Search

When can a man be declared 'really dead'? Being able to determine whether an individual's life has ended or not implies two important considerations, whether we can resuscitate him and avoid premature burial, the fear of which is termed 'taphophobia'. By the end of the 18th century, several scientists were involved in the study of apparent death and resuscitation. Pietro Manni was an obstetrician who, affected by his brother's death and his inability to help him, devoted himself to the study of apparent death, which became his aim in life. His Practical handbook for the care of the apparently dead is a detailed essay on resuscitation with a precise arrangement of topics - ventilation, tracheostomy, electricity and asphyxia in newborns - organised into chapters and paragraphs that resemble current texts on resuscitation., (© The Author(s) 2016.)

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas, the incidence of which is increasing, and the management of which requires multidisciplinary intervention. Our work is a prospective analysis of 356 cases of BP collected in the emergency services, Visceral A and B surgery, and resuscitation of the Hassan II teaching hospital in Fez over a 2-year period from April 2017 to May 2019. The goal of our job is to analyze the epidemiological aspects of PA and mainly to verify the reliability and the feasibility of the new SIRS score in the evaluation of the severity of PA in our context. The mean age was 55±17.29 with a clear female predominance. The diagnosis of BP was established in front of an evocative clinical picture associated with lipasemia> 3x normal in 91.5% of cases. Abdominal CT revealed a predominance of PA stage E balthazar with 37.5% followed by stage C with 32.5%. Biliary etiology is predominant in 78.4% of cases followed by origin Admission SIRS was present in 48% of cases and was persistent beyond 48 hours in 18% of cases. All of the patients who developed a complication during BP had a positive SIRS at admission. The superinfection of the necrosis flows was present in 75.8% of the patients having a persistent SIRS beyond 48h. The complications were mainly dominated by the superinfection of the necrosis flows found in 15% of the cases. According to the Atlanta classification, we found : Medical treatment was initiated in all patients while endoscopic and surgical treatment were much less common In the light of our study, it was concluded that the SIRS score is a simple, precise and specific means for predicting and evaluating the severity of acute pancreatitis taking into account the drawbacks of other multifactorial scores. [ABSTRACT FROM AUTHOR]

Background: Annually, 14 million newborns require stimulation to initiate breathing at birth and 6 million require bag-mask-ventilation (BMV). Many countries have invested in facility-based neonatal resuscitation equipment and training. However, there is no consistent tracking for neonatal resuscitation coverage.Methods: The EN-BIRTH study, in five hospitals in Bangladesh, Nepal, and Tanzania (2017-2018), collected time-stamped data for care around birth, including neonatal resuscitation. Researchers surveyed women and extracted data from routine labour ward registers. To assess accuracy, we compared gold standard observed coverage to survey-reported and register-recorded coverage, using absolute difference, validity ratios, and individual-level validation metrics (sensitivity, specificity, percent agreement). We analysed two resuscitation numerators (stimulation, BMV) and three denominators (live births and fresh stillbirths, non-crying, non-breathing). We also examined timeliness of BMV. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine recording of resuscitation.Results: Among 22,752 observed births, 5330 (23.4%) babies did not cry and 3860 (17.0%) did not breathe in the first minute after birth. 16.2% (n = 3688) of babies were stimulated and 4.4% (n = 998) received BMV. Survey-report underestimated coverage of stimulation and BMV. Four of five labour ward registers captured resuscitation numerators. Stimulation had variable accuracy (sensitivity 7.5-40.8%, specificity 66.8-99.5%), BMV accuracy was higher (sensitivity 12.4-48.4%, specificity > 93%), with small absolute differences between observed and recorded BMV. Accuracy did not vary by denominator option. < 1% of BMV was initiated within 1 min of birth. Enablers to register recording included training and data use while barriers included register design, documentation burden, and time pressure.Conclusions: Population-based surveys are unlikely to be useful for measuring resuscitation coverage given low validity of exit-survey report. Routine labour ward registers have potential to accurately capture BMV as the numerator. Measuring the true denominator for clinical need is complex; newborns may require BMV if breathing ineffectively or experiencing apnoea after initial drying/stimulation or subsequently at any time. Further denominator research is required to evaluate non-crying as a potential alternative in the context of respectful care. Measuring quality gaps, notably timely provision of resuscitation, is crucial for programme improvement and impact, but unlikely to be feasible in routine systems, requiring audits and special studies. [ABSTRACT FROM AUTHOR]

