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Fluid infusion during CPR and after ROSC—Is it safe?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Fluids are commonly infused during cardiopulmonary resuscitation (CPR) and following return of spontaneous circulation (ROSC). Fluids are given to increase circulating volume during CPR and improve cardiac output and blood pressure after ROSC. More recently, rapid infusions of a large volume (30mLkg−1) of cold (4°C) fluid have been used during CPR or in comatose patients after ROSC to induce therapeutic hypothermia. Fluids are often given liberally during CPR, yet after ROSC the fear of giving fluids to a patient with myocardial dysfunction causes some physicians to restrict the use of fluids. Variability in the use of ...
Source: Resuscitation - October 24, 2009 Category: Emergency Medicine Authors: Jasmeet Soar, Jane Foster, Raoul Breitkreutz Tags: Editorials Source Type: journals

Techniques for artefact filtering from chest compression corrupted ECG signals: Good, but not enoughEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The European Resuscitation Council and American Heart Association (AHA) guidelines have recommended minimising interruptions in chest compression during cardiopulmonary resuscitation (CPR). These guidelines were based on findings that many professionals provided chest compressions for less than half of the time during their resuscitation efforts. The lack of haemodynamic support, thus contributed to the poor long-term outcomes. There are many causes for such interruptions, such as the intervals for listening to each of the prompts, i.e., “stand back” for capacitor charging and delivering a shock, and pauses for rhythm ...
Source: Resuscitation - October 5, 2009 Category: Emergency Medicine Authors: Yongqin Li, Wanchun Tang Tags: Editorials Source Type: journals

Glucagon treatment for bradycardia and a junctional rhythm caused by excessive beta-blockadeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A 68-year-old female with a history of coronary artery disease and hypertension presented with a 3h history of lightheadedness and chest discomfort. She was transported to hospital by the emergency medical service. On her arrival she was talking and in obvious discomfort. Her heart rate was 36min−1 and her blood pressure was 72/40mm Hg. The initial physical examination was otherwise unremarkable. The patient's husband informed us of her current medications. These included 50mg oral atenolol twice daily. There had been no recent changes in her medications and there was no suggestion that the patient had taken an overdose....
Source: Resuscitation - September 10, 2009 Category: Emergency Medicine Authors: Michael J. Bindon, Kevin Barlotta Tags: Letters to the Editor Source Type: journals

Role of resuscitative emergency field thoracotomy in the Japanese helicopter emergency medical service systemEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Objective: We investigated whether emergency thoracotomy (ET) performed in pre-hospital settings contributed to saving the lives of blunt trauma patients with impending or recent cardiac arrest.Methods: Eighty-one consecutive cardiac arrest patients with blunt trauma were performed ET before or after arrival at the emergency department (ED). These were reviewed retrospectively and were classified into the following three groups: (1) an emergency field thoracotomy was performed (EFT group, n=34); (2) a doctor dispatched to the scene, but the thoracotomy was performed in the ED (EDT-a group, n=10); and (3) no docto...
Source: Resuscitation - September 9, 2009 Category: Emergency Medicine Authors: Hisashi Matsumoto, Kunihiro Mashiko, Yoshiaki Hara, Noriyoshi Kutsukata, Yuichiro Sakamoto, Kenkichi Takei, Katsuhiro Kanemaru, Yoshiteru Tomita, Nobuyuki Saito, Takanori Yagi, Shinichiro Tetsu, Hiroaki Iida, Yukiko Masuda, Hiroyuki Koami, Hiroyuki Yokota Tags: Clinical papers Source Type: journals

Abnormal vital signs are associated with an increased risk for critical events in US veteran inpatientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Aim: Establish the frequency of abnormal vital signs in medical and surgical ward patients; study their association with “critical events,” which for the purposes of this study, were mortality, cardiac arrests and unplanned ICU transfers.Design and methods: Four-month prospective, observational cohort study; University-affiliated US Veteran's hospital. Vital signs from all regular ward medical and surgical inpatients were recorded over the study period and compared with records of cardiac arrests, mortality and ICU admissions.Results: Using the Hospital's Medical Emergency Team criteria to define normal/abnor...
Source: Resuscitation - September 9, 2009 Category: Emergency Medicine Authors: Geoffrey K. Lighthall, Sharmin Markar, Robert Hsiung Tags: Clinical papers Source Type: journals

Delta-opioid receptor ligands in shock treatmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We read with interest the experimental paper by Drabek et al., which reports on the effect of the delta-opioid agonist DADLE (d-ala, d-leu-enkephalin) in lethal haemorrhagic shock. A reliable pharmacological approach to the prevention of haemodynamic and metabolic irreversibility in shock remains a major problem in critical care. Delta- (and kappa)-opioid agonists have been reported, though not consistently and involving differing mechanism of actions, to reduce ischaemia-reperfusion injury in multiple organs, to trigger ischaemic pre- and post-conditioning, and to improve haemodynamic stability and survival in haemorrhagi...
Source: Resuscitation - September 8, 2009 Category: Emergency Medicine Authors: Marco Carmignani, Anna Rita Volpe, Mario Stanislao, Guido Valle Tags: Letters to the Editor Source Type: journals

