The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial

Objectives

To examine effects of sedative music on cancer pain.

Design

A randomized controlled trial.

Settings

Two large medical centers in Kaoshiung City, in southern Taiwan.

Participants

126 hospitalized persons with cancer pain.

Methods

Participants were randomly assigned to an experimental (n = 62) or a control group (n = 64), with computerized minimization, stratifying on gender, pain, and hospital unit. Music choices included folk songs, Buddhist hymns (Taiwanese music), plus harp, and piano (American). The experimental group listened to music for 30 min; the control group rested in bed. Sensation and distress of pain were rated on 100 mm VAS before and after the 30-min test.

Results

Using MANCOVA, there was significantly less posttest pain in the music versus the control group, p < .001. Effect sizes were large, Cohen's d = .64, sensation, d = .70, distress, indicating that music was very helpful for pain. Thirty minutes of music provided 50% relief in 42% of the music group compared to 8% of the controls. The number needed to treat (NNT) to find one with 50% sensation relief was three patients. More patients chose Taiwanese music (71%) than American music (29%), but both were liked and effective.

Conclusions

Offering a choice of familiar, culturally appropriate music was a key element of the intervention. Findings extend the Good and Moore theory (1996) to cancer pain. Soft music was safe, effective, and liked by participants. It provided greater relief of cancer pain than analgesics alone. Thus nurses should offer calming, familiar music to supplement analgesic medication for persons with cancer pain.     

An exploratory Delphi study on the integration of disabled students into physiotherapy education

Objectives

The introduction of the Disability Discrimination Act (DDA) IV (1995) in the UK requires universities to ensure that they do not discriminate against disabled students. The objectives of this study were to achieve consensus on the attributes required for a competent physiotherapist, and to explore implementation of the DDA into physiotherapy education.

Design

An exploratory study was performed using the Delphi technique. Respondents were asked to comment on the skills required to be a physiotherapist, and the implementation of the DDA during the admission process.

Setting and participants

Participation was invited from all physiotherapy admission tutors working on pre-registration physiotherapy courses in England (n = 43). Twenty of these consented to be involved, and 13 completed the whole study.

Method

The Delphi study consisted of three questionnaires administered sequentially; the results from one questionnaire forming the basis of the next. On analysis of the third questionnaire, consensus and saturation had been achieved.

Results

The admission tutors showed strong consensus (92%) on the skills necessary to be a physiotherapist, although there was some debate about sensory and physical abilities. Participants were uneasy about the level of support for staff and their knowledge of support systems for disabled students. Respondents also expressed concern over the level of support for disabled students. The possibility of conditional qualification for disabled students was discussed.

Conclusion

Standards set out by the professional bodies could be used to enable disabled students to self-assess their abilities prior to application for courses. Disability support systems within universities need to include physiotherapy tutors.     

Examining the contextual effects of neighborhood on out-of-hospital cardiac arrest and the provision of bystander cardiopulmonary resuscitation

Objective

To understand the association between neighborhood and individual characteristics in determining whether or not bystanders perform cardiopulmonary resuscitation (CPR) in cases of out-of-hospital cardiac arrest (OHCA).

Methods

Between October 1, 2005 to November 30, 2008, 1108 OHCA cases from Fulton County (Atlanta), GA, were eligible for bystander CPR. We conducted multi-level non-linear regression analysis and derived Empirical Bayes estimates for bystander CPR by census tract.

Results

279 (25%) cardiac arrest victims received bystander CPR. Provision of bystander CPR was significantly more common in witnessed events (odds ratio [OR] 1.64; 95% confidence interval [CI] 1.21-2.22, p < 0.001) and those that occurred in public locations (OR 1.67; 95% CI 1.16-2.40, p < 0.001). Other individual-level characteristics were not significantly associated with bystander CPR. Cardiac arrests in the census tracts that rank in the highest income quintile, as compared to the lowest income quintile were much more likely (OR 4.98; 95% CI 1.65-15.04) to receive bystander CPR.