Background:Teleneonatology may improve the quality of high-risk newborn resuscitations performed by general providers in community settings. Variables that affect teleneonatology utilization have not been identified. Introduction:The objective of our mixed-methods study was to understand the barriers and facilitators experienced by local care providers who receive teleneonatology services. Materials and Methods:In October 2015, an electronic survey was sent to 349 teleneonatology participants at 6 community hospitals to assess user satisfaction, technology usability and acceptability, and impact on patient care. From December 2015 to June 2016, 49 participants were involved in focus groups and individual interviews to better understand barriers and facilitators of teleneonatology implementation. Qualitative data were analyzed using a thematic approach. Results:Survey response rate was 31.8% (N = 111). Of 93 survey respondents, 88 (94.6%) agreed that teleneonatology was needed at their hospitals, and of 52 participants, 50 (96.2%) believed that teleneonatology consults were helpful. We identified multiple facilitators and barriers to program implementation in education and training, process and work flow, communication, and technology. Discussion:Local care teams believed that teleneonatology was valuable for connection to a remote neonatologist. Successful program implementation may be facilitated by communicating the value of teleneonatology, engaging local stakeholders in program training and education, maintaining supportive professional relationships, and designing simple, highly reliable clinical work flows. Conclusions:Teleneonatology is viewed as an innovative, valuable service by local care teams. The identified barriers and facilitators to program use should be considered when implementing a teleneonatology program. [ABSTRACT FROM AUTHOR]

This article addresses whether cardiopulmonary resuscitation (CPR) and sustained physiological support should ever be permitted in individuals who are diagnosed as brain dead and who had held previously expressed moral or religious objections to the currently accepted criteria for such a determination. It contrasts how requests for care would normally be treated in cases involving a brain-dead individual with previously expressed wishes to donate and a similarly diagnosed individual with previously expressed beliefs that did not conform to a brain-based conception of death. The paper first focuses narrowly on requests for CPR and then expands its scope to address extended physiological support. It describes how refusing the brain-dead non-donor's requests for either CPR or extended support would represent enduring harm to the antemortem or previously autonomous individual by negating their beliefs and self-identity. The paper subsequently discusses potential implications of policy that would allow greater accommodations to those with conscientious objections to currently accepted brain-based death criteria, such as for cost, insurance, higher brain formulations and bedside communication. The conclusion is that granting wider latitude to personal conceptions around the definition of death, rather than forcing a contested definition on those with valid moral and religious objections, would benefit both individuals and society. [ABSTRACT FROM AUTHOR]

Background: Burn patients who require CPR before admission to a burn center are anecdotally known to suffer higher mortality than those who do not require pre-hospital CPR.Study Design: A retrospective chart review identified adult patients admitted to our burn center between 2013 and 2015. Included patients met 1 or both of the following criteria: 20% or more total body surface area burned and need for intubation before admission to our facility. We sought to identify predictors of early death, late death, and survival among burn patients who underwent CPR before admission.Results: Of the 80 patients meeting inclusion criteria, 17.5% underwent CPR before arrival at our facility. Seventy-nine percent of these died, compared with 29% of the patients who did not require CPR (p = 0.0005). Seventy-one percent of CPR patients died within 48 hours of admission, compared with 8% of non-CPR patients (p < 0.0001). The major predictor of death vs survival after CPR was lower initial arterial pH.Conclusions: Patients who undergo CPR before transfer to a burn center are at high risk for early death. Predictors of death and early death after CPR may include elevated initial lactate and lower initial arterial pH. [ABSTRACT FROM AUTHOR]

Background: Over 200,000 babies die yearly in Nigeria, of which about 26% is due to birth asphyxia. Effective neonatal resuscitation (NR) using basic equipment is capable of preventing up to 30% of deaths associated with perinatal asphyxia. However, NR is only effective where caregivers have sufficient knowledge and required skills. The frequent industrial actions by health workers in the public sector have brought to the fore the importance of private health facilities in healthcare delivery. Thus, there is a need to assess training of health workers and availability of basic equipment in private health institutions in Kano. Aim: To assess availability of trained providers on NR and resuscitation equipment in private health facilities in Kano. Materials and Methods: This is a cross sectional survey of 85 conveniently sampled private institutions that provide obstetric care as part of their services in Kano metropolis. A semi-structured self-administered questionnaire was used to collect data from each facility. Results: Seventy eight filled questionnaires were retrieved and analyzed. There were 25 specialist clinics, 44 general practice facilities, and nine maternity homes/primary healthcare (PHC). Only 29 (37.2%) of the facilities have caregivers trained on NR in attendance during normal deliveries. Thirty four (43.5%) facilities have written protocol on NR. Only two (22.2%) of the maternity homes/PHC have functional ambu bags; the corresponding figures for specialist and general practice clinics are 16 (64%) and 24 (54.5%) respectively. Conclusion: There is insufficient number of trained personnel on newborn resuscitation, and low availability of newborn resuscitation equipment in private health institutions in Kano metropolis. [ABSTRACT FROM AUTHOR]

