pulmonary embolism on CT, the patient underwent interventional radiology-guided ultrasonic catheter placement with local thrombolytic therapy and experienced immediate improvement in oxygenation. He later developed abdominal compartment syndrome, despite cessation of thrombolytic and anticoagulation therapy. Bedside exploratory abdominal laparotomy revealed a ruptured subcapsular haematoma of the liver. The patient's haemodynamics improved following surgery and he was extubated 11 days postarrest with intact neurological function. 2016 BMJ Publishing Group Ltd.

  18. Contingent leadership and effectiveness of trauma resuscitation teams.

    Science.gov (United States)

    Yun, Seokhwa; Faraj, Samer; Sims, Henry P

    2005-11-01

    This research investigated leadership and effectiveness of teams operating in a high-velocity environment, specifically trauma resuscitation teams. On the basis of the literature and their own ethnographic work, the authors proposed and tested a contingency model in which the influence of leadership on team effectiveness during trauma resuscitation differs according to the situation. Results indicated that empowering leadership was more effective when trauma severity was low and when team experience was high. Directive leadership was more effective when trauma severity was high or when the team was inexperienced. Findings also suggested that an empowering leader provided more learning opportunities than did a directive leader. The major contribution of this article is the linkage of leadership to team effectiveness, as moderated by relatively specific situational contingencies. ((c) 2005 APA, all rights reserved).

  19. Correlations between technical skills and behavioral skills in simulated neonatal resuscitations.

    Science.gov (United States)

    Sawyer, T; Leonard, D; Sierocka-Castaneda, A; Chan, D; Thompson, M

    2014-10-01

    Neonatal resuscitation requires both technical and behavioral skills. Key behavioral skills in neonatal resuscitation have been identified by the Neonatal Resuscitation Program. Correlations and interactions between technical skills and behavioral skills in neonatal resuscitation were investigated. Behavioral skills were evaluated via blinded video review of 45 simulated neonatal resuscitations using a validated assessment tool. These were statistically correlated with previously obtained technical skill performance data. Technical skills and behavioral skills were strongly correlated (ρ=0.48; P=0.001). The strongest correlations were seen in distribution of workload (ρ=0.60; P=0.01), utilization of information (ρ=0.55; P=0.03) and utilization of resources (ρ=0.61; P=0.01). Teams with superior behavioral skills also demonstrated superior technical skills, and vice versa. Technical and behavioral skills were highly correlated during simulated neonatal resuscitations. Individual behavioral skill correlations are likely dependent on both intrinsic and extrinsic factors.

  20. Midwives' Experiences, Education, and Support Needs Regarding Basic Newborn Resuscitation in Jordan.

    Science.gov (United States)

    Kassab, Manal; Alnuaimi, Karimeh; Mohammad, Khitam; Creedy, Debra; Hamadneh, Shereen

    2016-06-01

    Newborns who are compromised at birth require rapid attention to stabilize their respiration attempts. Lack of knowledge regarding basic newborn resuscitation is a contributing factor to poor newborn health outcomes and increased mortality. The purpose of this study was to explore Jordanian midwives' experiences, education, and support needs to competently perform basic newborn resuscitation. Qualitative descriptive methodology was used to analyze a convenience sample of 20 midwives. A thematic approach was used to analyze the data. Participants discussed their experiences of basic newborn resuscitation including knowledge, skills, and barriers and suggested solutions to improve practice. Four themes were revealed: lack of knowledge and skills in newborn resuscitation, organizational constraints, inadequate teamwork, and educational needs. The midwives perceived that their ability to perform newborn resuscitation was hindered by lack of knowledge and skills in newborn resuscitation, organizational constraints (such as lack of equipment), and poor co-ordination and communication among team members. © The Author(s) 2015.

  1. Fluid Resuscitation and Massive Transfusion Protocol in Pediatric Trauma

    OpenAIRE

    Marjanović Vesna; Budić Ivana

    2016-01-01

    Trauma is the leading cause of morbidity and mortality in children due to the occurrence of hemorrhagic shock. Hemorrhagic shock and its consequences, anemia and hypovolemia, decrease oxygen delivery, due to which appropriate transfusion and volume resuscitation are critical. Guidelines for massive transfusion, in the pediatric trauma, have not been defined yet. Current data indicate that early identification of coagulopathy and its treatment with RBSs, plasma and platelets in a 1:1:1 unit ra...

  2. Human granuloma in vitro model, for TB dormancy and resuscitation.

    Directory of Open Access Journals (Sweden)

    Nidhi Kapoor

    Full Text Available Tuberculosis (TB is responsible for death of nearly two million people in the world annually. Upon infection, Mycobacterium tuberculosis (Mtb causes formation of granuloma where the pathogen goes into dormant state and can live for decades before resuscitation to develop active disease when the immune system of the host is weakened and/or suppressed. In an attempt to better understand host-pathogen interactions, several groups have been developing in vitro models of human tuberculosis granuloma. However, to date, an in vitro granuloma model in which Mtb goes into dormancy and can subsequently resuscitate under conditions that mimic weakening of the immune system has not been reported. We describe the development of a biomimetic in vitro model of human tuberculosis granuloma using human primary leukocytes, in which the Mtb exhibited characteristics of dormant mycobacteria as demonstrated by (1 loss of acid-fastness, (2 accumulation of lipid bodies (3 development of rifampicin-tolerance and (4 gene expression changes. Further, when these micro granulomas were treated with immunosuppressant anti-tumor necrosis factor-alpha monoclonal antibodies (anti-TNFα mAbs, resuscitation of Mtb was observed as has been found in humans. In this human in vitro granuloma model triacylglycerol synthase 1deletion mutant (Δtgs1 with impaired ability to accumulate triacylglycerides (TG, but not the complemented mutant, could not go into dormancy. Deletion mutant of lipY, with compromised ability to mobilize the stored TG, but not the complemented mutant, was unable to come out of dormancy upon treatment with anti-TNFα mAbs. In conclusion, we have developed an in vitro human tuberculosis granuloma model that largely exhibits functional features of dormancy and resuscitation observed in human tuberculosis.

  3. Variable Saline Concentrations for Initial Resuscitation Following Polytrauma

    Science.gov (United States)

    2017-02-22

    control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD-MM-YYYY) 22 Feb 2017 2. REPORT TYPE Final Technical Report...cerebral edema. In addition, 3% saline may be the optimal crystalloid fluid to resuscitate in the setting of hypotension after head injury, as it limits...in the setting of hypotension after head injury, as it limits ongoing inflammation, cerebral edema, and neurologic injury while preserving blood

  4. Human granuloma in vitro model, for TB dormancy and resuscitation.

    Science.gov (United States)

    Kapoor, Nidhi; Pawar, Santosh; Sirakova, Tatiana D; Deb, Chirajyoti; Warren, William L; Kolattukudy, Pappachan E

    2013-01-01

    Tuberculosis (TB) is responsible for death of nearly two million people in the world annually. Upon infection, Mycobacterium tuberculosis (Mtb) causes formation of granuloma where the pathogen goes into dormant state and can live for decades before resuscitation to develop active disease when the immune system of the host is weakened and/or suppressed. In an attempt to better understand host-pathogen interactions, several groups have been developing in vitro models of human tuberculosis granuloma. However, to date, an in vitro granuloma model in which Mtb goes into dormancy and can subsequently resuscitate under conditions that mimic weakening of the immune system has not been reported. We describe the development of a biomimetic in vitro model of human tuberculosis granuloma using human primary leukocytes, in which the Mtb exhibited characteristics of dormant mycobacteria as demonstrated by (1) loss of acid-fastness, (2) accumulation of lipid bodies (3) development of rifampicin-tolerance and (4) gene expression changes. Further, when these micro granulomas were treated with immunosuppressant anti-tumor necrosis factor-alpha monoclonal antibodies (anti-TNFα mAbs), resuscitation of Mtb was observed as has been found in humans. In this human in vitro granuloma model triacylglycerol synthase 1deletion mutant (Δtgs1) with impaired ability to accumulate triacylglycerides (TG), but not the complemented mutant, could not go into dormancy. Deletion mutant of lipY, with compromised ability to mobilize the stored TG, but not the complemented mutant, was unable to come out of dormancy upon treatment with anti-TNFα mAbs. In conclusion, we have developed an in vitro human tuberculosis granuloma model that largely exhibits functional features of dormancy and resuscitation observed in human tuberculosis.

  5. Rabbit model of uncontrolled hemorrhagic shock and hypotensive resuscitation

    OpenAIRE

    Rezende-Neto,J.B.; Rizoli,S.B.; Andrade,M.V.; Lisboa,T.A.; Cunha-Melo,J.R.

    2010-01-01

    Clinically relevant animal models capable of simulating traumatic hemorrhagic shock are needed. We developed a hemorrhagic shock model with male New Zealand rabbits (2200-2800 g, 60-70 days old) that simulates the pre-hospital and acute care of a penetrating trauma victim in an urban scenario using current resuscitation strategies. A laparotomy was performed to reproduce tissue trauma and an aortic injury was created using a standardized single puncture to the left side of the infrarenal aort...

  6. Cardiopulmonary resuscitation knowledge and attitude among general dentists in Kuwait.

    Science.gov (United States)

    Alkandari, Sarah A; Alyahya, Lolwa; Abdulwahab, Mohammed

    2017-01-01

    Dentists as health care providers should maintain a competence in resuscitation. This cannot be overemphasized by the fact that the population in our country is living longer with an increasing proportion of medically compromised persons in the general population. This preliminary study aimed to assess the knowledge and attitude of general dentists towards cardiopulmonary resuscitation (CPR). A cross-sectional study was carried out among 250 licensed general dental practitioners working in ministry of health. Data were obtained through electronic self-administered questionnaire consisting of demographic data of general dentists, and their experience, attitude and knowledge about CPR based on the 2010 American Heart Association guidelines update for CPR. Totally 208 general dentists took part in the present study giving a response rate of 83.2%. Only 36% of the participants demonstrated high knowledge on CPR, while 64% demonstrated low knowledge. Participants' age, gender, nationality, years of experience, career hierarchy, and formal CPR training were associated significantly with CPR knowledge. Almost all the participants (99%) felt that dentists needed to be competent in basic resuscitation skills and showed a positive attitude towards attending continuing dental educational programs on CPR. This study showed that majority of general dental practitioners in Kuwait had inadequate knowledge on CPR. It was also found that CPR training significantly influenced the CPR knowledge of the participants. Therefore, training courses on CPR should be regularly provided to general dentists in the country.

  7. Providing PEEP during neonatal resuscitation: which device is best?

    Science.gov (United States)

    Dawson, Jennifer A; Gerber, Angela; Kamlin, C Omar F; Davis, Peter G; Morley, Colin J

    2011-10-01

    The study aims to compare three commonly used neonatal resuscitation devices, the Laerdal self-inflating bag with a positive end expiratory pressure (PEEP) valve, a T-piece resuscitator (T-piece) and a flow-inflating bag to provide peak inflation pressure (PIP) and PEEP. Participants were asked to use each device to give positive pressure ventilation to a modified neonatal mannequin via a face mask to achieve 40-60 inflations per minute, aiming for a PIP/PEEP of 30/5 cm H₂O. A manometer was visible to participants with each device. PIP, PEEP, percentage leak at the face mask and expired tidal volume were measured using a hot-wire anemometer. We analysed 20 inflations from each participant for each device. Fifty participants provided PIP and PEEP with each device. The T-piece was the most accurate and consistent. The flow-inflating bag had the most variation. The leak was lowest with the self-inflating bag and PEEP and highest with the flow-inflating bag, but all had wide variation. Each device was able to provide PIP and PEEP when used appropriately. When compared with other resuscitation devices, the T-piece provided the most accurate and consistent PIP and PEEP. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  8. Factors Influencing the Success Rate of Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    Aisyah Amanda Hanif

    2015-12-01

    Full Text Available Background: Cardiopulmonary resuscitation (CPR is a series of actions performed on cardiac arrest patients. Not all patients receiving CPR can survive. The outcome of CPR is influenced by several factors. This study was conducted to determine the success rate of CPR and the factors influencing it in Dr. Hasan Sadikin General Hospital in 2013. Methods: This study was conducted by using 168 patient medical records who underwent CPR and met the inclusion criteria in the Resuscitation Room of Dr. Hasan Sadikin General Hospital from January to December 2013. The collected data consisted of age, gender, pre-arrest diagnosis, initial rhythm, response time and clinical outcome of CPR. The results were expressed in frequencies and percentage. The data were analyzed using the chi-square test. Results: The Success rate of CPR was 15.5%. The success rate was higher in patients with cardiac prearrest diagnoses (8.33%, p=0.024. The most common initial rhythm was unshockable rhythms (83.92%, yet patients with shockable heart rhythms had higher success rates (40.74%, p<0.001. All of the surviving patients had response time within the first minute from cardiac arrest. Conclusions: Success rate of CPR in the resuscitation room of Dr. Hasan Sadikin General Hospital during 2013 is still low. The factors influencing the survival rate are the pre-arrest diagnosis and initial heart rhythm.

  9. [Materials for the paediatric resuscitation trolley or backpack: Expert recommendations].

    Science.gov (United States)

    López-Herce Cid, Jesús; Rodríguez Núñez, Antonio; Carrillo Álvarez, Ángel; Zeballos Sarrato, Gonzalo; Martínez Fernández-Llamazares, Cecilia; Calvo Macías, Custodio

    2017-07-05

    Cardio-respiratory arrest (CPA) is infrequent in children, but it can occur in any place and at any time. This fact means that every health care facility must always have the staff and material ready to resuscitate a child. These recommendations are the consensus of experts of the Spanish Paediatric and Neonatal Resuscitation Group on the material and medication for paediatric and neonatal resuscitation and their distribution and use. CPR trolleys and backpacks must include the essential material to quickly and efficiently perform a paediatric CPR. At least one CPR trolley must be available in every Primary Care facility, Paediatric Intensive Care Unit, Emergency Department, and Pre-hospital Emergency Areas, as well as in paediatric wards, paediatric ambulatory areas, and radiology suites. This trolley must be easily accessible and exclusively include the essential items to perform a CPR and to assist children (from newborns to adolescents) who present with a life-threatening event. Such material must be familiar to all healthcare staff and also include the needed spare parts, as well as enough drug doses. It must also be re-checked periodically. The standardisation and unification of the material and medication of paediatric CPR carts, trolleys, and backpacks, as well as the training of the personnel in their use are an essential part of the paediatric CPR. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  10. Phosphodiesterase-5 inhibition improves macrocirculation and microcirculation during cardiopulmonary resuscitation.

    Science.gov (United States)

    Wu, Junyuan; Li, Chunsheng; Yuan, Wei

    2016-02-01

    This study is to clarify whether sildenafil, which is a selective inhibitor of the isoform 5 of the enzyme phosphodiesterase, improves macrocirculation or/and microcirculation during ventricular fibrillation (VF) and cardiopulmonary resuscitation (CPR) so as to improve outcomes of resuscitation. Sixteen female pigs were used. After anesthesia, the abdominal cavity was opened to observe the mesenteric microcirculation. Following the guidelines, we determined microvascular flow index, perfused vessel density and proportion of perfused vessels both for large(diameter >20 μm)and small (diameter defibrillation was attempted. Compared with saline, sildenafil reduced the shocks and duration of CPR (all P .05). Microvascular flow index in both large and small microvessels were closely correlated to each other (r = 0.91, P < .01), and to CPP during CPR ([r = .88, P < .01] and [r = .70, P < .05], respectively). Sildenafil increases the success of resuscitation through improving macrocirculation and microcirculation during VF and CPR. There is a close relationship between microvascular flow and CPP during CPR. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. [Need of cardiopulmonary resuscitation training in the sport of soccer].

    Science.gov (United States)

    Guerra-Martín, María Dolores; Martínez-Montilla, José Manuel; Amador-Marín, Bárbara

    2016-01-01

    In Spain there are around 25,000 cardiac arrests, many of them in the presence of non-medical personnel. In less than 25% of the cardio-respiratory arrests witnessed, witnesses began cardiopulmonary resuscitation. Soccer is a contact sport with multiple physical characteristics and requirements which pushes your body to the limit, thus leading to a higher chance of developing multiple lesions, including cardio-respiratory arrest. Therefore, our goal was to know the actual situation on training in basic life support in soccer. A literature review was performed on different databases both national (IME, CUIDEN, ENCUENTR@, ENFERMERÍA AL DÍA, ISOC) and international (PUBMED, SCOPUS, CINAHL), with different MESH descriptors related to the topic. A total of 395 references were identified. 17 studies were selected; 8 of them had like main theme cardiopulmonary resuscitation and the remaining 9 spoke on the use of semi-automatic defibrillators. There is a lack of research on this topic in soccer. This strikes our attention because in this area there could be situations requiring immediate rescue action. Therefore, we emphasize the importance of early cardio-respiratory resuscitation because training in basic life support and semi-automatic defibrillators in soccer are fundamental. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  12. Outcomes and Cost Analysis of Patients With Successful In-Hospital Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    Wei-Lun Liu

    2011-12-01

    Conclusions: Given the fact that less than one quarter of the successfully resuscitated patients have a favorable outcome, two-thirds of the mortality cases died within 24 hours, which is a high cost for successful resuscitation, and one-third of the survivors had to stay on chronic respiratory care center. A better prognostic tool to predict outcomes should be developed to avoid futile resuscitation.

  13. Interhospital Transport of Children Undergoing Cardiopulmonary Resuscitation: A Practical and Ethical Dilemma.

    Science.gov (United States)

    Noje, Corina; Fishe, Jennifer N; Costabile, Philomena M; Klein, Bruce L; Hunt, Elizabeth A; Pronovost, Peter J

    2017-10-01

    To discuss risks and benefits of interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. Narrative review. Not applicable. Transporting children in cardiac arrest with ongoing cardiopulmonary resuscitation between hospitals is potentially lifesaving if it enables access to resources such as extracorporeal support, but may risk transport personnel safety. Research is needed to optimize outcomes of patients transported with ongoing cardiopulmonary resuscitation and reduce risks to the staff caring for them.

  14. Restricting volumes of resuscitation fluid in adults with septic shock after initial management

    DEFF Research Database (Denmark)

    Hjortrup, Peter B; Haase, Nicolai; Bundgaard, Helle

    2016-01-01

    PURPOSE: We assessed the effects of a protocol restricting resuscitation fluid vs. a standard care protocol after initial resuscitation in intensive care unit (ICU) patients with septic shock. METHODS: We randomised 151 adult patients with septic shock who had received initial fluid resuscitation...... patients with septic shock. The patient-centred outcomes all pointed towards benefit with fluid restriction, but our trial was not powered to show differences in these exploratory outcomes. TRIAL REGISTRATION: NCT02079402....

  15. Health professionals' perceptions regarding family witnessed resuscitation in adult critical care settings.

    Science.gov (United States)

    Bashayreh, Ibrahim; Saifan, Ahmad; Batiha, Abdul-Monim; Timmons, Stephen; Nairn, Stuart

    2015-09-01

    To deepen our understanding of the perceptions of health professionals regarding family witnessed resuscitation in Jordanian adult critical care settings. The issue of family witnessed resuscitation has developed dramatically in the last three decades. The traditional practice of excluding family members during cardiopulmonary resuscitation had been questioned. Family witnessed resuscitation has been described as good practice by many researchers and health organisations. However, family witnessed resuscitation has been perceived by some practitioners to be unhealthy and harmful to the life-saving process. The literature showed that there are no policies or guidelines to allow or to prevent family witnessed resuscitation in Jordan. An exploratory qualitative design was adopted. A purposive sample of 31 health professionals from several disciplines was recruited over a period of six months. Individual semi-structured interviews were used. These interviews were transcribed and analysed using thematic analysis. It was found that most healthcare professionals were against family witnessed resuscitation. They raised several concerns related to being verbally and physically attacked if they allowed family witnessed resuscitation. Almost all of the respondents expressed their fears of patients' family members' interfering in their work. Most of the participants in this study stated that family witnessed resuscitation is traumatic for family members. This was viewed as a barrier to allowing family witnessed resuscitation in Jordanian critical care settings. The study provides a unique understanding of Jordanian health professionals' perceptions regarding family witnessed resuscitation. They raised some views that contest some arguments in the broader literature. Further research with patients, family members, health professionals and policy makers is still required. This is the first study about family witnessed resuscitation in Jordan. Considering multi

  16. As seen on TV: observational study of cardiopulmonary resuscitation in British television medical dramas

    Science.gov (United States)

    Gordon, P N; Williamson, S; Lawler, P G

    1998-01-01

    Objective: To determine the frequency and accuracy with which cardiopulmonary resuscitation is portrayed in British television medical dramas. Design: Observational study. Subjects: 64 episodes of three major British television medical dramas: Casualty, Cardiac Arrest, and Medics. Main outcome measures: Frequency of cardiopulmonary resuscitation shown on television; age, sex, and diagnosis of the patients undergoing resuscitation; rate of survival through resuscitation. Results: Overall 52 patients had a cardiorespiratory arrest on screen and 3 had a respiratory arrest alone, all the arrests occurring in 40 of the 64 episodes. Of the 52 patients having cardiorespiratory arrest, 32 (62%) underwent an attempt at cardiopulmonary resuscitation; 8 attempts were successful. All 3 of the patients having respiratory arrests alone received ventilatory support and survived. On 48% of occasions, victims of cardiac arrest seemed to be less than 35 years old. Conclusions: Cardiorespiratory resuscitation is often depicted in British television medical dramas. Patients portrayed receiving resuscitation are likely to be in a younger age group than in real life. Though the reasons for resuscitation are more varied and more often associated with trauma than in reality, the overall success rate is nevertheless realistic. Widespread overoptimism of patients for survival after resuscitation cannot necessarily be blamed on British television medical dramas. Key messagesA quarter of patients in British television medical dramas who received cardiopulmonary resuscitation on screen seemed to surviveThis figure is comparable to initial survival rates in a series of patients in real lifePatients on television are more likely to suffer cardiac arrest as a result of trauma than in real life, and patients undergoing resuscitation are likely to be younger than patients in real lifeThe overall survival rate of patients after cardiopulmonary resuscitation in British television medical drama seems

  17. 2,3-Butanedione monoxime facilitates successful resuscitation in a dose-dependent fashion in a pig model of cardiac arrest.

    Science.gov (United States)

    Lee, Byung Kook; Kim, Mu Jin; Jeung, Kyung Woon; Choi, Sung Soo; Park, Sang Wook; Yun, Seong Woo; Lee, Sung Min; Lee, Dong Hun; Min, Yong Il

    2016-06-01

    Ischemic contracture compromises the hemodynamic effectiveness of cardiopulmonary resuscitation (CPR) and resuscitability from cardiac arrest. In a pig model of cardiac arrest, 2,3-butanedione monoxime (BDM) attenuated ischemic contracture. We investigated the effects of different doses of BDM to determine whether increasing the dose of BDM could improve the hemodynamic effectiveness of CPR further, thus ultimately improving resuscitability. After 16minutes of untreated ventricular fibrillation and 8minutes of basic life support, 36 pigs were divided randomly into 3 groups that received 50mg/kg (low-dose group) of BDM, 100mg/kg (high-dose group) of BDM, or an equivalent volume of saline (control group) during advanced cardiovascular life support. During advanced cardiovascular life support, the control group showed an increase in left ventricular (LV) wall thickness and a decrease in LV chamber area. In contrast, the BDM-treated groups showed a decrease in the LV wall thickness and an increase in the LV chamber area in a dose-dependent fashion. Mixed-model analyses of the LV wall thickness and LV chamber area revealed significant group effects and group-time interactions. Central venous oxygen saturation at 3minutes after the drug administration was 21.6% (18.4-31.9), 39.2% (28.8-53.7), and 54.0% (47.5-69.4) in the control, low-dose, and high-dose groups, respectively (Pfashion. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Cardiopulmonary resuscitation duration and survival in out-of-hospital cardiac arrest patients.

    Science.gov (United States)

    Adnet, Frederic; Triba, Mohamed N; Borron, Stephen W; Lapostolle, Frederic; Hubert, Hervé; Gueugniaud, Pierre-Yves; Escutnaire, Josephine; Guenin, Aurelien; Hoogvorst, Astrid; Marbeuf-Gueye, Carol; Reuter, Paul-Georges; Javaud, Nicolas; Vicaut, Eric; Chevret, Sylvie

    2017-02-01

    Relationship between cardiopulmonary arrest and resuscitation (CPR) durations and survival after out-of-hospital cardiac arrest (OHCA) remain unclear. Our primary aim was to determine the association between survival without neurologic sequelae and cardiac arrest intervals in the setting of witnessed OHCA. We analyzed 27,301 non-traumatic, witnessed OHCA patients in France included in the national registry from June 1, 2011 through December 1, 2015. We analyzed cardiac arrest intervals, designated as no-flow (NF; from collapse to start of CPR) and low-flow (LF; from start of CPR to cessation of resuscitation) in relation to 30-day survival without sequelae. We determined the influence of recognized prognostic factors (age, gender, initial rhythm, location of cardiac arrest) on this relation. For the entire cohort, the area delimited by a value of NF greater than 12min (95% confidence interval: 11-13min) and LF greater than 33min (95% confidence interval: 29-45min), yielded a probability of 30-day survival of less than 1%. These sets of values were greatly influenced by initial cardiac arrest rhythm, age, sex and location of cardiac arrest. Extended CPR duration (greater than 40min) in the setting of initial shockable cardiac rhythm is associated with greater than 1% survival with NF less than 18min. The NF interval was highly influential on the LF interval regardless of outcome, whether return of spontaneous circulation (pCPR duration in OHCA patients. The knowledge of (NF, LF) curves as function of age, initial rhythm, location of cardiac arrest or gender may aid in decision-making vis-à-vis the termination of CPR or employment of advanced techniques. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Critical care considerations in the management of the trauma patient following initial resuscitation

    National Research Council Canada - National Science Library

    Shere-Wolfe, Roger F; Galvagno, Jr, Samuel M; Grissom, Thomas E

    2012-01-01

    ... requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust...

  20. Family presence during cardiopulmonary resuscitation and invasive procedures: practices of critical care and emergency nurses

    National Research Council Canada - National Science Library

    MacLean, Susan L; Guzzetta, Cathie E; White, Cheri; Fontaine, Dorrie; Eichhorn, Dezra J; Meyers, Theresa A; Désy, Pierre

    2003-01-01

    Increasingly, patients' families are remaining with them during cardiopulmonary resuscitation and invasive procedures, but this practice remains controversial and little is known about the practices...

  1. [In-hospital resuscitation. Concept of first-responder resuscitation using semi-automated external defibrillators (AED)].

    Science.gov (United States)

    Hanefeld, C; Lichte, C; Laubenthal, H; Hanke, E; Mügge, A

    2006-09-29

    The prognosis after in-hospital resuscitation has not significantly improved in the last 40 years. This account presents the results over a three-year period of a hospital-wide emergency plan which implements the use of an automated external defibrillator (AED) by the first responder to the emergency call. 15 "defibrillator points" were installed, which could be reached within 30 s from all wards, out-patient departments and other areas, thus making them accessible for immediate defibrillator application. The hospital personnel is trained periodically in the alarm sequence, cardiopulmonary resuscitation and use of the defibrillator. Data on 57 patients who had sustained a cardiac arrest were prospectively recorded and analysed. In 46 patients (81%) the "on-the-spot" personnel (first-responder) was able to apply AED before arrival of the hospital's resuscitation team. Mean period between arrest alarm and activation of the AED was 2.2 (0.7-4.7) min. Ventricular fibrillation or ventricular tachyarrhythmia was recorded in 40 patients, making immediate shock delivery by AED possible. Restoration of the circulation was achieved in 23 (80%) of the patients and 20 (50%) were discharged home, 17 (43%) without neurological deficit. The high proportion of first-responder AED applications and evaluation of the personnel training indicate a wide acceptance of the emergency plan among the personnel. An immediate resuscitation plan consisting of an integrated programme of early defibrillation is feasible and seems to achieve an improved prognosis for patients who have sustained an in-hospital cardiac arrest.

  2. Abstract: Training of Advanced Cardiac Life Support Skills to ...

    African Journals Online (AJOL)

    Abstract: Training of Advanced Cardiac Life Support Skills to Nursing Staff in Critical Areas of Care. ... Ideally there needs to exist continued educational opportunities with ACLS recertification and continued resuscitation review to maintain the high quality standards initiated with this program. Conclusions: This intervention ...

  3. Minimal interruption of cardiopulmonary resuscitation for a single shock as mandated by automated external defibrillations does not compromise outcomes in a porcine model of cardiac arrest and resuscitation.

    Science.gov (United States)

    Ristagno, Giuseppe; Tang, Wanchun; Russell, James K; Jorgenson, Dawn; Wang, Hao; Sun, Shijie; Weil, Max Harry

    2008-11-01

    Current automated external defibrillations require interruptions in chest compressions to avoid artifacts during electrocardiographic analyses and to minimize the risk of accidental delivery of an electric shock to the rescuer. The earlier three-shock algorithm, with prolonged interruptions of chest compressions, compromised outcomes and increased severity of postresuscitation myocardial dysfunction. In the present study, we investigated the effect of timing of minimal automated external defibrillation-mandated interruptions of chest compressions on cardiopulmonary resuscitation outcomes, using a single-shock algorithm. We hypothesized that an 8-sec interruption of chest compressions for a single shock, as mandated by automated external defibrillations, would not impair initial resuscitation and outcomes of cardiopulmonary resuscitation. Randomized prospective animal study. University affiliated research laboratory. Domestic pigs. In 24 domestic male pigs weighing 41 +/- 2 kg, ventricular fibrillation was induced by left anterior descending coronary artery occlusion and untreated for 7 min. Cardiopulmonary resuscitation, including chest compressions and ventilation with oxygen, was then performed for an interval of 2 min before attempted defibrillation. Animals were randomized into three groups: A) interruption immediately before defibrillation; B) interruption after 1 min of cardiopulmonary resuscitation; or C) no interruption. Chest compressions were delivered with the aid of a mechanical chest compressor at a rate of 100 compressions/min and compression/ventilation ratio of 30:2. Defibrillation was attempted with a single biphasic 150-J shock. Each animal was successfully resuscitated and survived for >72 hr. No differences in the number of shocks before return of spontaneous circulation, frequency of recurrent ventricular fibrillation, duration of cardiopulmonary resuscitation, and severity of postresuscitation myocardial dysfunction were observed. In this

  4. Effects of biliverdin administration on acute lung injury induced by hemorrhagic shock and resuscitation in rats.

    Science.gov (United States)

    Kosaka, Junko; Morimatsu, Hiroshi; Takahashi, Toru; Shimizu, Hiroko; Kawanishi, Susumu; Omori, Emiko; Endo, Yasumasa; Tamaki, Naofumi; Morita, Manabu; Morita, Kiyoshi

    2013-01-01

    Hemorrhagic shock and resuscitation induces pulmonary inflammation that leads to acute lung injury. Biliverdin, a metabolite of heme catabolism, has been shown to have potent cytoprotective, anti-inflammatory, and anti-oxidant effects. This study aimed to examine the effects of intravenous biliverdin administration on lung injury induced by hemorrhagic shock and resuscitation in rats. Biliverdin or vehicle was administered to the rats 1 h before sham or hemorrhagic shock-inducing surgery. The sham-operated rats underwent all surgical procedures except bleeding. To induce hemorrhagic shock, rats were bled to achieve a mean arterial pressure of 30 mmHg that was maintained for 60 min, followed by resuscitation with shed blood. Histopathological changes in the lungs were evaluated by histopathological scoring analysis. Inflammatory gene expression was determined by Northern blot analysis, and oxidative DNA damage was assessed by measuring 8-hydroxy-2' deoxyguanosine levels in the lungs. Hemorrhagic shock and resuscitation resulted in prominent histopathological damage, including congestion, edema, cellular infiltration, and hemorrhage. Biliverdin administration prior to hemorrhagic shock and resuscitation significantly ameliorated these lung injuries as judged by histopathological improvement. After hemorrhagic shock and resuscitation, inflammatory gene expression of tumor necrosis factor-α and inducible nitric oxide synthase were increased by 18- and 8-fold, respectively. Inflammatory gene expression significantly decreased when biliverdin was administered prior to hemorrhagic shock and resuscitation. Moreover, after hemorrhagic shock and resuscitation, lung 8-hydroxy-2' deoxyguanosine levels in mitochondrial DNA expressed in the pulmonary interstitium increased by 1.5-fold. Biliverdin administration prior to hemorrhagic shock and resuscitation decreased mitochondrial 8-hydroxy-2' deoxyguanosine levels to almost the same level as that in the control animals. We also

  5. Effects of biliverdin administration on acute lung injury induced by hemorrhagic shock and resuscitation in rats.

    Directory of Open Access Journals (Sweden)

    Junko Kosaka

    Full Text Available Hemorrhagic shock and resuscitation induces pulmonary inflammation that leads to acute lung injury. Biliverdin, a metabolite of heme catabolism, has been shown to have potent cytoprotective, anti-inflammatory, and anti-oxidant effects. This study aimed to examine the effects of intravenous biliverdin administration on lung injury induced by hemorrhagic shock and resuscitation in rats. Biliverdin or vehicle was administered to the rats 1 h before sham or hemorrhagic shock-inducing surgery. The sham-operated rats underwent all surgical procedures except bleeding. To induce hemorrhagic shock, rats were bled to achieve a mean arterial pressure of 30 mmHg that was maintained for 60 min, followed by resuscitation with shed blood. Histopathological changes in the lungs were evaluated by histopathological scoring analysis. Inflammatory gene expression was determined by Northern blot analysis, and oxidative DNA damage was assessed by measuring 8-hydroxy-2' deoxyguanosine levels in the lungs. Hemorrhagic shock and resuscitation resulted in prominent histopathological damage, including congestion, edema, cellular infiltration, and hemorrhage. Biliverdin administration prior to hemorrhagic shock and resuscitation significantly ameliorated these lung injuries as judged by histopathological improvement. After hemorrhagic shock and resuscitation, inflammatory gene expression of tumor necrosis factor-α and inducible nitric oxide synthase were increased by 18- and 8-fold, respectively. Inflammatory gene expression significantly decreased when biliverdin was administered prior to hemorrhagic shock and resuscitation. Moreover, after hemorrhagic shock and resuscitation, lung 8-hydroxy-2' deoxyguanosine levels in mitochondrial DNA expressed in the pulmonary interstitium increased by 1.5-fold. Biliverdin administration prior to hemorrhagic shock and resuscitation decreased mitochondrial 8-hydroxy-2' deoxyguanosine levels to almost the same level as that in the

  6. Oral and Enteral Resuscitation of Burn Shock The Historical Record and Implications for Mass Casualty Care

    Science.gov (United States)

    Kramer, George C.; Michell, Michael W.; Oliveira, Hermes; Brown, Tim La H.; Herndon, David; Baker, R. David; Muller, Michael

    2010-01-01

    In the aftermath of a mass disaster, standard care methods for treatment of burn injury will often not be available for all victims. A method of fluid resuscitation for burns that has largely been forgotten by contemporary burn experts is enteral resuscitation. We identified 12 studies with over 700 patients treated with enteral resuscitation, defined as drinking or gastric infusion of salt solutions, from the literature. These studies suggest that enteral resuscitation can be an effective treatment for burn shock under conditions in which the standard IV therapy is unavailable or delayed, such as in mass disasters and combat casualties. Enteral resuscitation of burn shock was effective in patients with moderate (10–40% TBSA) and in some patients with more severe injuries. The data suggests that some hypovolemic burn and trauma patients can be treated exclusively with enteral resuscitation, and others might benefit from enteral resuscitation as an initial alternative and a supplement to IV therapy. A complication of enteral resuscitation was vomiting, which occurred less in children and much less when therapy was initiated within the first postburn hour. Enteral resuscitation is contra-indicated when the patient is in “peripheral circulatory collapse”. The optimal enteral solution and regimen has not yet been defined, nor has its efficacy been tested against modern IV resuscitation. The oldest studies used glucose-free solutions of buffered isotonic and hypotonic saline. Studies that are more recent show benefit of adding glucose to electrolyte solutions similar to those used in the treatment of cholera. If IV therapy for mass casualty care is delayed due to logistical constraints, enteral resuscitation should be considered. PMID:20827301

  7. [Discussing the resuscitation policy at a geriatric ward: the experience of patients or their representatives].

