PubMed · 15981313
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I P O'Leary. 2005-06-11. External defibrillators.. https://pubmed.ncbi.nlm.nih.gov/15981313/
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BACKGROUND: Endogenous adenosine might cause or perpetuate bradyasystole. Our aim was to determine whether aminophylline, an adenosine antagonist, increases the rate of return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest. METHODS: In a double-blind trial, we randomly assigned 971 patients older than 16 years with asystole or pulseless electrical activity at fewer than 60 beats per minute, and who were unresponsive to initial treatment with epinephrine and atropine, to receive intravenous aminophylline (250 mg, and an additional 250 mg if necessary) (n=486) or placebo (n=485). The patients were enrolled between January, 2001 and September, 2003, from 1886 people who had had cardiac arrests. Standard resuscitation measures were used for at least 10 mins after the study drug was administered. Analysis was by intention-to-treat. This trial is registered with the ClinicalTrials.gov registry with the number NCT00312273. FINDINGS: Baseline characteristics and survival predictors were similar in both groups. The median time from the arrival of the advanced life-support paramedic team to study drug administration was 13 min. The proportion of patients who had an ROSC was 24.5% in the aminophylline group and 23.7% in the placebo group (difference 0.8%; 95% CI -4.6% to 6.2%; p=0.778). The proportion of patients with non-sinus tachyarrhythmias after study drug administration was 34.6% in the aminophylline group and 26.2% in the placebo group (p=0.004). Survival to hospital admission and survival to hospital discharge were not significantly different between the groups. A multivariate logistic regression analysis showed no evidence of a significant subgroup or interactive effect from aminophylline. INTERPRETATION: Although aminophylline increases non-sinus tachyarrhythmias, we noted no evidence that it significantly increases the proportion of patients who achieve ROSC after bradyasystolic cardiac arrest.
BACKGROUND: As a condition of employment, many physicians practicing in the United States are mandated to remain current in their certification of some or all of the life-support courses. These courses reputedly set the standard of care by establishing nationally recognized paradigms of resuscitation. These courses' textbooks are revised and re-released at regular intervals. OBJECTIVES: To determine whether the source data for these texts are vigorously updated with each revision and whether there is an obvious literature-based impetus to release a new version. METHODS: A comparison was made of the years of the references contained within the three most recent textbook editions of the advanced cardiac life support (ACLS), advanced trauma life support, basic life support, and pediatric advanced life support courses. The years of the references were tallied for each text, and these tallies were compared both within and between the courses. Data were divided into three groups: group 1, references published before the previous versions' release; group 2, references published after previous versions' release; group 3, references dated within three years of the texts' release. RESULTS: There appears to be a large amount of overlap of group 1 data throughout most of the course texts; the number of references in group 2 and 3 varies greatly between and within these courses. CONCLUSIONS: With one exception (ACLS in 2003), the life-support courses appear to be based on similar reference sets for the last 7 to 11 years. There may be a reason other than an availability of a critical mass of new information that prompts the release of a new edition of these life-support courses.
OBJECTIVE: We introduce a web-based adaptive training simulator system to exercise cardiopulmonary resuscitation skills. Our purpose is to provide emergency physicians with an additional training tool for cardiac life support clinical cases, by integrating an adaptive learning environment with a web-based case simulator. METHODS AND MATERIALS: Adaptive systems reflect some features of the user in the user model and apply this model to adapt various visible aspects of the system to the user. Our system follows a stage-based learning model with several steps to personalize student learning. First, students learn the theory and content of life support and take computerized tests to evaluate their declarative knowledge of these areas. Second, they practice with clinical case examples and complete an exam at the appropriate level of difficulty to assess their practical knowledge. Finally, they train with additional clinical cases. RESULTS AND CONCLUSION: In order to evaluate the usefulness of the system, we used it in two traditional advanced life support courses at the Jaen Hospital in Spain, as an additional and complementary tool within the course. Results show that the use of adaptation techniques can improve student performance.