“Mouth to mouth ventilation”: A comparison of the laryngeal mask airway with the Laerdal Pocket FacemaskEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Ten nurses with basic airway management experience were formally trained to use a classic laryngeal mask airway (LMA) and a Laerdal Pocket Facemask (LPFM) for oxygen enriched expired air ventilation (EEAV). They then used both of these devices for EEAV in a randomised fashion in 100 anaesthetised ASA I/II patients for elective surgery. EEAV was considered successful if the patient's arterial oxygen saturation was maintained above 93% on room air for 3min. EEAV success rates for the LMA and LPFM were 95% and 51% respectively (P=0.03). There was no apparent learning curve for either apparatus. Mean time in seconds ...
Source: Resuscitation - September 8, 2009 Category: Emergency Medicine Authors: R. Alexander, J.P. Chinery, H. Swales, D. Sutton Tags: Clinical papers Source Type: journals

Strong corruption of electrocardiograms caused by cardiopulmonary resuscitation reduces efficiency of two-channel methods for removing motion artefacts in non-shockable rhythmsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Aim: Cardiopulmonary resuscitation (CPR) artefact removal methods provide satisfactory results when the rhythm is shockable but fail on non-shockable rhythms. We investigated the influence of the corruption level on the performance of four different two-channel methods for CPR artefact removal.Materials and methods: 395 artefact-free ECGs and 13 pure CPR artefacts with corresponding blood pressure readings as a reference channel were selected. Using a simplified additive data model we generated CPR-corrupted signals at different signal-to-noise ratio (SNR) levels from −10 to +10dB. The algorithms were optimized...
Source: Resuscitation - September 6, 2009 Category: Emergency Medicine Authors: Tobias Werther, Andreas Klotz, Marcus Granegger, Michael Baubin, Hans G. Feichtinger, Anton Amann, Hermann Gilly Tags: Simulation and education Source Type: journals

Quantitative analysis of chest compression interruptions during in-hospital resuscitation of older children and adolescentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Aim: To quantitatively describe pauses in chest compression (CC) delivery during resuscitation from in-hospital pediatric and adolescent cardiac arrest. We hypothesized that CPR error will be more likely after a chest compression provider change compared to other causes for pauses.Methods: CPR recording/feedback defibrillators were used to evaluate CPR quality for victims ≥8 years who received CPR in the PICU/ED. Audiovisual feedback was supplied in accordance with AHA targets. Etiology of CC pauses identified by post-event debriefing/reviews of stored CPR quality data.Results: Analysis yielded 205 pauses durin...
Source: Resuscitation - September 6, 2009 Category: Emergency Medicine Authors: Robert M. Sutton, Matthew R. Maltese, Dana Niles, Benjamin French, Akira Nishisaki, Kristy B. Arbogast, Aaron Donoghue, Robert A. Berg, Mark A. Helfaer, Vinay Nadkarni Tags: Clinical papers Source Type: journals

Reply to: Delta-opioid receptor ligands in shock treatmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We welcome the comments of Carmignani and colleagues on the potential protective effects of delta-receptor agonists in hemorrhagic shock and other models. Their input adds valuable points to the discussion of our paper published earlier in Resuscitation. In brief, we used a rapid lethal hemorrhagic shock resulting in exsanguination cardiac arrest in 5min. After 1min of normothermic no-flow, profound hypothermic circulatory arrest (15°C) was induced for 75min, followed by resuscitation with cardiopulmonary bypass. We tested the hypothesis that DADLE (d-ala2, d-leu5-enkephalin) will confer additional benefit to hypothermic ...
Source: Resuscitation - September 1, 2009 Category: Emergency Medicine Authors: Tomas Drabek, Samuel A. Tisherman, Robert H. Garman, Patrick M. Kochanek Tags: Letters to the Editor Source Type: journals

Extubation force: A comparison of adhesive tape, non-adhesive tape and a commercial endotracheal tube holderEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: Although the Lillehei method provided the greatest resistance to tube dislodgement, it may not be ideal for the prehospital or emergency department context. The Thomas Tube Holder™ was quick and effective and may provide a good compromise in these environments, although once time is no longer important, clinicians may elect to revert to the Lillehei method which provides greater security. (Source: Resuscitation)
Source: Resuscitation - September 1, 2009 Category: Emergency Medicine Authors: R. Owen, N. Castle, H. Hann, D. Reeves, R. Naidoo, S. Naidoo Tags: Simulation and education Source Type: journals