    Science.gov (United States)

    Bressers, J P A; Algra, A; Dautzenberg, P L J; van Delden, J J M

    2011-12-01

    To identify geriatric patients' and their surrogate decision makers' experience with regard to discussing cardio pulmonary resuscitation (CPR) policy. This is a prospective, observational, explorative survey. During 10 weeks, all patients admitted to a geriatric ward of a general Dutch hospital or their representatives were asked for their experience regarding discussion of the resuscitation policy with the physician in attendance. Discussing this policy is a standard procedure at the first day of admission. We also asked on several factors which could influence their experience and on factors to improve discussing resuscitation policies. The primary outcome was the participant's satisfaction expressed on a scale of 1 to l0 regarding satisfaction with the CPR discussion. Seventy-six participants were included, of which 29 patients and 47 surrogate decision makers. Discussing the resuscitation policy took an average of 4,5 minutes (SD 3.2) to complete. In 70% (n=53) of cases a do-not-resuscitate decision was made. Discussing the resuscitation policy was experienced positive, with an average rate of 7,8 (SD 1.5). A total of 121 positive comments were made, as opposed to 70 negative comments. When they talked about their resuscitation policy, most patients expressed positive emotional responses. As most important improvements were mentioned: a better introduction to discussing this subject (17%), a better explanation of resuscitation and chances of survival (17%) and providing information prior to admission to the ward, so that patient and surrogate decision maker have been informed that the resuscitation policy will be discussed (12%). Most patients and relatives in this study wished to discuss their resuscitation policy with physicians. Still, there is room for improvement in several respects. Patients and surrogate decision makers are in favour of discussing the standard resuscitation policy with the doctor, and evaluate this conversation with a 7.8 / 10. In order

  8. Recent Advances in Managing Acute Pancreatitis

    OpenAIRE

    Janisch, Nigeen; Gardner, Timothy

    2015-01-01

    This article will review the recent advances in managing acute pancreatitis. Supportive care has long been the standard of treatment for this disease despite extensive, but ultimately unsuccessful, efforts to develop disease-specific pharmacologic therapies. The primary interventions center on aggressive fluid resuscitation, initiation of early enteral nutrition, targeted antibiotic therapy, and the management of complications. In this article, we will detail treatment of acute pancreatitis w...

  9. Advances in Management of Acute Pancreatitis

    OpenAIRE

    Janisch, Nigeen H.; Gardner, Timothy B.

    2015-01-01

    This chapter will review advances in the management of acute pancreatitis. Medical treatment has been primarily supportive for this diagnosis in the past, and despite extensive research efforts, there are no pharmacologic therapies that improve prognosis. The current mainstay of management, notwithstanding the ongoing debate regarding the volume, fluid type, and rate of administration, is aggressive intravenous fluid resuscitation. While in the past antibiotics were used consistently for prop...

  10. ACUTE EFFECTS OF BALANCED VERSUS UNBALANCED COLLOID RESUSCITATION ON RENAL MACROCIRCULATORY AND MICROCIRCULATORY PERFUSION DURING ENDOTOXEMIC SHOCK

    NARCIS (Netherlands)

    Aksu, Ugur; Bezemer, Rick; Demirci, Cihan; Ince, Can

    2012-01-01

    This study was designed to investigate the acute effects of balanced versus unbalanced colloid resuscitation on renal macrocirculatory and microcirculatory perfusions during lipopolysaccharide-induced endotoxemic shock in rats. We tested the hypothesis that balanced colloid resuscitation would be

  11. Nurses' Perceptions of Role, Team Performance, and Education Regarding Resuscitation in the Adult Medical-Surgical Patient.

    Science.gov (United States)

    O'Donoghue, Sharon C; DeSanto-Madeya, Susan; Fealy, Natalie; Saba, Christine R; Smith, Stacey; McHugh, Allison T

    2015-01-01

    The purpose of this study was to explore nurses' perception of their roles, team performance, and educational needs during resuscitation using an electronic survey. Findings provide direction for clinical practice, nursing education, and future research to improve resuscitation care.

  12. Oxalate Nephropathy After Continuous Infusion of High-Dose Vitamin C as an Adjunct to Burn Resuscitation

    OpenAIRE

    Buehner, Michelle; Pamplin, Jeremy; Studer, Lynette; Hughes, Rhome L.; King, Booker T.; Graybill, John C.; Chung, Kevin K.

    2016-01-01

    Fluid resuscitation is the foundation of management in burn patients and is the topic of considerable research. One adjunct in burn resuscitation is continuous, high-dose vitamin C (ascorbic acid) infusion, which may reduce fluid requirements and thus decrease the risk for over resuscitation. Research in preclinical studies and clinical trials has shown continuous infusions of high-dose vitamin C to be beneficial with decrease in resuscitative volumes and limited adverse effects. However, hig...

  13. A video to improve patient and surrogate understanding of cardiopulmonary resuscitation choices in the ICU: a randomized controlled trial.

    Science.gov (United States)

    Wilson, Michael E; Krupa, Artur; Hinds, Richard F; Litell, John M; Swetz, Keith M; Akhoundi, Abbasali; Kashyap, Rahul; Gajic, Ognjen; Kashani, Kianoush

    2015-03-01

    To determine if a video depicting cardiopulmonary resuscitation and resuscitation preference options would improve knowledge and decision making among patients and surrogates in the ICU. Randomized, unblinded trial. Single medical ICU. Patients and surrogate decision makers in the ICU. The usual care group received a standard pamphlet about cardiopulmonary resuscitation and cardiopulmonary resuscitation preference options plus routine code status discussions with clinicians. The video group received usual care plus an 8-minute video that depicted cardiopulmonary resuscitation, showed a simulated hospital code, and explained resuscitation preference options. One hundred three patients and surrogates were randomized to usual care. One hundred five patients and surrogates were randomized to video plus usual care. Median total knowledge scores (0-15 points possible for correct answers) in the video group were 13 compared with 10 in the usual care group, p value of less than 0.0001. Video group participants had higher rates of understanding the purpose of cardiopulmonary resuscitation and resuscitation options and terminology and could correctly name components of cardiopulmonary resuscitation. No statistically significant differences in documented resuscitation preferences following the interventions were found between the two groups, although the trial was underpowered to detect such differences. A majority of participants felt that the video was helpful in cardiopulmonary resuscitation decision making (98%) and would recommend the video to others (99%). A video depicting cardiopulmonary resuscitation and explaining resuscitation preference options was associated with improved knowledge of in-hospital cardiopulmonary resuscitation options and cardiopulmonary resuscitation terminology among patients and surrogate decision makers in the ICU, compared with receiving a pamphlet on cardiopulmonary resuscitation. Patients and surrogates found the video helpful in decision

  14. Termination of pre-hospital resuscitation by anaesthesiologists - causes and consequences

    DEFF Research Database (Denmark)

    Mikkelsen, S; Lossius, H M; Binderup, L G

    2017-01-01

    contacts, 1275 patients were lifeless without reliable signs of death. In 642 of these patients (3.8%) resuscitation was initiated (median age 68 years). The remaining 633 patients (3.7%) were declared dead at the scene without any resuscitation attempt (median age 77 years). These latter patients would...

  15. Fluid Resuscitation Does Not Improve Renal Oxygenation during Hemorrhagic Shock in Rats

    NARCIS (Netherlands)

    Legrand, Matthieu; Mik, Egbert G.; Balestra, Gianmarco M.; Lutter, Rene; Pirracchio, Romain; Payen, Didier; Ince, Can

    2010-01-01

    Background: The resuscitation strategy for hemorrhagic shock remains controversial, with the kidney being especially prone to hypoxia. Methods: The authors used a three-phase hemorrhagic shock model to investigate the effects of fluid resuscitation on renal oxygenation. After a 1-h shock phase, rats

  16. Defibrillator charging before rhythm analysis significantly reduces hands-off time during resuscitation

    DEFF Research Database (Denmark)

    Hansen, L. K.; Folkestad, L.; Brabrand, M.

    2013-01-01

    BACKGROUND: Our objective was to reduce hands-off time during cardiopulmonary resuscitation as increased hands-off time leads to higher mortality. METHODS: The European Resuscitation Council (ERC) 2005 and ERC 2010 guidelines were compared with an alternative sequence (ALT). Pulseless ventricular...

  17. Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Folke, Fredrik; Kragholm, Kristian

    2016-01-01

    AIM: It is unclear whether prolonged resuscitation can result in successful outcome following out-of-hospital cardiac arrests (OHCA). We assessed associations between duration of pre-hospital resuscitation on survival and functional outcome following OHCA in patients achieving pre-hospital return...

  18. Outcome of out-of-hospital cardiac arrest--why do physicians withhold resuscitation attempts?

    DEFF Research Database (Denmark)

    Horsted, Tina I; Rasmussen, Lars S; Lippert, Freddy K

    2004-01-01

    To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts.......To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts....

  19. Does Cardiopulmonary Resuscitation Cause Rib Fractures in Children? A Systematic Review

    Science.gov (United States)

    Maguire, Sabine; Mann, Mala; John, Nia; Ellaway, Bev; Sibert, Jo R.; Kemp, Alison M.

    2006-01-01

    Background: There is a diagnostic dilemma when a child presents with rib fractures after cardiopulmonary resuscitation (CPR) where child abuse is suspected as the cause of collapse. We have performed a systematic review to establish the evidence base for the following questions: (i) Does cardiopulmonary resuscitation cause rib fractures in…

  20. Initial fluid resuscitation of patients with septic shock in the intensive care unit

    DEFF Research Database (Denmark)

    Carlsen, Sarah; Perner, A

    2011-01-01

    Fluid is the mainstay of resuscitation of patients with septic shock, but the optimal composition and volume are unknown. Our aim was to evaluate the current initial fluid resuscitation practice in patients with septic shock in the intensive care unit (ICU) and patient characteristics and outcome...

  1. Implementing a Sepsis Resuscitation Bundle Improved Clinical Outcome: A Before-and-After Study

    Directory of Open Access Journals (Sweden)

    Jeongmin Kim

    2014-11-01

    CONCLUSIONS: Repeated education led by a multidisciplinary team and interdisciplinary communication improved the compliance rate of the 6-h resuscitation bundle in severe sepsis and septic shock patients. Compliance with the sepsis resuscitation bundle was associated with improved 28-day mortality in the study population.

  2. When to stop septic shock resuscitation: clues from a dynamic perfusion monitoring

    NARCIS (Netherlands)

    Hernandez, Glenn; Luengo, Cecilia; Bruhn, Alejandro; Kattan, Eduardo; Friedman, Gilberto; Ospina-Tascon, Gustavo A.; Fuentealba, Andrea; Castro, Ricardo; Regueira, Tomas; Romero, Carlos; Ince, Can; Bakker, Jan

    2014-01-01

    Background: The decision of when to stop septic shock resuscitation is a critical but yet a relatively unexplored aspect of care. This is especially relevant since the risks of over-resuscitation with fluid overload or inotropes have been highlighted in recent years. A recent guideline has proposed

  3. In-hospital resuscitation: opioids and other factors influencing survival

    Directory of Open Access Journals (Sweden)

    Karamarie Fecho

    2009-12-01

    Full Text Available Karamarie Fecho1, Freeman Jackson1, Frances Smith1, Frank J Overdyk21Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA; 2Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USAPurpose: “Code Blue” is a standard term used to alertt hospital staff that a patient requires resuscitation. This study determined rates of survival from Code Blue events and the role of opioids and other factors on survival.Methods: Data derived from medical records and the Code Blue and Pharmacy databases were analyzed for factors affecting survival.Results: During 2006, rates of survival from the code only and to discharge were 25.9% and 26.4%, respectively, for Code Blue events involving cardiopulmonary resuscitation (CPR; N = 216. Survival rates for events not ultimately requiring CPR (N = 77 were higher, with 32.5% surviving the code only and 62.3% surviving to discharge. For CPR events, rates of survival to discharge correlated inversely with time to chest compressions and defibrillation, precipitating event, need for airway management, location and age. Time of week, witnessing, postoperative status, gender and opioid use did not influence survival rates. For non-CPR events, opioid use was associated with decreased survival. Survival rates were lowest for patients receiving continuous infusions (P < 0.01 or iv boluses of opioids (P < 0.05.Conclusions: One-quarter of patients survive to discharge after a CPR Code Blue event and two-thirds survive to discharge after a non-CPR event. Opioids may influence survival from non-CPR events.Keywords: code blue, survival, opioids, cardiopulmonary resuscitation, cardiac arrest, patient safety

  4. Use of self-inflating bags for neonatal resuscitation.

    Science.gov (United States)

    Oddie, Sam; Wyllie, Jonathan; Scally, Andrew

    2005-10-01

    Lung inflation is the most important, and most difficult step in newborn resuscitation. A wide variety of devices are used to achieve lung inflation, but there are relatively few data to guide clinicians in their choice of device. We tested the ability of instructors and trained candidates on a newborn life support course to deliver initial inflation breaths to a test lung, using a pressure limited blow-off valve, a 240-ml self-inflating bag and a 500-ml self-inflating bag in sequence. Use of a 240-ml self-inflating bag was associated with shorter initial inflations of 1.8 s mean (95% CI 1.60-1.99 s), compared with 2.42 s (2.24-2.61 s), 2.40 s (2.08-2.71 s) for 500-ml self-inflating bags and "Tom Thumb" T piece, respectively. Delivery of breaths within a target pressure range of 30+/-5 cm H2O was significantly better using a T piece than either self-inflating bag (proportion within target range 0.05 (95% CI 0-0.11), 0.17 (95% CI 0.12-0.23), 0.89 (95% CI 0.83-0.94) for 240-ml and 500-ml self-inflating bags and "Tom Thumb" T piece, respectively. Excessive pressure delivery with both sizes of self-inflating bag was frequent. These data do not support use of 240-ml or 500-ml self-inflating bags for resuscitation of newborn term infants. A variable pressure T piece blow-off system may be the easiest device to use for newborn resuscitation and the most reliable at delivering desired pressures for set times.

  5. Can a flowchart improve the quality of bystander cardiopulmonary resuscitation?

    Science.gov (United States)

    Rössler, B; Ziegler, M; Hüpfl, M; Fleischhackl, R; Krychtiuk, K A; Schebesta, K

    2013-07-01

    Since the introduction of basic life support in the 1950s, on-going efforts have been made to improve the quality of bystander cardiopulmonary resuscitation (CPR). Even though bystander-CPR can increase the chance of survival almost fourfold, the rates of bystander initiated CPR have remained low and rarely exceed 20%. Lack of confidence and fear of committing mistakes are reasons why helpers refrain from initiating CPR. The authors tested the hypothesis that quality and confidence of bystander-CPR can be increased by supplying lay helpers with a basic life support flowchart when commencing CPR, in a simulated resuscitation model. After giving written informed consent, 83 medically untrained laypersons were randomised to perform basic life support for 300s with or without a supportive flowchart. The primary outcome parameter was hands-off time (HOT). Furthermore, the participants' confidence in their actions on a 10-point Likert-like scale and time-to-chest compressions were assessed. Overall HOT was 147±30 s (flowchart) vs. 169±55 s (non-flowchart), p=0.024. Time to chest compressions was significantly longer in the flowchart group (60±24 s vs. 23±18 s, p<0.0001). Participants in the flowchart group were significantly more confident when performing BLS than the non-flowchart counterparts (7±2 vs. 5±2, p=0.0009). A chart provided at the beginning of resuscitation attempts improves quality of CPR significantly by decreasing HOT and increasing the participants' confidence when performing CPR. As reducing HOT is associated with improved outcome and positively impacting the helpers' confidence is one of the main obstacles to initiate CPR for lay helpers, charts could be utilised as simple measure to improve outcome in cardiopulmonary arrest. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  6. Goal-directed Hemostatic Resuscitation of Trauma-induced Coagulopathy

    Science.gov (United States)

    Gonzalez, Eduardo; Moore, Ernest E.; Moore, Hunter B.; Chapman, Michael P.; Chin, Theresa L.; Ghasabyan, Arsen; Wohlauer, Max V.; Barnett, Carlton C.; Bensard, Denis D.; Biffl, Walter L.; Burlew, Clay C.; Johnson, Jeffrey L.; Pieracci, Fredric M.; Jurkovich, Gregory J.; Banerjee, Anirban; Silliman, Christopher C.; Sauaia, Angela

    2017-01-01

    Background Massive transfusion protocols (MTPs) have become standard of care in the management of bleeding injured patients, yet strategies to guide them vary widely. We conducted a pragmatic, randomized clinical trial (RCT) to test the hypothesis that an MTP goal directed by the viscoelastic assay thrombelastography (TEG) improves survival compared with an MTP guided by conventional coagulation assays (CCA). Methods This RCT enrolled injured patients from an academic level-1 trauma center meeting criteria for MTP activation. Upon MTP activation, patients were randomized to be managed either by an MTP goal directed by TEG or by CCA (ie, international normalized ratio, fibrinogen, platelet count). Primary outcome was 28-day survival. Results One hundred eleven patients were included in an intent-to-treat analysis (TEG = 56, CCA = 55). Survival in the TEG group was significantly higher than the CCA group (log-rank P = 0.032, Wilcoxon P = 0.027); 20 deaths in the CCA group (36.4%) compared with 11 in the TEG group (19.6%) (P = 0.049). Most deaths occurred within the first 6 hours from arrival (21.8% CCA group vs 7.1% TEG group) (P = 0.032). CCA patients required similar number of red blood cell units as the TEG patients [CCA: 5.0 (2–11), TEG: 4.5 (2–8)] (P = 0.317), but more plasma units [CCA: 2.0 (0–4), TEG: 0.0 (0–3)] (P = 0.022), and more platelets units [CCA: 0.0 (0–1), TEG: 0.0 (0–0)] (P = 0.041) in the first 2 hours of resuscitation. Conclusions Utilization of a goal-directed, TEG-guided MTP to resuscitate severely injured patients improves survival compared with an MTP guided by CCA and utilizes less plasma and platelet transfusions during the early phase of resuscitation. PMID:26720428

  7. Defining, aligning, or declining do not resuscitate during surgery.

    Science.gov (United States)

    Jones, James W; McCullough, Laurence B

    2014-04-01

    A Professor A. Droit, 93 years of age, formerly your college ethics teacher, developed a painful ischemic foot from distal aortic blockage. A daughter, who is a nurse, brought him to the hospital. He has multiple comorbidities, including leukemia for which he is getting chemotherapy. He agrees to surgery but hands you a completed do not resuscitate (DNR) form and insists it be honored throughout his care. As the operative wound is being closed, he has a slow ventricular tachycardia, which does not respond to intravenous therapy. You should: Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  8. Fluid Resuscitation and Massive Transfusion Protocol in Pediatric Trauma

    Directory of Open Access Journals (Sweden)

    Marjanović Vesna

    2016-06-01

    Full Text Available Trauma is the leading cause of morbidity and mortality in children due to the occurrence of hemorrhagic shock. Hemorrhagic shock and its consequences, anemia and hypovolemia, decrease oxygen delivery, due to which appropriate transfusion and volume resuscitation are critical. Guidelines for massive transfusion, in the pediatric trauma, have not been defined yet. Current data indicate that early identification of coagulopathy and its treatment with RBSs, plasma and platelets in a 1:1:1 unit ratio, and limited use of crystalloids may improve survival in pediatric trauma patients.

  9. Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol.

    Science.gov (United States)

    Garcia, Santiago; Drexel, Todd; Bekwelem, Wobo; Raveendran, Ganesh; Caldwell, Emily; Hodgson, Lucinda; Wang, Qi; Adabag, Selcuk; Mahoney, Brian; Frascone, Ralph; Helmer, Gregory; Lick, Charles; Conterato, Marc; Baran, Kenneth; Bart, Bradley; Bachour, Fouad; Roh, Steven; Panetta, Carmelo; Stark, Randall; Haugland, Mark; Mooney, Michael; Wesley, Keith; Yannopoulos, Demetris

    2016-01-07

    In 2013 the Minnesota Resuscitation Consortium developed an organized approach for the management of patients resuscitated from shockable rhythms to gain early access to the cardiac catheterization laboratory (CCL) in the metro area of Minneapolis-St. Paul. Eleven hospitals with 24/7 percutaneous coronary intervention capabilities agreed to provide early (within 6 hours of arrival at the Emergency Department) access to the CCL with the intention to perform coronary revascularization for outpatients who were successfully resuscitated from ventricular fibrillation/ventricular tachycardia arrest. Other inclusion criteria were age >18 and cardiac etiology. Patients with other rhythms, known do not resuscitate/do not intubate, noncardiac etiology, significant bleeding, and terminal disease were excluded. The primary outcome was survival to hospital discharge with favorable neurological outcome. Patients (315 out of 331) who were resuscitated from VT/VF and transferred alive to the Emergency Department had complete medical records. Of those, 231 (73.3%) were taken to the CCL per the Minnesota Resuscitation Consortium protocol while 84 (26.6%) were not taken to the CCL (protocol deviations). Overall, 197 (63%) patients survived to hospital discharge with good neurological outcome (cerebral performance category of 1 or 2). Of the patients who followed the Minnesota Resuscitation Consortium protocol, 121 (52%) underwent percutaneous coronary intervention, and 15 (7%) underwent coronary artery bypass graft. In this group, 151 (65%) survived with good neurological outcome, whereas in the group that did not follow the Minnesota Resuscitation Consortium protocol, 46 (55%) survived with good neurological outcome (adjusted odds ratio: 1.99; [1.07-3.72], P=0.03). Early access to the CCL after cardiac arrest due to a shockable rhythm in a selected group of patients is feasible in a large metropolitan area in the United States and is associated with a 65% survival rate to hospital

  10. Assessment of Iranian Nurses and Emergency Medical Personnel in Terms of Cardiopulmonary Resuscitation Knowledge Based on the 2010 Guideline.

    Science.gov (United States)

    Kalhori, Reza Pourmirza; Jalali, Amir; Naderipour, Arsalan; Almasi, Afshin; Khavasi, Mohammad; Rezaei, Masoud; Abbasi, Mohammad

    2017-01-01

    The aim of this study was to compare the cardiopulmonary resuscitation (CPR) knowledge of hospital nurses and emergency medical personnel in Kermanshah, Iran. This descriptive cross-sectional study was conducted on 330 hospital nurses and 159 emergency medical personnel working in educational hospitals and emergency medical centers in Kermanshah. Data were collected using a validated and reliable (r = 0.74) researcher-made questionnaire consisting of a demographic characteristics questionnaire and the 2010 CPR knowledge questionnaire. Based on the most recent CPR guidelines, the knowledge of 19.5%, 78.6%, and 1.9% of the emergency medical staff was excellent, good, and moderate, respectively. None of the participants had poor knowledge. In addition, the knowledge of 20.2%, 65.4%, 14%, and 0.4% of the nurses in this study was excellent, good, moderate, and poor, respectively. There was no significant difference in CPR knowledge between hospital nurses and emergency medical staff. Moreover, no significant association was found between CPR knowledge and gender, age, work experience, field of study, previous occupation, and advanced resuscitation courses. However, CPR knowledge of individuals with training in basic CPR courses was higher than participants without training in these courses (P nurses and emergency medical personnel was in an acceptable range. Nevertheless, it is strongly recommended that nurses and emergency staff receive training according to the most recent CPR guidelines.

  11. A randomised control trial to determine if use of the iResus©application on a smart phone improves the performance of an advanced life support provider in a simulated medical emergency

    National Research Council Canada - National Science Library

    Low, D; Clark, N; Soar, J; Padkin, A; Stoneham, A; Perkins, G. D; Nolan, J

    2011-01-01

    This study sought to determine whether using the Resuscitation Council UK’s iResus © application on a smart phone improves the performance of doctors trained in advanced life support in a simulated emergency...

  12. [Experience assisting an AIDS-infected homosexual patient and his same-sex partner make a do-not-resuscitate decision].

    Science.gov (United States)

    Wang, Shu-Jang; Lai, Pei-Yu; Liou, Siao-Ying; Ko, Wen-Chien; Ko, Nai-Ying

    2012-10-01

    Family members play an important role in the process of writing advance directives. Homosexual men infected with HIV often wish to authorize their intimate same-sex partner or friends rather than immediate family members to make medical decisions on their behalf. Although same-sex marriage is currently illegal in Taiwan, HIV infected homosexual patients are able to write advance directives appointing their same-sex partner to be their surrogate decision maker for end-of-life medical decisions. This case report describes an experience assisting a homosexual patient with HIV to write his advance directives. The nurse assisted the patient and his partner to make a self-determined decision not to resuscitate. Family conferences held to discuss the patient's decisions regarding resuscitation helped legitimize his partner's primary role in making end-of-life healthcare decisions on his behalf. As an advocate for patient rights, nurses should understand the law as it relates to homosexuality and end-of-life decision making, inform patients on the durable power of autonomy, and help execute their advance directives.

  13. Advance care planning for patients with advanced neurology diseases.

    Science.gov (United States)

    Cheung, Ka-Chi; Lau, Vikki Wai-Kee; Un, Ka-Chun; Wong, Man-Sheung; Chan, Kwok-Ying

    2017-10-13

    Advanced neurology diseases including motor neuron disease (MND) are usually progressive life-limiting illness and could be devastating for patients, families and caregivers. Although medical technologies, such as enteral feeding and non-invasive ventilation, may prolong life expectancy of the patients, their utilization prompts important ethical questions in regard to their quality of life (QoL). Little attention had been paid on how ACP practice would practically help with patients suffering from different neurology diseases. We are unaware of any published studies on ACP practice among patients with different neurology diseases. In our study, we assessed end-of-life (EOL) care preferences, documentation, and communication in patients with various types of advanced neurology diseases. This was a retrospective chart review of all patients referred to the neuro-palliative care team (NPCT) in a local acute hospital in Hong Kong. The study was approved by the institutional review board of the University of Hong Kong. NPCT consultation was hand abstracted from the electronic health record if there was a subspecialty palliative care (PC) consultation note during the study period. Hand abstraction of data also included any content related to advance care planning (ACP) [advance directive (AD), resuscitation order, ventilator support, artificial feeding, patient wishes, legacy]. For patient who signed AD, items including cardiopulmonary resuscitation (100%), mechanical ventilation (100%), artificial nutrition and hydration (80%) were mentioned more frequently than other EOL interventions. For patients who had ACP but without AD, the most common diagnosis is bad stroke (60%). Place of death, artificial nutrition and hydration were most mentioned EOL interventions. EOL decision making in patients with advanced neurology disease is often delayed. This study showed that MND patients are readier to discuss their EOL issues and signed their AD. The NPCT can play a valuable

  14. New guidelines for cardiopulmonary resuscitation Nuevas directrices para la resucitación cardiopulmonar Novas diretrizes da ressuscitação cardiopulmonar

    Directory of Open Access Journals (Sweden)

    Maria Celia Barcellos Dalri

    2008-12-01

    Full Text Available Cardiopulmonary arrest (CPA poses a severe threat to life; cardiopulmonary resuscitation (CPR represents a challenge for research and assessment by nurses and their team. This study presents the most recent international recommendations for care in case of cardiopulmonary heart arrest, based on the 2005 Guidelines by the American Heart Association (AHA. These CPR guidelines are based on a large-scale review process, organized by the International Liaison Committee on Resuscitation (ILCOR. High-quality basic and advanced CPR maneuvers can save lives.La parada cardiorrespiratoria (PCR es una ocurrencia que presenta una grave amenaza a la vida; la resucitación cardiopulmonar (RCP representa un desafío para la investigación y la evaluación por parte del enfermero y su equipo. Este estudio presenta las más recientes recomendaciones internacionales sobre la atención a la parada cardiorrespiratoria, basada en las Directrices de 2005 de la American Heart Asociation (AHA. Esas directrices sobre RCP se fundamentan en un proceso de revisión extenso, organizado por el International Liasion Committee on Resuscitation (ILCOR. Las maniobras básicas y avanzadas de RCP ofrecidas con calidad pueden salvar vidas.A parada cardiorrespiratória (PCR é intercorrência de grave ameaça à vida; a ressuscitação cardiopulmonar (RCP representa desafio para a investigação e a avaliação por parte do enfermeiro e sua equipe. Esse estudo apresenta as mais recentes recomendações internacionais sobre atendimento da parada cardiorrespiratória, baseado nas Diretrizes de 2005 da American Heart Association (AHA. Essas diretrizes sobre RCP fundamentam-se num processo de revisão extenso, organizado pelo International Liasion Committee on Resuscitation (ILCOR. As manobras básicas e avançadas de RCP com qualidade podem salvar vidas.

  15. Do not attempt resuscitation: the importance of consensual decisions.

    Science.gov (United States)

    Imhof, Lorenz; Mahrer-Imhof, Romy; Janisch, Christine; Kesselring, Annemarie; Zuercher Zenklusend, Regula

    2011-02-03

    To describe the involvement and input of physicians and nurses in cardiopulmonary resuscitation (CPR / do not attempt resuscitation (DNAR) decisions; to analyse decision patterns; and understand the practical implications. A Qualitative Grounded Theory study using one-time open-ended interviews with 40 volunteer physicians and 52 nurses drawn from acute care wards with mixes of heterogeneous cases in seven different hospitals in German-speaking Switzerland. Establishing DNAR orders in the best interests of patients was described as a challenging task requiring the leadership of senior physicians and nurses. Implicit decisions in favour of CPR predominated at the beginning of hospitalisation; depending on the context, they were relieved/superseded by explicit DNAR decisions. Explicit decisions were the result of hierarchical medical expertise, of multilateral interdisciplinary expertise, of patient autonomy and/or of negotiated patient autonomy. Each type of decision, implicit or explicit, potentially represented a team consensus. Non-consensual decisions were prone to precipitate personal or team conflicts, and, occasionally, led to non-compliance. Establishing DNAR orders is a demanding task. Reaching a consensus is of crucial importance in guaranteeing teamwork and good patient care. Communication and negotiation skills, professional and personal life experience and empathy for patients and colleagues are pivotal. Therefore, leadership by experienced senior physicians and nurses is needed and great efforts should be made with regard to multidisciplinary education.

  16. Withdrawing Versus not Offering Cardiopulmonary Resuscitation: Is There a Difference?

    Directory of Open Access Journals (Sweden)

    Simon JW Oczkowski

    2015-01-01

    Full Text Available Conflict between substitute decision makers (SDMs and health care providers in the intensive care unit is commonly related to goals of treatment at the end of life. Based on recent court decisions, even medical consensus that ongoing treatment is not clinically indicated cannot justify withdrawal of mechanical ventilation without consent from the SDM. Cardiopulmonary resuscitation (CPR, similar to mechanical ventilation, is a life-sustaining therapy that can result in disagreement between SDMs and clinicians. In contrast to mechanical ventilation, in cases for which CPR is judged by the medical team to not be clinically indicated, there is no explicit or case law in Canada that dictates that withholding/not offering of CPR requires the consent of SDMs. In such cases, physicians can ethically and legally not offer CPR, even against SDM or patient wishes. To ensure that nonclinically indicated CPR is not inappropriately performed, hospitals should consider developing ‘scope of treatment’ forms that make it clear that even if CPR is desired, the individual components of resuscitation to be offered, if any, will be dictated by the medical team’s clinical assessment.

  17. Rib fractures in infants due to cardiopulmonary resuscitation efforts.

    Science.gov (United States)

    Dolinak, David

    2007-06-01

    Although it is widely known that adults may sustain fractures of the anterior and/or lateral aspects of the ribs due to cardiopulmonary resuscitation (CPR) efforts, relatively little is written about the generation of CPR-related rib fractures in the infant age range. In a series of 70 consecutive autopsies in infants ranging in age from 2 weeks to 8 months, with no history or indications of injury, the parietal pleura of the thoracic cage was stripped and the ribs carefully examined for fracture. Subtle fractures of the anterolateral aspects of the ribs were discovered in 8 (11%) of the 70 cases. In 7 of the 8 cases, multiple ribs were fractured (ranging up to 10 rib fractures), and in 5 of these cases, the rib fractures were bilateral. All of the rib fractures were subtle, had little if any associated blood extravasation, and would have been easily missed had the parietal pleura not been stripped. These anterolateral rib fractures in infants are the likely correlate of anterolateral rib fractures that are not uncommonly seen in the adult population, resulting from resuscitation efforts. The rib fractures are subtle and may not be identified unless the parietal pleura is stripped.

  18. Return of consciousness during ongoing cardiopulmonary resuscitation: A systematic review.

    Science.gov (United States)

    Olaussen, Alexander; Shepherd, Matthew; Nehme, Ziad; Smith, Karen; Bernard, Stephen; Mitra, Biswadev

    2015-01-01

    Cardio-pulmonary resuscitation (CPR) may generate sufficient cerebral perfusion pressure to make the patient conscious. The incidence and management of this phenomenon are not well described. This systematic review aims to identifying cases where CPR-induced consciousness is mentioned in the literature and explore its management options. The databases Medline, PubMed, EMBASE, Cinahl and the Cochrane Library were searched from their commencement to the 8th July 2014. We also searched Google (scholar) for grey literature. We combined MeSH terms and text words for consciousness and CPR, and included studies of all types. The search yielded 1997 unique records, of which 50 abstracts were reviewed. Nine reports, describing 10 patients, were relevant. Six of the patients had CPR performed by mechanical devices, three of these patients were sedated. Four patients arrested in the out-of-hospital setting and six arrested in hospital. There were four survivors. Varying levels of consciousness were described in all reports, including purposeful arm movements, verbal communication, and resuscitation interference. Management strategies directed at consciousness were offered to six patients and included both physical and chemical restraints. CPR-induced consciousness was infrequently reported in the medical literature, and varied in management. Given the increasing use of mechanical CPR, guidelines to identify and manage consciousness during CPR are required. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Damage control surgery in the era of damage control resuscitation.