Aim: Differentiating between a newly deceased patient and the lifeless patient in whom immediate resuscitation is required may be facilitated by a pre-hospital anaesthesiologist. The purpose of our study was to investigate to what extent and why the pre-hospital anaesthesiologist pronounced life extinct in situations where an emergency medical technician (EMT) would have been required to resuscitate.Methods: All lifeless patients seen pre-hospitally by the anaesthesiologist-manned Mobile Emergency Care Unit in Odense, Denmark, from 2010 to 2014 were retrospectively studied.Results: Of 17 035 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 have been attempted resuscitated, had the anaesthesiologist not been present. In 54.5% of cases where documentation was available in the patient records, reasons for not resuscitating these patients included time elapsed from incident to contact with physician, 'overall assessment', chronic disease, or do-not-resuscitate order.Conclusion: In one patient in 30, the MECU refrained from futile resuscitation in cases where legislation required an EMT to initiate resuscitation. This practice reduced unethical attempts of resuscitation, reduced unnecessary emergency ambulance transports, and reduced the work load of the hospital resuscitation teams for one unnecessary alarm every third day. Differentiating between lifeless patients and dead patients not exhibiting reliable signs of death, however, is a complex task which is only sparsely documented. [ABSTRACT FROM AUTHOR]

Aim: To provide therapeutic hypothermia (TH) to survivors after out-of-hospital cardiac arrest (OHCA), inter-hospital transfers (IHT) are frequently required. The safety of IHT remains controversial. The aim of this study was to investigate whether the effect of TH on brain recovery after OHCA differs between IHT and direct arrival groups.Methods: We identified patients with OHCA of presumed cardiac aetiology who were resuscitated by emergency medical services and experienced return-of-spontaneous circulation in 27 hospitals between January and December 2014. The main exposure variables were TH and IHT. The primary endpoint was discharge with good neurological recovery. We compared outcomes between the TH and non-TH groups using multivariable logistic regression with an interaction term between TH and IHT, after adjusting for potential confounders.Results: Among 1616 patients, 576 patients were included in the final analyses. Neurologic recovery was better in the TH group (46.2%) than in the non-TH group (20.1%) (adjusted odds ratio [aOR] 2.03 [95% confidence interval (CI) 1.24-3.33]). In the interaction model for the outcome of good neurological recovery, the aOR for TH was 2.82 (95% CI 1.59-5.01) in the direct transfer group vs. 0.76 (95% CI 0.29-2.01) in the IHT group. The measure of interaction on the multiplicative scale in this model was also statistically significant (OR 0.27 [95% CI 0.07-0.83]; p=0.02).Conclusion: IHT modified the effect of TH on neurological recovery for survivors of OHCA. TH is significantly less beneficial for good neurological recovery in patients who arrive via IHT than for those who arrive directly. [ABSTRACT FROM AUTHOR]

The article reflects on dynamic measures to guide fluid resuscitation. Topics discussed include potential methods to deliver volume resuscitation, method to assess need for fluid resuscitation, and limitations about widespread use of dynamic measures to assess responsiveness to volume. Also being discussed are biologically plausible surrogate outcomes measures in critical illness not associated with improved mortality.