Delayed pericardial tamponade after successful resuscitationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In September 2007, an 83-year-old man was hit by a car. In hospital traumatic brain injury with frontobasal skull fracture, and a dens fracture were diagnosed. Seven hours later, reduction in vigilance and agitation occurred, necessitating cranial computed tomography (Re-CCT). During moderate sedation by propofol 2% (4mg/kgbodyweight/h [≈20mg/ml]), circulatory depression occurred, requiring cardiopulmonary resuscitation (CPR). After 1min the patient regained circulatory stability. Re-CCT yielded no progressive intracranial bleeding. Surgery for dens fracture and intensive care unit (ICU) treatment was provided. After slo...
Source: Resuscitation - August 31, 2009 Category: Emergency Medicine Authors: C. Buschmann, F. Schulz Tags: Letters to the Editor Source Type: journals

A comparison of defibrillation efficacy between different impedance compensation techniques in high impedance porcine modelEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: For transthoracic impedances greater than average, the current-based compensation technique was more effective than the duration-based compensation technique. (Source: Resuscitation)
Source: Resuscitation - August 31, 2009 Category: Emergency Medicine Authors: Yongqin Li, Giuseppe Ristagno, Tao Yu, Joe Bisera, Max Harry Weil, Wanchun Tang Tags: Experimental paper Source Type: journals

Evaluating the effectiveness of a strategy for teaching neonatal resuscitation in West AfricaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Aim: To evaluate the effectiveness of a strategy for teaching neonatal resuscitation on the cognitive knowledge of health professionals who attend deliveries in Ghana, West Africa.Methods: Train-the-trainer model was used to train health professionals at 2–3 day workshops from 2003 to 2007. Obstetric Anticipatory Care and Basic Neonatal Care modules were taught as part of Neonatal Resuscitation Training package. American Neonatal Resuscitation Program was adapted to the clinical role of participants and local resources. Cognitive knowledge was evaluated by written pre- and post-training tests.Results: The media...
Source: Resuscitation - August 31, 2009 Category: Emergency Medicine Authors: Christabel Enweronu-Laryea, Cyril Engmann, Alexandra Osafo, Carl Bose Tags: Simulation and education Source Type: journals

Effects of AED device features on performance by untrained laypersonsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Most untrained laypersons were successful in delivering a shock. Device features had the most impact on these functions: ability and time to power-on device, adequacy of pad position and initiation of CPR. (Source: Resuscitation)
Source: Resuscitation - August 31, 2009 Category: Emergency Medicine Authors: Vincent N. Mosesso, Alan H. Shapiro, Karen Stein, Kelly Burkett, Henry Wang Tags: Simulation and education Source Type: journals

Cardiac arrest in Irish general practice: An observational study from 426 general practicesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Cardiac arrest in general practice is compatible with structured, effective interventions and significant rates of successful resuscitation. All general practices should be capable of providing this care. (Source: Resuscitation)
Source: Resuscitation - August 31, 2009 Category: Emergency Medicine Authors: Gerard Bury, Mary Headon, Mark Dixon, Mairead Egan Tags: Clinical papers Source Type: journals

Assessment of intravascular volume by transthoracic echocardiography during therapeutic hypothermia and rewarming in cardiac arrest survivorsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Our results support the hypothesis that inducing hypothermia following cardiac arrest, using cold intravenous fluid infusion does not cause serious haemodynamic side effects. Serial transthoracic echocardiographic estimation of intravascular volume suggests that many patients are hypovolaemic during therapeutic hypothermia and rewarming in spite of a positive fluid balance. (Source: Resuscitation)
Source: Resuscitation - August 31, 2009 Category: Emergency Medicine Authors: Johanna Nordmark, Jakob Johansson, Dan Sandberg, Sven-Olof Granstam, Tibor Huzevka, Lucian Covaciu, Erik Mörtberg, Sten Rubertsson Tags: Clinical papers Source Type: journals

Mechanical active compression–decompression cardiopulmonary resuscitation (ACD-CPR) versus manual CPR according to pressure of end tidal carbon dioxide (PETCO2) during CPR in out-of-hospital cardiac arrest (OHCA)Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: In this hypothesis generating study mechanical ACD-CPR compared with manual CPR generated the highest initial, minimum and average value of PETCO2. Whether these data can be repeated and furthermore be associated with an improved outcome after OHCA need to be confirmed in a large prospective randomised trial. (Source: Resuscitation)
Source: Resuscitation - August 31, 2009 Category: Emergency Medicine Authors: C. Axelsson, T. Karlsson, Å.B. Axelsson, J. Herlitz Tags: Clinical papers Source Type: journals