    Science.gov (United States)

    Lamb, C M; MacGoey, P; Navarro, A P; Brooks, A J

    2014-08-01

    Damage control surgery (DCS) is a concept of abbreviated laparotomy, designed to prioritize short-term physiological recovery over anatomical reconstruction in the seriously injured and compromised patient. Over the last 10 yr, a new addition to the damage control paradigm has emerged, referred to as damage control resuscitation (DCR). This focuses on initial hypotensive resuscitation and early use of blood products to prevent the lethal triad of acidosis, coagulopathy, and hypothermia. This review aims to present the evidence behind DCR and its current application, and also to present a strategy of overall damage control to include DCR and DCS in conjunction. The use of DCR and DCS have been associated with improved outcomes for the severely injured and wider adoption of these principles where appropriate may allow this trend of improved survival to continue. In particular, DCR may allow borderline patients, who would previously have required DCS, to undergo early definitive surgery as their physiological derangement is corrected earlier. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. Families’ Stressors and Needs at Time of Cardio-Pulmonary Resuscitation: A Jordanian Perspective

    Science.gov (United States)

    Masa’Deh, Rami; Saifan, Ahmad; Timmons, Stephen; Nairn, Stuart

    2014-01-01

    Background: During cardio-pulmonary resuscitation, family members, in some hospitals, are usually pushed to stay out of the resuscitation room. However, growing literature implies that family presence during resuscitation could be beneficial. Previous literature shows controversial belief whether or not a family member should be present during resuscitation of their relative. Some worldwide association such as the American Heart Association supports family-witnessed resuscitation and urge hospitals to develop policies to ease this process. The opinions on family-witnessed resuscitation vary widely among various cultures, and some hospitals are not applying such polices yet. This study explores family members’ needs during resuscitation in adult critical care settings. Methods: This is a part of larger study. The study was conducted in six hospitals in two major Jordanian cities. A purposive sample of seven family members, who had experience of having a resuscitated relative, was recruited over a period of six months. Semi-structured interview was utilised as the main data collection method in the study. Findings: The study findings revealed three main categories: families’ need for reassurance; families’ need for proximity; and families’ need for support. The need for information about patient’s condition was the most important need. Updating family members about patient’s condition would reduce their tension and improve their acceptance for the end result of resuscitation. All interviewed family members wanted the option to stay beside their loved one at end stage of their life. Distinctively, most of family members want this option for some religious and cultural reasons such as praying and supplicating to support their loved one. Conclusions: This study emphasizes the importance of considering the cultural and religious dimensions in any family-witnessed resuscitation programs. The study recommends that family members of resuscitated patients should

  1. Families' stressors and needs at time of cardio-pulmonary resuscitation: a Jordanian perspective.

    Science.gov (United States)

    Masa'Deh, Rami; Saifan, Ahmad; Timmons, Stephen; Nairn, Stuart

    2013-12-01

    During cardio-pulmonary resuscitation, family members, in some hospitals, are usually pushed to stay out of the resuscitation room. However, growing literature implies that family presence during resuscitation could be beneficial. Previous literature shows controversial belief whether or not a family member should be present during resuscitation of their relative. Some worldwide association such as the American Heart Association supports family-witnessed resuscitation and urge hospitals to develop policies to ease this process. The opinions on family-witnessed resuscitation vary widely among various cultures, and some hospitals are not applying such policies yet. This study explores family members' needs during resuscitation in adult critical care settings. This is a part of larger study. The study was conducted in six hospitals in two major Jordanian cities. A purposive sample of seven family members, who had experience of having a resuscitated relative, was recruited over a period of six months. Semi-structured interview was utilised as the main data collection method in the study. The study findings revealed three main categories: families' need for reassurance; families' need for proximity; and families' need for support. The need for information about patient's condition was the most important need. Updating family members about patient's condition would reduce their tension and improve their acceptance for the end result of resuscitation. All interviewed family members wanted the option to stay beside their loved one at end stage of their life. Distinctively, most of family members want this option for some religious and cultural reasons such as praying and supplicating to support their loved one. This study emphasizes the importance of considering the cultural and religious dimensions in any family-witnessed resuscitation programs. The study recommends that family members of resuscitated patients should be treated properly by professional communication and

  2. [Changes in the international recommendations on neonatal stabilisation and resuscitation (2015)].

    Science.gov (United States)

    Zeballos Sarrato, Gonzalo; Salguero García, Enrique; Aguayo Maldonado, Josefa; Gómez Robles, Celia; Thió Lluch, Marta; Iriondo Sanz, Martín

    2017-01-01

    The International Liaison Committee on Resuscitation (ILCOR) recommendations provide a universal guide of measures to support the transition and resuscitation of newborn after their birth. This guide is expected to be adapted by local groups or committees on resuscitation, according to their own circumstances. The objective of this review is to analyse the main changes, to discuss several of the controversies that have appeared since 2010, and contrasting with other national and international organisations, such as European Resuscitation Council (ERC), American Heart Association (AHA), or the Australian-New Zealand Committee on Resuscitation (ANZCOR). Thus, the Neonatal Resuscitation Group of the Spanish Society of Neonatology (GRN-SENeo) aims to give clear answers to many of the questions when different options are available, generating the forthcoming recommendations of our country to support the transition and/or resuscitation of a newborn after birth, safely and effectively. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. The first 3 minutes: Optimising a short realistic paediatric team resuscitation training session.

    Science.gov (United States)

    McKittrick, Joanne T; Kinney, Sharon; Lima, Sally; Allen, Meredith

    2018-01-01

    Inadequate resuscitation leads to death or brain injury. Recent recommendations for resuscitation team training to complement knowledge and skills training highlighted the need for development of an effective team resuscitation training session. This study aimed to evaluate and revise an interprofessional team training session which addressed roles and performance during provision of paediatric resuscitation, through incorporation of real-time, real team simulated training episodes. This study was conducted applying the principles of action research. Two cycles of data collection, evaluation and refinement of a 30-40 minute resuscitation training session for doctors and nurses occurred. Doctors and nurses made up 4 groups of training session participants. Their responses to the training were evaluated through thematic analysis of rich qualitative data gathered in focus groups held immediately after each training session. Major themes included the importance of realism, teamwork, and reflective learning. Findings informed important training session changes. These included; committed in-situ training; team diversity; realistic resources; role flexibility, definition and leadership; increased debriefing time and the addition of a team goal. In conclusion, incorporation of interprofessional resuscitation training which addresses team roles and responsibilities into standard medical and nursing training will enhance preparedness for participation in paediatric resuscitation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Is there a place for crystalloids and colloids in remote damage control resuscitation?

    Science.gov (United States)

    Medby, Christian

    2014-05-01

    Crystalloids and colloids are used in prehospital fluid resuscitation to replace blood loss and preserve tissue perfusion until definite surgical control of bleeding can be achieved. However, large volumes of fluids will increase bleeding by elevating blood pressure, dislodging blood clots, and diluting coagulation factors and platelets. Hypotensive fluid resuscitation strategies are used to avoid worsening of uncontrolled bleeding. This is largely supported by animal studies. Most clinical evidence suggests that restricting fluid therapy is associated with improved outcome. Remote damage control resuscitation emphasizes the early use of blood products and restriction of other fluids to support coagulation and tissue oxygenation. Controversy regarding the optimal choice and composition of resuscitation fluids is ongoing. Compared with crystalloids, less colloid is needed for the same expansion of intravascular volume. On the other hand, colloids may cause coagulopathy not only related to dilution. The most important advantage of using colloids is logistical because less volume and weight are needed. In conclusion, prehospital fluid resuscitation is considered the standard of care, but there is little clinical evidence supporting the use of either crystalloids or colloids in remote damage control resuscitation. Alternative resuscitation fluids are needed.

  5. A Rat Model of Ventricular Fibrillation and Resuscitation by Conventional Closed-chest Technique

    Science.gov (United States)

    Lamoureux, Lorissa; Radhakrishnan, Jeejabai; Gazmuri, Raúl J.

    2015-01-01

    A rat model of electrically-induced ventricular fibrillation followed by cardiac resuscitation using a closed chest technique that incorporates the basic components of cardiopulmonary resuscitation in humans is herein described. The model was developed in 1988 and has been used in approximately 70 peer-reviewed publications examining a myriad of resuscitation aspects including its physiology and pathophysiology, determinants of resuscitability, pharmacologic interventions, and even the effects of cell therapies. The model featured in this presentation includes: (1) vascular catheterization to measure aortic and right atrial pressures, to measure cardiac output by thermodilution, and to electrically induce ventricular fibrillation; and (2) tracheal intubation for positive pressure ventilation with oxygen enriched gas and assessment of the end-tidal CO2. A typical sequence of intervention entails: (1) electrical induction of ventricular fibrillation, (2) chest compression using a mechanical piston device concomitantly with positive pressure ventilation delivering oxygen-enriched gas, (3) electrical shocks to terminate ventricular fibrillation and reestablish cardiac activity, (4) assessment of post-resuscitation hemodynamic and metabolic function, and (5) assessment of survival and recovery of organ function. A robust inventory of measurements is available that includes – but is not limited to – hemodynamic, metabolic, and tissue measurements. The model has been highly effective in developing new resuscitation concepts and examining novel therapeutic interventions before their testing in larger and translationally more relevant animal models of cardiac arrest and resuscitation. PMID:25938619

  6. Effects of volume and composition of the resuscitative fluids in the treatment of hemorrhagic shock

    Directory of Open Access Journals (Sweden)

    Pushpa Sharma

    2012-01-01

    Full Text Available Objectives: To evaluate the effectiveness of normal saline, hypertonic saline, and Ringer′s lactate solution followed by blood infusion in ameliorating the physiological, biochemical, and organ functions following hemorrhagic shock (HS in rats. Materials and Methods: Anesthetized, male Sprague-Dawley rats underwent computer-controlled HS, and were randomly divided into five groups consisting of (1 sham, (2 HS without resuscitation, (3 resuscitation with normal saline, (4 resuscitation with hypertonic saline, and (5 resuscitation with Ringer′s lactate solution. All resuscitated animals were infused with subsequent infusion of shed blood. Animals were continuously monitored for physiological, hemodynamic, biochemical parameters, and organ dysfunctions. Results: Non-resuscitated animals were unable to survive due to hypotension, poor oxygen metabolism, and lactic acidosis. Although these HS related parameters were corrected by all the fluids used in this study, additional blood infusion was more effective than fluid resuscitation alone. Also, hypertonic saline was more effective than Ringer′s lactate solution, and normal saline was the least effective in preserving the liver and kidney functions and muscle damage. Conclusions: All crystalloid fluids were significantly more effective in reversing the HS outcome when used with blood infusion, but hypertonic salinewith blood was more effective in preventing the organ damage than Lactated Ringers solutions or normal saline in the treatment of HS.

  7. Attitudes towards the resuscitation of periviable infants: a national survey of American Muslim physicians.

    Science.gov (United States)

    Arzuaga, Bonnie; Adam, Huda; Ahmad, Maha; Padela, Aasim

    2016-03-01

    To examine the associations between American Muslim physicians' characteristics and intended behaviours towards resuscitation of 22- and 23-week gestation infants. This national survey of physician members of the Islamic Medical Association of North America inquired about physician religiosity, their practice of referring to Islamic resources for bioethical guidance, their preferred model of patient-doctor decision-making and the perceived importance of quality-of-life determinations with respect to medical decision-making. Four vignettes described birth of a 22- and a 23-week gestation infant. Respondents were given estimated survival data for each and asked whether they would attempt resuscitation. A total of 255 of 626 responses received. About 51% and 85% of respondents believed that a 22- and a 23-week gestation infant should be resuscitated, respectively. If parents opposed resuscitation, 44% (22 weeks) and 46% (23 weeks) of respondents still endorsed resuscitating. Respondents who were more religious, referred more often to Islamic bioethical resources and did not believe that quality-of-life determinations were tied to life's value had greater odds of endorsing resuscitation in many of the scenarios. American Muslim physicians have high rates of support for delivery room resuscitation of periviable infants. Their intended behaviour appears to associate with religious values. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  8. Forensic aspect of cause of subendocardial hemorrhage in cardiopulmonary resuscitation cases: chest compression or adrenaline.

    Science.gov (United States)

    Charaschaisri, Werasak; Jongprasartsuk, Kesanee; Rungruanghiranya, Suthat; Kaufman, Larry

    2011-03-01

    Subendocardial hemorrhage (SEH) is a striking feature seen in many forensic autopsy cases. It was believed earlier to represent an agonal phenomenon without any particular reference to the cause of death. However, the latest study showed that even minor SEH might have an influence on cardiac function and might be involved in the mechanism of death. To rule out the possible cause of SEH from defibrillation, autopsies were performed in 240 adults admitted to Department of Forensic Medicine, Faculty of Medicine, Srinakarinwirot University and Department of Forensic Medicine, Faculty of Medicine, Chulalongkorn University between July 2006 and June 2008. All the subjects were subdivided into 2 groups: one group receiving resuscitation and the other group receiving no resuscitation. In the former group, 76 patients had attempted cardiopulmonary resuscitation with adrenaline and 44 patients without adrenaline. While in the latter group, 120 patients received no resuscitation attempt. Approximately, 43.4% of resuscitation with adrenaline cases (33/76) demonstrated SEH in contrast to 4 cases of resuscitation without adrenaline (9.1%, P < 0.05). This demonstrates an increasing trend of SEH in cases with prolonged resuscitation and higher level of adrenaline utilizations.

  9. Early cerebral metabolic crisis after TBI influences outcome despite adequate hemodynamic resuscitation.

    Science.gov (United States)

    Stein, Nathan R; McArthur, David L; Etchepare, Maria; Vespa, Paul M

    2012-08-01

    Optimal resuscitation after traumatic brain injury (TBI) remains uncertain. We hypothesize that cerebral metabolic crisis is frequent despite adequate resuscitation of the TBI patient and that metabolic crisis negatively influences outcome. We assessed the effectiveness of a standardized trauma resuscitation protocol in 89 patients with moderate to severe TBI, and determined the frequency of adequate resuscitation. Prospective hourly values of heart rate, blood pressure, pulse oximetry, intracranial pressure (ICP), respiratory rate, jugular venous oximetry, and brain extracellular values of glucose, lactate, pyruvate, glycerol, and glutamate were obtained. The incidence during the initial 72 h after injury of low brain glucose 25, and metabolic crisis, defined as the simultaneous occurrence of both low glucose and high LPR, were determined for the group. 5 patients were inadequately resuscitated and eight patients had intractable ICP. In patients with successful resuscitation and controlled ICP (n = 76), within 72 h of trauma, 76% had low glucose, 93% had elevated LPR, and 74% were in metabolic crisis. The duration of metabolic crisis was longer in those patients with unfavorable (GOSe ≤ 6) versus favorable (GOSe ≥ 7) outcome at 6 months (P = 0.011). In four multivariate models the burden of metabolic crisis was a powerful independent predictor of poor outcome. Metabolic crisis occurs frequently after TBI despite adequate resuscitation and controlled ICP, and is a strong independent predictor of poor outcome at 6 months.

  10. Impact of Standardized Communication Techniques on Errors during Simulated Neonatal Resuscitation.

    Science.gov (United States)

    Yamada, Nicole K; Fuerch, Janene H; Halamek, Louis P

    2016-03-01

    Current patterns of communication in high-risk clinical situations, such as resuscitation, are imprecise and prone to error. We hypothesized that the use of standardized communication techniques would decrease the errors committed by resuscitation teams during neonatal resuscitation. In a prospective, single-blinded, matched pairs design with block randomization, 13 subjects performed as a lead resuscitator in two simulated complex neonatal resuscitations. Two nurses assisted each subject during the simulated resuscitation scenarios. In one scenario, the nurses used nonstandard communication; in the other, they used standardized communication techniques. The performance of the subjects was scored to determine errors committed (defined relative to the Neonatal Resuscitation Program algorithm), time to initiation of positive pressure ventilation (PPV), and time to initiation of chest compressions (CC). In scenarios in which subjects were exposed to standardized communication techniques, there was a trend toward decreased error rate, time to initiation of PPV, and time to initiation of CC. While not statistically significant, there was a 1.7-second improvement in time to initiation of PPV and a 7.9-second improvement in time to initiation of CC. Should these improvements in human performance be replicated in the care of real newborn infants, they could improve patient outcomes and enhance patient safety. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  11. Do-not-resuscitate status and observational comparative effectiveness research in patients with septic shock*.

    Science.gov (United States)

    Bradford, Mark A; Lindenauer, Peter K; Wiener, Renda Soylemez; Walkey, Allan J

    2014-09-01

    To assess the importance of including do-not-resuscitate status in critical care observational comparative effectiveness research. Retrospective analysis. All California hospitals participating in the 2007 California State Inpatient Database, which provides do-not-resuscitate status within the first 24 hours of admission. Septic shock present at admission. None. We investigated the association of early do-not-resuscitate status with in-hospital mortality among patients with septic shock. We also examined the strength of confounding of do-not-resuscitate status on the association between activated protein C therapy and mortality, an association with conflicting results between observational and randomized studies. We identified 24,408 patients with septic shock; 19.6% had a do-not-resuscitate order. Compared with patients without a do-not-resuscitate order, those with a do-not-resuscitate order were significantly more likely to be older (75 ± 14 vs 67 ± 16 yr) and white (62% vs 53%), with more acute organ failures (1.44 ± 1.15 vs 1.38 ± 1.15), but fewer inpatient interventions (1.0 ± 1.0 vs 1.4 ± 1.1). Adding do-not-resuscitate status to a model with 47 covariates improved mortality discrimination (c-statistic, 0.73-0.76; p observational and randomized studies of activated protein C. Inclusion of early do-not-resuscitate status into more administrative databases may improve observational comparative effectiveness methodology.

  12. A survey of delivery room resuscitation practices in the United States.

    Science.gov (United States)

    Leone, Tina A; Rich, Wade; Finer, Neil N

    2006-02-01

    To determine current resuscitation practices of neonatologists in the United States. A 15-question survey was developed and mailed to neonatal directors in May 2004. Of the total of 797 surveys mailed, 84 were returned undeliverable or unanswered and 450 were returned completed (63% response rate). Respondents were mainly (70%) from level III NICUs. Most programs resuscitate newborns in the delivery room (83%), rather than in a separate room. The number and background of individuals attending deliveries vary greatly, with 31% of programs having inflating bags are most commonly used (51%), followed by self-inflating bags (40%) and T-piece resuscitators (14%). Pulse oximeters are used during resuscitation by 52% of programs, and 23% of respondents indicated that there was a useful signal within 1 minute after application. Blenders are available for 42% of programs, of which 77% use pure oxygen for the initial resuscitation and 68% use oximeters to alter the fraction of inspired oxygen. Thirty-two percent of programs use carbon dioxide detectors to confirm intubation, 48% routinely and 43% when there is difficulty confirming intubation. Preterm infants are wrapped with plastic wrap to prevent heat loss in 29% of programs, of which 77% dry the infant before wrap application. A majority of programs (76%) attempt to provide continuous positive airway pressure or positive end expiratory pressure (PEEP) during resuscitation, most commonly with a flow-inflating bag (58%), followed by a self-inflating bag with PEEP valve (19%) and T-piece resuscitator (16%). A level of 5 cm H2O is used by 55% of programs. Substantial variations exist in neonatal resuscitation practices, some of which are not addressed in standard guidelines. Future guidelines should include recommendations regarding the use of blenders, oximeters, continuous positive airway pressure/PEEP, and plastic wrap during resuscitation.

  13. Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey

    Directory of Open Access Journals (Sweden)

    Robert S. Green

    2016-09-01

    Full Text Available Introduction: Respiratory failure is a common problem in emergency medicine (EM and critical care medicine (CCM. However, little is known about the resuscitation of critically ill patients prior to emergency endotracheal intubation (EETI. Our aim was to describe the resuscitation practices of EM and CCM physicians prior to EETI. Methods: A cross-sectional survey was developed and tested for content validity and retest reliability by members of the Canadian Critical Care Trials Group. The questionnaire was distributed to all EM and CCM physician members of three national organizations. Using three clinical scenarios (trauma, pneumonia, congestive heart failure, we assessed physician preferences for use and types of fluid and vasopressor medication in pre-EETI resuscitation of critically ill patients. Results: In total, 1,758 physicians were surveyed (response rate 50.2%, 882/1,758. Overall, physicians would perform pre-EETI resuscitation using either fluids or vasopressors in 54% (1,193/2,203 of cases. Most physicians would “always/often” administer intravenous fluid pre-EETI in the three clinical scenarios (81%, 1,484/1,830. Crystalloids were the most common fluid physicians would “always/often” administer in congestive heart failure (EM 43%; CCM 44%, pneumonia (EM 97%; CCM 95% and trauma (EM 96%; CCM 96%. Pre-EETI resuscitation using vasopressors was uncommon (4.9%. Training in CCM was associated with performing pre-EETI resuscitation (odds ratio, 2.20; 95% CI, [1.44-3.36], p<0.001. Conclusion: Pre-EETI resuscitation is common among Canadian EM and CCM physicians. Most physicians use crystalloids pre-EETI as a resuscitation fluid, while few would give vasopressors. Physicians with CCM training were more likely to perform pre-EETI resuscitation.

  14. Impact of hemoglobin nitrite to nitric oxide reductase on blood transfusion for resuscitation from hemorrhagic shock

    Directory of Open Access Journals (Sweden)

    Chad Brouse

    2015-01-01

    Full Text Available Background: Transfusion of blood remains the gold standard for fluid resuscitation from hemorrhagic shock. Hemoglobin (Hb within the red blood cell transports oxygen and modulates nitric oxide (NO through NO scavenging and nitrite reductase. Aims: This study was designed to examine the effects of incorporating a novel NO modulator, RRx-001, on systemic and microvascular hemodynamic response after blood transfusion for resuscitation from hemorrhagic shock in a hamster window chamber model. In addition, to RRx-001 the role of low dose of nitrite (1 × 10−9 moles per animal supplementation after resuscitation was studied. Materials and Methods: Severe hemorrhage was induced by arterial controlled bleeding of 50% of the blood volume (BV and the hypovolemic state was maintained for 1 h. The animals received volume resuscitation by an infusion of 25% of BV using fresh blood alone or with added nitrite, or fresh blood treated with RRx-001 (140 mg/kg or RRx-001 (140 mg/kg with added nitrite. Systemic and microvascular hemodynamics were followed at baseline and at different time points during the entire study. Tissue apoptosis and necrosis were measured 8 h after resuscitation to correlate hemodynamic changes with tissue viability. Results: Compared to resuscitation with blood alone, blood treated with RRx-001 decreased vascular resistance, increased blood flow and functional capillary density immediately after resuscitation and preserved tissue viability. Furthermore, in RRx-001 treated animals, both mean arterial pressure (MAP and met Hb were maintained within normal levels after resuscitation (MAP >90 mmHg and metHb <2%. The addition of nitrite to RRx-001 did not significantly improve the effects of RRx-001, as it increased methemoglobinemia and lower MAP. Conclusion: RRx-001 alone enhanced perfusion and reduced tissue damage as compared to blood; it may serve as an adjunct therapy to the current gold standard treatment for resuscitation from

  15. Adherence to ATLS primary and secondary surveys during pediatric trauma resuscitation.

    Science.gov (United States)

    Carter, Elizabeth A; Waterhouse, Lauren J; Kovler, Mark L; Fritzeen, Jennifer; Burd, Randall S

    2013-01-01

    Adherence to Advanced Trauma Life Support (ATLS) protocol has been associated with improved management of injured patients. The objective of this study is to determine factors associated with delayed and omitted ATLS primary and secondary survey tasks at a level 1 pediatric trauma center. Video recorded resuscitations of 237 injured patients ATLS. Multivariate analyses were performed to identify features associated with decreased ATLS performance. Primary survey findings were stated less often in patients with burn injuries compared to those with blunt injuries (RR=1.72; 95% CI: 1.26-2.35) and less often during the overnight shift [11 PM-7 AM] (RR=1.22; 95% CI: 1.02-1.46). Secondary survey findings were verbalized less often in patients with penetrating injures (RR=2.30; 95% CI: 1.06-5.00). Time to statement of primary surveys findings was delayed in patients with burn injuries (HR=0.69; 95% CI: 0.48-0.98) and among those transferred from another hospital. Completeness and timeliness of ATLS task performance were not associated with age or injury severity score. Mechanism of injury and hospital factors are associated with incomplete and delayed primary and secondary surveys. Interventions that address deficient ATLS adherence related to these factors may lead to a reduction in errors during this critical period of patient care. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  16. Association of bystander cardiopulmonary resuscitation and survival according to ambulance response-times after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik

    2016-01-01

    Background: Bystander-initiated cardiopulmonary resuscitation (CPR) increases patient survival after out-of-hospital cardiac arrest, but it is unknown to what degree bystander CPR remains positively associated with survival with increasing time to potential defibrillation. The main objective...... was to examine the association of bystander CPR with survival as time to advanced treatment increases. Methods: We studied 7623 out-of-hospital cardiac arrest patients between 2005 and 2011, identified through the nationwide Danish Cardiac Arrest Registry. Multiple logistic regression analysis was used...... out-of-hospital cardiac arrest statistics, an additional 233 patients could potentially be saved annually if response time was reduced from 10 to 5 minutes and 119 patients if response time was reduced from 7 (the median response time in this study) to 5 minutes. Conclusions: The absolute survival...

  17. Assessing Decision Making Capacity for Do Not Resuscitate Requests in Depressed Patients: How to Apply the "Communication" and "Appreciation" Criteria.

    Science.gov (United States)

    Brody, Benjamin D; Meltzer, Ellen C; Feldman, Diana; Penzner, Julie B; Gordon-Elliot, Janna S

    2017-12-01

    The Patient Self Determination Act (PSDA) of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient's preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity (DMC). In general, patients are presumed to have DMC. A patient's DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders.

  18. Indication for resuscitative thoracotomy in thoracic injuries-Adherence to the ATLS guidelines. A forensic autopsy based evaluation

    DEFF Research Database (Denmark)

    Ohrt-Nissen, S; Colville-Ebeling, B; Kandler, K

    2016-01-01

    BACKGROUND: The appropriate indications for Resuscitative Thoracotomy (RT) are still debated in the literature and various guidelines have been proposed. This study aimed to evaluate whether Advanced Trauma Life Support (ATLS) guidelines for RT were applied correctly and to evaluate the proportion...... caused by a traumatic event with trauma team activation. Patient cases were blinded for any surgical intervention and evaluated independently by two reviewers for indications or contraindications for RT as determined by the ATLS guidelines. Second, autopsy reports were evaluated for the presence of PRTL......%) patients. CONCLUSIONS: Agreement with ATLS guidelines for RT was 63% for intervention and 100% for non-intervention in deceased patients with thoracic trauma. Agreement was higher for penetrating trauma than for blunt trauma. The adherence to guidelines did not improve the ability to predict autopsy...

  19. Fluid resuscitation protocols for burn patients at intensive care units of the United Kingdom and Ireland

    Directory of Open Access Journals (Sweden)

    Al-Benna, Sammy

    2011-01-01

    Full Text Available Introduction: The objective of this study was to determine the thermal injury fluid resuscitation protocols at intensive care units (ICUs in the United Kingdom and Ireland. Materials and methods: A telephone questionnaire was designed to survey the fluid resuscitation protocols of ICUs at all hospitals with plastic/burn surgery departments in the British Isles in 2010. The feedback from the questionnaire was from the senior nurse in charge of the ICUs. Results: 32/64 (50% of these ICUs had provided care to burns patients. A 100% response from these 32 units was obtained. 71.4% commence fluid resuscitation at 15% total body surface area burn (TBSA, 21.4% at 20% TBSA and 7.1% at 10% TBSA in adults. The estimated resuscitation volume was most often calculated using the Parkland/Modified Parkland formula (87.5% or the Muir and Barclay formula (12.5%. Interestingly, of the ICUs using formulae, two had recently moved from using the Muir and Barclay formula to Parkland formula and one had recently moved from using the Parkland formula to Muir and Barclay formula. Despite this, 37.5% of ICUs using a formula did not rigidly follow it exactly. The most commonly used resuscitation fluid was Ringer’s lactate solution (46.9% and Human Albumin Solution was used in 12.5%. No ICU used red cell concentrate as a first line fluid. 18.8% used a central line. 40.6% ICUs considered changing the IV solution during resuscitation. 78.1% ICUs consider urine output to be the most important factor in modifying resuscitation volumes. 59.4% ICUs calculate a maintenance fluid rate after completion of resuscitation. The endpoint for resuscitation was at 24 h in 46.9% ICUs and at 36 h in 9.4%. 5/32 (16% felt their protocol gave too little and 6/32 (19% felt their protocol gave too much. 59.3% ICUs gave oral/enteral fluids by naso-gastric or naso-jejenal tubes. 21.9% felt that oral/enteral resuscitation worked. Exactly half of the units believed that the formula that they used

  20. Recommendations in dispatcher-assisted bystander resuscitation from emergency call center.

    Science.gov (United States)

    García del Águila, J; López-Messa, J; Rosell-Ortiz, F; de Elías Hernández, R; Martínez del Valle, M; Sánchez-Santos, L; López-Herce, J; Cerdà-Vila, M; Roza-Alonso, C L; Bernardez-Otero, M

    2015-01-01

    Dispatch-assisted bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest has been shown as an effective measure to improve the survival of this process. The development of a unified protocol for all dispatch centers of the different emergency medical services can be a first step towards this goal in our environment. The process of developing a recommendations document and the realization of posters of dispatch-assisted cardiopulmonary resuscitation, agreed by different actors and promoted by the Spanish Resuscitation Council, is presented. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  1. Protocolised Management In Sepsis (ProMISe): a multicentre randomised controlled trial of the clinical effectiveness and cost-effectiveness of early, goal-directed, protocolised resuscitation for emerging septic shock.

    Science.gov (United States)

    Mouncey, Paul R; Osborn, Tiffany M; Power, G Sarah; Harrison, David A; Sadique, M Zia; Grieve, Richard D; Jahan, Rahi; Tan, Jermaine C K; Harvey, Sheila E; Bell, Derek; Bion, Julian F; Coats, Timothy J; Singer, Mervyn; Young, J Duncan; Rowan, Kathryn M

    2015-11-01

    Early goal-directed therapy (EGDT) is recommended in international guidance for the resuscitation of patients presenting with early septic shock. However, adoption has been limited and uncertainty remains over its clinical effectiveness and cost-effectiveness. The primary objective was to estimate the effect of EGDT compared with usual resuscitation on mortality at 90 days following randomisation and on incremental cost-effectiveness at 1 year. The secondary objectives were to compare EGDT with usual resuscitation for requirement for, and duration of, critical care unit organ support; length of stay in the emergency department (ED), critical care unit and acute hospital; health-related quality of life, resource use and costs at 90 days and at 1 year; all-cause mortality at 28 days, at acute hospital discharge and at 1 year; and estimated lifetime incremental cost-effectiveness. A pragmatic, open, multicentre, parallel-group randomised controlled trial with an integrated economic evaluation. Fifty-six NHS hospitals in England. A total of 1260 patients who presented at EDs with septic shock. EGDT (n = 630) or usual resuscitation (n = 630). Patients were randomly allocated 1 : 1. All-cause mortality at 90 days after randomisation and incremental net benefit (at £20,000 per quality-adjusted life-year) at 1 year. Following withdrawals, data on 1243 (EGDT, n = 623; usual resuscitation, n = 620) patients were included in the analysis. By 90 days, 184 (29.5%) in the EGDT and 181 (29.2%) patients in the usual-resuscitation group had died [p = 0.90; absolute risk reduction -0.3%, 95% confidence interval (CI) -5.4 to 4.7; relative risk 1.01, 95% CI 0.85 to 1.20]. Treatment intensity was greater for the EGDT group, indicated by the increased use of intravenous fluids, vasoactive drugs and red blood cell transfusions. Increased treatment intensity was reflected by significantly higher Sequential Organ Failure Assessment scores and more advanced

  2. [Basic resuscitation of adults and automatic external defibrillation].

    Science.gov (United States)

    Berlac, Peter Anthony; Torp-Pedersen, Christian T; Lippert, Freddy K

    2008-11-17

    The new ERC guidelines on resuscitation emphasize the importance of quality CPR. BLS should be started as early as possible. Lay rescuers should not check for a pulse, they should call for help and start chest compressions immediately. Compression depth should be 4-5 cm at a rate of 100 compressions per minute. Chest compressions and ventilation should be performed in a ratio of 30:2. Lay rescuers should continue until professional help arrives. Lay rescuers may use the same procedure for children as recommended for adults. Professionals should, however, initiate CPR in children with 5 ventilations followed by a compression-ventilation ratio of 15:2. Automatic External Defibrillation should be used as early as possible.

  3. Code Carnivals: resuscitating Code Blue training with accelerated learning.

    Science.gov (United States)

    Keys, Vicky A; Malone, Peggy; Brim, Carla; Schoonover, Heather; Nordstrom, Cindy; Selzler, Melissa

    2009-12-01

    Nurses in the hospital setting must be knowledgeable about resuscitation procedures and proficient in the delivery of care during an emergency. They must be ready to implement their knowledge and skills at a moment's notice. A common dilemma for many nurses is that cardiopulmonary emergencies (Code Blues) are infrequent occurrences. Therefore, how do nurses remain competent and confident in their implementation of emergency skills while having limited exposure to the equipment and minimal experience in emergency situations? A team of nurse educators at a regional medical center in Washington State applied adult learning theory and accelerated learning techniques to develop and present a series of learning activities to enhance the staff's familiarity with emergency equipment and procedures. The series began with a carnival venue that provided hands-on practice and review of emergency skills and was reinforced with subsequent random unannounced code drills led by both educators and charge nurses. Copyright 2009, SLACK Incorporated.

