| Alternative ventilation strategies in cardiopulmonary resuscitation. | |
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MedLine Citation:
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PMID: 12386498 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The introduction of the 2000 Guidelines for Cardiopulmonary Resuscitation emphasizes a new, evidence-based approach to the science of ventilation during cardiopulmonary resuscitation (CPR). New laboratory and clinical science underemphasizes the role of ventilation immediately after a dysrhythmic cardiac arrest (arrest primarily resulting from a cardiovascular event, such as ventricular defibrillation or asystole). However, the classic airway patency, breathing, and circulation (ABC) CPR sequence remains a fundamental factor for the immediate survival and neurologic outcome of patients after asphyxial cardiac arrest (cardiac arrest primarily resulting from respiratory arrest). The hidden danger of ventilation of the unprotected airway during cardiac arrest either by mouth-to-mouth or by mask can be minimized by applying ventilation techniques that decrease stomach gas insufflation. This goal can be achieved by decreasing peak inspiratory flow rate, increasing inspiratory time, and decreasing tidal volume to approximately 5 to 7 mL/kg, if oxygen is available. Laboratory and clinical evidence recently supported the important role of alternative airway devices to mask ventilation and endotracheal intubation in the chain of survival. In particular, the laryngeal mask airway and esophageal Combitube proved to be effective alternatives in providing oxygenation and ventilation to the patient in cardiac arrest in the prehospital arena in North America. Prompt recognition of supraglottic obstruction of the airway is fundamental for the management of patients in cardiac arrest when ventilation and oxygenation cannot be provided by conventional methods. "Minimally invasive" cricothyroidotomy devices are now available for the professional health care provider who is not proficient or comfortable with performing an emergency surgical tracheotomy or cricothyroidotomy. Finally, a recent device that affects the relative influence of positive pressure ventilation on the hemodynamics during cardiac arrest has been introduced, the inspiratory impedance threshold valve, with the goal of maximizing coronary and cerebral perfusion while performing CPR. Although the role of this alternative ventilatory methodology in CPR is rapidly being established, we cannot overemphasize the need for proper training to minimize complications and maximize the efficacy of these new devices. |
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Authors:
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Andrea Gabrielli; A Joseph Layon; Volker Wenzel; Volker Dorges; Ahamed H Idris |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Current opinion in critical care Volume: 8 ISSN: 1070-5295 ISO Abbreviation: Curr Opin Crit Care Publication Date: 2002 Jun |
Date Detail:
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Created Date: 2002-10-18 Completed Date: 2002-11-22 Revised Date: 2005-11-16 |
Medline Journal Info:
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Nlm Unique ID: 9504454 Medline TA: Curr Opin Crit Care Country: United States |
Other Details:
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Languages: eng Pagination: 199-211 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, University of Florida, Gainesville, Florida 32610, USA. gabriell@anest1.anest.ufl.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Cardiopulmonary Resuscitation
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methods*,
mortality Critical Care Female Heart Arrest / mortality, therapy* Humans Intubation, Intratracheal Laryngeal Masks Male Oxygen Inhalation Therapy / methods Respiration, Artificial / methods* Sensitivity and Specificity Survival Analysis Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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