Hypothermia after drowning in paediatric patientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We present two cases of children who suffered cardiac arrest and hypothermia after drowning. The first case was a two-year-old boy who fell in a swimming pool. He was found lifeless after about 10min. Cardiopulmonary resuscitation (CPR) was initiated 5min later by the medical emergency personnel. Forty-five minutes later, the boy regained sinus rhythm and a pulse. On admission to the intensive care unit (ICU), urinary bladder temperature (UBT) was 26.7°C. Passive re-warming was started and a temperature of 37.1°C was achieved 6h later. Forty-eight hours after admission the patient showed an apallic syndrome with extensio...
Source: Resuscitation - August 27, 2009 Category: Emergency Medicine Authors: Rafael Kawati, Lucian Covaciu, Sten Rubertsson Tags: Letters to the Editor Source Type: journals

Sudden cardiac arrest after minor abdominal trauma: A successful resuscitation in a patient with haemorrhagic phaeochromocytomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A 38-year-old woman with no history of hypertension or heart disease presented to the emergency department with chest tightness 30min after minor abdominal trauma. On arrival, she was ambulatory. The electrocardiogram showed normal sinus rhythm. Her chest X-ray showed no infiltration or cardiomegaly. The troponin-I concentration was normal. After 90min, she suddenly developed respiratory distress with and was sweating. Her heart rate increased to 158beatsmin−1, her respiratory rate increased to 32breathsmin−1, and her blood pressure decreased to 80/40mmHg. She developed severe hypoxaemia and required mechanical ventila...
Source: Resuscitation - August 27, 2009 Category: Emergency Medicine Authors: Chun-Chieh Chiu, Ying-Cheng Chen, Tsung-Han Teng, Li-Heng Yang, Ya-Pei Chen, Fu-Yuan Siao Tags: Letters to the Editor Source Type: journals

Use of transcranial Doppler ultrasound in the management of post-cardiac arrest syndromeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The current flow-focussed approach to resuscitation demands sensitive and reliable monitoring systems. Accurate measurements of cerebral blood flow (CBF) have, until recently, been restricted to complex techniques such as single-photon emission computed tomography (SPECT) or positron emission tomography (PET), which can generally be undertaken only in research laboratories. However, there is strong evidence that changes of the mean blood flow velocities (VM) registered by transcranial Doppler ultrasonography (TCD) in the main arteries of the circle of Willis, faithfully reflects changes of the CBF in patients undergoing ca...
Source: Resuscitation - August 27, 2009 Category: Emergency Medicine Authors: Jesús A. Álvarez-Fernández, Raquel Pérez-Quintero Tags: Letters to the Editor Source Type: journals

Neonatal CPR: Room at the top—A mathematical study of optimal chest compression frequency versus body sizeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Fundamental geometry and physics suggest that the most effective chest compression frequency in CPR depends upon body size and weight. In neonates there is room for improvement at the top of the compression frequency scale at rates >120/min. In adults there may be benefit from lower compression frequencies near 60/min. (Source: Resuscitation)
Source: Resuscitation - August 27, 2009 Category: Emergency Medicine Authors: Charles F. Babbs, Andrew Meyer, Vinay Nadkarni Tags: Simulation and education Source Type: journals

Ventricular fibrillation in Rochester, Minnesota: Experience over 18 yearsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report outcomes and incidence of VF OHCA over 18 years in a medium-sized city incorporating an aggressive approach to OHCA.Methods: The city, which increased in population over the study period from 70,000 to 100,000 persons, utilizes an emergency response system which dispatches defibrillator-equipped police, fire-rescue and ambulance personnel simultaneously. Police and fire-rescue personnel are equipped with automated external defibrillators (AEDs). Advanced life-support is provided as needed by paramedics.Results: There were 454 arrests during the study period attributed to a cardiac cause. Of 271 bystander-witnesse...
Source: Resuscitation - August 27, 2009 Category: Emergency Medicine Authors: Dipti A. Agarwal, Erik P. Hess, Elizabeth J. Atkinson, Roger D. White Tags: Clinical papers Source Type: journals

An algorithm to discriminate supraventricular from ventricular tachycardia in automated external defibrillators valid for adult and paediatric patientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: A new algorithm to discriminate SVT/VT was designed that showed high SVT specificity and VT sensitivity in both adults and children. This algorithm could be incorporated into current AEDs with arrhythmia analysis algorithms designed for adult patients to accurately diagnose fast-rate paediatric SVT. (Source: Resuscitation)
Source: Resuscitation - August 27, 2009 Category: Emergency Medicine Authors: Unai Irusta, Jesús Ruiz Tags: Clinical papers Source Type: journals