  4. Colloids versus crystalloids for fluid resuscitation in critically ill patients.

    Science.gov (United States)

    Perel, Pablo; Roberts, Ian; Ker, Katharine

    2013-02-28

    Colloid solutions are widely used in fluid resuscitation of critically ill patients. There are several choices of colloid, and there is ongoing debate about the relative effectiveness of colloids compared to crystalloid fluids. To assess the effects of colloids compared to crystalloids for fluid resuscitation in critically ill patients. We searched the Cochrane Injuries Group Specialised Register (17 October 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library) (Issue 10, 2012), MEDLINE (Ovid) 1946 to October 2012, EMBASE (Ovid) 1980 to October 2012, ISI Web of Science: Science Citation Index Expanded (1970 to October 2012), ISI Web of Science: Conference Proceedings Citation Index-Science (1990 to October 2012), PubMed (October 2012), www.clinical trials.gov and www.controlled-trials.com. We also searched the bibliographies of relevant studies and review articles. Randomised controlled trials (RCTs) of colloids compared to crystalloids, in patients requiring volume replacement. We excluded cross-over trials and trials involving pregnant women and neonates. Two review authors independently extracted data and rated quality of allocation concealment. We analysed trials with a 'double-intervention', such as those comparing colloid in hypertonic crystalloid to isotonic crystalloid, separately. We stratified the analysis according to colloid type and quality of allocation concealment. We identified 78 eligible trials; 70 of these presented mortality data.COLLOIDS COMPARED TO CRYSTALLOIDS: Albumin or plasma protein fraction - 24 trials reported data on mortality, including a total of 9920 patients. The pooled risk ratio (RR) from these trials was 1.01 (95% confidence interval (CI) 0.93 to 1.10). When we excluded the trial with poor-quality allocation concealment, pooled RR was 1.00 (95% CI 0.92 to 1.09). Hydroxyethyl starch - 25 trials compared hydroxyethyl starch with crystalloids and included 9147 patients. The pooled RR was 1.10 (95% CI 1

  5. Subcapsular liver haematoma after cardiopulmonary resuscitation by untrained personnel.

    Science.gov (United States)

    Monsuez, Jean-Jacques; Charniot, Jean-Christophe; Veilhan, Luc Antoine; Mougué, Ferdinand; Bellin, Marie-France; Boissonnas, Alain

    2007-05-01

    Although early cardiopulmonary resuscitation (CPR) is associated with increased survival of sudden cardiac arrest victims, it may also result in miscellaneous injuries. A 25-year-old inebriated man rescued from drowning in a swimming pool was apnoeic and pulseless after being pulled out of the water. Successful CPR was provided by untrained bystanders, including abdominal thrusts thought to remove water from the airways and chest compressions to provide haemodynamic support. As the patient progressively improved during his subsequent hospital stay, he complained of right upper abdominal and thoracic pain. A computed tomographic scan showed a 11 cm subcapsular haematoma contiguous to the right hepatic lobe. A favourable outcome was obtained after conservative, non-operative treatment. Subcapsular haematoma of the liver is a potentially life threatening complication that warrants consideration in survivors of cardiac arrest who have received closed chest compression and/or abdominal thrusts.

  6. Model based optimization of the cardiopulmonary resuscitation (CPR) procedure.

    Science.gov (United States)

    Jalali, Ali; Berg, Robert A; Nadkarni, Vinay; Nataraj, C

    2012-01-01

    This paper is concerned with the optimization of the cardiopulmonary resuscitation (CPR) procedure, which plays a critical rule in saving the life of patients suffering from cardiac arrest. In this paper, we define the performance index for optimization using the oxygen delivery. A model developed earlier is used to calculate the oxygen delivery through CPR. The free parameters of this model which depend on the rescuer performance are ventilation time, compression speed, tidal volume, and fraction of oxygen in the inspired air. Two different optimization problems are carried out. First, a global optimization is implemented to discover the best values of the free parameters which maximize the oxygen delivery. In addition to this, a sequential optimization scheme is explored which uses a two step optimization in each CPR sequence to maximize the oxygen delivery. Results show that the sequential optimization procedure will enhance the performance of the CPR significantly.

  7. A large ventricular septal defect complicating resuscitation after blunt trauma

    Directory of Open Access Journals (Sweden)

    Henry D I De′Ath

    2012-01-01

    Full Text Available A young adult pedestrian was admitted to hospital after being hit by a car. On arrival to the Accident and Emergency Department, the patient was tachycardic, hypotensive, hypoxic, and acidotic with a Glasgow Coma Scale of 3. Despite initial interventions, the patient remained persistently hypotensive. An echocardiogram demonstrated a traumatic ventricular septal defect (VSD with right ventricular strain and increased pulmonary artery pressure. Following a period of stabilization, open cardiothoracic surgery was performed and revealed an aneurysmal septum with a single large defect. This was repaired with a bovine patch, resulting in normalization of right ventricular function. This case provides a vivid depiction of a large VSD in a patient following blunt chest trauma with hemodynamic compromise. In all thoracic trauma patients, and particularly those poorly responsive to resuscitation, VSDs should be considered. Relevant investigations and management strategies are discussed.

  8. Implementing Cardiopulmonary Resuscitation Training Programs in High Schools: Iowa's Experience.

    Science.gov (United States)

    Hoyme, Derek B; Atkins, Dianne L

    2017-02-01

    To understand perceived barriers to providing cardiopulmonary resuscitation (CPR) education, implementation processes, and practices in high schools. Iowa has required CPR as a graduation requirement since 2011 as an unfunded mandate. A cross-sectional study was performed through multiple choice surveys sent to Iowa high schools to collect data about school demographics, details of CPR programs, cost, logistics, and barriers to implementation, as well as automated external defibrillator training and availability. Eighty-four schools responded (26%), with the most frequently reported school size of 100-500 students and faculty size of 25-50. When the law took effect, 51% of schools had training programs already in place; at the time of the study, 96% had successfully implemented CPR training. Perceived barriers to implementation were staffing, time commitment, equipment availability, and cost. The average estimated startup cost was CPR training programs can be implemented with reasonable resource and time allocations. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Certified Basic Life Support Instructors Assess Cardiopulmonary Resuscitation Skills Poorly

    DEFF Research Database (Denmark)

    Hansen, Camilla; Rasmussen, Stinne E; Kristensen, Mette Amalie

    2016-01-01

    Introduction: High-quality cardiopulmonary resuscitation (CPR) improves survival from cardiac arrest. During basic life support (BLS) training, instructors assess CPR skills to enhance learning outcome. Emergency department staff and senior residents have been shown to assess chest compression...... out of 3 CPR cycles with 30±2 chest compressions at a depth of 50-60mm and rate of 100-120 min-1. Correct rescue breathing was defined as ≥50% efficient breaths in 3 CPR cycles with visible, but not excessive, manikin’s chest raise (for instructors) or a volume of 500-600 mL (manikin data).Results: We...... of CPR skills may be beneficial to ensure high-quality learning outcome.Author Disclosures: C. Hansen: None. S.E. Rasmussen: None. M.A. Nebsbjerg: None. M. Stærk: None. B. Løfgren: None....

  10. Retrospective investigation of cardiopulmonary resuscitation outcome in 146 exotic animals.

    Science.gov (United States)

    Onuma, Mamoru; Kondo, Hirotaka; Ono, Sadaharu; Murakami, Akiyoshi; Harada, Tomoko; Sano, Tadashi

    2017-09-29

    The outcomes of cardiopulmonary resuscitation (CPR) were retrospectively evaluated in 146 exotic animals including 20 pet birds, 47 rabbits, 34 hamsters, 18 ferrets, 7 turtles and 20 other small mammals in cardiopulmonary arrest (CPA) at presentation or during hospitalization at an animal clinic. The rates of return of spontaneous circulation, survival after CPR and discharge were 9.3, 2.3 and 1.2%, respectively. The mean success rate of CPR in animals included in this study was lower than those previously reported in dogs and cats. This might have been because of the challenges in effective chest compression, airway management and monitoring as well as establishment of intravenous catheterization route in exotic animals.

  11. Honoring do-not-attempt-resuscitation requests in schools.

    Science.gov (United States)

    Murray, Robert D; Antommaria, Armand H Matheny

    2010-05-01

    Increasingly, children and adolescents with complex chronic conditions are living in the community. Federal legislation and regulations facilitate their participation in school. Some of these children and adolescents and their families may wish to forego life-sustaining medical treatment, including cardiopulmonary resuscitation, because they would be ineffective or because the risks outweigh the benefits. Honoring these requests in the school environment is complex because of the limited availability of school nurses and the frequent lack of supporting state legislation and regulations. Understanding and collaboration on the part of all parties is essential. Pediatricians have an important role in helping school nurses incorporate a specific action plan into the student's individualized health care plan. The action plan should include both communication and comfort-care plans. Pediatricians who work directly with schools can also help implement policies, and professional organizations can advocate for regulations and legislation that enable students and their families to effectuate their preferences.

  12. Laboratory evaluation of the Vortran Automatic Resuscitator Model RTM.

    Science.gov (United States)

    Babic, Mark D; Chatburn, Robert L; Stoller, James K

    2007-12-01

    One device that has been proposed to address the need for emergency ventilation is the Vortran Automatic Resuscitator. To test the hypothesis that increasing load (ie, increasing resistance or decreasing compliance) significantly affects minute alveolar ventilation. A Vortran Automatic Resuscitator was connected to a passive lung model and we measured load with 8 combinations of 4 compliances (14, 28, 46, and 63 mL/cm H(2)O) and 2 resistances (20 and 42 cm H(2)O/L/s). Source gas flow was either 20 or 40 L/min. We measured tidal volume (V(T)), frequency, inspiratory time, expiratory time, peak inspiratory pressure, and intrinsic positive end-expiratory pressure. We calculated the ratio of inspiratory time to total cycle time (T(I)/T(tot)), minute ventilation, minute alveolar ventilation, and estimated P(aCO(2)). Raw data were summarized with descriptive statistics. A subset of the experimental data (outcome measures for conditions with high and low values for resistance, compliance, and source gas flow) was analyzed with a 2-level factorial design, with standard "design of experiments" procedure, including analysis of variance. Differences associated with p values < or = 0.05 were considered significant. Assuming the model lung represented a 68-kg adult, the measured V(T) ranged from a low of 1.7 mL/kg to a high of 16.7 mL/kg. T(I)/T(tot) was greatly affected by the input flow. At 40 L/min the average T(I)/T(tot) was 30%, and at 20 L/min T(I)/T(tot) was 52%. As the load increased, V(T) decreased and frequency increased. However, neither the minute ventilation nor the minute alveolar ventilation stayed constant. Minute ventilation ranged from 5.2 L/min to 11.3 L/min at 40 L/min source flow. More importantly, minute alveolar ventilation ranged from zero to 9.8 L/min, resulting in a calculated P(aCO(2)) range of over 100 mm Hg to 16 mm Hg, respectively. Indeed, calculated P(aCO(2)) was never in the normal range (35-45 mm Hg). "Design of experiments" analysis showed

  13. Manual versus mechanical cardiopulmonary resuscitation. An experimental study in pigs

    Directory of Open Access Journals (Sweden)

    Wohlfart Björn

    2010-10-01

    Full Text Available Abstract Background Optimal manual closed chest compressions are difficult to give. A mechanical compression/decompression device, named LUCAS, is programmed to give compression according to the latest international guidelines (2005 for cardiopulmonary resuscitation (CPR. The aim of the present study was to compare manual CPR with LUCAS-CPR. Methods 30 kg pigs were anesthetized and intubated. After a base-line period and five minutes of ventricular fibrillation, manual CPR (n = 8 or LUCAS-CPR (n = 8 was started and run for 20 minutes. Professional paramedics gave manual chest compression's alternating in 2-minute periods. Ventilation, one breath for each 10 compressions, was given to all animals. Defibrillation and, if needed, adrenaline were given to obtain a return of spontaneous circulation (ROSC. Results The mean coronary perfusion pressure was significantly (p Conclusions LUCAS-CPR gave significantly higher coronary perfusion pressure and significantly fewer rib fractures than manual CPR in this porcine model.

  14. Pre-resuscitation Lactate and Hospital Mortality in Prehospital Patients

    Science.gov (United States)

    Tobias, Adam Z.; Guyette, Francis X.; Seymour, Christopher W.; Suffoletto, Brian P.; Martin-Gill, Christian; Quintero, Jorge; Kristan, Jeffrey; Callaway, Clifton W.; Yealy, Donald M.

    2014-01-01

    Objective Serum lactate elevations are associated with morbidity and mortality in trauma patients, but their value in prehospital medical patients prior to resuscitation is unknown. We sought to assess the distribution of blood lactate concentrations prior to intravenous (IV) resuscitation and examine the association of elevation on in-hospital death. Methods A convenience sample of adult patients over 14 months who received an IV line by eight EMS agencies in Western Pennsylvania had lactate measurement prior to any IV treatment. We assessed the lactate values and any relationship between these and hospital mortality (our primary outcome) and admission to the intensive care unit (ICU). We also compared the ability of lactate to discriminate outcomes with a prehospital critical illness score using age, Glasgow Coma Score, and initial vital signs. Results We included 673 patients, among whom 71 (11%) were admitted to the ICU and 21 (3.1%) died in-hospital. Elevated lactate (≥2 mmol/L) occurred in 307 (46%) patients and was strongly associated with hospital death after adjustment for known covariates (odds ratio = 3.57, 95% confidence interval [CI]: 1.10, 11.6). Lactate ≥2 mmol/L had a modest sensitivity (76%) and specificity (55%), and discrimination for hospital death (area under the curve [AUC] = 0.66, 95%CI: 0.56, 0.75). Compared to the prehospital critical illness score alone (AUC = 0.69, 95% CI: 0.59, 0.80), adding lactate to the score offered modest improvement (net reclassification improvement = 0.63, 95%CI: 0.23, 1.01, p prehospital medical patient population was associated with hospital mortality. However, it is a modest predictor of outcome, offering similar discrimination to a prehospital critical illness score. PMID:24548128

  15. Hyaluronidase-Assisted Resuscitation in Kenya for Severely Dehydrated Children.

    Science.gov (United States)

    Zubairi, Hijab; Nelson, Brett D; Tulshian, Priyanka; Fredricks, Karla; Altawil, Zaid; Mireles, Sarah; Odongo, Fred; Burke, Thomas F

    2017-07-04

    Dehydration, mainly due to diarrheal illnesses, is a leading cause of childhood mortality worldwide. Intravenous (IV) therapy is the standard of care for patients who were unable to tolerate oral rehydration; however, placing IVs in fragile, dehydrated veins can be challenging. Studies in resource-rich settings comparing hyaluronidase-assisted subcutaneous rehydration with standard IV rehydration in children have demonstrated several benefits of subcutaneous rehydration, including time and success of line placement, ease of use, satisfaction, and cost-effectiveness. A single-arm trial assessing the feasibility of hyaluronidase-assisted subcutaneous resuscitation for the treatment of moderately to severely dehydrated individuals in western Kenya was conducted. Children aged 2 months or older who presented with moderately to severely dehydration clinically warranting parenteral rehydration and had at least 2 failed IV attempts were eligible. Study staff received training on standard dehydration management and hyaluronidase infusion processes. Children received all other standards of care. They were monitored from presentation and through discharge, with a 1-week phone follow-up. Predischarge surveys were completed by caregivers, and semistructured interviews with providers were performed. A total of 51 children were enrolled (median age, 13.0 months; interquartile range of 18 months). Fifty-one patients (100%) had severe dehydration. The median length of subcutaneous infusion was 3.0 hours (interquartile range [IQR], 2.95). The median total subcutaneous infusion was 700.0 mL (IQR, 420 mL). Median time to resolution of moderate to severe dehydration symptoms was 3.0 hours (IQR, 2.95 hours). There were no significant complications. Hyaluronidase-assisted subcutaneous resuscitation is a feasible alternative to IV hydration in moderately to severely dehydrated children with difficult to obtain IV access in resource-limited areas.

  16. A pilot randomized controlled trial of EKG for neonatal resuscitation.

    Directory of Open Access Journals (Sweden)

    Anup Katheria

    Full Text Available The seventh edition of the American Academy of Pediatrics Neonatal Resuscitation Program recommends the use of a cardiac monitor in infants that need resuscitation. Previous trials have shown that EKG heart rate is available before pulse rate from a pulse oximeter. To date no trial has looked at how the availability of electrocardiogram (EKG affects clinical interventions in the delivery room.To determine whether the availability of an EKG heart rate value and tracing to the clinical team has an effect on physiologic measures and related interventions during the stabilization of preterm infants.Forty (40 premature infants enrolled in a neuro-monitoring study (The Neu-Prem Trial: NCT02605733 who had an EKG monitor available were randomized to have the heart rate information from the bedside EKG monitor either displayed or not displayed to the clinical team. Heart rate, oxygen saturation, FiO2 and mean airway pressure from a data acquisition system were recorded every 2 seconds. Results were averaged over 30 seconds and the differences analyzed using two-tailed t-test. Interventions analyzed included time to first change in FiO2, first positive pressure ventilation, first increase in airway pressure, and first intubation.There were no significant differences in time to clinical interventions between the blinded and unblinded group, despite the unblinded group having access to a visible heart rate at 66 +/- 20 compared to 114 +/- 39 seconds for the blinded group (p < .0001. Pulse rate from oximeter was lower than EKG heart rate during the first 2 minutes of life, but this was not significant.EKG provides an earlier, and more accurate heart rate than pulse rate from an oximeter during stabilization of preterm infants, allowing earlier intervention. All interventions were started earlier in the unblinded EKG group but these numbers were not significant in this small trial. Earlier EKG placement before pulse oximeter placement may affect other

  17. Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: Conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation.

    Science.gov (United States)

    Siao, Fu-Yuan; Chiu, Chun-Chieh; Chiu, Chun-Wen; Chen, Ying-Chen; Chen, Yao-Li; Hsieh, Yung-Kun; Lee, Chien-Hui; Wu, Chang-Te; Chou, Chu-Chung; Yen, Hsu-Heng

    2015-07-01

    Refractory ventricular fibrillation, resistant to conventional cardiopulmonary resuscitation (CPR), is a life threatening rhythm encountered in the emergency department. Although previous reports suggest the use of extracorporeal CPR can improve the clinical outcomes in patients with prolonged cardiac arrest, the effectiveness of this novel strategy for refractory ventricular fibrillation is not known. We aimed to compare the clinical outcomes of patients with refractory ventricular fibrillation managed with conventional CPR or extracorporeal CPR in our institution. This is a retrospective chart review study from an emergency department in a tertiary referral medical center. We identified 209 patients presenting with cardiac arrest due to ventricular fibrillation between September 2011 and September 2013. Of these, 60 patients were enrolled with ventricular fibrillation refractory to resuscitation for more than 10 min. The clinical outcome of patients with ventricular fibrillation received either conventional CPR, including defibrillation, chest compression, and resuscitative medication (C-CPR, n = 40) or CPR plus extracorporeal CPR (E-CPR, n = 20) were compared. The overall survival rate was 35%, and 18.3% of patients were discharged with good neurological function. The mean duration of CPR was longer in the E-CPR group than in the C-CPR group (69.90 ± 49.6 min vs 34.3 ± 17.7 min, p = 0.0001). Patients receiving E-CPR had significantly higher rates of sustained return of spontaneous circulation (95.0% vs 47.5%, p = 0.0009), and good neurological function at discharge (40.0% vs 7.5%, p = 0.0067). The survival rate in the E-CPR group was higher (50% vs 27.5%, p = 0.1512) at discharge and (50% vs 20%, p = 0. 0998) at 1 year after discharge. The management of refractory ventricular fibrillation in the emergency department remains challenging, as evidenced by an overall survival rate of 35% in this study. Patients with refractory ventricular fibrillation receiving E

  18. The impact of television fiction on public expectations of survival following inhospital cardiopulmonary resuscitation by medical professionals.

    Science.gov (United States)

    Van den Bulck, Jan J M

    2002-12-01

    Research has shown that the public overestimates the survival chances of patients after cardiopulmonary resuscitation. Other studies have suggested that demonstrably exaggerated survival rates in medical television fiction might affect these estimates. Such studies were mostly conducted in the United States, dealt with cardiopulmonary resuscitation in general, and asked respondents to indicate their source of medical information, an unreliable survey technique. To examine whether public perceptions of survival after inhospital cardiopulmonary resuscitation by physicians and nurses is related to the consumption of medical drama, without relying on respondents' self-reports of what influences them. To examine whether training in basic cardiopulmonary resuscitation techniques mediates this relationship. A random sample of 820 third and fifth year secondary school students completed a questionnaire in which they indicated their consumption of medical television fiction, their practical knowledge of cardiopulmonary resuscitation techniques, and their estimates of the survival rate after inhospital cardiopulmonary resuscitation. A relationship was found between the consumption of medical television drama and higher estimates of cardiopulmonary resuscitation survival. Practical knowledge of cardiopulmonary resuscitation also resulted in increased estimated survival rates. An interaction effect of drama and practical knowledge was found. Respondents with practical knowledge were less affected by television. The consumption of medical television drama is related to overestimating survival chances after inhospital resuscitation by physicians and nurses following cardiopulmonary arrest. A practical knowledge of basic cardiopulmonary resuscitation techniques moderates but does not eliminate the television effect.

  19. Associations of Hospital and Patient Characteristics with Fluid Resuscitation Volumes in Patients with Severe Sepsis

    DEFF Research Database (Denmark)

    Hjortrup, Peter Buhl; Haase, Nicolai; Wetterslev, Jørn

    2016-01-01

    characteristics and fluid resuscitation volumes in ICU patients with severe sepsis. METHODS: We explored the 6S trial database of ICU patients with severe sepsis needing fluid resuscitation randomised to hydroxyethyl starch 130/0.42 vs. Ringer's acetate. Our primary outcome measure was fluid resuscitation volume...... and secondary outcome total fluid input administered from 24 hours before randomisation until the end of day 3 post-randomisation. We performed multivariate analyses with hospital and patient baseline characteristics as covariates to assess associations with fluid volumes given. RESULTS: We included 654....... The data indicate variations in clinical practice not explained by patient characteristics emphasizing the need for RCTs assessing fluid resuscitation volumes fluid in patients with sepsis....

  20. Evaluating Neonatal Resuscitation Skills of Nursing and Midwifery Students Using Objective Structured Clinical Examination (OSCE

    Directory of Open Access Journals (Sweden)

    Javad Malekzadeh

    2015-07-01

    Conclusion: The students’ skills in neonatal resuscitation were lower than expected. As competence in this area is of high significance for the improvement of neonatal outcomes, holding training workshops through applying novel training methods is recommended.

  1. "In the beginning...": tools for talking about resuscitation and goals of care early in the admission.

    Science.gov (United States)

    White, Jocelyn; Fromme, Erik K

    2013-11-01

    Quality standards no longer allow physicians to delay discussing goals of care and resuscitation. We propose 2 novel strategies for discussing goals and resuscitation on admission. The first, SPAM (determine Surrogate decision maker, determine resuscitation Preferences, Assume full care, and advise them to expect More discussion especially with clinical changes), helps clinicians discover patient preferences and decision maker during routine admissions. The second, UFO-UFO (Understand what they know, Fill in knowledge gaps, ask about desired Outcomes, Understand their reasoning, discuss the spectrum Feasible Outcomes), helps patients with poor or uncertain prognosis or family-team conflict. Using a challenging case example, this article illustrates how SPAM and UFO-UFO can help clinicians have patient-centered resuscitation and goals of care discussions at the beginning of care.

  2. Hypertonic Saline Resuscitation Restores Inflammatory Cytokine Balance in Post-Traumatic Hemorrhagic Shock Patients

    National Research Council Canada - National Science Library

    Rhind, Shawn G; Rizoli, Sandro B; Shek, Pang N; Inaba, Kenji; Filips, Dennis; Tien, Homer; Brenneman, Fred; Rotstein, Ori D

    2004-01-01

    .... Early monocyte dysregulation and excessive pro-inflammatory cytokine production are thought to play a key role in the development of post-traumatic multi-organ dysfunction in resuscitated trauma patients...

  3. Knowledge and preferences regarding cardiopulmonary resuscitation : A survey among older patients

    NARCIS (Netherlands)

    Zijlstra, Trudy J.; Leenman-Dekker, Sonja J.; Oldenhuis, Hilbrand K. E.; Bosveld, Henk E. P.; Berendsen, Annette J.

    Objective: Survival rates following cardiopulmonary resuscitation (CPR) are low for older people, and are associated with a high risk of neurological damage. This study investigated the relationship between the preferences, knowledge of survival chances, and characteristics among older people

  4. Permissive Hypotension Strategies for the Far-Forward Fluid Resuscitation of Significant Hemorrhage

    National Research Council Canada - National Science Library

    Dubick, Michael A; Atkins, James L

    2004-01-01

    ... within the Army's Combat Casualty Care Research Program is focused to investigate limited- or small-volume fluid resuscitation strategies, including permissive hypotension, in far forward areas for the treatment...

  5. Changing attitudes to cardiopulmonary resuscitation in older people: a 15-year follow-up study.

    LENUS (Irish Health Repository)

    Cotter, P E

    2009-03-01

    while it is well established that individual patient preferences regarding cardiopulmonary resuscitation (CPR) may change with time, the stability of population preferences, especially during periods of social and economic change, has received little attention.

  6. Structured communication: teaching delivery of difficult news with simulated resuscitations in an emergency medicine clerkship

    National Research Council Canada - National Science Library

    Lamba, Sangeeta; Nagurka, Roxanne; Offin, Michael; Scott, Sandra R

    2015-01-01

    The objective is to describe the implementation and outcomes of a structured communication module used to supplement case-based simulated resuscitation training in an emergency medicine (EM) clerkship...

  7. Evolution of peripheral vs metabolic perfusion parameters during septic shock resuscitation. A clinical-physiologic study

    NARCIS (Netherlands)

    Hernandez, Glenn; Pedreros, Cesar; Veas, Enrique; Bruhn, Alejandro; Romero, Carlos; Rovegno, Maximiliano; Neira, Rodolfo; Bravo, Sebastian; Castro, Ricardo; Kattan, Eduardo; Ince, Can

    2012-01-01

    Purpose: Perfusion assessment during septic shock resuscitation is difficult and usually complex determinations. Capillary refill time (CRT) and central-to-toe temperature difference (Tc-toe) have been proposed as objective reproducible parameters to evaluate peripheral perfusion. The comparative

  8. The amplitude spectrum area correctly predicts improved resuscitation and facilitated defibrillation with head cooling.

    Science.gov (United States)

    Tsai, Min-Shan; Barbut, Denise; Guan, Jun; Bisera, Joe; Inderbitzen, Becky; Weil, Max Harry; Tang, Wanchun

    2008-11-01

    When systemic hypothermia was maintained before inducing cardiac arrest, the likelihood of successful defibrillation and meaningful survival was increased. When hypothermia is induced during cardiopulmonary resuscitation, mortality is also improved. With the introduction of the amplitude spectrum area as a predictor of the success of electrical defibrillation, we investigated the effect of preferential head cooling initiated coincident with cardiopulmonary resuscitation on amplitude spectrum area as a predictor. We hypothesized that rapid head cooling initiated coincident with cardiopulmonary resuscitation improves amplitude spectrum area, and therefore is predictive of successful defibrillation. Prospective randomized controlled study. University-affiliated research institute. Domestic pigs. Sixteen pigs, weighing 40.6 +/- 1.4 kg, were randomized to the hypothermia (n = 8), or control (n = 8) group. Ventricular fibrillation was induced and untreated for 10 mins. Cardiopulmonary resuscitation was then initiated for 5 mins followed by attempted defibrillation with a biphasic 150-J electric shock. Coincident with starting cardiopulmonary resuscitation, hypothermia was induced with evaporative intranasal cooling using a perfluorochemical. If spontaneous circulation was not restored after defibrillation, cardiopulmonary resuscitation was resumed for 1 min before the next defibrillation attempt until the animal was either successfully resuscitated or for a total of 15 mins. The target core temperature was 34 degrees C. Control animals were identically treated except for hypothermia. Five seconds of ventricular fibrillation waveform were recorded immediately preceding delivery of a shock. The ventricular fibrillation waveforms were analyzed using the amplitude spectrum area algorithm. A smaller epinephrine dose (60 +/- 32.1 vs. 30 +/- 0 mg/mL, p = .01) and shorter cardiopulmonary resuscitation duration (365 +/- 42 sec vs. 600 +/- 243 sec, p = .01) were required to

  9. Reduction of intubation rate during newborn resuscitation after transition from self-inflating bag to T-piece resuscitator.

    Science.gov (United States)

    Ng, K F; Choo, P; Paramasivam, U; Soelar, S A

    2015-08-01

    T-piece resuscitator (TPR) has many advantages compared to self-inflating bag (SIB). Early Continuous Positive Airway Pressure (CPAP) during newborn resuscitation (NR) with TPR at delivery can reduce intubation rate. We speculated that the intubation rate at delivery room was high because SIB had always been used during NR and this can be improved with TPR. Intubation rate of newborn 50%. An audit was carried out in June 2010 to verify this problem using a check sheet. 25 neonates without major congenital anomalies who required NR with SIB at delivery were included. Intubation rate of babies rate within 24 hours dropped to 8% when TPR was used. Proportion of intubated babies reduced from 48.3% (2008-2009) to 35.1% (2011-2012), odds ratio 0.58 (95% CI 0.49-0.68). Proportion of neonates on CPAP increased from 63.5% (2008-2009) to 81.0% (2011-2012), odds ratio 2.44 (95% CI 2.03-2.93). Mean ventilation days fell to below 4 days after 2010. Since then, all delivery standbys were accompanied by TPR and it was used for all NR regardless of settings. There was decline in intubation rate secondary to early provision of CPAP with TPR during NR. Mean ventilation days, mortality and length of NICU stay were reduced. This practice should be adopted by all hospitals in the country to achieve Millennium Development Goal 4 (2/3 decline of under 5 mortality rate) by 2015.

  10. Family Presence During Resuscitation (FPDR): Observational case studies of emergency personnel in Victoria, Australia.

    Science.gov (United States)

    Porter, Joanne E; Miller, Nareeda; Giannis, Anita; Coombs, Nicole

    2017-07-01

    Family Presence During Resuscitation (FPDR), although not a new concept, remains inconsistently implemented by emergency personnel. Many larger metropolitan emergency departments (ED) have instigated a care coordinator role, however these personnel are often from a non-nursing background and have therefore limited knowledge about the clinical aspects of the resuscitation. In rural emergency departments there are simply not enough staff to allocate an independent role. A separate care coordinator role, who is assigned to care for the family and not take part in the resuscitation has been well documented as essential to the successful implementation of FPDR. One rural and one metropolitan emergency department in the state of Victoria, Australia were observed and data was collected on FPDR events. The participants consisted of resuscitation team members, including; emergency trained nurses, senior medical officers, general nurses and doctors. The participants were not told that the data would be recorded around interactions with family members or team discussions regarding family involvement in the resuscitation, following ethical approval involving limited disclosure of the aims of the study. Seventeen adult presentations (Metro n=9, Rural n=8) were included in this study and will be presented as resuscitation case studies. The key themes identified included ambiguity around resuscitation status, keeping the family informed, family isolation and inter-professional communication. During 17 adult resuscitation cases, staff were witnessed communicating with family, which was often limited and isolation resulted. Family were often uninformed or separated from their family member, however when a family liaison person was available it was found to be beneficial. This research indicated that staff could benefit from a designated family liaison role, formal policy and further education. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Increased susceptibility to cardiovascular effects of dihydrocapcaicin in resuscitated rats. Cardiovascular effects of dihydrocapsaicin

    DEFF Research Database (Denmark)

    Fosgerau, Keld; Ristagno, Giuseppe; Jayatissa, Magdalena Niepsuj

    2010-01-01

    Survivors of a cardiac arrest often have persistent cardiovascular derangements following cardiopulmonary resuscitation including decreased cardiac output, arrhythmias and morphological myocardial damage. These cardiovascular derangements may lead to an increased susceptibility towards the extern...... and internal environment of the cardiovascular system as compared to the healthy situation.......Survivors of a cardiac arrest often have persistent cardiovascular derangements following cardiopulmonary resuscitation including decreased cardiac output, arrhythmias and morphological myocardial damage. These cardiovascular derangements may lead to an increased susceptibility towards the external...

  12. Teamwork among midwives during neonatal resuscitation at a maternity hospital in Nepal.

    Science.gov (United States)

    Wrammert, Johan; Sapkota, Sabitri; Baral, Kedar; Kc, Ashish; Målqvist, Mats; Larsson, Margareta

    2017-06-01

    The ability of health care providers to work together is essential for favourable outcomes in neonatal resuscitation, but perceptions of such teamwork have rarely been studied in low-income settings. Neonatal resuscitation is a proven intervention for reducing neonatal mortality globally, but the long-term effects of clinical training for this skill need further attention. Having an understanding of barriers to teamwork among nurse midwives can contribute to the sustainability of improved clinical practice. To explore nurse midwives' perceptions of teamwork when caring for newborns in need of resuscitation. Nurse midwives from a tertiary-level government hospital in Nepal participated in five focus groups of between 4 and 11 participants each. Qualitative Content Analysis was used for analysis. One overarching theme emerged: looking for comprehensive guidelines and shared responsibilities in neonatal resuscitation to avoid personal blame and learn from mistakes. Participants discussed the need for protocols relating to neonatal resuscitation and the importance of shared medical responsibility, and the importance of the presence of a strong and transparent leadership. The call for clear and comprehensive protocols relating to neonatal resuscitation corresponded with previous research from different contexts. Nurse midwives working at a maternity health care facility in Nepal discussed the benefits and challenges of teamwork in neonatal resuscitation. The findings suggest potential benefits can be made from clarifying guidelines and responsibilities in neonatal resuscitation. Furthermore, a structured process to deal with clinical incidents must be considered. Management must be involved in all processes. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  13. Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT)

    Science.gov (United States)

    2015-10-01

    Award Number: W81XWH-07-1-0682 TITLE: Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT) PRINCIPAL INVESTIGATOR...COVERED (From - To) 26 SEP 2014 – 25 SEP 2015 4. TITLE AND SUBTITLE Emergency Preservation and Resuscitation for Cardiac Arrest 5a. CONTRACT NUMBER From...study. It was felt that patients who arrive at the hospital with a pulse, but then develop cardiac arrest in the operating room, rather than in the

  14. Post-resuscitation care following out-of-hospital and in-hospital cardiac arrest.

    Science.gov (United States)

    Girotra, Saket; Chan, Paul S; Bradley, Steven M

    2015-12-01

    Cardiac arrest is a leading cause of death in developed countries. Although a majority of cardiac arrest patients die during the acute event, a substantial proportion of cardiac arrest deaths occur in patients following successful resuscitation and can be attributed to the development of post-cardiac arrest syndrome. There is growing recognition that integrated post-resuscitation care, which encompasses targeted temperature management (TTM), early coronary angiography and comprehensive critical care, can improve patient outcomes. TTM has been shown to improve survival and neurological outcome in patients who remain comatose especially following out-of-hospital cardiac arrest due to ventricular arrhythmias. Early coronary angiography and revascularisation if needed may also be beneficial during the post-resuscitation phase, based on data from observational studies. In addition, resuscitated patients usually require intensive care, which includes mechanical ventilator, haemodynamic support and close monitoring of blood gases, glucose, electrolytes, seizures and other disease-specific intervention. Efforts should be taken to avoid premature withdrawal of life-supporting treatment, especially in patients treated with TTM. Given that resources and personnel needed to provide high-quality post-resuscitation care may not exist at all hospitals, professional societies have recommended regionalisation of post-resuscitation care in specialised 'cardiac arrest centres' as a strategy to improve cardiac arrest outcomes. Finally, evidence for post-resuscitation care following in-hospital cardiac arrest is largely extrapolated from studies in patients with out-of-hospital cardiac arrest. Future studies need to examine the effectiveness of different post-resuscitation strategies, such as TTM, in patients with in-hospital cardiac arrest. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. Plasma Resuscitation Improved Survival in a Cecal Ligation and Puncture Rat Model of Sepsis.