Conclusion

Cardiac arrest victims in the highest income census tracts were much more likely to receive bystander CPR than in the lowest income census tracts, even after controlling for individual and arrest characteristics. Low-income neighborhoods may be particularly appropriate targets for community-based CPR training and awareness efforts.     

Severe QTc prolongation under mild hypothermia treatment and incidence of arrhythmias after cardiac arrest--a prospective study in 34 survivors with continuous Holter ECG

Background

Mild hypothermia treatment (32-34 °C) in survivors after cardiac arrest (CA) is clearly recommended by the current guidelines. The effects of cooling procedure towards QT interval have not been evaluated so far outside of case series. In a prospective study 34 consecutive survivors after cardiac arrest were continuously monitored with Holter ECG over the first 48 h.

Patients and methods

A total of 34 patients were analysed and received mild therapeutic hypothermia treatment (MTH) according to the current guidelines and irrespective of the initial rhythm. At admission to hospital and in the field in case of OHCA, a 12-lead ECG was performed in all patients.

Results

During cooling the incidence of ventricular tachycardia was low (8.8%) and in none of the patients Torsade de pointes occurred. The QTc interval was within normal range at first patient contact with EMS in the field (440.00 ms; IQR 424.25-476.75; n = 17) but during hypothermia treatment the QTc interval was significantly prolonged at 33 °C after 24 h of cooling (564.47 ms; IQR 512.41-590.00; p = 0.0001; n = 34) and decreased after end of hypothermia to baseline levels (476.74 ms; 448.71-494.97; p = 0.15).

Conclusion

The QTc interval was found to be significantly prolonged during MTH treatment, and some severe prolongations >670 ms were observed, without a higher incidence of life-threatening arrhythmias, especially no Torsade des pointes were detected. However, routine and frequent ECG recording with respect to the QTc interval should become part of any hypothermia standard operation protocol and should be recommended by official guidelines.     

Therapeutic hypothermia after cardiac arrest: A retrospective comparison of surface and endovascular cooling techniques

Objectives

Therapeutic hypothermia (32-34 °C) is recommended for comatose survivors of cardiac arrest; however, the optimal technique for cooling is unknown. We aimed to compare therapeutic hypothermia using either surface or endovascular techniques in terms of efficacy, complications and outcome.

Design

Retrospective cohort study.

Setting

Thirty-bed teaching hospital intensive care unit (ICU).

Patients

All patients (n = 83) undergoing therapeutic hypothermia following cardiac arrest over a 2.5-year period. The mean age was 61 ± 16 years; 88% of arrests occurred out of hospital, and 64% were ventricular fibrillation/tachycardia.

Interventions

Therapeutic hypothermia was initiated in the ICU using iced Hartmann's solution, followed by either surface (n = 41) or endovascular (n = 42) cooling; choice of technique was based upon endovascular device availability. The target temperature was 32-34 °C for 12-24 h, followed by rewarming at a rate of 0.25 °C h⁻¹.

Measurements and main results

Endovascular cooling provided a longer time within the target temperature range (p = 0.02), less temperature fluctuation (p = 0.003), better control during rewarming (0.04), and a lower 48-h temperature load (p = 0.008). Endovascular cooling also produced less cooling-associated complications in terms of both overcooling (p = 0.05) and failure to reach the target temperature (p = 0.04). After adjustment for known confounders, there were no differences in outcome between the groups in terms of ICU or hospital mortality, ventilator free days and neurological outcome.

Conclusion

Endovascular cooling provides better temperature management than surface cooling, as well as a more favorable complication profile. The equivalence in outcome suggested by this small study requires confirmation in a randomized trial.     

Two simple questions to assess neurologic outcomes at 3 months after out-of-hospital cardiac arrest: Experience from the Public Access Defibrillation Trial

Background

Two simple questions have been used to classify neurologic outcome in patients with stroke. Could they be similarly applied to patients with cardiac arrest?