Impact of Chemical, Biological, Radiation, and Nuclear Personal Protective Equipment on the performance of low- and high-dexterity airway and vascular access skillsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Background: Following CBRN incidents health care professionals will be required to care for critically ill patients within the warm zone, prior to decontamination, whilst wearing CBRN-PPE. The loss of fine-motor skills may adversely affect delivery of medical care.Methods: 64 clinicians were recruited to perform, intubation, LMA placement, insertion of an IV cannula and IO needle whilst wearing CBRN-PPE. A fractional factorial design was employed, in which each of the 64 clinicians had two attempts at performing each skill whilst wearing CBRN-PPE and once unsuited according to a pre-specified sequence.Analysis: T...
Source: Resuscitation - August 26, 2009 Category: Emergency Medicine Authors: Nicholas Castle, Robert Owen, Mark Hann, Simon Clark, David Reeves, Ian Gurney Tags: Simulation and education Source Type: journals

Out-of hospital advanced life support with or without a physician: Effects on quality of CPR and outcomeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Survival after out-of-hospital cardiac arrest was not different for patients treated by the PMA and non-PMA in our EMS system. (Source: Resuscitation)
Source: Resuscitation - August 26, 2009 Category: Emergency Medicine Authors: Theresa M. Olasveengen, Inger Lund-Kordahl, Petter A. Steen, Kjetil Sunde Tags: Clinical papers Source Type: journals

Deadly vasospasmEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: A patient with Prinzmetal's variant angina (PVA) developed a cardiac arrest due to coronary vasospasm and subsequent myocardial infarction. After resuscitation postanoxic brain injury was diagnosed. After an initial improvement of consciousness he deteriorated rapidly on the seventh day after admission due to severe brain ischaemia apparently caused by cerebral vasospasm, until ultimately brain death was diagnosed. To our knowledge, the association between PVA and cerebral vasospasm has never been described. The combination suggests that this patient had a generalized vasospastic disorder. (Source: Resuscitation)
Source: Resuscitation - August 24, 2009 Category: Emergency Medicine Authors: D.P.H. Eijking, C.L.A. Reichert, A.M. Wagenvoort, B.M. Van Geel, A.C. Toornvliet, M.L.H. Honing Tags: Case report Source Type: journals

Resuscitation on television: Realistic or ridiculous? A quantitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical dramaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: 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 incidence and likely success of CPR is equal across all age groups. (Source: Resuscitation)
Source: Resuscitation - August 20, 2009 Category: Emergency Medicine Authors: Dylan Harris, Hannah Willoughby Tags: Simulation and education Source Type: journals

Expert clinical assessment of thorax stiffness of infants and children during chest compressionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: Experienced health care providers consistently identified and agreed on the manikin thorax stiffness which they felt best approximated downstroke chest compression stiffness of children and infants. Expert opinion can be used to create manikins with realistic spring stiffness for CPR training. Further study is needed to evaluate whether enhanced manikin biofidelity will improve CPR performance. (Source: Resuscitation)
Source: Resuscitation - August 20, 2009 Category: Emergency Medicine Authors: Kristy B. Arbogast, Akira Nishisaki, Sriram Balasubramanian, Jon Nysaether, Dana Niles, Robert M. Sutton, Kathryn E. Roberts, Lauren Nadkarni, John Boulet, Matthew R. Maltese, Vinay M. Nadkarni Tags: Simulation and education Source Type: journals

Mechanical chest compression devices—Will we ever get the evidence?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The past decade has seen increased efforts to evaluate systematically the resuscitation science from which evidence-based guidelines may be developed. The Consensus on Resuscitation Science and Treatment Recommendations published in 2005 was the most extensive and robust review of the resuscitation science undertaken to date. Like many systematic reviews of the published literature, the process identifies not only the supporting evidence, but also the lack of such evidence, on which interventions to improve outcome and guidelines can be based. This is clearly evident in relation to the efficacy and effectiveness of mechani...
Source: Resuscitation - August 20, 2009 Category: Emergency Medicine Authors: Ian Jacobs Tags: Editorial Source Type: journals

Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unitEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: ECPR can be used successfully to resuscitate children following refractory cardiac arrest in the ICU, and grossly intact neurologic outcomes can be achieved in a majority of cases. (Source: Resuscitation)
Source: Resuscitation - August 19, 2009 Category: Emergency Medicine Authors: Parthak Prodhan, Richard T. Fiser, Umesh Dyamenahalli, Jeffrey Gossett, Michiaki Imamura, Robert D.B. Jaquiss, Adnan T. Bhutta Tags: Clinical papers Source Type: journals

Improved chest recoil using an adhesive glove device for active compression–decompression CPR in a pediatric manikin modelEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: A simple, inexpensive glove device for ACD-CPR improved chest decompression with emphasis on active pull in manikins without excessive rescuer fatigue. The clinical implication of fewer compressions/minute in the AGD group needs to be evaluated. (Source: Resuscitation)
Source: Resuscitation - August 16, 2009 Category: Emergency Medicine Authors: Jai P. Udassi, Sharda Udassi, Melissa A. Lamb, Kenneth E. Lamb, Douglas W. Theriaque, Jonathan J. Shuster, Arno L. Zaritsky, Ikram U. Haque Tags: Simulation and education Source Type: journals