    Science.gov (United States)

    Chang, Ronald; Holcomb, John B; Johansson, Par I; Pati, Shibani; Schreiber, Martin A; Wade, Charles E

    2017-06-06

    The paradigm shift from crystalloid to plasma resuscitation of traumatic hemorrhagic shock has improved patient outcomes due in part to plasma-mediated reversal of catecholamine and inflammation-induced endothelial injury, decreasing vascular permeability and attenuating organ injury. Since sepsis induces a similar endothelial injury as seen in hemorrhage, we hypothesized that plasma resuscitation would increase 48-hour survival in a rat sepsis model. Adult male Sprague-Dawley rats (375-425 g) were subjected to 35% cecal ligation and puncture (CLP) (t = 0 h). Twenty-two hours post-CLP and prior to resuscitation (t = 22 h), animals were randomized to resuscitation with normal saline (NS, 10 cc/kg/hr) or pooled rat fresh frozen plasma (FFP, 3.33 cc/kg/hr). Resuscitation under general anesthesia proceeded for the next six hours (t = 22 h to t = 28 h); lactate was checked every 2 hours, and fluid volumes were titrated based on lactate clearance. Blood samples were obtained before (t = 22 h) and after resuscitation (t = 28 h), and at death or study conclusion. Lung specimens were obtained for calculation of wet-to-dry weight ratio. Fisher's exact test was used to analyze the primary outcome of 48-hour survival. ANOVA with repeated measures was used to analyze the effect of FFP versus NS resuscitation on blood gas, electrolytes, blood urea nitrogen (BUN), creatinine, interleukin (IL)-6, IL-10, catecholamines, and syndecan-1 (marker for endothelial injury). A two-tailed alpha level of dry weight ratio (5.28 vs 5.94) (all p < 0.05). Compared to crystalloid, plasma resuscitation increased 48-hour survival in a rat sepsis model, improved pulmonary function and decreased pulmonary edema, and attenuated markers for inflammation, endothelial injury, and catecholamines.

  16. Resuscitation at the limit of viability: trapped between a rock and a hard place.

    Science.gov (United States)

    Bhat, S B; Weinberger, B; Hanna, N N

    2013-01-01

    Current professional guidelines, such as the Neonatal Resuscitation Program, specify significant roles for parents in decision-making at periviability. However, current federal regulations and some legal precedents indicate that resuscitation decisions should be made by the physician at the time of delivery, based on physical assessment of the infant. The enforcement of such approach would potentially increase the resuscitation of infants with poor prognoses. To characterize the resuscitation practices of neonatologists attending deliveries of premature infants at the borderline of viability, in the context of current federal legislation. A questionnaire was administered to directors of all level III neonatal intensive care units in the state of New Jersey, eliciting resuscitation decisions for hypothetical birth scenarios as well as knowledge of legal statutes. Resuscitation decisions for infants born at 24 weeks of gestational age were not associated with parental wishes. In contrast, parental requests were significantly associated with decisions whether to treat infants born at 22 and 23 weeks gestation. Most neonatologists believed they were knowledgeable about federal legislation, but that knowledge did not change the way they practiced. Our findings suggest that resuscitation of premature infants at 24 weeks gestation is the standard of care in New Jersey, a socioeconomically and ethnically diverse state that may represent broader national trends. The high compliance with parental wishes at 22 or 23 weeks is probably related to physicians' expectation of poor outcomes at these gestational ages. This approach is consistent with current recommendations of the Neonatal Resuscitation Program but may not be compatible with existing federal statutes and legal precedent.

  17. Pharmacologically induced hypothermia with cannabinoid receptor agonist WIN55, 212-2 after cardiopulmonary resuscitation.

    Science.gov (United States)

    Sun, Shijie; Tang, Wanchun; Song, Fengqing; Chung, Sung Phil; Weng, Yinlun; Yu, Tao; Weil, Max Harry

    2010-12-01

    To investigate whether hypothermia could be induced pharmacologically after resuscitation with the cannabinoid CB1/CB2 receptor agonist in a rat model and its effects on outcomes of cardiopulmonary resuscitation. Prospective, randomized, placebo-controlled experimental study. University-affiliated animal research laboratory. Ten healthy male Sprague-Dawley rats. Ventricular fibrillation was induced and untreated for 6 mins. Defibrillation was attempted after 8 mins of cardiopulmonary resuscitation. Thirty minutes after resuscitation, animals were randomized to receive either WIN55, 212-2 (1.0 mg/kg/hr) or vehicle placebo (1.4 mL/kg/hr) for 6 hrs. Before infusion, the temperature was maintained at 37°C in all the animals with the help of a heating lamp. The same temperature environment was maintained for both groups after infusion. Hemodynamic measurements and cardiac output, ejection fraction, and myocardial performance index were measured at baseline and hourly for 6 hrs after resuscitation. Survival time up to 72 hrs was observed. Blood temperature decreased progressively after infusion of WIN55, 212-2 from 37°C to 34°C 4 hrs after resuscitation. There was no significant change in blood temperature after 6 hrs of placebo infusion of the same volume and same infusate temperature. Significantly better postresuscitation myocardial function and longer durations of survival were observed in WIN55, 212-2-treated animals. The selective cannabinoid agonist, WIN55, 212-2, produced a significant reduction in blood temperature and improved postresuscitation myocardial functions and survival after cardiopulmonary resuscitation. The study results may provide a further option for early and effective induction of therapeutic hypothermia in settings of cardiopulmonary resuscitation.

  18. Protection against ischemia-reperfusion injury in prolonged resuscitation: A case report and review of literature

    OpenAIRE

    Mohseni, Masood; Ziaeifard, Mohsen; Abbasi, Zahra

    2014-01-01

    BACKGROUND The severity of ischemia/reperfusion injury determines the neurologic outcome after successful cardiopulmonary resuscitation. CASE REPORT We present a case of prolonged open-chest resuscitation who survived without neurologic sequel. Multiple applied strategies to limit the deleterious effects of ischemia and reperfusion injury, that is, infusion of magnesium sulfate and mannitol, protective lung ventilation and optimal postoperative pain control prevented the end organ damage in t...

  19. Survey of "do not resuscitate" orders in a district general hospital.

    OpenAIRE

    Aarons, E J; Beeching, N J

    1991-01-01

    OBJECTIVE--To evaluate the local use of written "Do not resuscitate" orders to designate inpatients unsuitable for cardiopulmonary resuscitation in the event of cardiac arrest. DESIGN--Point prevalence questionnaire survey of inpatients' medical and nursing records. SETTING--10 acute medical and six acute surgical wards of a district general hospital. PARTICIPANTS--Questionnaires were filled in anonymously by nurses and doctors working on the wards surveyed. MAIN OUTCOME MEASURES--Responses t...

  20. Whole Blood and Hextend: Bookends of Modern Tactical Combat Casualty Care Field Resuscitation and Starting Point For Multi-functional Resuscitation Fluid Development.

    Science.gov (United States)

    Sheppard, Forest R; Mitchell, Thomas A; Macko, Antoni R; Fryer, Darren M; Schaub, Leasha J; Ozuna, Kassandra M; Glaser, Jacob J

    2017-12-20

    Hemorrhage is the leading cause of preventable death in traumatically injured civilian and military populations. Pre-hospital resuscitation largely relies on crystalloid and colloid intra-vascular expansion, as whole blood and component blood therapy are logistically arduous. In this experiment, we evaluated the bookends of Tactical Combat Casualty Care Guidelines recommendations of pre-hospital resuscitation with Hextend and whole blood in a controlled hemorrhagic shock model within non-human primates, as means of a multi-functional resuscitative fluid development. In the non-human primate, a poly-trauma model was utilized, consisting of a musculoskeletal injury (femur fracture), soft tissue injury (15cm laparotomy), and controlled hemorrhage to a mean arterial pressure of 20 mmHg, demarcating the beginning of the shock period. Animals were randomized to pre-hospital interventions of whole blood or Hextend at T=0 minutes, and at T=90 minutes definitive surgical interventions and balanced sanguineous damage control resuscitation could be implemented. All animals were euthanized at T=480 minutes. Data are expressed as mean±SEM; significance, p<0.05. No significant differences in survival, 83% vs. 100%, p=0.3), tissue perfusion (EtCO2 & StO2) or endpoints of resuscitation (base deficit, lactate, pH) between Hextend and whole blood were identified. Secondly, whole blood compared to Hextend demonstrated significantly earlier normalization of clot formation time, maximal clot firmness, and α angle. A future multi-functional resuscitative fluid including an asanguineous, oncotic, non-oxygen carrying component to facilitate intra-vascular volume expansion and a component with synthetic coagulation factors and fibrinogen to deter coagulopathy may show equivalence to whole blood. Translational animal model LEVEL OF EVIDENCE: N/A.

  1. Comparison of the T-piece resuscitator with other neonatal manual ventilation devices: a qualitative review.

    Science.gov (United States)

    Hawkes, Colin Patrick; Ryan, C Anthony; Dempsey, Eugene Michael

    2012-07-01

    To review the literature surrounding various aspects of T-piece resuscitator use, with particular emphasis on the evidence comparing the device to other manual ventilation devices in neonatal resuscitation. The Medline, EMBASE, Cochrane databases were searched in April 2011. Ongoing trials were identified using www.clinicaltrials.gov and www.controlled-trials.com. Additional studies from reference lists of eligible articles were considered. All studies including T-piece resuscitator use were eligible for inclusion. Thirty studies were included. There were two randomised controlled trials in newborn infants comparing the devices, one of which addressed short and intermediate term morbidity and mortality outcomes and found no difference between the T-piece resuscitator and self inflating bag. From manikin studies, advantages to the T-piece resuscitator include the delivery of inflating pressures closer to predetermined target pressures with least variation, the ability to provide prolonged inflation breaths and more consistent tidal volumes. Disadvantages include a technically more difficult setup, more time required to adjust pressures during resuscitation, a larger mask leak and less ability to detect changes in compliance. There is a need for appropriately designed randomised controlled trials in neonates to highlight the efficacy of one device over another. Until these are performed, healthcare providers should be appropriately trained in the use of the device available in their departments, and be aware of its own limitations. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  2. Comparison of the T-piece resuscitator with other neonatal manual ventilation devices: A qualitative review.

    LENUS (Irish Health Repository)

    2012-01-31

    AIM: To review the literature surrounding various aspects of T-piece resuscitator use, with particular emphasis on the evidence comparing the device to other manual ventilation devices in neonatal resuscitation. DATA SOURCES: The Medline, EMBASE, Cochrane databases were searched in April 2011. Ongoing trials were identified using www.clinicaltrials.gov and www.controlled-trials.com. Additional studies from reference lists of eligible articles were considered. All studies including T-piece resuscitator use were eligible for inclusion. RESULTS: Thirty studies were included. There were two randomised controlled trials in newborn infants comparing the devices, one of which addressed short and intermediate term morbidity and mortality outcomes and found no difference between the T-piece resuscitator and self inflating bag. From manikin studies, advantages to the T-piece resuscitator include the delivery of inflating pressures closer to predetermined target pressures with least variation, the ability to provide prolonged inflation breaths and more consistent tidal volumes. Disadvantages include a technically more difficult setup, more time required to adjust pressures during resuscitation, a larger mask leak and less ability to detect changes in compliance. CONCLUSIONS: There is a need for appropriately designed randomised controlled trials in neonates to highlight the efficacy of one device over another. Until these are performed, healthcare providers should be appropriately trained in the use of the device available in their departments, and be aware of its own limitations.

  3. Cardiopulmonary resuscitation: a historical perspective leading up to the end of the 19th century.

    Science.gov (United States)

    Ekmektzoglou, Konstantinos A; Johnson, Elizabeth O; Syros, Periklis; Chalkias, Athanasios; Kalambalikis, Lazaros; Xanthos, Theodoros

    2012-01-01

    Social laws and religious beliefs throughout history underscore the leaps and bounds that the science of resuscitation has achieved from ancient times until today. The effort to resuscitate victims goes back to ancient history, where death was considered a special form of sleep or an act of God. Biblical accounts of resuscitation attempts are numerous. Resuscitation in the Middle Ages was forbidden, but later during Renaissance, any prohibition against performing cardiopulmonary resuscitation (CPR) was challenged, which finally led to the Enlightenment, where scholars attempted to scientifically solve the problem of sudden death. It was then that the various components of CPR (ventilation, circulation, electricity, and organization of emergency medical services) began to take shape. The 19th century gave way to hallmarks both in the ventilatory support (intubation innovations and the artificial respirator) and the open-and closed chest circulatory support. Meanwhile, novel defibrillation techniques had been employed and ventricular fibrillation described. The groundbreaking discoveries of the 20th century finally led to the scientific framework of CPR. In 1960, mouth-to-mouth resuscitation was eventually combined with chest compression and defibrillation to become CPR as we now know it. This review presents the scientific milestones behind one of medicine's most widely used fields.

  4. Scribe during emergency department resuscitation: Registered Nurse domain or up for grabs?

    Science.gov (United States)

    Molan, Emily L

    2013-05-01

    Scribe nurses within metropolitan emergency departments are traditionally Registered Nurses who document the resuscitation event to provide a true and timely representation of what occurred. Enrolled Nurses undertake the scribe role in some Australian emergency department resuscitations, particularly in rural and remote health services. There is no Australian research evidence pertaining to the role of the scribe nurse within a resuscitation team. This study explored the scribe role and the nursing work involved within it to appraise whether it is appropriate to delegate the responsibility away from Registered Nurses. Using a qualitative descriptive design, semi-structured interviews were conducted with eight Registered Nurses who had emergency department scribe nurse experience. Thematic analysis was adopted to identify common threads within the interview data. The four themes identified were the role, scribe effectiveness, expertise and 'scribe by default'. Participants were generally positive regarding the potential for Enrolled Nurses to scribe in metropolitan emergency department resuscitation teams. The characteristics of an effective scribe; well developed communication skills, confidence and assertiveness and resuscitation 'know how', may be the measurement of readiness for the position of scribe nurse within the resuscitation team, rather than number of years of clinical experience or designation. Copyright © 2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

  5. Predicting the Presence of an Acute Coronary Lesion Among Patients Resuscitated From Cardiac Arrest.

    Science.gov (United States)

    Waldo, Stephen W; Chang, Lee; Strom, Jordan B; O'Brien, Cashel; Pomerantsev, Eugene; Yeh, Robert W

    2015-10-01

    A mechanism to stratify patients resuscitated from a cardiac arrest according to the likelihood of an acute coronary lesion would have significant utility. We thus sought to develop and validate a risk prediction model for the presence of an acute coronary lesion among patients resuscitated from an arrest. All subjects undergoing coronary angiography after resuscitation from a cardiac arrest were identified in an ongoing institutional registry from 2009 to 2014. Backwards stepwise selection of candidate covariates was used to create a logistic regression model for the presence of an angiographic culprit lesion and internally validated with bootstrapping. A clinical point score was generated and its prognostic abilities compared with contemporary measures. Among 247 subjects undergoing coronary angiography after resuscitation from a cardiac arrest, 130 (52%) had an acute lesion in a coronary artery. A multivariable model-including angina, congestive heart failure symptoms, shockable arrest rhythm (ventricular fibrillation/ventricular tachycardia), and ST-elevations-had excellent discrimination (optimism corrected C-Statistic, 0.88) and calibration (Hosmer-Lemeshow P=0.540) for an acute coronary lesion. Compared with electrocardiographic findings alone, a point score based on this model more accurately predicted the presence of an acute lesion among patients resuscitated from a cardiac arrest (integrated discrimination improvement, 0.10; 95% confidence interval, 0.04-0.19; Plesion using 4 easily measured variables. This simple risk score may be used to improve patient selection for emergent coronary angiography among resuscitated patients. © 2015 American Heart Association, Inc.

  6. Resuscitation complications encountered in forensic autopsy cases performed in Muğla province.

    Science.gov (United States)

    Beydilli, Halil; Balcı, Yasemin; Işık, Şahin; Erbaş, Melike; Acar, Ethem; Savran, Bülent

    2015-12-01

    The purpose of this study was to determine complications of resuscitation seen during autopsies and evaluate the effectiveness of basic life support training. Autopsy case reports conducted in The Forensic Branch Manager of Muğla were retrospectively examined. Demographic data of the patients with resuscitation complications such as age, gender, manner of death, and kinds and features of the complications were recorded. In total, seventy-fourof the 100 cases with resuscitation complications were males. The autopsies in most of these cases were performed during the summer season. Among the patients, 68% died for non-traumatic reasons. Rib fractures were detected in seventy-one patients and sternum fractures in thirty-two patients. Moreover, damage to the pericardium (2%) and lung parenchymal (4%), heart lesions (4%), and liver lacerations (2%) were detected. Regarding rib fractures, fractures were found between the first and eighth ribs on both sides, with the highest numbers occurring in the fourth rib. Resuscitation complications are important since they can be presumed to have carried out for traumatic reasons.Resuscitation complications seen in autopsy cases with non-traumatic causes can be perceived as traumatic events. They can be assumed incorrectly as trauma symptoms. These complications can be reduced with a good resuscitation training of the health personnel.

  7. 24 Hour Survival Rate and its Determinants in Patients with Successful Cardiopulmonary Resuscitation in Ghaem Hospital of Mashhad

    OpenAIRE

    Ali Movahedi; Ali Kavosi; Hamidreza Behnam Vashani; Gholamreza Mohammadi; Hasan Mehrad Majd; Javad Malekzadeh

    2016-01-01

    Introduction and Aims The main cause of death in the adult population in the industrialized world is sudden cardiac arrest. The first purpose of cardiopulmonary resuscitation is return of spontaneous circulation. Post cardiopulmonary resuscitation cares are fifth stage of American Heart Association cardiopulmonary resuscitation that less take into consideration. Therefore, the present study was conducted with the aim of “24 Hour Survival Rate and it’s determinants in patients w...

  8. Goal-Directed Resuscitative Interventions During Pediatric Interfacility Transport.

    Science.gov (United States)

    Stroud, Michael H; Sanders, Ronald C; Moss, M Michele; Sullivan, Janice E; Prodhan, Parthak; Melguizo-Castro, Maria; Nick, Todd

    2015-08-01

    This article reports results of the first National Institutes of Health-funded prospective interfacility transport study to determine the effect of goal-directed therapy administered by a specialized pediatric team to critically ill children with the systemic inflammatory response syndrome. We hypothesized that goal-directed therapy during interfacility transport would decrease hospital length of stay, prevent multiple organ dysfunction, and reduce subsequent ICU interventions. Before-and-after intervention trial. During interfacility transport of critically ill patients by a specialized pediatric transport team, back to a tertiary care children's hospital. Before-and-after intervention trial. Interfacility pediatric transport patients, age 1 month to 17 years, with systemic inflammatory response syndrome. Prospective data were collected on all pediatric interfacility transport patients with systemic inflammatory response syndrome transported by the Angel One Transport team at Arkansas Children's Hospital. A 10-month data collection period was followed by institution of a goal-directed resuscitation protocol. Data were subsequently collected for 10 additional months followed by comparison of pre- and postintervention groups. All transport personnel underwent training with didactics and high-fidelity simulation until mastery with goal-directed resuscitation was achieved. All transport patients were screened for systemic inflammatory response syndrome using established variables and 235 (123 preintervention and 112 postintervention) were enrolled. Univariate analysis revealed shorter hospital stay (11 ± 15 d vs 7 ± 10 d; p = 0.02) and fewer required therapeutic ICU interventions in the postintervention group (Therapeutic Intervention Scoring System-28 Scores, 19.4 ± 6.8 vs 17.3 ± 6.6; p = 0.04). ICU stay and prevalence of organ dysfunction were not statistically different. Multivariable analysis showed a 1.6-day (95% CI, 1.3-2.03; p = 0.02) decrease in hospital

  9. Aortic Hemostasis and Resuscitation Advanced REBOA for NCTH and Reversal of HiTCA

    Science.gov (United States)

    2017-06-01

    train the emergency providers in the technique to demonstrate its feasibility. The training will be a combination of didactic lectures, vascular ... access training, and labs, using a non-recovered swine model of NCTH and HiTCA. The aim is for the results to demonstrate that AHR improves ROSC and...the AHR/SAAP catheter technique which uses an oxygenated fluid to achieve ROSC in order to sustain post-ROSC survival until vascular control of

  10. Reanimación cerebrocardiopulmonar prolongada exitosa: Reporte de un caso Prolonged successful cerebrocardiopulmonary resuscitation: A case report

    Directory of Open Access Journals (Sweden)

    Libardo A Medina

    2010-02-01

    Full Text Available Se presenta el caso de un paciente a quien se le realizó coronariografía diagnóstica la cual reportó enfermedad coronaria de tres vasos. Inmediatamente después de finalizar el procedimiento presentó paro cardiorrespiratorio, y se iniciaron maniobras de reanimación básicas y avanzadas por dos horas. Durante la reanimación se practicó angioplastia e implante de stent en la arteria circunfleja. El paciente recuperó la circulación espontánea y fue trasladado a la unidad de cuidado coronario; en el segundo día se llevó a revascularización quirúrgica miocárdica exitosa y fue dado de alta luego de dieciséis días del evento inicial sin déficit neurológico evidente.We present the case of a 57 year old patient patient who underwent a diagnostic coronariography that showed three-vessel coronary disease. He presented cardiorespiratory arrest immediately at the end of the procedure; basic and advanced resuscitation maneuvers were started during a two hours period. During the resuscitation, primary angioplasty and stent implantation in the circumflex artery was performed. The patient recovered spontaneous circulation and was transferred to the coronary care unit. On the second day, a successful myocardial revascularization was performed and was discharged 16 days after the event without evident neurological deficit.

  11. Prehospital traumatic cardiac arrest: Management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries.

    Science.gov (United States)

    Evans, Christopher C D; Petersen, Ashley; Meier, Eric N; Buick, Jason E; Schreiber, Martin; Kannas, Delores; Austin, Michael A

    2016-08-01

    Traumatic arrests have historically had poor survival rates. Identifying salvageable patients and ideal management is challenging. We aimed to (1) describe the management and outcomes of prehospital traumatic arrests; (2) determine regional variation in survival; and (3) identify Advanced Life Support (ALS) procedures associated with survival. This was a secondary analysis of cases from the Resuscitation Outcomes Consortium Epistry-Trauma and Prospective Observational Prehospital and Hospital Registry for Trauma (PROPHET) registries. Patients were included if they had a blunt or penetrating injury and received cardiopulmonary resuscitation. Logistic regression analyses were used to determine the association between ALS procedures and survival. We included 2,300 patients who were predominately young (Epistry mean [SD], 39 [20] years; PROPHET mean [SD], 40 [19] years), males (79%), injured by blunt trauma (Epistry, 68%; PROPHET, 67%), and treated by ALS paramedics (Epistry, 93%; PROPHET, 98%). A total of 145 patients (6.3%) survived to hospital discharge. More patients with blunt (Epistry, 8.3%; PROPHET, 6.5%) vs. penetrating injuries (Epistry, 4.6%; PROPHET, 2.7%) survived. Most survivors (81%) had vitals on emergency medical services arrival. Rates of survival varied significantly between the 12 study sites (p = 0.048) in the Epistry but not PROPHET (p = 0.14) registries.Patients in the PROPHET registry who received a supraglottic airway insertion or intubation experienced decreased odds of survival (adjusted OR, 0.27; 95% confidence interval, 0.08-0.93; and 0.37; 95% confidence interval, 0.17-0.78, respectively) compared to those receiving bag-mask ventilation. No other procedures were associated with survival. Survival from traumatic arrest may be higher than expected, particularly in blunt trauma and patients with vitals on emergency medical services arrival. Although limited by confounding and statistical power, no ALS procedures were associated with increased

  12. Practices and Perspectives in Cardiopulmonary Resuscitation Attempts and the Use of Do Not Attempt Resuscitation Orders: A Cross-sectional Survey in Sri Lanka.

    Science.gov (United States)

    Beane, Abi; Ambepitiyawaduge, Pubudu De Silva; Thilakasiri, Kaushila; Stephens, Tim; Padeniya, Anuruddha; Athapattu, Priyantha; Mahipala, Palitha G; Sigera, Ponsuge Chathurani; Dondorp, Arjen M; Haniffa, Rashan

    2017-12-01

    The objective of this study is to describe the characteristics of in-hospital cardiopulmonary resuscitation (CPR) attempts, the perspectives of junior doctors involved in those attempts and the use of do not attempt resuscitation (DNAR) orders. A cross-sectional telephone survey aimed at intern doctors working in all medical/surgical wards in government hospitals. Interns were interviewed based on the above objective. A total of 42 CPR attempts from 82 hospitals (338 wards) were reported, 3 of which were excluded as the participating doctor was unavailable for interview. 16 (4.7%) wards had at least 1 patient with an informal DNAR order. 42 deaths were reported. 8 deaths occurred without a known resuscitation attempt, of which 6 occurred on wards with an informal DNAR order in place. 39 resuscitations were attempted. Survival at 24 h was 2 (5.1%). In 5 (13%) attempts, CPR was the only intervention reported. On 25 (64%) occasions, doctors were "not at all" or "only a little bit surprised" by the arrest. CPR attempts before death in hospitals across Sri Lanka is prevalent. DNAR use remains uncommon.

  13. Decoding twitter: Surveillance and trends for cardiac arrest and resuscitation communication.

    Science.gov (United States)

    Bosley, Justin C; Zhao, Nina W; Hill, Shawndra; Shofer, Frances S; Asch, David A; Becker, Lance B; Merchant, Raina M

    2013-02-01

    Twitter has over 500 million subscribers but little is known about how it is used to communicate health information. We sought to characterize how Twitter users seek and share information related to cardiac arrest, a time-sensitive cardiovascular condition where initial treatment often relies on public knowledge and response. Tweets published April-May 2011 with keywords cardiac arrest, CPR, AED, resuscitation, heart arrest, sudden death and defib were identified. Tweets were characterized by content, dissemination, and temporal trends. Tweet authors were further characterized by: self-identified background, tweet volume, and followers. Of 62,163 tweets (15,324, 25%) included resuscitation/cardiac arrest-specific information. These tweets referenced specific cardiac arrest events (1130, 7%), CPR performance or AED use (6896, 44%), resuscitation-related education, research, or news media (7449, 48%), or specific questions about cardiac arrest/resuscitation (270, 2%). Regarding dissemination (1980, 13%) of messages were retweeted. Resuscitation specific tweets primarily occurred on weekdays. Most users (10,282, 93%) contributed three or fewer tweets during the study time frame. Users with more than 15 resuscitation-specific tweets in the study time frame had a mean 1787 followers and most self-identified as having a healthcare affiliation. Despite a large volume of tweets, Twitter can be filtered to identify public knowledge and information seeking and sharing about cardiac arrest. To better engage via social media, healthcare providers can distil tweets by user, content, temporal trends, and message dissemination. Further understanding of information shared by the public in this forum could suggest new approaches for improving resuscitation related education. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  14. Family presence during resuscitation in a paediatric hospital: health professionals' confidence and perceptions.

    Science.gov (United States)

    McLean, Julie; Gill, Fenella J; Shields, Linda

    2016-04-01

    To investigate medical and nursing staff's perceptions of and self-confidence in facilitating family presence during resuscitation in a paediatric hospital setting. Family presence during resuscitation is the attendance of family members in a location that affords visual or physical contact with the patient during resuscitation. Providing the opportunity for families to be present during resuscitation embraces the family-centred care philosophy which underpins paediatric care. Having families present continues to spark much debate amongst health care professionals. A descriptive cross-sectional randomised survey using the 'Family Presence Risk/Benefit Scale' and the 'Family Presence Self-Confidence Scale 'to assess health care professionals' (doctors and nurses) perceptions and self-confidence in facilitating family presence during resuscitation of a child in a paediatric hospital. Surveys were distributed to 300 randomly selected medical and nursing staff. Descriptive and inferential statistics were used to compare medical and nursing, and critical and noncritical care perceptions and self-confidence. Critical care staff had statistically significant higher risk/benefit scores and higher self-confidence scores than those working in noncritical care areas. Having experience in paediatric resuscitation, having invited families to be present previously and a greater number of years working in paediatrics significantly affected participants' perceptions and self-confidence. There was no difference between medical and nursing mean scores for either scale. Both medical and nursing staff working in the paediatric setting understood the needs of families and the philosophy of family-centred care is a model of care practised across disciplines. This has implications both for implementing guidelines to support family presence during resuscitation and for education strategies to shift the attitudes of staff who have limited or no experience. © 2016 John Wiley & Sons Ltd.

  15. Toxicological Emergencies in the Resuscitation Area of a Pediatric Emergency Department: A 12-Month Review.

    Science.gov (United States)

    Beauchamp, Gillian A; Kerrey, Benjamin T; Mittiga, Matthew R; Rinderknecht, Andrea S; Yin, Shan

    2017-10-01

    Few studies of children with toxicological emergencies describe those undergoing acute resuscitation, and most describe exposures to single agents. We describe a 12-month sample of patients evaluated in the resuscitation area of a pediatric emergency department (ED) for a toxicological emergency. We conducted a retrospective chart review of patients in a high-volume, academic pediatric ED. We identified patients evaluated in the ED resuscitation area for toxicological exposure and conducted structured chart reviews to collect relevant data. For all variables of interest, we calculated standard descriptive statistics. Of 2999 patients evaluated in the resuscitation area through 12 months (March 2009 to April 2010), we identified 80 (2.7%) whose primary ED diagnosis was toxicological. The mean age was 11.4 years. Eighty-six percent of patients were triaged to the resuscitation area for significantly altered mental status. The most frequent single exposures were ethanol (25%), clonidine (10%), and acetaminophen (5%). At least 1 laboratory test was performed for almost all patients (97%). Interventions performed in the resuscitation area included intravenous access placement (97%), activated charcoal (20%), naloxone (19%), and endotracheal intubation (12%). Eighty-two percent of patients were admitted to the hospital; 37% to the intensive care unit. No patients studied in this sample died and most received only supportive care. In a high-volume pediatric ED, toxicological emergencies requiring acute resuscitation were rare. Ethanol and clonidine were the most frequent single exposures. Most patients received diagnostic testing and were admitted. Further studies are needed to describe regional differences in pediatric toxicological emergencies.

  16. Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style.

    Science.gov (United States)

    Silva, Rose Mary Ferreira Lisboa da; Silva, Bruna Adriene Gomes de Lima E; Silva, Fábio Junior Modesto E; Amaral, Carlos Faria Santos

    2016-01-01

    The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style. This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year. The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively. The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low.

  17. Decoding twitter: Surveillance and trends for cardiac arrest and resuscitation communication✩

    Science.gov (United States)

    Bosley, Justin C.; Zhao, Nina W.; Hill, Shawndra; Shofer, Frances S.; Asch, David A.; Becker, Lance B.; Merchant, Raina M.

    2013-01-01

    Aim of the study Twitter has over 500 million subscribers but little is known about how it is used to communicate health information. We sought to characterize how Twitter users seek and share information related to cardiac arrest, a time-sensitive cardiovascular condition where initial treatment often relies on public knowledge and response. Methods Tweets published April–May 2011 with keywords cardiac arrest, CPR, AED, resuscitation, heart arrest, sudden death and defib were identified. Tweets were characterized by content, dissemination, and temporal trends. Tweet authors were further characterized by: self-identified background, tweet volume, and followers. Results Of 62,163 tweets (15,324, 25%) included resuscitation/cardiac arrest-specific information. These tweets referenced specific cardiac arrest events (1130, 7%), CPR performance or AED use (6896, 44%), resuscitation-related education, research, or news media (7449, 48%), or specific questions about cardiac arrest/resuscitation (270, 2%). Regarding dissemination (1980, 13%) of messages were retweeted. Resuscitation specific tweets primarily occurred on weekdays. Most users (10,282, 93%) contributed three or fewer tweets during the study time frame. Users with more than 15 resuscitation-specific tweets in the study time frame had a mean 1787 followers and most self-identified as having a healthcare affiliation. Conclusion Despite a large volume of tweets, Twitter can be filtered to identify public knowledge and information seeking and sharing about cardiac arrest. To better engage via social media, healthcare providers can distil tweets by user, content, temporal trends, and message dissemination. Further understanding of information shared by the public in this forum could suggest new approaches for improving resuscitation related education. PMID:23108239

  18. Survivors' quality of life after cardiopulmonary resuscitation: an integrative review of the literature.

    Science.gov (United States)

    Haydon, Gunilla; van der Riet, Pamela; Maguire, Jane

    2017-03-01

    The incidence of cardiac arrest and cardiopulmonary resuscitation continues to increase worldwide largely due to greater awareness of the symptoms of cardiac events and increased attention to cardiopulmonary resuscitation training in the community. Globally, predicted survival rates after cardiopulmonary resuscitation have remained at 10% for decades and although patient outcome remains unpredictable, there is a positive trend in life expectancy. For a resuscitation attempt to be classed as successful, not only survival but also quality of life has to be evaluated. The aim of this review was to examine literature that explores the quality of life (QOL) for survivors' after CPR and the influence cognitive impairment, anxiety, depression and post-traumatic stress disorder (PTSD) has had on their QOL. This review follows Whittemore and Knafl's framework for an integrative literature review. Electronic databases EBSCO, Ovid, PubMed and EMBASE were searched. After application of the inclusion and exclusion criteria, thirty-six papers published from January 2000 to June 2015 were included in this review. These papers represent a broad spectrum of research evaluating quality of life for survivors of cardiopulmonary resuscitation. The heterogeneous research methods and vast number of different research tools make it challenging to compare the findings. The majority of papers concluded that quality of life for survivors of cardiac arrest and cardiopulmonary resuscitation was generally acceptable. However, studies also described survivors' experience of anxiety, depression, post-traumatic stress and cognitive dysfunction. A majority of papers reported an acceptable quality of life if the patient survived to hospital discharge. The heterogeneity in quantitative papers was noticeable and indicates a marked variance in patient outcomes. This review highlights the absence of specialized tools used to investigate survivors' experience of the event. Further exploration of the

  19. [Pulse oximetry versus electrocardiogram for heart rate assessment during resuscitation of the preterm infant].

    Science.gov (United States)

    Iglesias, B; Rodríguez, M J; Aleo, E; Criado, E; Herranz, G; Moro, M; Martínez Orgado, J; Arruza, L

    2016-05-01

    Heart rate (HR) assessment is essential during neonatal resuscitation, and it is usually done by auscultation or pulse oximetry (PO). The aim of the present study was to determine whether HR assessment with ECG is as fast and reliable as PO during preterm resuscitation. Thirty-nine preterm (<32 weeks of gestational age and/or<1.500g of birth weight) newborn resuscitations were video-recorded. Simultaneous determinations of HR using ECG and PO were registered every 5s for the first 10min after birth. Time needed to place both devices and to obtain reliable readings, as well as total time of signal loss was registered. The proportion of reliable HR readings available at the beginning of different resuscitation manoeuvres was also determined. Time needed to connect the ECG was shorter compared with the PO (26.64±3.01 vs. 17.10±1.28 s, for PO and ECG, respectively, P<.05). Similarly, time to obtain reliable readings was shorter for the ECG (87.28±12.11 vs. 26.38±3.41 s, for PO and ECG, respectively, P<.05). Availability of reliable HR readings at initiation of different resuscitation manoeuvres was lower with the PO (PO vs. ECG for positive pressure ventilation: 10.52 vs. 57.89% P<.05; intubation: 33.33 vs. 91.66%, P<.05). PO displayed lower HR values during the first 6min after birth (P<.05, between 150 and 300s). Reliable HR is obtained later with the PO than with the ECG during preterm resuscitation. PO underestimates HR in the first minutes of resuscitation. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  20. Impact of common crystalloid solutions on resuscitation markers following Class I hemorrhage: A randomized control trial.