Methods

As part of a randomized trial, study personnel interviewed by telephone survivors of out-of-hospital cardiac arrest to assess their outcomes 3 months after discharge. They asked two simple questions: (1) In the last 2 weeks, did you require help from another person for your everyday activities? and (2) Do you feel that you have made a complete mental recovery form your heart arrest? Next they administered the Mini-Mental State Examination (MMSE) from the Adult Lifestyles and Function Interview (ALFI) to assess cognition on a scale from 0 to 22 and the Health Utilities Index Mark 3 (HUI3) to assess quality of life on a scale from 0 (death) to 1 (perfect health).

Results

Based on responses to the two simple questions, 32 survivors were classified as dependent (n = 5, 16%), independent (n = 3, 9%) and full recovery (n = 24, 75%). The mean ALFI-MMSE score was 19.1 (standard deviation 5.1), and the mean HUI3 score was 0.76 (standard deviation 0.28). The classification based on the two simple questions was significantly correlated with ALFI-MMSE (p = 0.002) and HUI3 (p = 0.001). Scores for the HUI3 were missing in eight survivors.

Conclusions

Neurologic outcomes based on the two simple questions after cardiac arrest can be easily determined, sensibly applied, and readily interpreted. These preliminary findings justify further evaluation of this simple and practical approach to classify neurologic outcome in survivors of cardiac arrest.     

Can early serum levels of S100B protein predict the prognosis of patients with out-of-hospital cardiac arrest?

Objective

This study aims to know if the level of S100B protein at the initiation of cardiopulmonary resuscitation (CPR) and immediately after return of spontaneous circulation (ROSC) can predict clinical outcome.

Materials and methods

A prospective observational study from December 2004 to October 2006 was conducted in an urban tertiary hospital emergency department. Clinical demographics for out-of-hospital cardiac arrest patients were collected based on the Utstein style. Outcomes collected included ROSC for 20 min, survival to admission, survival and Glasgow Outcome Scale (GOS) at 1 month. S100B protein was measured twice before starting CPR (first S100B) and immediately after ROSC (second S100B). We investigated the association between S100B protein levels and clinical outcomes using a multivariate logistic regression model.

Results

A total of 151 patients were included (age: 60.2 ± 16.8 years, male: 64.2%). Of these, 60 (39.7%) had ROSC and 46 (30.5%) survived to admission. After 1 month, 12 (8.0%) survived and only three patients showed good GOS (≥4 points). The S100B levels were not different for ROSC, survival to admission and 1-month survival between survivors and non-survivors (p > 0.05, first and second S100 B level). For the witnessed out-of-hospital cardiac arrest (OHCA) group (N = 87), only the first S100B (1.22 ± 0.85 μg l⁻¹ vs. 3.91 ± 4.25 μg l⁻¹, p < 0.001) showed significant difference for 1-month survival between survivors and non-survivors. The first S100B showed significant association with survival to emergency department (ED) but not 1-month survival (adjusted odds ratio (OR) = 0.905, 95% confidence interval = 0.821-0.998).

Conclusion

Higher levels of S100B at start of CPR were significantly associated with lower survival to admission, and not for 1-month survival.     

A comparison of paediatric airway anatomy with the SimBaby high-fidelity patient simulator

Background

The SimBaby high-fidelity patient simulator is a widely used paediatric simulator for the training of standard and critical airway management scenarios. Furthermore this simulator is frequently used for the evaluation of different airway devices and techniques. However, the anatomic structures of the SimBaby have not been compared to actual patients’ anatomy.

Methods

The CT radiographic measures of the upper airway anatomy of two SimBaby simulators were compared to MRI images of the upper airway of 20 children aged 1-11 months who underwent routine MRI scans under sedation for diagnostic purposes. Various distances of the tongue, soft palate and pharynx, cross sectional areas and volumes of anatomic structures of the upper airway including the retroglossal airspace were compared.