Rudolf Juchems—A pioneer of cardiopulmonary resuscitation in GermanyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Rudolf Juchems () was born in Würselen, Germany, on June 6, 1929. He attended the medical schools in Erlangen and Bonn, and in 1956 he spent a period of time in the USA. Having completed his internship, Rudolf Juchems stayed on in the United States and worked at the Mayo Clinic in Rochester, Minnesota, before he returned to Germany in 1961 and started research on various aspects of haemodynamics at the University of Würzburg. After completing his residency, he mastered the Habilitation scientific procedure to become “Privatdozent”, i.e. an academic lecturer. He was promoted to a chief resident in clinical medicine a...
Source: Resuscitation - August 16, 2009 Category: Emergency Medicine Authors: Bernd W. Böttiger, Douglas A. Chamberlain, Leo Bossaert, Markus Juchems Tags: Resuscitation Great Source Type: journals

The mouth-to-bag resuscitator during standard anaesthesia induction in apnoeic patientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Aim: Ventilation of a non-intubated emergency patient by inexperienced rescuers with a standard bag-valve device may result in high inspiratory flow rates and subsequently high airway pressures with stomach inflation. Therefore, a self-inflating bag has been developed that requires lay rescuers to blow up a single-use balloon inside an adult bag-valve device, which, in turn, displaces air within the bag towards the patient. This concept has been compared to standard adult bag-valve devices earlier in bench models but not in patients.Methods: An anaesthetist who was blinded to all monitor tracings ventilated the l...
Source: Resuscitation - August 12, 2009 Category: Emergency Medicine Authors: Holger Herff, Peter Paal, Thomas Mitterlechner, Achim von Goedecke, Karl H. Stadlbauer, Wolfgang G. Voelckel, Angelika Zecha-Stallinger, Volker Wenzel Tags: Clinical papers Source Type: journals

Effects of large volume, ice-cold intravenous fluid infusion on respiratory function in cardiac arrest survivorsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: International guidelines for cardiopulmonary resuscitation recommend mild hypothermia (32–34°C) for 12–24h in comatose survivors of cardiac arrest. To induce therapeutic hypothermia a variety of external and intravascular cooling devices are available. A cheap and effective method for inducing hypothermia is the infusion of large volume, ice-cold intravenous fluid. There are concerns regarding the effects of rapid infusion of large volumes of fluid on respiratory function in cardiac arrest survivors. We have retrospectively studied the effects of high volume cold fluid infusion on respiratory function in 52 ...
Source: Resuscitation - August 11, 2009 Category: Emergency Medicine Authors: Claudius Jacobshagen, Anja Pax, Bernhard W. Unsöld, Tim Seidler, Stephan Schmidt-Schweda, Gerd Hasenfuss, Lars S. Maier Tags: Clinical papers Source Type: journals

Effect of caregiver gender, age, and feedback prompts on chest compression rate and depthEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Background: Quality of chest compressions (CC) is an important determinant of resuscitation outcome for cardiac arrest patients.Purpose: To characterize the quality of CC performed by hospital personnel, evaluate for predictors of CC performance, and determine the effects of audiovisual feedback on CC performance.Methods: Seven hundred and fifty four individuals participated in a CPR quality improvement challenge at 30 US hospitals. Participants performed 2min of CC on a manikin with an accelerometer-based system for measuring both rate (CC/min) and depth (in.) of CC (AED Plus:ZOLL Medical). Real-time audiovisual...
Source: Resuscitation - August 11, 2009 Category: Emergency Medicine Authors: Mary Ann Peberdy, Annemarie Silver, Joseph P. Ornato Tags: Simulation and education Source Type: journals

Advanced life support performance with manual and mechanical chest compressions in a randomized, multicentre manikin studyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: In this manikin study, HOF for manual vs. mechanical chest compressions varied between sites. Study protocol implementation should be simulation tested before launching multicentre trials, to optimize performance and improve reliability and scientific interpretation. (Source: Resuscitation)
Source: Resuscitation - August 9, 2009 Category: Emergency Medicine Authors: Oystein Tomte, Kjetil Sunde, Tonje Lorem, Bjorn Auestad, Chris Souders, Jeff Jensen, Lars Wik Tags: Simulation and education Source Type: journals

The role of Desmopressin in a patient with severe coagulopathy aggravated by mild therapeutic hypothermiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A 42-year-old man was admitted to the intensive care unit (ICU) for acute pulmonary oedema secondary to acute renal failure. A renal biopsy showed thrombotic microangiopathy with tubulo-interstitial nephritis, for which two courses of plasmapheresis were given. He continued to complain of intermittent shortness of breath. A chest radiograph showed a globular cardiac silhouette that was compatible with a pericardial effusion. He was awaiting an urgent echocardiogram when he developed asystole. Cardiopulmonary resuscitation was immediately started, three doses of 1mg adrenaline were given intravenously. A bedside echocardiog...
Source: Resuscitation - August 2, 2009 Category: Emergency Medicine Authors: Lee K. Tam, Kwok F.J. Ng Tags: Letters to the Editor Source Type: journals