In the post-nuclear deal scenario, Iran has reformulated the terms of the oil contract model, called the Iran Petroleum Contract (IPC), to attract international investments and technology in field development. In addition, it has ramped up production and competitively priced its oil to Asia and Europe so as to recapture the market share lost during the sanctions period. Any further enhancement of production capacity, however, requires expansion of green fields and resuscitation of brown fields under the IPC. The success of this effort will depend upon Iran's domestic political stability as much as the international environment, where sanctions are held in abeyance and oil prices continue to rise to a level that unlocks the investment capital of the big oil companies. Nonetheless, in a scenario of increasing global commitment to adopt green energy, whether oil companies would still want to make long-term investments in large hydrocarbon projects in general, remains an open question. [ABSTRACT FROM AUTHOR]

Introduction: Fall from height leads to many serious and fatal injuries every year. This study was conducted to identify the pattern of injuries after a fall from height. Materials and Method: 73 victims were considered into the study based on the suspicious deaths with an allegation of fall from height. Post mortem report, first information report, inquest report, any attempts at resuscitation, chemical reports and other forensic reports wer taken into consideration in the study. Results: Out of the 73 cases studies, 59(80.8%) were males and 14 (19.2%) were females. The most common age group was 21-30 years followed by 31-40 years. Of the victims, most common profession was construction workers with 37 victims followed by 11 toddy collectors. Head injury was the most common site of primary impact followed by fall to side of the body. The most common bone to be injured was the skull as that was the primary contact area in most of the cases followed by rib and vertebrae. Conclusion: Fall from height can be prevented by taking proper measures and care as most of the accidents are caused due to negligence and inexperience during work. [ABSTRACT FROM AUTHOR]

Copyright of Acta Facultatis Medicae Naissensis is the property of Nis University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: Neonatal infections carry a heavy burden of morbidity and mortality. Poor practice can result in unintentional colonisation of medical equipment with potentially pathogenic organisms. This study will determine the prevalence and type of bacterial contamination on exposed neonatal resuscitation equipment in different clinical settings and explore simple measures to reduce contamination risk.Methods: A survey determined the rates of resuscitation equipment usage. All environmentally exposed items were identified on resuscitaires hospital-wide and swabbed for bacterial contamination. A new cleaning and storage policy was implemented and the prevalence of environmentally exposed equipment re-measured post-intervention.Results: Resuscitation equipment was used in 28% of neonatal deliveries. Bacterial colony forming units were present on 44% of the 236 exposed equipment pieces swabbed. There was no significant difference in contamination rates between equipment types. Coagulase negative staphylococcus was the most prevalent species (59 pieces, 25%) followed by Escherichia coli and Enterobacter cloacae (20 pieces, 9% each). Opened items stored inside plastic remained sterile, whilst those in low-use areas had significantly less contamination than those in high-use areas (22% vs. 51%, P < 0.05). Implementing a simple educational programme led to a significant reduction in environmentally exposed equipment (79% reduction, P < 0.01).Conclusions: Pathogenic bacteria can colonise commonly used pieces of neonatal resuscitation equipment. Whilst the clinical significance remains uncertain, equipment should be kept packaged until required and discarded once open, even if unused. Standardising cleaning policies results in rapid and significant improvements in equipment storage conditions, reducing microbial colonisation opportunities. [ABSTRACT FROM AUTHOR]

Background: Implications from the pragmatic, randomize, optimal platelet and plasma ratios (PROPPR) trial are critical for remote damage control resuscitation (DCR). Utilizing DCR principals in remote settings can combat early mortality from hemorrhage. Identifying the appropriate transfusion strategy is mandatory prior to adopting prehospital hemostatic resuscitation strategies.Study Design and Methods: The PROPPR study was examined in relation to the following questions: 1) Why is it important to have blood products in the prehospital setting?; 2) Which products should be investigated for prehospital hemostatic resuscitation?; 3) What is the appropriate ratio of blood product transfusion?; and 4) What are the appropriate indications for hemostatic resuscitation?Results: PROPPR demonstrates that early and balanced blood product transfusion ratios reduced mortality in all patients at 3 hours and death from exsanguination at 24 hours (p = 0.03). The median time to death from exsanguination was 2.3 hours, highlighting the need for point-of-injury DCR capabilities. A 1:1:1 transfusion ratio of plasma:platelets:packed red blood cells increased the percentage of patients achieving anatomic hemostasis (p = 0.006). PROPPR used the assessment of blood consumption score to identify patients likely to require ongoing hemostatic resuscitation. The critical administration threshold predicted patient mortality and identified patients likely to require ongoing hemostatic resuscitation.Conclusion: A balanced resuscitation strategy demonstrates an early survival benefit, decreased death from exsanguination at 24 hours and a greater likelihood of achieving hemostasis in critically injured patients receiving a 1:1:1 ratio of plasma:platelets:PRBCs. This finding highlights the need to import DCR principals to remote locations. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess whether there was a significant difference in the complications of cardiopulmonary resuscitation (CPR) between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) survivors using multidetector computed tomography (MDCT). Subjects and Methods: We performed a retrospective analysis of prospective registry data. We enrolled both OHCA and IHCA patients who underwent successful CPR. We classified chest injuries secondary to chest compression into rib fractures, sternum fractures, and uncommon complications such as lung contusions and extrathoracic complications. We compared these complications according to CPR locations. We also analysed risk factors for CPR complications using multiple regression analysis and classification and regression tree analysis. Results: During the study period, a total of 148 patients were included in the primary analysis. Rib fractures were detected more in OHCA survivors than in IHCA survivors (74 patients (83.2%) vs. 37 patients (62.7%), p=0.05), and frequency of multiple rib fractures was higher in OHCA survivors than IHCA survivors (69 patients (77.5%) vs. 34 patients (57.6%), p=0.01). Although other complications were not significantly different between the groups, there was a trend for OHCA survivors to sustain more serious and direct high-energy related complications. Older age, longer CPR, and OHCA were significantly associated with incidence of rib fractures, multiple rib fractures, and number of rib fractures. Conclusions: Rib fractures were more likely to occur in OHCA survivors, and serious complications tended to occur more often in OHCA compared to IHCA survivors. [ABSTRACT FROM AUTHOR]