Results

The SimBaby's retroglossal airspace volume greatly differed from the measurements in patients (SimBaby 5.3 ± 0.4 vs. 1.9 ± 0.8 cm³ in infants, p < 0.01). Furthermore the distance from the alveolar process of the mandible to the posterior pharyngeal wall was larger in the SimBaby than in infants (5.8 ± 0.1 vs. 4.5 ± 0.5 cm, p < 0.001) and dimensions of the epiglottis and pharynx were larger in the Simbaby.

Conclusion

The anatomic features of the SimBaby do not adequately simulate the upper airway anatomy of infants. These results imply inadequate realism of this simulator for airway training and compromise the validity of comparative trials of different airway devices with the SimBaby as airway model.     

Comparing the survival between extracorporeal rescue and conventional resuscitation in adult in-hospital cardiac arrests: Propensity analysis of three-year data

Aim

Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to have survival benefit over conventional CPR (CCPR) in patients with in-hospital cardiac arrest of cardiac origin. We compared the survival of patients who had return of spontaneous beating (ROSB) after ECPR with the survival of those who had return of spontaneous circulation (ROSC) after conventional CPR.

Methods

Propensity score-matched cohort of adults with in-hospital prolonged CPR (>10 min) of cardiac origin in a university-affiliated tertiary extracorporeal resuscitation center were included in this study. Fifty-nine patients with ROSB after ECPR and 63 patients with sustained ROSC by CCPR were analyzed. Main outcome measures were survival at hospital discharge, 30 days, 6 months, and one year, and neurological outcome.

Results

There was no statistical difference in survival to discharge (29.1% of ECPR responders vs. 22.2% of CCPR responders, p = 0.394) and neurological outcome at discharge and one year later. In the propensity score-matched groups, 9 out of 27 ECPR patients survived to one month (33.3%) and 7 out of 27 CCPR patients survived (25.9%). Survival analysis showed no survival difference (HR: 0.856, p = 0.634, 95% CI: 0.453-1.620) between the groups, either at 30 days or at the end of one year (HR: 0.602, p = 0.093, 95% CI: 0.333-1.088).

Conclusions

This study failed to demonstrate a survival difference between patients who had ROSB after institution of ECMO and those who had ROSC after conventional CPR. Further studies evaluating the role of ECMO in conventional CPR rescued patients are warranted.     

Mean flow velocity in the middle cerebral artery is associated with rehabilitation success in ischemic stroke patients

Treger I, Aidinof L, Lutsky L, Kalichman L. Mean flow velocity in the middle cerebral artery is associated with rehabilitation success in ischemic stroke patients.

Objective

To evaluate the association between mean flow velocity (MFV) in the middle cerebral artery (MCA) measured by using transcranial Doppler (TCD) and functional and neurologic impairment change during rehabilitation after acute stroke.

Design

Cross-sectional observational study.

Setting

Acute neurologic rehabilitation department.

Participants

Consecutive patients (N=67; 53 men, 14 women; mean ± SD age, 61.54±8.92y) referred to the rehabilitation center during the first 6 months of 2006 for a first ischemic stroke in the MCA area.

Interventions

Not applicable.

Main Outcome Measures

All subjects were evaluated on admission and at discharge by using the National Institutes of Health Stroke Scale (NIHSS) and the FIM. TCD measurements of MFV of the ipsilateral and contralateral MCA were performed on admission (during the first 20 days after stroke) and a few days before discharge.

Results

Contralateral MFV at admission was associated significantly with all indexes of functional rehabilitation success (FIM score at discharge [β=.169; P=.010], change in FIM score [β=.554; P=.010], relative improvement in FIM score [β=.783; P=.003]). No significant association was found between indexes of NIHSS change and ipsilateral or contralateral MFV.