Ventricular fibrillation diagnosed with trans-thoracic echocardiographyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Electrocardiographic artifacts on scope are frequently observed in pre-hospital settings. They can lead to misdiagnosis or inappropriate resuscitation treatments. Here we report a case of ventricular fibrillation by electrical injury masked by ECG artifacts, after the savage of a victim, due to persistent 50Hz domestic current and identified by trans-thoracic ultrasonography. No clinical randomized studies define precisely the benefit of such an examination. In cases where ECG analysis is impossible due to artifacts, ultrasonographic exam could be useful to identify ventricular fibrillation. This case underlines ...
Source: Resuscitation - August 2, 2009 Category: Emergency Medicine Authors: Emgan Querellou, Daniel Meyran, Frederic Petitjean, Pierre Le Dreff, Olivier Maurin Tags: Case report Source Type: journals

Safety of the inter-nipple line hand position landmark for chest compressionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Simulation of hand position determined by the inter-nipple line resulted in placement of the rescuer's hands over the xiphoid process in nearly half of the patients. Hand deviation to the epigastric region may occur when the patient is a short-statured or elderly female, and when the rescuer is male. (Source: Resuscitation)
Source: Resuscitation - August 2, 2009 Category: Emergency Medicine Authors: Shinji Kusunoki, Koichi Tanigawa, Takashi Kondo, Masashi Kawamoto, Osafumi Yuge Tags: Simulation and education Source Type: journals

Pediatric CPR quality monitoring: Analysis of thoracic anthropometric dataEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: Extension of adult-based CPR quality monitoring and feedback systems will require pediatric-specific tailoring and adaptation. Future studies should examine chest compression depths in clinical settings with correlation to physiologic parameters to determine the best targets for pediatric CPR guidelines. (Source: Resuscitation)
Source: Resuscitation - August 2, 2009 Category: Emergency Medicine Authors: Robert M. Sutton, Dana Niles, Jon Nysaether, Kristy B. Arbogast, Akira Nishisaki, Matthew R. Maltese, Ram Bishnoi, Mark A. Helfaer, Vinay Nadkarni, Aaron Donoghue Tags: Clinical papers Source Type: journals

Effectiveness of simplified chest compression-only CPR training program with or without preparatory self-learning video: A randomized controlled trialEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Objectives: To evaluate the effectiveness of 1-h practical chest compression-only cardiopulmonary resuscitation (CPR) training with or without a preparatory self-learning video.Methods: Participants were randomly assigned to either a control group or a video group who received a self-learning video before attending the 1-h chest compression-only CPR training program. The primary outcome measure was the total number of chest compressions during a 2-min test period.Results: 214 participants were enrolled, 183 of whom completed this study. In a simulation test just before practical training began, 88 (92.6%) of the ...
Source: Resuscitation - July 30, 2009 Category: Emergency Medicine Authors: Chika Nishiyama, Taku Iwami, Takashi Kawamura, Masahiko Ando, Kentaro Kajino, Naohiro Yonemoto, Risa Fukuda, Haruyuki Yuasa, Hiroyuki Yokoyama, Hiroshi Nonogi Tags: Simulation and education Source Type: journals

Out-of-hospital cardiac arrest: An indication for immediate computed tomography brain imaging?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In this issue of Resuscitation, Inamasu and colleagues present a prospective observational study of brain computed tomography (CT) scanning in those with return of spontaneous circulation (ROSC) following witnessed, non-traumatic, out-of-hospital cardiac arrest. They excluded those with an extrinsic cause such as asphyxia, drug overdose or drowning. During 4 years they scanned 142 patients and found 26 (18.3%) with intracranial haemorrhage of which 23 (16.2%) were subarachnoid haemorrhage (SAH). (Source: Resuscitation)
Source: Resuscitation - July 28, 2009 Category: Emergency Medicine Authors: Rachel Prout, Jerry Nolan Tags: Editorials Source Type: journals

The European Trauma Course (ETC) and the team approach: Past, present and futureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article describes the lessons learnt during the European Trauma Course development and provides an outline of the planned future development. (Source: Resuscitation)
Source: Resuscitation - July 26, 2009 Category: Emergency Medicine Authors: Carsten Lott, Rui Araujo, Mary Rose Cassar, Stefano Di Bartolomeo, Peter Driscoll, Ivan Esposito, Ernestina Gomes, Peter Goode, Carl Gwinnutt, Michael Huepfl, Freddy Lippert, Giuseppe Nardi, David Robinson, Markus Roessler, Mike Davis, Karl-Christian Thie Tags: Simulation and education Source Type: journals