    Science.gov (United States)

    Ross, Samuel W; Christmas, A Britton; Fischer, Peter E; Holway, Haley; Walters, Amanda L; Seymour, Rachel; Gibbs, Michael A; Heniford, B Todd; Sing, Ronald F

    2015-11-01

    Resuscitation after hemorrhage with crystalloid solutions can lead to marked acidosis and iatrogenically worsen the lethal triad. The effect of differing solutions on base deficit and lactate has been sparsely prospectively studied in humans. We sought to quantify the effect of normal saline (NS) and lactated Ringer's (LR) resuscitation in voluntary blood donors as a model for Class I hemorrhage. A prospective randomized control trial was conducted in conjunction with blood drives. Donors were randomized to receive no intravenous fluid (noIVF), 2-L NS, or 2-L LR after blood donation of 500 mL. Lactate and base deficit were measured before and after fluid administration using an iSTAT. The mean laboratory values were compared between groups first using a global test followed by pairwise testing between groups using the Wilcoxon rank-sum and Kruskal-Wallis tests. The Bonferroni correction was used and a statistical significance of p 0.0167). Donors had comparable increases in lactate and base deficit after donation regardless of the group (p > 0.0167). After resuscitation with 2-L crystalloid, the lactate level increased higher in the LR group than in the noIVF or the NS group (1.36 mmol/L vs. 1.00 mmol/L vs. 1.54 mmol/L, p < 0.0001). In addition, the resuscitation base deficit increased in the NS group more than in the noIVF or LR group (-0.65 vs. -3.06 vs. -0.34, p < 0.0001). This study is one of the first human studies to prospectively demonstrate quantifiable differences in base deficit and lactate by type of crystalloid resuscitation. LR resuscitation elevated lactate levels, and NS negatively affected the base deficit. These findings are critical to the interpretation of trauma patient resuscitation with crystalloid solutions. Therapeutic study, level II.

  1. Minocycline and Doxycycline, but not Tetracycline, Mitigate Liver and Kidney Injury after Hemorrhagic Shock/Resuscitation*

    Science.gov (United States)

    Kholmukhamedov, Andaleb; Czerny, Christoph; Hu, Jiangting; Schwartz, Justin; Zhong, Zhi; Lemasters, John J.

    2014-01-01

    Background Despite recovery of hemodynamics by fluid resuscitation after hemorrhage, development of the systemic inflammatory response and multiple organ dysfunction syndromes can nonetheless lead to death. Minocycline and doxycycline are tetracycline derivatives that are protective in models of hypoxic, ischemic and oxidative stress. Our Aim was to determine whether minocycline and doxycycline protect liver and kidney and improve survival in a mouse model of hemorrhagic shock and resuscitation. Methods Mice were hemorrhaged to 30 mm Hg for 3 h and then resuscitated with shed blood followed by half the shed volume of lactated Ringer's solution containing tetracycline (10 mg/kg), minocycline (10 mg/kg), doxycycline (5 mg/kg) or vehicle. For pre-plus post-treatment, drugs were administered intraperitoneally prior to hemorrhage followed by second equal dose in Ringer's solution after blood resuscitation. Blood and tissue were harvested after 6 h. Results Serum alanine aminotransferase (ALT) increased to 1988 and 1878 U/L after post-treatment with vehicle and tetracycline, respectively, whereas minocycline and doxycycline post-treatment decreased ALT to 857 and 863 U/L. Pre-plus post-treatment with minocycline and doxycycline also decreased ALT to 849 and 834 U/L. After vehicle, blood creatinine increased to 279 μM, which minocycline and doxycycline post-treatment decreased to 118 and 112 μM. Minocycline and doxycycline pre- plus post-treatment decreased creatinine similarly. Minocycline and doxycycline also decreased necrosis and apoptosis in liver and apoptosis in both liver and kidney, the latter assessed by TUNEL and caspase-3 activation. Lastly after 4.5 h of hemorrhage followed by resuscitation, minocycline and doxycycline (but not tetracycline) post-treatment improved 1-week survival from 38%(vehicle) to 69% and 67%, respectively. Conclusion Minocycline and doxycycline were similarly protective when given before as after blood resuscitation and might therefore

  2. The Iranian physicians attitude toward the do not resuscitate order.

    Science.gov (United States)

    Fallahi, Masood; Banaderakhshan, Homayion; Abdi, Alireza; Borhani, Fariba; Kaviannezhad, Rasool; Karimpour, Hassan Ali

    2016-01-01

    Physicians are responsible for making decisions about the do not resuscitate (DNR) order of patients; however, most of them are faced with some uncertainty in decision making and ethical aspects. Moreover, there are differences on decision making related to the DNR order among physicians, which may be related to the different attitudes toward this issue. Considering the lack of information, this study was performed to investigate doctors' attitude about DNR order for patients in their final phases of life. In a descriptive-analytical study, 152 physicians were enrolled as quota sampling subjects from educational hospitals affiliated to the Kermanshah University of Medical Sciences. The tool used was a researcher-developed questionnaire. Data were analyzed using SPSS 16 software by descriptive and inferential statistics. The mean of attitude toward DNR was 3.22, for which the univariate t-test showed a significant positive attitude toward DNR (P=0.002); the mean of attitude number toward DNR was higher in physicians with higher education level (P=0.002). But this difference was not found in terms of age group, sex, and experiences in participating in DNR decisions. Due to the positive attitude of doctors toward DNR orders and lack of identified guidance, clear guidelines that comply with the Iranian Islamic culture are necessary to be established. Implementing this directive requires comprehensive training to various groups, including patients, doctors, nurses, administrators, and policy makers of the health system.

  3. Trainers’ Attitudes towards Cardiopulmonary Resuscitation, Current Care Guidelines, and Training

    Directory of Open Access Journals (Sweden)

    M. Mäkinen

    2016-01-01

    Full Text Available Objectives. Studies have shown that healthcare personnel hesitate to perform defibrillation due to individual or organisational attitudes. We aimed to assess trainers’ attitudes towards cardiopulmonary resuscitation and defibrillation (CPR-D, Current Care Guidelines, and associated training. Methods. A questionnaire was distributed to CPR trainers attending seminars in Finland (N=185 focusing on the updated national Current Care Guidelines 2011. The questions were answered using Likert scale (1 = totally disagree, 7 = totally agree. Factor loading of the questionnaire was made using maximum likelihood analysis and varimax rotation. Seven scales were constructed (Hesitation, Nurse’s Role, Nontechnical Skill, Usefulness, Restrictions, Personal, and Organisation. Cronbach’s alphas were 0.92–0.51. Statistics were Student’s t-test, ANOVA, stepwise regression analysis, and Pearson Correlation. Results. The questionnaire was returned by 124/185, 67% CPR trainers, of whom two-thirds felt that their undergraduate training in CPR-D had not been adequate. Satisfaction with undergraduate defibrillation training correlated with the Nontechnical Skills scale (p<0.01. Participants scoring high on Hesitation scale (p<0.01 were less confident about their Nurse’s Role (p<0.01 and Nontechnical Skills (p<0.01. Conclusion. Quality of undergraduate education affects the work of CPR trainers and some feel uncertain of defibrillation. The train-the-trainers courses and undergraduate medical education should focus more on practical scenarios with defibrillators and nontechnical skills.

  4. Cardiopulmonary resuscitation knowledge and skills of registered nurses in Botswana

    Directory of Open Access Journals (Sweden)

    Lakshmi Rajeswaran

    2014-02-01

    Full Text Available Background: In Botswana nurses provide most health care in the primary, secondary and tertiary level clinics and hospitals. Trauma and medical emergencies are on the increase, and nurses should have cardiopulmonary resuscitation (CPR knowledge and skills in order to be able to implement effective interventions in cardiac arrest situations.Objective: The objective of this descriptive study was to assess registered nurses’ CPR knowledge and skills.Method: A pre-test, intervention and re-test time-series research design was adopted, and data were collected from 102 nurses from the 2 referral hospitals in Botswana. A multiple choice questionnaire and checklist were used to collect data.Results: All nurses failed the pre-test. Their knowledge and skills improved after training, but deteriorated over the three months until the post-test was conducted.Conclusion: The significantly low levels of registered nurses’ CPR skills in Botswana should be addressed by instituting country-wide CPR training and regular refresher courses.

  5. Whole blood: the future of traumatic hemorrhagic shock resuscitation.

    Science.gov (United States)

    Murdock, Alan D; Berséus, Olle; Hervig, Tor; Strandenes, Geir; Lunde, Turid Helen

    2014-05-01

    Toward the end of World War I and during World War II, whole-blood transfusions were the primary agent in the treatment of military traumatic hemorrhage. However, after World War II, the fractionation of whole blood into its components became widely accepted and replaced whole-blood transfusion to better accommodate specific blood deficiencies, logistics, and financial reasons. This transition occurred with very few clinical trials to determine which patient populations or scenarios would or would not benefit from the change. A smaller population of patients with trauma hemorrhage will require massive transfusion (>10 U packed red blood cells in 24 h) occurring in 3% to 5% of civilian and 10% of military traumas. Advocates for hemostatic resuscitation have turned toward a ratio-balanced component therapy using packed red blood cells-fresh frozen plasma-platelet concentration in a 1:1:1 ratio due to whole-blood limited availability. However, this "reconstituted" whole blood is associated with a significantly anemic, thrombocytopenic, and coagulopathic product compared with whole blood. In addition, several recent military studies suggest a survival advantage of early use of whole blood, but the safety concerns have limited is widespread civilian use. Based on extensive military experience as well as recent published literature, low-titer leukocyte reduced cold-store type O whole blood carries low adverse risks and maintains its hemostatic properties for up to 21 days. A prospective randomized trial comparing whole blood versus ratio balanced component therapy is proposed with rationale provided.

  6. Measuring and improving cardiopulmonary resuscitation quality inside the emergency department.

    Science.gov (United States)

    Crowe, Christopher; Bobrow, Bentley J; Vadeboncoeur, Tyler F; Dameff, Christian; Stolz, Uwe; Silver, Annemarie; Roosa, Jason; Page, Rianne; LoVecchio, Frank; Spaite, Daniel W

    2015-08-01

    To evaluate CPR quality during cardiac resuscitation attempts in an urban emergency department (ED) and determine the influence of the combination of scenario-based training, real-time audiovisual feedback (RTAVF), and post-event debriefing on CPR quality. CPR quality was recorded using an R Series monitor-defibrillator (ZOLL Medical) during the treatment of adult cardiac arrest patients. Phase 1 (P1; 11/01/2010-11/15/2012) was an observation period of CPR quality. Phase 2 (P2; 11/15/2012-11/08/2013) was after a 60-min psychomotor skills CPR training and included RTAVF and post-event debriefing. A total of 52 cardiac arrest patients were treated in P1 (median age 56 yrs, 63.5% male) and 49 in P2 (age 60 yrs, 83.7% male). Chest compression (CC) depth increased from 46.7 ± 3.8mm in P1 to 61.6 ± 2.8mm in P2 (p CPR feedback, and post-event debriefing was associated with improved CPR quality and compliance with CPR guidelines in this urban teaching emergency department. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Do not resuscitate, brain death, and organ transplantation: Islamic perspective

    Science.gov (United States)

    Chamsi-Pasha, Hassan; Albar, Mohammed Ali

    2017-01-01

    Muslim patients and families are often reluctant to discuss and accept fatal diagnoses and prognoses. In many instances, aggressive therapy is requested by a patient's family, prolonging the life of the patient at all costs. Islamic law permits the withdrawal of futile treatment, including life support, from terminally ill patients allowing death to take its natural course. “Do not resuscitate” is permitted in Islamic law in certain situations. Debate continues about the certainty of brain death criteria within Islamic scholars. Although brain death is accepted as true death by the majority of Muslim scholars and medical organizations, the consensus in the Muslim world is not unanimous, and some scholars still accept death only by cardiopulmonary criteria. Organ transplantation has been accepted in Islamic countries (with some resistance from some jurists). Many fatwas (decrees) of Islamic Jurisprudence Councils have been issued and allowed organs to be donated from living competent adult donor; and from deceased (cadavers), provided that they have agreed to donate or their families have agreed to donate after their death (usually these are brain-dead cases). A clear and well-defined policy from the ministry of health regarding do not resuscitate, brain death, and other end-of-life issues is urgently needed for all hospitals and health providers in most (if not all) Muslim and Arab countries. PMID:28469984

  8. The attitude of Iranian nurses about do not resuscitate orders.

    Science.gov (United States)

    Mogadasian, Sima; Abdollahzadeh, Farahnaz; Rahmani, Azad; Ferguson, Caleb; Pakanzad, Fermisk; Pakpour, Vahid; Heidarzadeh, Hamid

    2014-01-01

    Do not resuscitate (DNR) orders are one of many challenging issues in end of life care. Previous research has not investigated Muslim nurses' attitudes towards DNR orders. This study aims to investigate the attitude of Iranian nurses towards DNR orders and determine the role of religious sects in forming attitudes. In this descriptive-comparative study, 306 nurses from five hospitals affiliated to Tabriz University of Medical Sciences (TUOMS) in East Azerbaijan Province and three hospitals in Kurdistan province participated. Data were gathered by a survey design on attitudes on DNR orders. Data were analyzed using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL) software examining descriptive and inferential statistics. Participants showed their willingness to learn more about DNR orders and highlights the importance of respecting patients and their families in DNR orders. In contrast, in many key items participants reported their negative attitude towards DNR orders. There were statistical differences in two items between the attitude of Shiite and Sunni nurses. Iranian nurses, regardless of their religious sects, reported negative attitude towards many aspects of DNR orders. It may be possible to change the attitude of Iranian nurses towards DNR through education.

  9. Which factors influence spontaneous state transitions during resuscitation?

    Science.gov (United States)

    Kvaløy, Jan Terje; Skogvoll, Eirik; Eftestøl, Trygve; Gundersen, Kenneth; Kramer-Johansen, Jo; Olasveengen, Theresa Mariero; Steen, Petter Andreas

    2009-08-01

    The clinical state (i.e. ventricular fibrillation/tachycardia: VF/VT, asystole: ASY, pulseless electrical activity: PEA, or return of spontaneous circulation, ROSC) during cardiopulmonary resuscitation determines patient management. We investigate how spontaneous transitions (i.e. not forced by DC shock) between these states are influenced by factors like age, gender, bystander CPR, CPR quality, proportion of time spent in a state, or the number of state transitions. Detailed recordings from CPR attempts in 304 out-of-hospital cardiac arrests in Akershus (Norway), Stockholm (Sweden), and London (UK) were obtained from modified Heartstart 4000 defibrillators. Spontaneous state transitions were studied using a non-parametric intensity regression method that can handle dynamic factors like the state history properly. The initial state tended to preserve itself, as did cumulative time in any state. Recent DC shock, bystander CPR, location, response time, gender, compression depth, and ventilation rate were important for some transitions. More ventilation during PEA might possibly avert development to ASY and favour ROSC; otherwise observed variations in CPR quality had little impact. Using a novel intensity regression approach we studied the influence of various factors on spontaneous (i.e. non-shock) state transitions during CPR. State development was largely determined by the initial state, the proportion of time spent in a state, and the transition frequency; all probably reflecting the underlying aetiology.

  10. Evaluation of manual resuscitators used in ICUs in Brazil.

    Science.gov (United States)

    Ortiz, Tatiana de Arruda; Forti, Germano; Volpe, Márcia Souza; Beraldo, Marcelo do Amaral; Amato, Marcelo Britto Passos; Carvalho, Carlos Roberto Ribeiro; Tucci, Mauro Roberto

    2013-01-01

    To evaluate the performance of manual resuscitators (MRs) used in Brazil in accordance with international standards. Using a respiratory system simulator, four volunteer physiotherapists employed eight MRs (five produced in Brazil and three produced abroad), which were tested for inspiratory and expiratory resistance of the patient valve; functioning of the pressure-limiting valve; and tidal volume (VT) generated when the one-handed and two-handed techniques were used. The tests were performed and analyzed in accordance with the American Society for Testing and Materials (ASTM) F920-93 criteria. Expiratory resistance was greater than 6 cmH2O . L-1 . s-1 in only one MR. The pressure-limiting valve, a feature of five of the MRs, opened at low pressures (technique were lower than the 600 mL recommended by the ASTM. In the situations studied, mean VT was generally lower from the Brazilian-made MRs that had a pressure-limiting valve. The resistances imposed by the patient valve met the ASTM criteria in all but one of the MRs tested. The pressure-limiting valves of the Brazilian-made MRs usually opened at low pressures, providing lower VT values in the situations studied, especially when the one-handed technique was used, suggesting that both hands should be used and that the pressure-limiting valve should be closed whenever possible.

  11. Evaluation of manual resuscitators used in ICUs in Brazil*

    Science.gov (United States)

    Ortiz, Tatiana de Arruda; Forti, Germano; Volpe, Márcia Souza; Beraldo, Marcelo do Amaral; Amato, Marcelo Britto Passos; Carvalho, Carlos Roberto Ribeiro; Tucci, Mauro Roberto

    2013-01-01

    OBJECTIVE: To evaluate the performance of manual resuscitators (MRs) used in Brazil in accordance with international standards. METHODS: Using a respiratory system simulator, four volunteer physiotherapists employed eight MRs (five produced in Brazil and three produced abroad), which were tested for inspiratory and expiratory resistance of the patient valve; functioning of the pressure-limiting valve; and tidal volume (VT) generated when the one-handed and two-handed techniques were used. The tests were performed and analyzed in accordance with the American Society for Testing and Materials (ASTM) F920-93 criteria. RESULTS: Expiratory resistance was greater than 6 cmH2O . L−1 . s−1 in only one MR. The pressure-limiting valve, a feature of five of the MRs, opened at low pressures (technique were lower than the 600 mL recommended by the ASTM. In the situations studied, mean VT was generally lower from the Brazilian-made MRs that had a pressure-limiting valve. CONCLUSIONS: The resistances imposed by the patient valve met the ASTM criteria in all but one of the MRs tested. The pressure-limiting valves of the Brazilian-made MRs usually opened at low pressures, providing lower VT values in the situations studied, especially when the one-handed technique was used, suggesting that both hands should be used and that the pressure-limiting valve should be closed whenever possible. PMID:24310633

  12. Family presence during cardiopulmonary resuscitation: cardiac health care professionals' perspectives.

    Science.gov (United States)

    Kosowan, Sarah; Jensen, Louise

    2011-01-01

    Family presence (FP) during cardiopulmonary resuscitation (CPR) is becoming an increasing practice. Within current literature, the attitudes and beliefs towards FP of cardiac health care professionals in Canada are limited. The purpose of this project was to examine the perceptions of cardiac health care professionals (n=368) concerning FP during CPR. A survey was conducted to explore the attitudes and beliefs of cardiac health care professionals towards family presence during CPR within five Edmonton and surrounding area hospitals. The response rate was 46%, with the greatest response from nurses and physicians. Of the respondents, 44.3% believed that family should have the option to be present, and 40.9% believed that family should be allowed at the bedside during CPR. Less than half of the respondents had experience with FP during CPR. The barriers identified towards FP were lack of support for families, the experience would be too traumatic for families, families would not understand the procedures, fear of families physically interfering with procedures, FP would increase stress levels among staff, and tradition and politics excludes FP. Despite less than half the respondents supporting FP the majority endorsed development of policy and procedures to overcome barriers to FP during CPR.

  13. A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    U. Ayala

    2014-01-01

    Full Text Available Interruptions in cardiopulmonary resuscitation (CPR compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies.

  14. Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for noncompressible truncal hemorrhage.

    Science.gov (United States)

    Moore, Laura J; Brenner, Megan; Kozar, Rosemary A; Pasley, Jason; Wade, Charles E; Baraniuk, Mary S; Scalea, Thomas; Holcomb, John B

    2015-10-01

    Hemorrhage remains the leading cause of death in trauma patients. Proximal aortic occlusion, usually performed by direct aortic cross-clamping via thoracotomy, can provide temporary hemodynamic stability, permitting definitive injury repair. Resuscitative endovascular balloon occlusion of the aorta (REBOA) uses a minimally invasive, transfemoral balloon catheter, which is rapidly inserted retrograde and inflated for aortic occlusion, and may control inflow and allow time for hemostasis. We compared resuscitative thoracotomy with aortic cross-clamping (RT) with REBOA in trauma patients in profound hemorrhagic shock. Trauma registry data was used to compare all patients undergoing RT or REBOA during an 18-month period from two Level 1 trauma centers. There was no difference between RT (n = 72) and REBOA groups (n = 24) in terms of demographics, mechanism of injury, or Injury Severity Scores (ISSs). There was no difference in chest and abdominal Abbreviated Injury Scale (AIS) scores between the groups. However, the RT patients had lower extremity AIS score as compared with REBOA patients (1.5 [0-3] vs. 4 [3-4], p < 0.001). Of the 72 RT patients, 45 (62.5%) died in the emergency department, 6 (8.3%) died in the operating room, and 14 (19.4%) died in the intensive care unit. Of the 24 REBOA patients, 4 (16.6%) died in the emergency department, 3 (12.5%) died in the operating room, and 8 (33.3%) died in the intensive care unit. In comparing location of death between the RT and REBOA groups, there were a significantly higher number of deaths in the emergency department among the RT patients as compared with the REBOA patients (62.5% vs. 16.7%, p < 0.001). REBOA had fewer early deaths and improved overall survival as compared with RT (37.5% vs. 9.7%, p = 0.003). REBOA is feasible and controls noncompressible truncal hemorrhage in trauma patients in profound shock. Patients undergoing REBOA have improved overall survival and fewer early deaths as compared with patients

  15. Recent Advances in Managing Acute Pancreatitis [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Nigeen Janisch

    2015-12-01

    Full Text Available This article will review the recent advances in managing acute pancreatitis. Supportive care has long been the standard of treatment for this disease despite extensive, but ultimately unsuccessful, efforts to develop disease-specific pharmacologic therapies. The primary interventions center on aggressive fluid resuscitation, initiation of early enteral nutrition, targeted antibiotic therapy, and the management of complications. In this article, we will detail treatment of acute pancreatitis with a focus on intravenous fluid resuscitation, enteral feeding, and the current evidence behind the use of antibiotics and other pharmacologic therapies.

  16. Computational simulation of passive leg-raising effects on hemodynamics during cardiopulmonary resuscitation.

    Science.gov (United States)

    Shin, Dong Ah; Park, Jiheum; Lee, Jung Chan; Shin, Sang Do; Kim, Hee Chan

    2017-03-01

    The passive leg-raising (PLR) maneuver has been used for patients with circulatory failure to improve hemodynamic responsiveness by increasing cardiac output, which should also be beneficial and may exert synergetic effects during cardiopulmonary resuscitation (CPR). However, the impact of the PLR maneuver on CPR remains unclear due to difficulties in monitoring cardiac output in real-time during CPR and a lack of clinical evidence. We developed a computational model that couples hemodynamic behavior during standard CPR and the PLR maneuver, and simulated the model by applying different angles of leg raising from 0° to 90° and compression rates from 80/min to 160/min. The simulation results showed that the PLR maneuver during CPR significantly improves cardiac output (CO), systemic perfusion pressure (SPP) and coronary perfusion pressure (CPP) by ∼40-65% particularly under the recommended range of compression rates between 100/min and 120/min with 45° of leg raise, compared to standard CPR. However, such effects start to wane with further leg lifts, indicating the existence of an optimal angle of leg raise for each person to achieve the best hemodynamic responses. We developed a CPR-PLR model and demonstrated the effects of PLR on hemodynamics by investigating changes in CO, SPP, and CPP under different compression rates and angles of leg raising. Our computational model will facilitate study of PLR effects during CPR and the development of an advanced model combined with circulatory disorders, which will be a valuable asset for further studies. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Perception of realism during mock resuscitations by pediatric housestaff: the impact of simulated physical features.

    Science.gov (United States)

    Donoghue, Aaron J; Durbin, Dennis R; Nadel, Frances M; Stryjewski, Glenn R; Kost, Suzanne I; Nadkarni, Vinay M

    2010-02-01

    Physical signs that can be seen, heard, and felt are one of the cardinal features that convey realism in patient simulations. In critically ill children, physical signs are relied on for clinical management despite their subjective nature. Current technology is limited in its ability to effectively simulate some of these subjective signs; at the same time, data supporting the educational benefit of simulated physical features as a distinct entity are lacking. We surveyed pediatric housestaff as to the realism of scenarios with and without simulated physical signs. Residents at three children's hospitals underwent a before-and-after assessment of performance in mock resuscitations requiring Pediatric Advanced Life Support (PALS), with a didactic review of PALS as the intervention between the assessments. Each subject was randomized to a simulator with physical features either activated (simulator group) or deactivated (mannequin group). Subjects were surveyed as to the realism of the scenarios. Univariate analysis of responses was done between groups. Subjects in the high-fidelity group were surveyed as to the relative importance of specific physical features in enhancing realism. Fifty-one subjects completed all surveys. Subjects in the high-fidelity group rated all scenarios more highly than low-fidelity subjects; the difference achieved statistical significance in scenarios featuring a patient in asystole or pulseless ventricular tachycardia (P realism. PALS scenarios were rated as highly realistic by pediatric residents. Slight differences existed between subjects exposed to simulated physical features and those not exposed to them; these differences were most pronounced in scenarios involving pulselessness. Specific physical features were rated as more important than others by subjects. Data from these surveys may be informative in designing future simulation technology.

  18. 10-Year trend in crystalloid resuscitation: Reduced volume and lower mortality.

    Science.gov (United States)

    Harada, Megan Y; Ko, Ara; Barmparas, Galinos; Smith, Eric J T; Patel, Bansuri K; Dhillon, Navpreet K; Thomsen, Gretchen M; Ley, Eric J

    2017-02-01

    Liberal emergency department (ED) resuscitation after trauma may lead to uncontrolled hemorrhage, reduced organ perfusion, and compartment syndrome. Recent guidelines reduced the standard starting point for crystalloid resuscitation from 2 L to 1 L and emphasized "balanced" resuscitation. The purpose of this study was to characterize how an urban, Level 1 trauma center has responded to changes in crystalloid resuscitation practices over time and to describe associated patient outcomes. This is a retrospective review of trauma patients who sustained moderate to severe injury (ISS > 9) and received crystalloid resuscitation in the ED during 1/2004-12/2013 at an urban, Level 1 trauma center. Patient data collected included age, gender, Glasgow Coma Scale (GCS) score, initial systolic blood pressure (SBP), mechanism of injury, regional Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), volume of blood products and crystalloids administered in the ED. Patients who received <2 L of crystalloid were considered low-volume while those who received ≥2 L were high-volume patients. Clinical characteristics and outcomes were compared between high- and low-volume cohorts, and multivariate regression was used to adjust for confounders. Trend analysis examined changes in variables over time. 1571 moderate to severely injured patients received crystalloid resuscitation; 1282 (82%) were low-volume and 289 (18%) were high-volume. Compared to high-volume patients, low-volume patients presented with a higher median SBP (134 vs. 122 mmHg, p < 0.001) and GCS (15 vs. 14, p < 0.001). Low-volume patients also had lower median ISS (15 vs. 19, p < 0.001). Unadjusted mortality was lower in the low-volume cohort (7% vs. 19%, p < 0.001). Multivariate analysis demonstrated that high-volume patients had increased odds of mortality compared to low-volume patients (AOR 1.88, p = 0.008). Decreased rates of high-volume resuscitation and overall mortality were

  19. A tourniquet assisted cardiopulmonary resuscitation augments myocardial perfusion in a porcine model of cardiac arrest.

    Science.gov (United States)

    Yang, Zhengfei; Tang, David; Wu, Xiaobo; Hu, Xianwen; Xu, Jiefeng; Qian, Jie; Yang, Min; Tang, Wanchun

    2015-01-01

    During cardiopulmonary resuscitation (CPR), myocardial blood flow generated by chest compression rarely exceeds 35% of its normal level. Cardiac output generated by chest compression decreases gradually with the prolongation of cardiac arrest and resuscitation. Early studies have demonstrated that myocardial blood flow during CPR is largely dependent on peripheral vascular resistance. In this study, we investigated the effects of chest compression in combination with physical control of peripheral vascular resistance assisted by tourniquets on myocardial blood flow during CPR. Ventricular fibrillation was induced and untreated for 7 min in ten male domestic pigs weighing between 33 and 37 kg. The animals were then randomized to receive CPR alone or a tourniquet assisted CPR (T-CPR). In the CPR alone group, chest compression was performed by a miniaturized mechanical chest compressor. In the T-CPR group, coincident with the start of resuscitation, the thin elastic tourniquets were wrapped around the four limbs from the distal end to the proximal part. After 2 min of CPR, epinephrine (20 μg/kg) was administered via the femoral vein. After 5 min of CPR, defibrillation was attempted by a single 150 J shock. If resuscitation was not successful, CPR was resumed for 2 min before the next defibrillation. The protocol was continued until successful resuscitation or for a total of 15 min. Five minutes after resuscitation, the elastic tourniquets were removed. The resuscitated animals were observed for 2h. T-CPR generated significantly greater coronary perfusion pressure, end-tidal carbon dioxide and carotid blood flow. There was no difference in both intrathoracic positive and negative pressures between the two groups. All animals were successfully resuscitated with a single shock in both groups. There were no significant changes in hemodynamics observed in the animals treated in the T-CPR group before-and-after the release of tourniquets at post-resuscitation 5 min. T

  20. Survey of delivery room resuscitation practices at tertiary perinatal centers in Japan.

    Science.gov (United States)

    Hosono, Shigeharu; Tamura, Masanori; Kunikata, Tetsuya; Wada, Masaki; Kusakawa, Isao; Ibara, Satoshi

    2015-04-01

    The aim of this study was to determine the current neonatal resuscitation practices for term infants in Japan, immediately before the 2010 publication of the international neonatal resuscitation consensus. In January 2010, a 26-question survey was mailed to neonatal department directors. A total of 287 neonatal departments were identified. Four surveys were returned as undeliverable. A total of 191 surveys were returned completed, but four departments had no labor and delivery rooms (66.6% response rate, 65.2% survey available response rate). Flow-inflating bags were most commonly used (63.2%), followed by self-inflating bags (35.8%), and T-piece resuscitators (1.0%). Among the participants, 42.1% used oxygen blenders, 56.2% used pure oxygen for initial resuscitation, and 79.5% used a pulse oximeter to change the fraction of inspired oxygen. Among the participants, 45.3% used carbon dioxide detectors to confirm intubation, 42.5% routinely used the detectors, and 55.2% used them when confirming a difficult intubation. In addition, 42.5% of the participants used continuous positive airway pressure to treat breathing problems, most commonly with flow-inflating bags (93.2%). The equipment and techniques used in Japanese perinatal center delivery room resuscitation practices are highly varied. Further research is required to determine which devices and techniques are appropriate for this important and common intervention. © 2014 Japan Pediatric Society.

  1. Short Duration Combined Mild Hypothermia Improves Resuscitation Outcomes in a Porcine Model of Prolonged Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Tao Yu

    2015-01-01

    Full Text Available Objective. In this study, our aim was to investigate the effects of combined hypothermia with short duration maintenance on the resuscitation outcomes in a porcine model of ventricular fibrillation (VF. Methods. Fourteen porcine models were electrically induced with VF and untreated for 11 mins. All animals were successfully resuscitated manually and then randomized into two groups: combined mild hypothermia (CH group and normothermia group (NT group. A combined hypothermia of ice cold saline infusion and surface cooling was implemented in the animals of the CH group and maintained for 4 hours. The survival outcomes and neurological function were evaluated every 24 hours until a maximum of 96 hours. Neuron apoptosis in hippocampus was analyzed. Results. There were no significant differences in baseline physiologies and primary resuscitation outcomes between both groups. Obvious improvements of cardiac output were observed in the CH group at 120, 180, and 240 mins following resuscitation. The animals demonstrated better survival at 96 hours in the CH group when compared to the NT group. In comparison with the NT group, favorable neurological functions were observed in the CH group. Conclusion. Short duration combined cooling initiated after resuscitation improves survival and neurological outcomes in a porcine model of prolonged VF.

  2. A review of simulation-enhanced, team-based cardiopulmonary resuscitation training for undergraduate students.

    Science.gov (United States)

    Onan, Arif; Simsek, Nurettin; Elcin, Melih; Turan, Sevgi; Erbil, Bülent; Deniz, Kaan Zülfikar

    2017-11-01

    Cardiopulmonary resuscitation training is an essential element of clinical skill development for healthcare providers. The International Liaison Committee on Resuscitation has described issues related to cardiopulmonary resuscitation and emergency cardiovascular care education. Educational interventions have been initiated to try to address these issues using a team-based approach and simulation technologies that offer a controlled, safe learning environment. The aim of the study is to review and synthesize published studies that address the primary question "What are the features and effectiveness of educational interventions related to simulation-enhanced, team-based cardiopulmonary resuscitation training?" We conducted a systematic review focused on educational interventions pertaining to cardiac arrest and emergencies that addressed this main question. The findings are presented together with a discussion of the effectiveness of various educational interventions. In conclusion, student attitudes toward interprofessional learning and simulation experiences were more positive. Research reports emphasized the importance of adherence to established guidelines, adopting a holistic approach to training, and that preliminary training, briefing, deliberate practices, and debriefing should help to overcome deficiencies in cardiopulmonary resuscitation training. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. The effect of a nurse team leader on communication and leadership in major trauma resuscitations.

    Science.gov (United States)

    Clements, Alana; Curtis, Kate; Horvat, Leanne; Shaban, Ramon Z

    2015-01-01

    Effective assessment and resuscitation of trauma patients requires an organised, multidisciplinary team. Literature evaluating leadership roles of nurses in trauma resuscitation and their effect on team performance is scarce. To assess the effect of allocating the most senior nurse as team leader of trauma patient assessment and resuscitation on communication, documentation and perceptions of leadership within an Australian emergency department. The study design was a pre-post-test survey of emergency nursing staff (working at resuscitation room level) perceptions of leadership, communication, and documentation before and after the implementation of a nurse leader role. Patient records were audited focussing on initial resuscitation assessment, treatment, and nursing clinical entry. Descriptive statistical analyses were performed. Communication trended towards improvement. All (100%) respondents post-test stated they had a good to excellent understanding of their role, compared to 93.2% pre-study. A decrease (58.1-12.5%) in 'intimidating personality' as a negative aspect of communication. Nursing leadership had a 6.7% increase in the proportion of those who reported nursing leadership to be good to excellent. Accuracy of clinical documentation improved (P = 0.025). Trauma nurse team leaders improve some aspects of communication and leadership. Development of trauma nurse leaders should be encouraged within trauma team training programmes. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  4. Utilization of donors who have suffered cardiopulmonary arrest and resuscitation in intestinal transplantation.