The author presents tips to physicians on how to diagnose the exact time of the death of a patient or a person. Topics discussed include the question of exactly when a person is actually dead, premature burial and resuscitation. Other topics include legislation defining death, physical signs of death, and diagnosing death after at least two minutes of electrical asystole or mechanical asystole is confirmed.

The first specific techniques and triages for medical resuscitation developed in the XVIII century, specifically to rescue the drowned persons. The topic of resuscitation in strictly connected to the theme of the apparent death, to the dread of the "buried alive", to the progress of forensic medicine and to the administrative and legislative policies. The contribute aims to focus on the contribution of the medical and pathologic nosology about the conception of the apparent death, read as asphyxia. [ABSTRACT FROM AUTHOR]

Many families of patients hold the view that it is their right to be present during a loved one's resuscitation, while the majority of patients also express the comfort and support they would feel by having them there. Currently, family presence is more commonly accepted in paediatric cardiopulmonary resuscitation (CPR) than adult CPR. Even though many guidelines are in favour of this practice and recognise potential benefits, healthcare professionals are hesitant to support adult family presence to the extent that paediatric family presence is supported. However, in this paper, we suggest that the ethical case to justify family presence during paediatric resuscitation (P-FPDR) is weaker than the justification of family presence during adult resuscitation (A-FPDR). We go on to support this claim using three main arguments that people use in clinical ethics to justify FPDR. These include scarcity of evidence documenting disruption, psychological benefits to family members following the incident and respect for patient autonomy. We demonstrate that these arguments actually apply more strongly to A-FPDR compared with P-FPDR, thereby questioning the common attitude of healthcare professionals of allowing the latter while mostly opposing A-FPDR. Importantly, we do not wish to suggest that P-FPDR should not be allowed. Rather, we suggest that since P-FPDR is commonly (and should be) allowed, so should A-FPDR. This is because the aforementioned arguments that are used to justify FPDR in general actually make a stronger case for A-FPDR. [ABSTRACT FROM AUTHOR]

Purpose: In the 2010 American Heart Association guidelines, supraglottic devices (SGDs) such as the laryngeal mask are proposed as alternatives to tracheal intubation for cardiopulmonary resuscitation. Some SGDs can also serve as a means for tracheal intubation after successful ventilation. The purpose of this study was to evaluate the effect of chest compression on airway management with four intubating SGDs, aura-i (aura-i), air-Q (air-Q), i-gel (i-gel), and Fastrack (Fastrack), during cardiopulmonary resuscitation using a manikin. Methods: Twenty novice physicians inserted the four intubating SGDs into a manikin with or without chest compression. Insertion time and successful ventilation rate were measured. For cases of successful ventilation, blind tracheal intubation via the intubating SGD was performed with chest compression and success or failure within 30 s was recorded. Results: Chest compression did not decrease the ventilation success rate of the four intubating SGDs (without chest compression (success/total): air-Q, 19/20; aura-i, 19/20; i-gel, 18/20; Fastrack, 19/20; with chest compression: air-Q, 19/20; aura-i, 19/20; i-gel, 16/20; Fastrack, 18/20). Insertion time was significantly lengthened by chest compression in the i-gel trial ( P < 0.05), but not with the other three devices. The blind intubation success rate with chest compression was the highest in the air-Q trial (air-Q, 15/19; aura-i, 14/19; i-gel, 12/16; Fastrack, 10/18). Conclusions: This simulation study revealed the utility of intubating SGDs for airway management during chest compression. [ABSTRACT FROM AUTHOR]