Mechanical loading of the low back during cardiopulmonary resuscitationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: The results suggest that the HT task of chest compression produces the lowest low back moment and compression force. Thus, HT positioning may decrease the probability of low back pain and is suggested to be optimal height for inexperienced resuscitators, those with back injury, or those requiring a long operating duration. (Source: Resuscitation)
Source: Resuscitation - July 26, 2009 Category: Emergency Medicine Authors: Jui-Yi Tsou, Chih-Hsien Chi, Rebekah Min-Fang Hsu, Hui-Fen Wu, Fong-Chin Su Tags: Simulation and education Source Type: journals

Prehospital endotracheal intubation in patients with severe traumatic brain injury: Guidelines versus realityEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: The international Brain Trauma Foundation guidelines recommend prehospital endotracheal intubation in all patients with traumatic brain injury (TBI) and a Glasgow Coma Scale (GCS)≤8. Close adherence to these guidelines is associated with improved outcome, but not all severely injured TBI patients receive adequate prehospital airway support. Here we hypothesized that guideline adherence varies when skills are involved that rely on training and expertise, such as endotracheal intubation.We retrospectively studied the medical records of CT-confirmed TBI patients with a GCS≤8 who were referred to a level 1 trauma...
Source: Resuscitation - July 26, 2009 Category: Emergency Medicine Authors: G. Franschman, S.M. Peerdeman, S. Greuters, J. Vieveen, A.C.M. Brinkman, H.M.T. Christiaans, E.J. Toor, G.N. Jukema, S.A. Loer, C. Boer, The ALARM-TBI investigators Tags: Clinical papers Source Type: journals

Non-invasive central venous pressure measurement by compression ultrasound—A step into real lifeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Aim of the study: Information on central venous pressure (CVP) is helpful in clinical situations like cardiac failure and sepsis. Compression ultrasound (CU) of a forearm vein has been shown to be a reliable method for CVP measurement when assessed by experienced personal under study conditions.To test the hypothesis, that CU can be reliably used for CVP measurement after a training program and using a portable ultrasound system, we investigated feasibility and accuracy of CU, comparing the results of vascular experts vs. trainees as well as high-end vs. a portable ultrasound system.Methods: CU with non-invasive ...
Source: Resuscitation - July 26, 2009 Category: Emergency Medicine Authors: Christoph Thalhammer, Martin Siegemund, Markus Aschwanden, Mirjam Gassmann, Ulrich A. Baumann, Kurt A. Jaeger, Stephan Imfeld Tags: Clinical papers Source Type: journals

Perceptions of collapse and assessment of cardiac arrest by bystanders of out-of-hospital cardiac arrest (OOHCA)Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: In this sample of interviewed bystanders of OOHCA, almost half of the arrests were not detected. This might be a reason for the low rate of bystander resuscitation. Common bystander perceptions of arrest presence included “bluish skin colour” and abnormal breathing of the victim. These findings indicate that improvement of perception capabilities should be incorporated as a major learning objective into lay basic life support training. In addition, information regarding skin colour may be of value in dispatch protocols. (Source: Resuscitation)
Source: Resuscitation - July 26, 2009 Category: Emergency Medicine Authors: Jan Breckwoldt, Sebastian Schloesser, Hans-Richard Arntz Tags: Clinical papers Source Type: journals

Airway obstruction caused by the systemic inflammatory syndrome associated with trauma and retrosternal goitreEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A 71-year-old previously healthy male presented to the emergency department following a high speed motorcycle crash. Computed tomography (CT) of the brain, cervical spine, chest, abdomen and pelvis showed bilateral pulmonary contusion, a left third rib fracture, and an incidental finding of a right-sided retrosternal thyroid mass causing tracheal compression and deviation. He was admitted to the intensive care unit (ICU) because of the pulmonary contusion but was discharged to the ward after 48h. Twelve hours after discharge from ICU, he complained of shortness of breath and of difficulty clearing sputum from his throat. H...
Source: Resuscitation - July 26, 2009 Category: Emergency Medicine Authors: Shashank Patil, Sadiq Bhayani Tags: Images in Resuscitation Source Type: journals

Can the implementation of an ILS course prevent in-hospital cardiac arrests?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
About 1–5 over 1000 patients admitted to hospitals in Western countries undergo an unanticipated cardiac arrest and about 80% of them die before hospital discharge. The prognosis of in-hospital cardiac arrest (IHCA) has improved little over the last 30 years, and prevention remains the better strategy to reduce mortality from IHCA. (Source: Resuscitation)
Source: Resuscitation - July 26, 2009 Category: Emergency Medicine Authors: Claudio Sandroni Tags: Editorials Source Type: journals