    Science.gov (United States)

    Matsumoto, Cal S; Kaufman, Stuart S; Girlanda, Raffaele; Little, Cheryl M; Rekhtman, Yuliya; Raofi, Vandad; Laurin, Jaqueline M; Shetty, Kirti; Fennelly, Erin M; Johnson, Lynt B; Fishbein, Thomas M

    2008-10-15

    Cardiopulmonary resuscitation (CPR) of a person destined to become an organ donor has been associated with overall poor donor quality, especially for the intestinal donor, as splanchnic vasoconstriction that is intended to preserve coronary and cerebral blood flow may result in clinically relevant intestinal ischemia. Outcomes of recipients who receive intestine grafts that have suffered CPR are unknown. We sought to analyze our clinical experience in using intestinal grafts from donors who suffered cardiopulmonary arrest and resuscitation and to evaluate the outcome of recipients of organs coming from resuscitated donors when compared with recipients of nonresuscitated donors. We retrospectively analyzed the donor and recipient charts of all of our intestinal transplants with regard to the performance of donor CPR. Sixty-seven intestinal transplants were performed in 65 patients from November 2003 to December 2007. Twelve donors (18%) were identified as having suffered cardiac arrest and subsequent CPR. Mean duration of CPR was 19.3+/-12.7 min. Terminal laboratory profiles of CPR donors and non-CPR donors were similar. Of the 12 resuscitated grafts, two were used for multivisceral, one for a modified multivisceral, seven for liver-intestine, and two for isolated intestinal transplant. There were no significant differences in outcome parameters such as operative time, blood use, ventilation days, length of stay, time to enteral independence, rejection, enteric bacteremia, and survival between the 12 resuscitated grafts and the 55 nonresuscitated grafts. A donor history of cardiac arrest should not automatically exclude the use of the intestine graft for transplantation.

  5. Google Glass Video Capture of Cardiopulmonary Resuscitation Events: A Pilot Simulation Study.

    Science.gov (United States)

    Kassutto, Stacey M; Kayser, Joshua B; Kerlin, Meeta P; Upton, Mark; Lipschik, Gregg; Epstein, Andrew J; Dine, C Jessica; Schweickert, William

    2017-12-01

    Video recording of resuscitation from fixed camera locations has been used to assess adherence to guidelines and provide feedback on performance. However, inpatient cardiac arrests often happen in unpredictable locations and crowded rooms, making video recording of these events problematic. We sought to understand the feasibility of Google Glass (GG) as a method for recording inpatient cardiac arrests and capturing salient resuscitation factors for post-event review. This observational study involved recording simulated cardiac arrest events on inpatient medical wards. Each simulation was reviewed by 3 methods: in-room physician direct observation, stationary video camera (SVC), and GG. Nurse and physician specialists analyzed the videos for global visibility and audibility, as well as recording quality of predefined resuscitation events and behaviors. Resident code leaders were surveyed regarding attitudes toward GG use in the clinical emergency setting. Of 11 simulated cardiac arrest events, 9 were successfully recorded by all observation methods (1 GG failure, 1 SVC failure). GG was judged slightly better than SVC recording for average global visualization (3.95 versus 3.15, P = .0003) and average global audibility (4.77 versus 4.42, P = .002). Of the GG videos, 19% had limitations in overall interpretability compared with 35% of SVC recordings (P = .039). All 10 survey respondents agreed that GG was easy to use; however, 2 found it distracting and 3 were uncomfortable with future use during actual resuscitations. GG is a feasible and acceptable method for capturing simulated resuscitation events in the inpatient setting.

  6. Albumin administration for fluid resuscitation in burn patients: A systematic review and meta-analysis.

    Science.gov (United States)

    Eljaiek, Roberto; Heylbroeck, Christophe; Dubois, Marc-Jacques

    2017-02-01

    The objective was to systematically review the literature summarizing the effect on mortality of albumin compared to non-albumin solutions during the fluid resuscitation phase of burn injured patients. We searched MEDLINE, EMBASE and CENTRAL and the content of two leading journals in burn care, Burns and Journal of Burn Care and Research. Two reviewers independently selected randomized controlled trials comparing albumin vs. non-albumin solutions for the acute resuscitation of patients with >20% body surface area involvement. Reviewers abstracted data independently and assessed methodological quality of the included trials using predefined criteria. A random effects model was used to assess mortality. We identified 164 trials of which, 4 trials involving 140 patients met our inclusion criteria. Overall, the methodological quality of the included trials was fair. We did not find a significant benefit of albumin solutions as resuscitation fluid on mortality in burn patients (relative risk (RR) 1.6; 95% confidence interval (CI), 0.63-4.08). Total volume of fluid infusion during the phase of resuscitation was lower in patients receiving albumin containing solution -1.00ml/kg/%TBSA (total body surface area) (95% CI, -1.42 to -0.58). The pooled estimate demonstrated a neutral effect on mortality in burn patients resuscitated acutely with albumin solutions. Due to limited evidence and uncertainty, an adequately powered, high quality trial could be required to assess the impact of albumin solutions on mortality in burn patients. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  7. Pediatric resuscitation training-instruction all at once or spaced over time?

    Science.gov (United States)

    Patocka, Catherine; Khan, Farooq; Dubrovsky, Alexander Sasha; Brody, Danny; Bank, Ilana; Bhanji, Farhan

    2015-03-01

    Healthcare providers demonstrate limited retention of knowledge and skills in the months following completion of a resuscitation course. Resuscitation courses are typically taught in a massed format (over 1-2 days) however studies in education psychology have suggested that spacing training may result in improved learning and retention. Our study explored the impact of spaced instruction compared to traditional massed instruction on learner knowledge and pediatric resuscitation skills. Medical students completed a pediatric resuscitation course in either a spaced or massed format. Four weeks following course completion students completed a knowledge exam and blinded observers used expert-developed checklists to assess student performance of three skills (bag-valve mask ventilation (BVMV), intra-osseous insertion (IOI) and chest compressions (CC)). Forty-five out of 48 students completed the study protocol. Students in both groups had similar scores on the knowledge exam spaced: (37.8±6.1) vs. massed (34.3±7.6)(ptraining group Learner knowledge and performance of procedural skills in pediatric resuscitation taught in a spaced format is at least as good as learning in a massed format. Procedures learned in a spaced format may result in better retention of skills when compared to massed training. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. Advances in Management of Acute Pancreatitis.

    Science.gov (United States)

    Janisch, Nigeen H; Gardner, Timothy B

    2016-03-01

    This article reviews advances in the management of acute pancreatitis. Medical treatment has been primarily supportive for this diagnosis, and despite extensive research efforts, there are no pharmacologic therapies that improve prognosis. The current mainstay of management, notwithstanding the ongoing debate regarding the volume, fluid type, and rate of administration, is aggressive intravenous fluid resuscitation. Although antibiotics were used consistently for prophylaxis in severe acute pancreatitis to prevent infection, they are no longer used unless infection is documented. Enteral nutrition, especially in patients with severe acute pancreatitis, is considered a cornerstone in management of this disease. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Old age and poor prognosis increase the likelihood of disagreement between cancer patients and their oncologists on the indication for resuscitation attempt

    DEFF Research Database (Denmark)

    Saltbaek, Lena; Michelsen, Hanne M; Nelausen, Knud M

    2013-01-01

    The do-not-resuscitate decision is a common ethical problem. However, the concordance between patients' preferences and physicians' assessments of the indication for cardiopulmonary resuscitation attempt (CPR) has only been modestly investigated.......The do-not-resuscitate decision is a common ethical problem. However, the concordance between patients' preferences and physicians' assessments of the indication for cardiopulmonary resuscitation attempt (CPR) has only been modestly investigated....

  10. 2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

    Science.gov (United States)

    Atkins, Dianne L; de Caen, Allan R; Berger, Stuart; Samson, Ricardo A; Schexnayder, Stephen M; Joyner, Benny L; Bigham, Blair L; Niles, Dana E; Duff, Jonathan P; Hunt, Elizabeth A; Meaney, Peter A

    2018-01-02

    This focused update to the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care follows the Pediatric Task Force of the International Liaison Committee on Resuscitation evidence review. It aligns with the International Liaison Committee on Resuscitation's continuous evidence review process, and updates are published when the International Liaison Committee on Resuscitation completes a literature review based on new science. This update provides the evidence review and treatment recommendation for chest compression-only CPR versus CPR using chest compressions with rescue breaths for children American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care." Two demonstrated worse 30-day outcomes with chest compression-only CPR for children 1 through 18 years of age, whereas 2 studies documented no difference between chest compression-only CPR and CPR using chest compressions with rescue breaths. When the results were analyzed for infants American Heart Association, Inc.

  11. Evaluation of Microvascular Perfusion and Resuscitation after Severe Injury.

    Science.gov (United States)

    Lee, Yann-Leei L; Simmons, Jon D; Gillespie, Mark N; Alvarez, Diego F; Gonzalez, Richard P; Brevard, Sidney B; Frotan, Mohammad A; Schneider, Andrew M; Richards, William O

    2015-12-01

    Achieving adequate perfusion is a key goal of treatment in severe trauma; however, tissue perfusion has classically been measured by indirect means. Direct visualization of capillary flow has been applied in sepsis, but application of this technology to the trauma population has been limited. The purpose of this investigation was to compare the efficacy of standard indirect measures of perfusion to direct imaging of the sublingual microcirculatory flow during trauma resuscitation. Patients with injury severity scores >15 were serially examined using a handheld sidestream dark-field video microscope. In addition, measurements were also made from healthy volunteers. The De Backer score, a morphometric capillary density score, and total vessel density (TVD) as cumulative vessel area within the image, were calculated using Automated Vascular Analysis (AVA3.0) software. These indices were compared against clinical and laboratory parameters of organ function and systemic metabolic status as well as mortality. Twenty severely injured patients had lower TVD (X = 14.6 ± 0.22 vs 17.66 ± 0.51) and De Backer scores (X = 9.62 ± 0.16 vs 11.55 ± 0.37) compared with healthy controls. These scores best correlated with serum lactate (TVD R(2) = 0.525, De Backer R(2) = 0.576, P trauma patients, and seems to provide real-time assessment of microcirculatory perfusion. This study suggests that in severe trauma, many indirect measurements of perfusion do not correlate with microvascular perfusion. However, visualized perfusion deficiencies do reflect a shift toward anaerobic metabolism.

  12. Hemostatic resuscitation with plasma and platelets in trauma

    Directory of Open Access Journals (Sweden)

    Pär I Johansson

    2012-01-01

    Full Text Available Background: Continued hemorrhage remains a major contributor of mortality in massively transfused patients and controversy regarding the optimal management exists although recently, the concept of hemostatic resuscitation, i.e., providing large amount of blood products to critically injured patients in an immediate and sustained manner as part of an early massive transfusion protocol has been introduced. The aim of the present review was to investigate the potential effect on survival of proactive administration of plasma and/or platelets (PLT in trauma patients with massive bleeding. Materials and Methods: English databases were searched for reports of trauma patients receiving massive transfusion (10 or more red blood cell (RBC within 24 hours or less from admission that tested the effects of administration of plasma and/or PLT in relation to RBC concentrates on survival from January 2005 to November 2010. Comparison between highest vs lowest blood product ratios and 30-day mortality was performed. Results: Sixteen studies encompassing 3,663 patients receiving high vs low ratios were included. This meta-analysis of the pooled results revealed a substantial statistical heterogeneity (I 2 = 58% and that the highest ratio of plasma and/or PLT or to RBC was associated with a significantly decreased mortality (OR: 0.49; 95% confidence interval: 0.43-0.57; P<0.0001 when compared with lowest ratio. Conclusion: Meta-analysis of 16 retrospective studies concerning massively transfused trauma patients confirms a significantly lower mortality in patients treated with the highest fresh frozen plasma (FFP and/or PLT ratio when compared with the lowest FFP and/or PLT ratio. However, optimal ranges of FFP: RBC and PLT : RBC should be established in randomized controlled trials.

  13. Delivery of cardiopulmonary resuscitation in the microgravity environment

    Science.gov (United States)

    Barratt, M. R.; Billica, R. D.

    1992-01-01

    The microgravity environment presents several challenges for delivering effective cardiopulmonary resuscitation (CPR). Chest compressions must be driven by muscular force rather than by the weight of the rescuer's upper torso. Airway stabilization is influenced by the neutral body posture. Rescuers will consist of crew members of varying sizes and degrees of physical deconditioning from space flight. Several methods of CPR designed to accommodate these factors were tested in the one G environment, in parabolic flight, and on a recent shuttle flight. Methods: Utilizing study participants of varying sizes, different techniques of CPR delivery were evaluated using a recording CPR manikin to assess adequacy of compressive force and frequency. Under conditions of parabolic flight, methods tested included conventional positioning of rescuer and victim, free floating 'Heimlich type' compressions, straddling the patient with active and passive restraints, and utilizing a mechanical cardiac compression assist device (CCAD). Multiple restrain systems and ventilation methods were also assessed. Results: Delivery of effective CPR was possible in all configurations tested. Reliance on muscular force alone was quickly fatiguing to the rescuer. Effectiveness of CPR was dependent on technique, adequate restraint of the rescuer and patient, and rescuer size and preference. Free floating CPR was adequate but rapidly fatiguing. The CCAD was able to provide adequate compressive force but positioning was problematic. Conclusions: Delivery of effective CPR in microgravity will be dependent on adequate resuer and patient restraint, technique, and rescuer size and preference. Free floating CPR may be employed as a stop gap method until patient restraint is available. Development of an adequate CCAD would be desirable to compensate for the effects of deconditioning.

  14. Outcome after cardiopulmonary resuscitation in patients with congenital heart disease.

    Science.gov (United States)

    Van Puyvelde, Tim; Ameloot, Koen; Roggen, Mieke; Troost, Els; Gewillig, Marc; Budts, Werner; Van De Bruaene, Alexander

    2017-03-01

    Outcome after cardiopulmonary resuscitation (CPR) in patients with underlying congenital heart disease is uncertain. This study aimed at evaluating outcome after CPR in patients with underlying congenital heart disease, factors related to worse outcome after CPR and whether survivors of sudden cardiac death (SCD) have a worse outcome when compared to an age, gender and disease-matched control population. Between 1984 and 2015, all patients with congenital heart disease who received in or out-of-hospital CPR were identified from the database of congenital heart disease from the University Hospitals Leuven. Postoperative and neonatal (heart defect were included in the study. Thirty-eight patients (66% men; median age 25 years (interquartile range 9-40); 68% out-of-hospital) were identified, of which 27 (66%) survived the event. The main cause of SCD was ventricular tachycardia or fibrillation ( n=21). Heart defect complexity (odds ratio (OR) 5.1; 95% confidence interval (CI) 1.2-21.9; P=0.027), pulmonary hypertension (OR 13.8; 95% CI 2.1-89.5; P=0.006) and time to return of spontaneous circulation (OR 1.1; 95% CI 1.0-1.1; P=0.046) were related to worse outcome. Survivors of SCD had a worse prognosis when compared to an age, gender and disease-matched control group (5-year survival 76% vs. 98%; P=0.002). The complexity of underlying heart defect, pulmonary hypertension and time to return of spontaneous circulation are related to worse outcome in the case of CPR. Survivors of SCD have a worse outcome when compared to matched controls, indicating the need for adequate implantable cardioverter defibrillator indication assessment and for stringent follow-up of patients with worsening haemodynamics.

  15. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery.

    Science.gov (United States)

    Li, Ji-ke; Wang, Jun; Li, Tian-fa

    2014-12-01

    The management of cardiac arrest after cardiac surgery differs from the management of cardiac arrest under other circumstances. In other studies, interposed abdominal compression-cardiopulmonary resuscitation (IAC-CPR) resulted in a better outcome compared with conventional CPR. The aim of the present study was to determine the feasibility, safety and efficacy of IAC-CPR compared with conventional CPR in patients with cardiac arrest after cardiac surgery. Data on all cardiac surgical patients who suffered a sudden cardiac arrest during the first 24 h after surgery were collected prospectively. Cardiac arrest was defined as the cessation of cardiac mechanical activity with the absence of a palpable central pulse, apnoea and unresponsiveness, including ventricular fibrillation, asystole and pulseless electrical activity. Forty patients were randomized to either conventional CPR (n = 21) or IAC-CPR (n = 19). IAC-CPR was initially performed by compressing the abdomen midway between the xiphoid and the umbilicus during the relaxation phase of chest compression. If spontaneous circulation was not restored after 10-15 min, the surgical team would immediately proceed to resternotomy. The endpoints of the study were safety, return of spontaneous circulation (ROSC) >5 min, survival to hospital discharge and survival for 6 months. With IAC-CPR, there were more patients in terms of ROSC, survival to hospital discharge, survival for 6 months and fewer CPR-related injuries compared with patients who underwent conventional CPR. IAC-CPR is feasible and safe and may be advantageous in cases of cardiac arrest after cardiac surgery. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  16. Survival and neurocognitive outcomes in pediatric extracorporeal-cardiopulmonary resuscitation.

    Science.gov (United States)

    Garcia Guerra, Gonzalo; Zorzela, Liliane; Robertson, Charlene M T; Alton, Gwen Y; Joffe, Ari R; Moez, Elham Khodayari; Dinu, Irina A; Ross, David B; Rebeyka, Ivan M; Lequier, Laurance

    2015-11-01

    Extracorporeal Cardiopulmonary Resuscitation (E-CPR) is the initiation of extracorporeal life support during active chest compressions. There are no studies describing detailed neurocognitive outcomes of this population. We aim to describe the survival and neurocognitive outcomes of children who received E-CPR. Prospective cohort study. Children who received E-CPR at the Stollery Children's Hospital between 2000 and 2010 were included. Neurocognitive follow-up, including Wechsler Preschool and Primary Scales of Intelligence, was completed at the age of 4.5 years, and at a minimum of 6 months after the E-CPR admission. Fifty-five patients received E-CPR between 2000 and 2010. Children with cardiac disease had a 49% survival to hospital discharge and 43% survival at age 5-years, with no survivors (n=4) in those with non-cardiac disease. Pediatric E-CPR survivors had a mean (SD) Full Scale Intelligence quotient (FSIQ) score of 76.5 (15.9); with 4 children (24%) having intellectual disability (defined as FSIQ over 2 standard deviations below the population mean; i.e., CPR, open chest CPR, longer duration of CPR, low pH and more red blood cells given on the first day of ECMO, and longer time for lactate to normalize on ECMO were associated with higher mortality at age 5-years. Pediatric patients with cardiac disease who required E-CPR had 43% survival at age 5 years. Of concern, the intelligence quotient in E-CPR survivors was significantly lower than the population mean, with 24% having intellectual disability. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Evaluation of manual resuscitators used in ICUs in Brazil

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    Tatiana de Arruda Ortiz

    2013-09-01

    Full Text Available OBJECTIVE: To evaluate the performance of manual resuscitators (MRs used in Brazil in accordance with international standards. METHODS: Using a respiratory system simulator, four volunteer physiotherapists employed eight MRs (five produced in Brazil and three produced abroad, which were tested for inspiratory and expiratory resistance of the patient valve; functioning of the pressure-limiting valve; and tidal volume (VT generated when the one-handed and two-handed techniques were used. The tests were performed and analyzed in accordance with the American Society for Testing and Materials (ASTM F920-93 criteria. RESULTS: Expiratory resistance was greater than 6 cmH2O . L−1 . s−1 in only one MR. The pressure-limiting valve, a feature of five of the MRs, opened at low pressures (< 17 cmH2O, and the maximal pressure was 32.0-55.9 cmH2O. Mean VT varied greatly among the MRs tested. The mean VT values generated with the one-handed technique were lower than the 600 mL recommended by the ASTM. In the situations studied, mean VT was generally lower from the Brazilian-made MRs that had a pressure-limiting valve. CONCLUSIONS: The resistances imposed by the patient valve met the ASTM criteria in all but one of the MRs tested. The pressure-limiting valves of the Brazilian-made MRs usually opened at low pressures, providing lower VT values in the situations studied, especially when the one-handed technique was used, suggesting that both hands should be used and that the pressure-limiting valve should be closed whenever possible.

  18. Perceptions of basic, advanced, and pediatric life support training in a United States medical school.

    Science.gov (United States)

    Pillow, Malford Tyson; Stader, Donald; Nguyen, Matthew; Cao, Dazhe; McArthur, Robert; Hoxhaj, Shkelzen

    2014-05-01

    Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS) are integral parts of emergency resuscitative care. Although this training is usually reserved for residents, introducing the training in the medical student curriculum may enhance acquisition and retention of these skills. We developed a survey to characterize the perceptions and needs of graduating medical students regarding BLS, ACLS, and PALS training. This was a study of graduating 4th-year medical students at a U.S. medical school. The students were surveyed prior to participating in an ACLS course in March of their final year. Of 152 students, 109 (71.7%) completed the survey; 48.6% of students entered medical school without any prior training and 47.7% started clinics without training; 83.4% of students reported witnessing an average of 3.0 in-hospital cardiac arrests during training (range of 0-20). Overall, students rated their preparedness 2.0 (SD 1.0) for adult resuscitations and 1.7 (SD 0.9) for pediatric resuscitations on a 1-5 Likert scale, with 1 being unprepared. A total of 36.8% of students avoided participating in resuscitations due to lack of training; 98.2%, 91.7%, and 64.2% of students believe that BLS, ACLS, and PALS, respectively, should be included in the medical student curriculum. As per previous studies that have examined this topic, students feel unprepared to respond to cardiac arrests and resuscitations. They feel that training is needed in their curriculum and would possibly enhance perceived comfort levels and willingness to participate in resuscitations. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Assessment of cardiopulmonary resuscitation practices in emergency departments for out-of-hospital cardiac arrest victims in Lebanon

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    Samar Noureddine

    2016-01-01

    Full Text Available Background: The survival rate of out-of-hospital cardiac arrest (OHCA victims in Lebanon is low. A national policy on resuscitation practice is lacking. This survey explored the practices of emergency physicians related to the resuscitation of OHCA victims in Lebanon. Methods: A sample of 705 physicians working in emergency departments (EDs was recruited and surveyed using the LimeSurvey software (Carsten Schmitz, Germany. Seventy-five participants responded, yielding 10.64% response rate. Results: The most important factors in the participants' decision to initiate or continue resuscitation were presence of pulse on arrival (93.2%, underlying cardiac rhythm (93.1%, the physician's ethical duty to resuscitate (93.2%, transport time to the ED (89%, and down time (84.9%. The participants were optimistic regarding the survival of OHCA victims (58.1% reporting > 10% survival and reported frequent resuscitation attempts in medically futile situations. The most frequently reported challenges during resuscitation decisions were related to pressure or presence of victim's family (38.8% and lack of policy (30%. Conclusion: In our setting, physicians often rely on well-established criteria for initiating/continuing resuscitation; however, their decisions are also influenced by cultural factors such as victim's family wishes. The findings support the need for a national policy on resuscitation of OHCA victims.

  20. Resuscitation of very preterm infants with 30% vs. 65% oxygen at birth: Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    D. Rook (Denise); H. Schierbeek (Henk); A.C. van der Eijk (Anne ); M. Longini (Mariangela); G. Buonocore (Giuseppe); M. Vento (Maximo); J.B. van Goudoever (Hans); M.J. Vermeulen (Marijn)

    2012-01-01

    textabstractBackground: Resuscitation at birth with 100% oxygen is known to increase the oxidative burden with concomitant deleterious effects. Although fractions of inspired oxygen (FiO 2) < 100% are widely used in preterm infants, starting resuscitation at a (too) low FiO 2 may result in hypoxia.

  1. Trained first-responders with an automated external defibrillator: how do they perform in real resuscitation attempts?

    NARCIS (Netherlands)

    de Vries, Wiebe; van Alem, Anouk P.; de Vos, Rien; van Oostrom, Joost; Koster, Rudolph W.

    2005-01-01

    Introduction: The quality of first-responder performance at the end of automated external defibrillator (AED) training may not predict the performance adequately during a real resuscitation attempt. Methods: Between January and December 2000, we evaluated 67 resuscitation attempts in Amsterdam and

  2. Is peer tutoring beneficial in the context of school resuscitation training?

    Science.gov (United States)

    Lester, C; Donnelly, P; Weston, C

    1997-09-01

    First year pupils at a Cardiff comprehensive school were trained in cardiopulmonary resuscitation, 106 by the teacher only and 137 by the teacher assisted by older pupils (peer tutoring). Scores in a multiple choice theory test and in practical skill assessment showed no significant difference between instruction methods, but boys taught by the teacher assisted by older pupils expressed less willingness to resuscitate in an emergency than girls instructed by either method (P < 0.01). Girls had higher scores in the multiple choice paper (P < 0.025) and in the skills assessment (P < 0.01). Those pupils who reported some prior knowledge of resuscitation techniques performed better during skill assessment than novice trainees (P < 0.025).

  3. Disseminating cardiopulmonary resuscitation training by distributing 35,000 personal manikins among school children

    DEFF Research Database (Denmark)

    Isbye, Dan L; Rasmussen, Lars S; Ringsted, Charlotte

    2007-01-01

    BACKGROUND: Because most cardiac arrests occur at home, widespread training is needed to increase the incidence of cardiopulmonary resuscitation (CPR) by lay persons. The aim of this study was to evaluate the effect of mass distribution of CPR instructional materials among schoolchildren. METHODS...... AND RESULTS: We distributed 35,002 resuscitation manikins to pupils (12 to 14 years of age) at 806 primary schools. Using the enclosed 24-minute instructional DVD, they trained in CPR and subsequently used the kit to train family and friends (second tier). They completed a questionnaire on who had trained...... the project did not increase significantly compared with the previous year (25.0% versus 27.9%; P=0.16). CONCLUSIONS: CPR training can be disseminated in a population by distributing personal resuscitation manikins among children in primary schools. The teachers felt able to easily facilitate CPR training...

  4. Compression-only life support (COLS for cardiopulmonary resuscitation by layperson outside the hospital

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    Syed Moied Ahmed

    2017-01-01

    Full Text Available The cardiopulmonary resuscitation (CPR guidelines of compression-only life support (COLS for management of the victim with cardiopulmonary arrest in adults provide a stepwise algorithmic approach for optimal outcome of the victim outside the hospital by untrained laypersons. These guidelines have been developed to recommend practical, uniform and acceptable resuscitation algorithms across India. As resuscitation data of the Indian population are inadequate, these guidelines have been based on international literature. The guidelines have been recommended after discussion among Indian experts and the recommendations modified to ensure its practical applicability across the country. The COLS emphasises on early recognition of cardiac arrest and activation, early chest compression and early transfer to medical facility. The guidelines emphasise avoidance of any interruption of chest compression, and thus relies primarily on chest compression-only CPR by laypersons.

  5. Perioperative do-not-resuscitate orders: it is time to talk

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    Brindley Peter G

    2013-01-01

    Full Text Available Abstract A study by Burkle et al. in BMC Anesthesiology examined attitudes around perioperative do-not-resuscitate orders. Questionnaires were given to patients, as well as to anesthesiologists, internists and surgeons. The study has limitations and is open to interpretation. However, the findings are important. There appear to be attitudinal differences between patients and doctors, and between specialties. A small majority of patients are content to have a do-not-resuscitate order postponed during the perioperative period. A large majority expects open communication from doctors before proceeding. However, this article could also encourage a broader debate. This is about how to respect patient autonomy, while ensuring that resuscitation truly serves the patient’s best interests. This commentary outlines how more communication is needed at the bedside and in wider society.

  6. The effect of resuscitation strategy on the longitudinal immuno-inflammatory response to blunt trauma

    DEFF Research Database (Denmark)

    Bonde, Alexander; Nordestgaard, Ask Tybjærg; Kirial, Rasmus

    2017-01-01

    INTRODUCTION: Resuscitation strategies following blunt trauma have been linked to immuno-inflammatory complications leading to systemic inflammatory syndrome (SIRS), sepsis and multiple organ failure (MOF). The effect of resuscitation strategy on longitudinal inflammation marker trajectories is......, however, unknown. We hypothesized that the effect of resuscitation strategy extends beyond the trauma-related coagulopathy, perhaps affecting the longitudinal immuno-inflammatory response to injury. METHODS: We analyzed data prospectively collected for the Inflammation and Host Response to Injury (Glue...... Grant) study. Blood sampling for inflammation marker analyses from blunt trauma patients was done on admission days 0, 1, 4, 7, 14, 21 and 28 where applicable. Total volume transfused of packed red blood cells (PRBC), fresh frozen plasma (FFP), platelets (PLT), and crystalloids during the initial 48h...

  7. Assessment of the Quality of Basic and Expanded Resuscitative Measures in a Multifield Hospital (Simulation Course

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    A. N. Kuzovlev

    2016-01-01

    Full Text Available The survival of patients after the sudden circulatory arrest (SCA depends not only on immediate onset of resuscitative measures, but also on their quality.The purpose of the study. The purpose is to assess the compliance of basic and expanded resuscitative measures carried out by healthcare providers in hospitals with modern national and international guidelines within the frames of a stimulation course.Materials and Methods. The research was perfomed in a multifield hospital in Moscow, in 2016. It consisted of two phases. During the first phase, within the frames of a simulation course, providers' skills in the cardiopul monary resuscitation (CPR and chest compression (CC technique mastership were evaluated. During the second stage, their skills in expanded CPR and ability to work as a part of resuscitation teams were assessed. During the simulation, all team activities were recorded (both audio and video; CC parameters were also registered using a CC pressure control sensor (hereinafter referred to as a sensor and audiovisual tips. The European Resuscitation Council Guidelines for Resuscitation 2015 were used as reference criteria. The analysis was performed using the ZOLL RescueNet Code Review® software. A statistical analysis was performed using the Statistica 7.0 software (MannWhitney Utest. The data were presented as a mean, median ± 25—75 percentiles (25—75 IQR, minimum and maximum values. The difference was considered significant at P<0.05.Results. Test results of most healthcare providers were unsatisfactory when the CPR was performed without sensors and audiovisual tips: the percentage of target CCs was not more than 10% in 72% of providers (n=18. When the CPR was performed with sensors and audiovisual tips regulating the CC quality, the percentage of target CCs was 65.7%. i.e. it was significantly higher than that during the CPR without the sensor and the tips (P=0.0000. While only one provider was able to perform

  8. Physiologic and Clinical Principles behind Noninvasive Resuscitation Techniques and Cardiac Output Monitoring

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    Anthony M. Napoli

    2012-01-01

    Full Text Available Clinical assessment and vital signs are poor predictors of the overall hemodynamic state. Optimal measurement of the response to fluid resuscitation and hemodynamics has previously required invasive measurement with radial and pulmonary artery catheterization. Newer noninvasive resuscitation technology offers the hope of more accurately and safely monitoring a broader range of critically ill patients while using fewer resources. Fluid responsiveness, the cardiac response to volume loading, represents a dynamic method of improving upon the assessment of preload when compared to static measures like central venous pressure. Multiple new hemodynamic monitors now exist that can noninvasively report cardiac output and oxygen delivery in a continuous manner. Proper assessment of the potential future role of these techniques in resuscitation requires understanding the underlying physiologic and clinical principles, reviewing the most recent literature examining their clinical validity, and evaluating their respective advantages and limitations.

  9. Does teaching crisis resource management skills improve resuscitation performance in pediatric residents?*.

    Science.gov (United States)

    Blackwood, Jaime; Duff, Jonathan P; Nettel-Aguirre, Alberto; Djogovic, Dennis; Joynt, Chloe

    2014-05-01

    The effect of teaching crisis resource management skills on the resuscitation performance of pediatric residents is unknown. The primary objective of this pilot study was to determine if teaching crisis resource management to residents leads to improved clinical and crisis resource management performance in simulated pediatric resuscitation scenarios. A prospective, randomized control pilot study. Simulation facility at tertiary pediatric hospital. Junior pediatric residents. Junior pediatric residents were randomized to 1 hour of crisis resource management instruction or no additional training. Time to predetermined resuscitation tasks was noted in simulated resuscitation scenarios immediately after intervention and again 3 months post intervention. Crisis resource management skills were evaluated using the Ottawa Global Rating Scale. Fifteen junior residents participated in the study, of which seven in the intervention group. The intervention crisis resource management group placed monitor leads 24.6 seconds earlier (p = 0.02), placed an IV 47.1 seconds sooner (p = 0.04), called for help 50.4 seconds faster (p = 0.03), and checked for a pulse after noticing a rhythm change 84.9 seconds quicker (p = 0.01). There was no statistically significant difference in time to initiation of cardiopulmonary resuscitation (p = 0.264). The intervention group had overall crisis resource management performance scores 1.15 points higher (Ottawa Global Rating Scale [out of 7]) (p = 0.02). Three months later, these differences between the groups persisted. A 1-hour crisis resource management teaching session improved time to critical initial steps of pediatric resuscitation and crisis resource management performance as measured by the Ottawa Global Rating Scale. The control group did not develop these crisis resource management skills over 3 months of standard training indicating that obtaining these skills requires specific education. Larger studies of crisis resource education are

  10. Prehospital plasma resuscitation associated with improved neurologic outcomes after traumatic brain injury.

    Science.gov (United States)

    Hernandez, Matthew C; Thiels, Cornelius A; Aho, Johnathon M; Habermann, Elizabeth B; Zielinski, Martin D; Stubbs, James A; Jenkins, Donald H; Zietlow, Scott P

    2017-09-01

    Trauma-related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBIs). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improves neurologic function after TBI; however, data in humans are lacking. We retrospectively identified all patients with multiple injuries age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single Level I trauma center from January 2002 to December 2013. Inclusion criteria were prehospital resuscitation with either packed red blood cells (pRBCs) or thawed plasma as sole colloid resuscitation. Patients who died in hospital and those using anticoagulants were excluded. Primary outcomes were Glasgow Outcomes Score Extended (GOSE) and Disability Rating Score (DRS) at dismissal and during follow-up. Of 76 patients meeting inclusion criteria, 53% (n = 40) received prehospital pRBCs and 47% (n = 36) received thawed plasma. Age, gender, injury severity or TBI severity, arrival laboratory values, and number of prehospital units were similar (all p > 0.05). Patients who received thawed plasma had an improved neurologic outcome compared to those receiving pRBCs (median GOSE 7 [7-8] vs. 5.5 [3-7], p plasma had improved functionality compared to pRBCs (median DRS 2 [1-3.5] vs. 9 [3-13], p plasma compared to pRBCs by both median GOSE (8 [7-8] vs. 6 [6-7], p plasma is associated with improved neurologic and functional outcomes at discharge and during follow-up compared to pRBCs alone. These preliminary data support the further investigation and use of plasma in the resuscitation of critically injured TBI patients. Therapeutic, level V.