Conclusions

Ipsilateral or contralateral MFV measured at admission did not change during the 2-month rehabilitation period. Our data showed a significant association between blood flow velocity in the contralateral MCA and functional rehabilitation parameters of patients after first ischemic stroke in the MCA area.     

Post-resuscitation myocardial microcirculatory dysfunction is ameliorated with eptifibatide

Background

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.

Methods

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 12 min 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.

Results

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 4 h after cardiac arrest.

Conclusion

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 30 min post-resuscitation. Post-cardiac arrest ventricular dysfunction may require a multi-modality treatment strategy for successful prevention or amelioration.     

Impact of transport to critical care medical centers on outcomes after out-of-hospital cardiac arrest

Background

Post-resuscitation care has emerged as an important predictor of survival from out-of-hospital cardiac arrest (OHCA). In Japan, selected hospitals are certified as Critical Care Medical Centers (CCMCs) based on their ability and expertise.

Hypothesis

Outcome after OHCA is better in patients transported to a CCMC compared a non-critical care hospital (NCCH).

Materials and methods

Adults with OHCA of presumed cardiac etiology, treated by emergency medical services systems, and transported in Osaka from January 1, 2005 to December 31, 2007 were registered using a prospective Utstein style population cohort database. Primary outcome measure was 1 month neurologically favorable survival (CPC ≤ 2). Outcomes of patients transported to CCMC were compared with patients transported to NCCH using multiple logistic regressions and stratified on the basis of stratified field ROSC.

Results

10,383 cases were transported. Of these, 2881 were transported to CCMC and 7502 to NCCH. Neurologically favorable 1-month survival was greater in the CCMC group [6.7% versus 2.8%, P < 0.001]. Among patients who were transported to hospital without field ROSC, neurologically favorable outcome was greater in the CCMC group than the NCCH group [1.7% versus 0.5%; adjusted odds ratio (OR), 3.39; 95% confidence interval (CI), 2.17-5.29; P < 0.001]. In the presence of field ROSC, survival was similar between the groups [43% versus 41%; adjusted OR, 1.09; 95% CI, 0.82-1.45; P = 0.554].

Conclusions

Survival after OHCA of presumed cardiac etiology transported to CCMCs was better than those transported to NCCHs. For OHCA patients without field ROSC, transport to a CCMC was an independent predictor for a good neurological outcome.     

S-100B is superior to NSE, BDNF and GFAP in predicting outcome of resuscitation from cardiac arrest with hypothermia treatment

Objective

To conduct a pilot study to evaluate the blood levels of brain derived neurotrophic factor (BDNF), glial fibrillary acidic protein (GFAP), neuron specific enolase (NSE) and S-100B as prognostic markers for neurological outcome 6 months after hypothermia treatment following resuscitation from cardiac arrest.

Design

Prospective observational study.

Setting

One intensive care unit at Uppsala University Hospital.

Patients

Thirty-one unconscious patients resuscitated after cardiac arrest.

Interventions

None.

Measurements and main results

Unconscious patients after cardiac arrest with restoration of spontaneous circulation (ROSC) were treated with mild hypothermia to 32-34 °C for 26 h. Time from cardiac arrest to target temperature was measured. Blood samples were collected at intervals of 1-108 h after ROSC. Neurological outcome was assessed with Glasgow-Pittsburgh cerebral performance category (CPC) scale at discharge from intensive care and again 6 months later, when 15/31 patients were alive, of whom 14 had a good outcome (CPC 1-2). Among the predictive biomarkers, S-100B at 24 h after ROSC was the best, predicting poor outcome (CPC 3-5) with a sensitivity of 87% and a specificity of 100%. NSE at 96 h after ROSC predicted poor outcome, with sensitivity of 57% and specificity of 93%. BDNF and GFAP levels did not predict outcome. The time from cardiac arrest to target temperature was shorter for those with poor outcome.

Conclusions

The blood concentration of S-100B at 24 h after ROSC is highly predictive of outcome in patients treated with mild hypothermia after cardiac arrest.     