  11. Comparison of not for resuscitation (NFR) forms across five Victorian health services.

    Science.gov (United States)

    Levinson, M; Mills, A; Hutchinson, A M; Heriot, G; Stephenson, G; Gellie, A

    2014-07-01

    Within Australian hospitals, cardiac and respiratory arrests result in a resuscitation attempt unless the patient is documented as not for resuscitation. To examine the consistency of policies and documentation for withholding in-hospital resuscitation across health services. An observational, qualitative review of hospital policy and documentation was conducted in June 2013 in three public and two private sector hospitals in metropolitan Melbourne. Not for resuscitation (NFR) forms were evaluated for physical characteristics, content, authorisation and decision-making. Hospital policies were coded for alerts, definition of futility and burden of treatment and management of discussions and dissent. There was a lack of standardisation, with each site using its own unique NFR form and accompanying site-specific policies. Differences were found in who could authorise the decision, what was included on the form, the role of patients and families, and how discussions were managed and dissent resolved. Futility and burden of treatment were not defined independently. These inconsistencies across sites contribute to a lack of clarity regarding the decision to withhold resuscitation, and have implications for staff employed across multiple hospitals. NFR forms should be reviewed and standardised so as to be clear, uniform and consistent with the legislative framework. We propose a two-stage process of documentation. Stage 1 facilitates discussion of patient-specific goals of care and consideration of limitations of treatment. Stage 2 serves to communicate a NFR order. Decisions to withhold resuscitation are inherently complex but could be aided by separating the decision-making process from the communication of the decision, resulting in improved end-of-life care. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

  12. Effect of four resuscitation methods on lung ventilation of pigs with respiratory arrest

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    Ya-hua LIU

    2012-03-01

    Full Text Available Objective To observe the effects of four cardiopulmonary resuscitation (CPR methods on lung ventilation of pigs with respiratory arrest. The four CPR methods included chest compression CPR (C-CPR, compression under the diaphragm CPR (D-CPR, abdominal compression CPR (A-CPR, and abdominal wall lifting and compression CPR (L-CPR. Methods  A total of 28 healthy domestic pigs were randomly divided into four groups. The pig respiratory arrest model was reproduced by intravenous injection of suxamethonium. Instantly after respiratory arrest, one of the 4 CPR methods was performed immediately on the groups of pigs respectively. After 2min of CPR, compression was stopped. The experimental pigs were given assisted respiration using a ventilator until autonomous respiration recovered. The tidal volume (VT in basic status and that during resuscitation by the four respective resuscitation methods was determined, and minute ventilation (MV was calculated. Furthermore, heart rate (HR, mean arterial blood pressure, and recovery time of autonomous respiration were compared between all the groups. Results In basic status, there was no statistical difference (P > 0.05 in VT and MV between the four groups. Approximately 2min after resuscitation, the VT and MV of D-CPR were higher than that of C-CPR; that of A-CPR was higher than that of D-CPR; and that of L-CPR was higher than that of A-CPR. The differences were statistically significant (P 0.05. HR in C-CPR and D-CPR were notably lower than the basic value (P < 0.01. Two minutes after resuscitation, mechanical ventilation was given, and HR in all the groups was close to the basic value 5 min after resuscitation. In the respiratory arrest pig model, L-CPR could provide more effective VT and MV than the other methods. Conclusion For the porcine respiratory arrest model, L-CPR can provide more effective lung ventilation than the other methods.

  13. Do our newly graduated medical doctors have adequate knowledge about neonatal resuscitation?

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    Ana Paula de Carvalho Panzeri Carlotti

    Full Text Available CONTEXT AND OBJECTIVE: Neonatal resuscitation should be part of medical school curriculums. We aimed to evaluate medical school graduates' knowledge of neonatal resuscitation. DESIGN AND SETTING: Cross-sectional study on the performance of candidates sitting a medical residency exam at Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, in 2004. METHODS: There were two questions on neonatal resuscitation. One question in the theory test aimed at evaluating basic knowledge on the initial approach towards newly born infants. The question in the practical exam was designed to evaluate the candidate's ability to perform the initial steps of resuscitation and to establish bag-mask ventilation. RESULTS: Out of 642 candidates from 74 medical schools, 151 (23.5% answered the theory question correctly. Significantly more physicians from public medical schools in the State of São Paulo answered correctly than did those from other schools in Brazil (52.5% versus 9.2%; p < 0.05. A total of 436 candidates did the practical exam. The grades among graduates from medical schools belonging to the State of São Paulo were significantly higher than among those from other schools (5.9 ± 2.6 versus 4.1 ± 2.1; p < 0.001. The grades for the practical question among candidates who had answered the theory question correctly were significantly higher than those obtained by candidates who had given wrong answers (p < 0.05. CONCLUSION: Medical school graduates' knowledge of neonate resuscitation in the delivery room is quite precarious. Emphasis on neonatal resuscitation training is urgently needed in medical schools.

  14. Use of Naloxone by Emergency Medical Services during Opioid Drug Overdose Resuscitation Efforts.

    Science.gov (United States)

    Sumner, Steven Allan; Mercado-Crespo, Melissa C; Spelke, M Bridget; Paulozzi, Leonard; Sugerman, David E; Hillis, Susan D; Stanley, Christina

    2016-01-01

    Naloxone administration is an important component of resuscitation attempts by emergency medical services (EMS) for opioid drug overdoses. However, EMS providers must first recognize the possibility of opioid overdose in clinical encounters. As part of a public health response to an outbreak of opioid overdoses in Rhode Island, we examined missed opportunities for naloxone administration and factors potentially influencing EMS providers' decision to administer naloxone. We reviewed medical examiner files on all individuals who died of an opioid-related drug overdose in Rhode Island from January 1, 2012 through March 31, 2014, underwent attempted resuscitation by EMS providers, and had records available to assess for naloxone administration. We evaluated whether these individuals received naloxone as part of their resuscitation efforts and compared patient and scene characteristics of those who received naloxone to those who did not receive naloxone via chi-square, t-test, and logistic regression analyses. One hundred and twenty-four individuals who underwent attempted EMS resuscitation died due to opioid overdose. Naloxone was administered during EMS resuscitation attempts in 82 (66.1%) of cases. Females were nearly three-fold as likely not to receive naloxone as males (OR 2.9; 95% CI 1.2-7.0; p-value 0.02). Additionally, patients without signs of potential drug abuse also had a greater than three-fold odds of not receiving naloxone (OR 3.3; 95% CI 1.2-9.2; p-value 0.02). Older individuals, particularly those over age 50, were more likely not to receive naloxone than victims younger than age 30 (OR 4.8; 95% CI 1.3-17.4; p-value 0.02). Women, older individuals, and those patients without clear signs of illicit drug abuse, were less likely to receive naloxone in EMS resuscitation attempts. Heightened clinical suspicion for opioid overdose is important given the recent increase in overdoses among patients due to prescription opioids.

  15. Have ATLS and national transfer guidelines improved the quality of resuscitation and transfer of head-injured patients? A prospective survey from a Regional Neurosurgical Unit.

    Science.gov (United States)

    Price, Stephen J; Suttner, Nigel; Aspoas, A Robert

    2003-11-01

    High-quality resuscitation and care during transfer of head-injured patients is essential to prevent secondary brain injury. We have prospectively assessed the standard of resuscitation in 50 consecutive head-injured patients transferred to our unit, and compared our findings with previous studies performed before the advanced trauma life support course (ATLS) had become widespread and national guidelines on the transfer of head injuries had been produced by the Association of Anaesthetists of Great Britain and Ireland (AAGBI). Delays in transfer, management of the airway, adequate cervical spine assessment, hypoxia (P(a)O(2) ATLS and AAGBI Guidelines. The mean, unavoidable delay from arrival at the local accident and emergency unit to arrival was 7.4+/-1.9h (mean+/-95%CI) with most of the delay being prior to initial referral. Two patients arrived with an unsecured airway with a GCS=8/15; 26 had inadequate cervical spine imaging; 7 patients arrived hypoxic and 2 patients arrived hypotensive; most of these insults occurred during the transfer. Forty-six percent of medical escorts did not fulfil the minimum standard of experience. ATLS and AAGBI guidelines have provided only modest improvements in patient care at the expense of long delays in transfer. The incidence of hypoxia and hypotension remains unacceptably high.

  16. Resuscitation at birth and cognition at 8 years of age: a cohort study.

    Science.gov (United States)

    Odd, David E; Lewis, Glyn; Whitelaw, Andrew; Gunnell, David

    2009-05-09

    Mild cerebral injury might cause subtle defects in cognitive function that are only detectable as the child grows older. Our aim was to determine whether infants receiving resuscitation after birth, but with no symptoms of encephalopathy, have reduced intelligence quotient (IQ) scores in childhood. Three groups of infants were selected from the Avon Longitudinal Study of Parents and Children: infants who were resuscitated at birth but were asymptomatic for encephalopathy and had no further neonatal care (n=815), those who were resuscitated and had neonatal care for symptoms of encephalopathy (n=58), and the reference group who were not resuscitated, were asymptomatic for encephalopathy, and had no further neonatal care (n=10 609). Cognitive function was assessed at a mean age of 8.6 years (SD 0.33); a low IQ score was defined as less than 80. IQ scores were obtained for 5953 children with a shortened version of the Weschler intelligence scale for children (WISC-III), the remaining 5529 were non-responders. All children did not complete all parts of the test, and therefore multiplied IQ values comparable to the full-scale test were only available for 5887 children. Results were adjusted for clinical and social covariates. Chained equations were used to impute missing values of covariates. In the main analysis at 8 years of age (n=5887), increased risk of a low IQ score was recorded in both resuscitated infants asymptomatic for encephalopathy (odds ratio 1.65 [95% CI 1.13-2.43]) and those with symptoms of encephalopathy (6.22 [1.57-24.65]). However, the population of asymptomatic infants was larger than that of infants with encephalopathy, and therefore the population attributable risk fraction for an IQ score that might be attributable to the need for resuscitation at birth was 3.4% (95% CI 0.5-6.3) for asymptomatic infants and 1.2% (0.2-2.2) for those who developed encephalopathy. Infants who were resuscitated had increased risk of a low IQ score, even if they

  17. Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm.

    Science.gov (United States)

    Moreno, Daniel H; Cacione, Daniel G; Baptista-Silva, Jose C C

    2016-05-13

    An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 population. The outcome of people with ruptured AAA varies among countries and healthcare systems, with mortality ranging from 53% to 90%. Definitive treatment for ruptured AAA includes open surgery or endovascular repair. The management of haemorrhagic shock is crucial for the person's outcome and aims to restore organ perfusion and systolic blood pressure above 100 mm Hg through immediate and aggressive fluid replacement. This rapid fluid replacement is known as the normotensive resuscitation strategy. However, evidence suggests that infusing large volumes of cold fluid causes dilutional and hypothermic coagulopathy. The association of these factors may exacerbate bleeding, resulting in a 'lethal triad' of hypothermia, acidaemia, and coagulopathy. An alternative to the normotensive resuscitation strategy is the controlled (permissive) hypotension resuscitation strategy, with a target systolic blood pressure of 50 to 100 mm Hg. The principle of controlled or hypotensive resuscitation has been used in some management protocols for endovascular repair of ruptured AAA. It may be beneficial in preventing blood loss by avoiding the clot disruption caused by the rapid increase in systolic blood pressure; avoiding dilution of clotting factors, platelets and fibrinogen; and by avoiding the temperature decrease that inhibits enzyme activity involved in platelet and clotting factor function. To compare the effects of controlled (permissive) hypotension resuscitation and normotensive resuscitation strategies for people with ruptured AAA. The Cochrane Vascular Information Specialist searched the Specialised Register (April 2016) and the Cochrane Register of Studies (CENTRAL (2016

  18. Public cardiopulmonary resuscitation training rates and awareness of hands-only cardiopulmonary resuscitation: a cross-sectional survey of Victorians.

    Science.gov (United States)

    Bray, Janet E; Smith, Karen; Case, Rosalind; Cartledge, Susie; Straney, Lahn; Finn, Judith

    2017-04-01

    To provide contemporary Australian data on the public's training in cardiopulmonary resuscitation (CPR) and awareness of hands-only CPR. A cross-sectional telephone survey in April 2016 of adult residents of the Australian state of Victoria was conducted. Primary outcomes were rates of CPR training and awareness of hands-only CPR. Of the 404 adults surveyed (mean age 55 ± 17 years, 59% female, 73% metropolitan residents), 274 (68%) had undergone CPR training. Only 50% (n = 201) had heard of hands-only CPR, with most citing first-aid courses (41%) and media (36%) as sources of information. Of those who had undergone training, the majority had received training more than 5 years previously (52%) and only 28% had received training or refreshed training in the past 12 months. Most received training in a formal first-aid class (43%), and received training as a requirement for work (67%). The most common reasons for not having training were: they had never thought about it (59%), did not have time (25%) and did not know where to learn (15%). Compared to standard CPR, a greater proportion of respondents were willing to provide hands-only CPR for strangers (67% vs 86%, P CPR training rates and awareness of hands-only CPR. Further promotion of hands-only CPR and self-instruction (e.g. DVD kits or online) may see further improvements in CPR training and bystander CPR rates. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  19. Novel electronic refreshers for cardiopulmonary resuscitation: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Magura Stephen

    2012-11-01

    Full Text Available Abstract Background Currently the American Red Cross requires that individuals renew their cardiopulmonary resuscitation (CPR certification annually; this often requires a 4- to 8-hour refresher course. Those trained in CPR often show a decrease in essential knowledge and skills within just a few months after training. New electronic means of communication have expanded the possibilities for delivering CPR refreshers to members of the general public who receive CPR training. The study’s purpose was to determine the efficacy of three novel CPR refreshers - online website, e-mail and text messaging – for improving three outcomes of CPR training - skill retention, confidence for using CPR and intention to use CPR. These three refreshers may be considered “novel” in that they are not typically used to refresh CPR knowledge and skills. Methods The study conducted two randomized clinical trials of the novel CPR refreshers. A mailed brochure was a traditional, passive refresher format and served as the control condition. In Trial 1, the refreshers were delivered in a single episode at 6 months after initial CPR training. In Trial 2, the refreshers were delivered twice, at 6 and 9 months after initial CPR training, to test the effect of a repeated delivery. Outcomes for the three novel refreshers vs. the mailed brochure were determined at 12 months after initial CPR training. Results Assignment to any of three novel refreshers did not improve outcomes of CPR training one year later in comparison with receiving a mailed brochure. Comparing outcomes for subjects who actually reviewed some of the novel refreshers vs. those who did not indicated a significant positive effect for one outcome, confidence for performing CPR. The website refresher was associated with increased behavioral intent to perform CPR. Stated satisfaction with the refreshers was relatively high. The number of episodes of refreshers (one vs. two did not have a significant effect

  20. Development of Reliable and Validated Tools to Evaluate Technical Resuscitation Skills in a Pediatric Simulation Setting: Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics.

    Science.gov (United States)

    Faudeux, Camille; Tran, Antoine; Dupont, Audrey; Desmontils, Jonathan; Montaudié, Isabelle; Bréaud, Jean; Braun, Marc; Fournier, Jean-Paul; Bérard, Etienne; Berlengi, Noémie; Schweitzer, Cyril; Haas, Hervé; Caci, Hervé; Gatin, Amélie; Giovannini-Chami, Lisa

    2017-09-01

    To develop a reliable and validated tool to evaluate technical resuscitation skills in a pediatric simulation setting. Four Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics (RESCAPE) evaluation tools were created, following international guidelines: intraosseous needle insertion, bag mask ventilation, endotracheal intubation, and cardiac massage. We applied a modified Delphi methodology evaluation to binary rating items. Reliability was assessed comparing the ratings of 2 observers (1 in real time and 1 after a video-recorded review). The tools were assessed for content, construct, and criterion validity, and for sensitivity to change. Inter-rater reliability, evaluated with Cohen kappa coefficients, was perfect or near-perfect (>0.8) for 92.5% of items and each Cronbach alpha coefficient was ≥0.91. Principal component analyses showed that all 4 tools were unidimensional. Significant increases in median scores with increasing levels of medical expertise were demonstrated for RESCAPE-intraosseous needle insertion (P = .0002), RESCAPE-bag mask ventilation (P = .0002), RESCAPE-endotracheal intubation (P = .0001), and RESCAPE-cardiac massage (P = .0037). Significantly increased median scores over time were also demonstrated during a simulation-based educational program. RESCAPE tools are reliable and validated tools for the evaluation of technical resuscitation skills in pediatric settings during simulation-based educational programs. They might also be used for medical practice performance evaluations. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. [Adequate fluid resuscitation in septic shock with high catecholamine doses].

    Science.gov (United States)

    Lewejohann, J C; Braasch, H; Hansen, M; Zimmermann, C; Muhl, E; Keck, T

    2016-09-01

    Appropriate fluid resuscitation is a fundamental aspect for the hemodynamic management of septic shock patients and should ideally be achieved before vasopressors and positive inotropic substances are administered. The development of hemodynamic monitoring has revealed that in some cases patients had been improperly treated with high-dose catecholamines for initially insufficient fluid resuscitation. The aim of this study was to show that in some cases it is possible to actively reduce catecholamines by a volume challenge adapted according to the individual patient needs. In this retrospective observational study 29 patients with septic shock in a surgical intensive care unit (ICU) at a university hospital (17 male, 12 female, mean age 71 ± 10 years) on high-dose catecholamines (median values norepinephrine 0.204 µg/kg body weight/min, dobutamine 3.876 µg/kg/min and epinephrine 0.025 µg/kg/min, ranging up to 0.810 µg/kg/min, 22.222 µg/kg/min and 0.407 µg/kg/min in 28, 20 and 17 patients, respectively) were analyzed. The extremities of the patients were initially cold with a mottled marbled appearance whereas the mean arterial pressure (MAP) was ≥ 65 mmHg. The median central venous pressure (CVP) was 17 mmHg (range 55-34 mmHg) and the mean lactate concentration was 2.78 mmol/l (range 0.93-10.67 mmol/l). The standard therapy concept consisted of a forced volume challenge combined with active reduction of catecholamines to achieve an adequate fluid loading status, guided by the passive leg raising test (PLR), clinical signs and in 19 cases by hemodynamic monitoring (pulmonary artery catheter Vigilance II(™) n = 10, FloTrac(™), Vigileo(™) n = 9 and PreSep(™) n = 5; Edwards Life Sciences). The forced volume challenge was stopped after clinical improvement with rewarmed extremities, increasing diuresis volumes and lack of improvement by PLR. Catecholamine doses could be significantly reduced in all patients: norepinephrine

  2. Análise crítica das novas recomendações para reanimação cardiopulmonar The new guidelines for cardiopulmonary resuscitation: a critical analysis

    Directory of Open Access Journals (Sweden)

    Liliane Zorzela

    2007-05-01

    Full Text Available OBJETIVO: Descrever as novas recomendações da American Heart Association (AHA, baseado em evidências científicas organizadas pelo Comitê Internacional de Reanimação, endossado e disseminado por entidades norte-americanas e européias. FONTES DOS DADOS: Os guias para suporte básico e avançado de vida em pediatria publicados nas revistas Circulation em novembro de 2005 foram revisados, bem como as subseqüentes publicações sobre o mesmo tópico usando as palavras-chave cardiac arrest, basic life support, advanced life support, cardiopulmonary resuscitation e pediatric resuscitation, através dos métodos de busca PubMed e MEDLINE. SÍNTESE DOS DADOS: As maiores alterações foram na área de suporte básico de vida. O novo guia enfatiza a relação compressão torácica/ventilação para os profissionais da saúde treinados, que passa a ser 15:2 em todas as idades, exceto neonatos. É ressaltada a importância das compressões torácicas fortes e rápidas e a necessidade de se evitar a hiperventilação durante e após a parada cardiorrespiratória. O uso de megadoses de adrenalina foi retirado, bem como outras orientações. CONCLUSÃO: O guia mais recente de reanimação em pediatria da AHA tem como foco principal o atendimento básico pré-hospitalar. Está baseado na melhor evidência científica disponível, porém futuras pesquisas são necessárias para corroborar essas mudanças e trazer novas evidências para os futuros protocolos.OBJECTIVE: To describe the new American Heart Association (AHA guidelines for pediatric life support, based on the scientific evidence evaluated by the International Liaison Committee on Resuscitation, and endorsed and disseminated by North American resuscitation councils. SOURCES: The guidelines for basic and advanced life support published in Circulation in November 2005 were reviewed together with subsequent publications on the same topics, identified in PubMed and MEDLINE using the keywords

  3. Telehealth on advanced networks.

    Science.gov (United States)

    Wilson, Laurence S; Stevenson, Duncan R; Cregan, Patrick

    2010-01-01

    We address advanced Internet for complex telehealth applications by reviewing four hospital-based broadband telehealth projects and identifying common threads. These projects were conducted in Australia under a 6-year research project on broadband Internet applications. Each project addressed specific clinical needs and its development was guided by the clinicians involved. Each project was trialed in the field and evaluated against the initial requirements. The four projects covered remote management of a resuscitation team in a district hospital, remote guidance and interpretation of echocardiography, virtual-reality-based instructor-student surgical training, and postoperative outpatient consultations following pediatric surgery. Each was characterized by a high level of interpersonal communication, a high level of clinical expertise, and multiple participants. Each made use of multiple high-quality video and audio links and shared real-time access to clinical data. Four common threads were observed. Each application provided a high level of usability and task focus because the design and use of broadband capability was aimed directly to meet the clinicians' needs. Each used the media quality available over broadband to convey words, gestures, body movements, and facial expressions to support communication and a sense of presence among the participants. Each required a complex information space shared among the participants, including real-time access to stored patient data and real-time interactive access to the patients themselves. Finally, each application supported the social and organizational aspects of their healthcare focus, creating and maintaining relationships between the various participants, and this was done by placing the telehealth application into a wider functioning clinical context. These findings provide evidence for a significantly enhanced role for appropriate telemedicine systems running on advanced networks, in a wider range of clinical

  4. extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital refractory cardiac arrest

    DEFF Research Database (Denmark)

    Obling, Laust; Wiberg, Sebastian; Møller, Jacob Eifer

    2017-01-01

    Out-of-hospital cardiac arrest is associated with high mortality and morbidity. Treatment options remain few in refractory cases, but extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly applied to improve the outcome. This article summarizes the use, experience and outcome of e...

  5. Impact of a novel, resource appropriate resuscitation curriculum on Nicaraguan resident physician's management of cardiac arrest.

    Science.gov (United States)

    Taira, Breena R; Orue, Aristides; Stapleton, Edward; Lovato, Luis; Vangala, Sitaram; Tinoco, Lucia Solorzano; Morales, Orlando

    2016-01-01

    Project Strengthening Emergency Medicine, Investing in Learners in Latin America (SEMILLA) created a novel, language and resource appropriate course for the resuscitation of cardiac arrest for Nicaraguan resident physicians. We hypothesized that participation in the Project SEMILLA resuscitation program would significantly improve the physician's management of simulated code scenarios. Thirteen Nicaraguan resident physicians were evaluated while managing simulated cardiac arrest scenarios before, immediately, and at 6 months after participating in the Project SEMILLA resuscitation program. This project was completed in 2014 in Leon, Nicaragua. The Cardiac Arrest Simulation Test (CASTest), a validated scoring system, was used to evaluate performance on a standardized simulated cardiac arrest scenario. Mixed effect logistic regression models were constructed to assess outcomes. On the pre-course simulation exam, only 7.7% of subjects passed the test. Immediately post-course, the subjects achieved a 30.8% pass rate and at 6 months after the course, the pass rate was 46.2%. Compared with pre-test scores, the odds of passing the CASTest at 6 months after the course were 21.7 times higher (95% CI 4.2 to 112.8, PSEMILLA resuscitation course and retain these skills.

  6. Do-not-resuscitate orders and early mortality in hip fracture patients

    NARCIS (Netherlands)

    Simons, Anouk E.; Karres, Julian; Nijland, Leontien M. G.; Ultee, Jan M.; Kerkhoffs, Gino M. M. J.; Vrouenraets, Bart C.

    2017-01-01

    Background: factors affecting mortality after hip fracture surgery have been studied extensively. It has been suggested that do-not-resuscitate (DNR) orders are associated with higher mortality in surgical patients due to less aggressive treatment. However, the effect of DNR orders on mortality in

  7. Implementation of a High-Performance Cardiopulmonary Resuscitation Protocol at a Collegiate Emergency Medical Services Program

    Science.gov (United States)

    Stefos, Kathryn A.; Nable, Jose V.

    2016-01-01

    Out-of-hospital cardiac arrest (OHCA) is a significant public health issue. Although OHCA occurs relatively infrequently in the collegiate environment, educational institutions with on-campus emergency medical services (EMS) agencies are uniquely positioned to provide high-quality resuscitation care in an expedient fashion. Georgetown University's…

  8. Development and psychometric evaluation of the Resuscitation Self-efficacy Scale for nurses.

    Science.gov (United States)

    Roh, Young Sook; Issenberg, S Barry; Chung, Hyun Soo; Kim, So Sun

    2012-12-01

    The purpose of this study was to develop and evaluate psychometric properties of the instrument, Resuscitation Self-Efficacy Scale for nurses. This was a methodological study for instrument development and psychometric testing. The initial item pool derived from literature review and experts resulted in 30 items linked to resuscitation self-efficacy. A convenience sample of 509 Korean nurses from eleven academic teaching hospitals participated in a survey to examine psychometric properties of the scale. To examine construct validity, exploratory factor analysis and known-group comparison were used. Cronbach's coefficient alpha was used to determine the scale's internal consistency reliability. The final scale included 17 items with four-component structure termed 'Recognition', 'Debriefing and recording', 'Responding and rescuing', and 'Reporting'. These four factors accounted for 57.5% of the variance. Each subscale and the total scale demonstrated satisfactory internal consistency: .82; .88; .87; .83; and .91 respectively. Experienced nurses reported significantly higher self-efficacy mean scores in both total and subscales compared to new graduate nurses. The Resuscitation Self-Efficacy Scale for nurses yields reliable and valid results in appraising the level of resuscitation self-efficacy for Korean nurses. Further study is needed to test and refine the scale.

  9. [Peer-led training in basic life support and resuscitation using an automatic external defibrillator].

    Science.gov (United States)

    Løfgren, Bo; Petersen, Christina Børlum; Mikkelsen, Ronni; Secher, Niels; Eika, Berit; Grove, Erik L

    2009-11-30

    Peer-led training has been identified as a useful tool for delivering undergraduate healthcare training. In this paper we describe the implementation of the European Resuscitation Council BLS/AED Course as a peer-led training program for medical students.

  10. Smartphone Apps for Cardiopulmonary Resuscitation Training and Real Incident Support: A Mixed-Methods Evaluation Study

    NARCIS (Netherlands)

    Kalz, Marco; Lenssen, Niklas; Felzen, Marco; Rossaint, Rolf; Tabuenca, Bernardo; Specht, Marcus; Skorning, Max

    2014-01-01

    Background: No systematic evaluation of smartphone/mobile apps for resuscitation training and real incident support is available to date. To provide medical, usability, and additional quality criteria for the development of apps, we conducted a mixed-methods sequential evaluation combining the

  11. A Curriculum-Based Health Service Program in Hypertension, Diabetes, Venereal Diseases and Cardiopulmonary Resuscitation

    Science.gov (United States)

    Coker, Samuel T.; Janer, Ann L.

    1978-01-01

    Special screening and education courses in hypertension, diabetes, venereal disease, and cardiopulmonary resuscitation were added as electives at the Auburn University School of Pharmacy. Applied learning experiences for students and services to the community are achieved. Course goals and content and behavioral objectives in each area are…

  12. A Retrospective Review of Resuscitation Planning at a Children’s Hospital

    Directory of Open Access Journals (Sweden)

    Jean Kelly

    2018-01-01

    Full Text Available Resuscitation plans (RP are an important clinical indicator relating to care at the end of life in paediatrics. A retrospective review of the medical records of children who had been referred to the Royal Children’s Hospital, Brisbane, Australia who died in the calendar year 2011 was performed. Of 62 records available, 40 patients (65% had a life limiting condition and 43 medical records (69% contained a documented RP. This study demonstrated that both the underlying condition (life-limiting or life-threatening and the setting of care (Pediatric Intensive Care Unit or home influenced the development of resuscitation plans. Patients referred to the paediatric palliative care (PPC service had a significantly longer time interval from documentation of a resuscitation plan to death and were more likely to die at home. All of the patients who died in the paediatric intensive care unit (PICU had a RP that was documented within the last 48 h of life. Most RPs were not easy to locate. Documentation of discussions related to resuscitation planning should accommodate patient and family centered care based on individual needs. With varied diagnoses and settings of care, it is important that there is inter-professional collaboration, particularly involving PICU and PPC services, in developing protocols of how to manage this difficult but inevitable clinical scenario.

  13. Fibrinogen Availability and Coagulation Function After Hemorrhage and Resuscitation in Pigs

    Science.gov (United States)

    2011-08-01

    next morning (24 h after hemor- rhage and resuscitation), the pigs were tranquilized with diazepam (0.5 mg/kg intramuscular [IM]) before being trans...it facilitates the liver’s synthesis of proteins, which are critical for survival (24). From a coagula- tion perspective, the increase of fibrino- gen

  14. Effects of Age, Gender, School Class on Cardiopulmonary Resuscitation Skills of Nigerian Secondary School Students

    Science.gov (United States)

    Onyeaso, Adedamola Olutoyin; Onyeaso, Chukwudi Ochi

    2016-01-01

    Background: The need for training of schoolchildren on cardiopulmonary resuscitation (CPR) as potential bystander CPR providers is growing globally but Nigeria is still behind and lacks basic necessary data. Purpose: The purpose of this study was to investigate the effects of age, gender and school class on CPR skills of Nigerian secondary school…

  15. Spirituality and support for family presence during invasive procedures and resuscitations in adults.

    Science.gov (United States)

    Baumhover, Nancy; Hughes, Linda

    2009-07-01

    Many health care professionals believe that they provide holistic care. The role of spirituality, a known variable of holism, has not been explored in relation to the support among health care professionals for family presence during invasive procedures and resuscitative efforts in adults. To determine the relationship between spirituality of health care professionals and their support for family presence during invasive procedures and resuscitative efforts in adults. In this descriptive correlational study, 108 participants (physicians, physician assistants, and nurses) completed the Howden Spirituality Assessment Scale and a survey to measure their support for family presence. A significant positive relationship was found between spirituality and support for family presence during resuscitative efforts in adults (r = 0.24, P = .05) and a significant negative correlation was found between support for family presence and the age of the health care professional (r = - 0.27, P = .01). No significant correlations were found between any of the study variables and invasive procedures in adults. Adopting a more holistic perspective may support family presence, especially during resuscitative efforts in adults. Allowing the option for patients' families to remain present promotes holistic family-centered care.

  16. Shock duration after resuscitation is associated with occurrence of post-cardiac arrest acute kidney injury.

    Science.gov (United States)

    Kim, Yong Won; Cha, Kyoung Chul; Cha, Yong Sung; Kim, Oh Hyun; Jung, Woo Jin; Kim, Tae Hoon; Han, Byoung Keun; Kim, Hyun; Lee, Kang Hyun; Choi, Eunhee; Hwang, Sung Oh

    2015-06-01

    This retrospective observational study investigated the clinical course and predisposing factors of acute kidney injury (AKI) developed after cardiac arrest and resuscitation. Eighty-two patients aged over 18 yr who survived more than 24 hr after cardiac arrest were divided into AKI and non-AKI groups according to the diagnostic criteria of the Kidney Disease/Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for AKI. Among 82 patients resuscitated from cardiac arrest, AKI was developed in 66 (80.5%) patients (AKI group) leaving 16 (19.5%) patients in the non-AKI group. Nineteen (28.8%) patients of the AKI group had stage 3 AKI and 7 (10.6%) patients received renal replacement therapy during admission. The duration of shock developed within 24 hr after resuscitation was shorter in the non-AKI group than in the AKI group (OR 1.02, 95% CI 1.01-1.04, P cardiac arrest AKI was the duration of shock. In conclusion, occurrence and severity of post-cardiac arrest AKI is associated with the duration of shock after resuscitation. Renal replacement therapy is required for patients with severe degree (stage 3) post-cardiac arrest AKI.

  17. Quality of bystander cardiopulmonary resuscitation during real-life out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Gyllenborg, Tore; Granfeldt, Asger; Lippert, Freddy

    2017-01-01

    BACKGROUND: Cardiopulmonary resuscitation (CPR) can increase survival in out-of-hospital cardiac arrest (OHCA). However, little is known about bystander CPR quality in real-life OHCA. AIM: To describe bystander CPR quality based on automated external defibrillator (AED) CPR process data during OHCA...

  18. Mechanical cardiopulmonary resuscitation in in-hospital cardiac arrest : a systematic review

    NARCIS (Netherlands)

    Lameijer, Heleen; Immink, Rosa S.; Broekema, Josien J.; Ter Maaten, Jan C.

    2015-01-01

    With increasing rates of in-hospital cardiac arrest, improving resuscitation outcomes is essential. Mechanical chest compressors seem to be related to improved outcome in out-of hospital cardiac arrest; however, the literature on its use in in-hospital cardiac arrest is scarce. We used the Medline

  19. Comparison of Airway Control Methods and Ventilation Success with an Automatic Resuscitator

    Science.gov (United States)

    2015-10-08

    urban basic life support first responders as the primary airway device for out-of-hospital cardiac arrest . Resuscitation. Jul 12. [Epub ahead of print...conventional force-on-force conflicts. The example being World War II, where there was a definite “forward” and a definite “rear”. In the conflicts

  20. Preferences of critical care registrars in fluid resuscitation of major trauma patients: concordance with current guidelines.

    Science.gov (United States)

    Cade, J A; Truesdale, M

    2011-03-01

    Fluid resuscitation of patients with major trauma remains a controversial topic. We hypothesised that current practice amongst critical care registrars at our centre might differ from current clinical guidelines. Sixty-six registrars from anaesthesia, intensive care and emergency medicine completed a survey giving their preferences for fluid resuscitation in major trauma patients. Most (85%) appropriately would choose a crystalloid (normal saline 68%, Hartmann's solution 17%), although intensive care registrars reported an early preference for colloids (20% of intensive care registrars would choose a colloid vs 0% of other departmental registrars, P < 0.01). Many responses indicated that the presence of an acidosis would not influence their choice of primary resuscitation fluid. Few participants were unfamiliar with the current practice of avoiding colloids as a primary resuscitation fluid in head-injured patients. Most (62%) would choose to transfuse trauma patients after 2 litres of crystalloid, although there was significant inter-departmental variation (P < 0.01). In addition, participants would transfuse an older patient (P=0.02) or an actively bleeding patient (P < 0.01) earlier than the younger or not visibly bleeding trauma patient. We concluded that our study demonstrated general consistency with current clinical guidelines but with interesting interdepartmental variations. We suggest that this type of study could enhance clinical practice by pointing to targeted additional learning opportunities.