Effect of time and day of admission on 1-month survival and neurologically favourable 1-month survival in out-of-hospital cardiopulmonary arrest patients

Aim

We sought to examine whether the outcomes of out-of-hospital cardiopulmonary arrest (OHCA) patients differed between weekday and weekend/holiday admissions, or between daytime and nighttime admissions.

Methods

From a national registry of OHCA events in Japan between 2005 and 2008, 173,137 cases where the call-to-hospital admission interval was shorter than 120 min and collapse was witnessed by a bystander were included in this study. One-month survival rate and neurologically favourable 1-month survival rate were used as outcome measures. Logistic regression was used to adjust for potential confounding factors.

Results

No significant differences in outcome were found between weekday and holiday/weekend admissions in rates of 1-month survival or neurologically favourable 1-month survival (p = 0.78 and p = 0.80, respectively). In contrast, patients admitted in the daytime exhibited significantly better outcomes than those admitted at night, on both outcome measures (p < 0.001 and p < 0.001). After adjusting for possible confounding factors, outcomes were significantly better for daytime admissions, with odds ratios of 1.26 (95% confidence interval (CI) 1.22-1.31; p < 0.001) for 1-month survival, and 1.26 (95% CI 1.20-1.32; p < 0.001) for neurologically favourable 1-month survival. In contrast, no significant differences on either outcome measure were found between weekday and weekend/holiday cases, with odds ratios of 1.00 (95% CI 0.96-1.04; p = 0.96) for 1-month survival and 0.99 (95% CI 0.94-1.04; p = 0.78) for neurologically favourable 1-month survival.

Conclusions

Even after adjusting for confounding factors, admission day (weekday vs. weekend/holiday) had no effect on 1-month survival or neurologically favourable 1-month survival. In contrast, daytime admission was associated with significantly better outcomes than nighttime admissions.     

Visual evaluation of left ventricular performance predicts volume responsiveness early after resuscitation from cardiac arrest

Purpose

Haemodynamic optimisation is a fundamental goal of post-cardiac arrest therapy. Therefore, predicting volume responsiveness is a key issue in therapy of these high-risk patients and transoesophageal echocardiography (TEE) may provide helpful information. The aim of the present study was to evaluate the performance of visual evaluation (eyeballing) of standardised TEE-loops to predict volume responsiveness during post-cardiac arrest period.

Methods

After approval of the local animal investigation committee, TEE mid-oesophageal long-axis views were recorded before a 5 ml/kg volume bolus at baseline and both 1 and 4 h after return of spontaneous circulation (ROSC) from 8 min electrically induced cardiac arrest. Post-hoc, TEE loops were independently presented in randomized order to 7 blinded TEE-experts and 14 blinded TEE novices who were asked to predict whether the ventricle will increase stroke volume ≥15% after volume loading or not. Statistics were performed calculating sensitivity and specificity for the correct evaluation and agreement of raters.

Results

14 out of 20 pigs were successfully resuscitated, and 924 ratings from 21 echocardiographers were included into analysis. Overall, we observed a sensitivity between 71 and 100%, whereas the specificity showed rather low values between 0 and 67% for prediction of volume responsiveness. Best prediction was recorded 1 h after ROSC with median sensitivity (95% CI) of 100% (89-100%) and median specificity of 67% (61-72%). No significant difference was found between ratings of experienced and inexperienced echocardiographers. The concordance rate within the two groups was comparable.

Conclusions

In post-cardiac arrest period, visual evaluation of long-axis TEE loops allows prediction of volume responsiveness with good sensitivity and reasonable specificity even by novice users, and may therefore be suitable for implementation into treatment protocols.     

Survival does not improve when therapeutic hypothermia is added to post-cardiac arrest care

Background

We investigated whether the use of therapeutic hypothermia improves the outcome after cardiac arrest (CA) under routine clinical conditions.

Method

In a retrospective study, data of CA survivors treated from 2003 to 2010 were analysed. Of these, 143 patients were treated with hypothermia at 33 ± 0.5 °C for 24 h according to predefined inclusion criteria, while 67 who did not fulfil these criteria received comparable therapy without hypothermia.

Results

210 patients were included, 143 in the hypothermia group (HG) and 67 in the normothermia group (NG). There was no significant difference in mortality between the groups; 69 (48.2%) in the HG died in the first four weeks, compared to 30 patients (44.8%) in the NG (p = 0.659). Patients in the NG were older and more seriously ill, and CA occurred more often in-hospital. Binary logistic regression revealed ventricular fibrillation (p = 0.044), NSE serum level <33 ng ml⁻¹ (p < 0.001), age (p = 0.035) and witnessed cardiac arrest (p = 0.043) as independent factors significantly improving survival after CA, whereas hypothermia was not (p = 0.69). The target temperature was maintained for a significantly longer time (19.5 h vs. 15.2 h; p = 0.003) in hypothermia patients with a favourable outcome than in those with an unfavourable outcome.

Conclusion

There was no improvement in survival rates when hypothermia was added to standard therapy in this case series, as compared to standard therapy alone. The time at target temperature may be of relevance. We need better evidence in order to expand the recommendations for hypothermia after CA.     

Association between PON1 5′-regulatory region polymorphisms, PON1 activity and ischemic stroke

Objectives

Paraoxonase I (PON1) was known as a risk factor for cerebrovascular diseases. This study assessed the association of single nucleotide polymorphisms (SNPs) in the PON1 5′-regulatory region with ischemic stroke and serum PON1 activity.

Design and methods

Study subjects consisted of 418 healthy controls and 86 ischemic stroke patients with small vessel occlusion. SNPs were identified by DNA sequencing and a primer extension-based method.

Results

Among 10 identified SNPs, only −1434GG genotype was observed with a lower frequency in patients on borderline statistical significance (OR(95% CI), 0.297(0.083-1.060), p = 0.0615). However, haplotype analysis in a dominant model revealed that ht2 was observed with a significantly lower frequency in patients (OR(95% CI), 0.390(0.153-0.991), p = 0.0477). Both C(−1434)G mutation and ht2 distribution were associated with serum PON1 activity.

Conclusion

Our results suggest that haplotypes observed in the PON1 5′-regulatory region should be considered as risk factors for ischemic stroke.     

A randomised control trial comparing two techniques for locating chest compression hand position in adult Basic Life Support

Introduction

Chest compressions performed correctly have the potential to increase survival post cardiac arrest. The 2005 European Resuscitation Council (ERC) guidelines altered and simplified instructions for hand position placement to increase the number of chest compressions performed. This randomised controlled trial compares chest compression efficacy (hand position and number of effective chest compressions) after training using the 2005 guidelines or the 2005 guidelines with a hand position modification based on 2000 ERC guidelines.

Methods

First year healthcare students at the University of Birmingham, United Kingdom, were randomly allocated to either ‘2005’ or ‘intervention’ group immediately after passing a Basic Life Support (BLS) assessment to ERC standards. The 2005 group performed 2 min of BLS on a SkillReporter™ manikin (Laerdal Medical, Stavanger, Norway). The intervention group received training on hand placement using landmark techniques from the 2000 ERC guidelines; emphasising rapid hand positioning. This group also performed 2 min of BLS on a SkillReporter™ manikin.

Results

82 students were assessed; 41 in the 2005 group and 41 in the intervention group. Average compression rate was 102 in the 2005 group and 104 in the intervention group (p = 0.29). Average number of incorrect hand placements was 24 in the 2005 group and 9 in the intervention group (p = 0.03).

Conclusions

The use of landmark measurement techniques in hand placement for external chest compressions does not have a detrimental effect on the number of chest compressions performed during BLS and increases correct hand positioning.