Introduction: Cardiopulmonary resuscitation (CPR) is being used extensively in the hospital settings for life saving purposes. Resuscitation guidelines are reviewed and published frequently for better outcome of the patient. The objective of this study was to identify predictors of outcome of CPR and compare the outcome of CPR with other centers. Method: This is a retrospective analytical study of one year duration carried out in tertiary level teaching hospital. Data were collected and then entered in Microsoft excel software with all the variables. Statistical analysis was done using Statistical Package for Social Sciences 17 software. Results: There was no influence of gender, age, time of call and site of call on outcome of CPR. Strong correlation was observed with primary rhythm of the patient at the time of CPR, with better outcome for ventricular fibrillation (VF) & pulseless ventricular tachycardia (VT) (survival 65%), and worse for asystole (survival 25%) and pulseless electrical activity (survival 54%). Conclusion: In this study it was found that primary rhythm at the time of CPR is strong predictor of survival. Outcome of CPR in this centre is comparable to other centres following standard protocols for CPR. [ABSTRACT FROM AUTHOR]

Assessing burn surface area is essential to triage patients and determine fluid resuscitation. The three commonly used methods are: (i) the palmar method, where palmar surface area is assumed to equal 1% of body surface area ( BSA); (ii) the rule of nines; and (iii) the Lund and Browder method, where body parts are assigned a percentage surface area. Calculation of BSA involvement in dermatological disease is used to measure disease severity and treatment responses. The grid-point counting method may also be used. Mycosis fungoides ( MF), a form of cutaneous T-cell lymphoma, typically presents with patches and plaques with progression to tumours and erythroderma in advanced disease. Quantifying skin involvement in MF requires assessment of both BSA involvement and lesion type. The severity-weighted assessment tool ( SWAT) was designed for this purpose, using grid-point counting, and weighting patch as × 1, plaque as × 2 and tumour as × 3. The SWAT was modified in an international consensus paper to use Lund and Browder charts, and the weighting of tumours was increased to × 4. The patients' palm or hand is frequently the method of choice for skin scoring. However, both the definition of the palm and whether this includes the fingers or even the thumb, and the percentage BSA assigned to the palm, vary in the literature. A review of published planimetry studies found that the most consistent measure across age and race was the palm without fingers reflecting 0·5% total BSA. We recommend the use of the patient's palm to represent 0·5% BSA as the most convenient and reliable tool to measure surface area, and we introduce an iPhone application to record BSA electronically and calculate modified SWAT. [ABSTRACT FROM AUTHOR]

Fetal to neonatal transition is characterized by abrupt changes in the cardio-respiratory physiology. In few minutes, the newly born infant expands the lungs, diminishes pulmonary vascular resistance dilating the pulmonary vessels, and establishes a highly efficient gas exchange between alveoli and the pulmonary capillary bed. However, under certain pathologic conditions asphyxia ensues. Asphyxia is characterized by prolonged periods of hypoxia and ischemia that cause brain energy exhaustion leading in many occasions to a hypoxic ischemic encephalopathy. The cornerstones of newborn resuscitation consist in the establishment of a functional residual capacity and an adequate oxygenation. Of note, the need for oxygen during resuscitation varies substantially between term and preterm infants as has been shown in physiologic studies. The aim of this review article is to present updated knowledge in the management of oxygen in the delivery room both in term babies suffering from birth asphyxia and in preterm babies needing aid to overcome postnatal adaptation. [ABSTRACT FROM AUTHOR]

Background: The optimal age to begin CPR training is a matter of debate. This study aims to determine if elementary schoolchildren have the capacity to administer CPR efficiently. Methods: This quasi-experimental study took place in a Quebec City school. Eighty-two children 10 to 12 years old received a 6-hour CPR course based on the American Heart Association (AHA) Guidelines. A comparison group of 20 adults who had taken the same CPR course was recruited. After training, participants' performance was evaluated using a Skillreporter manikin. The primary outcome was depth of compressions. The secondary outcomes were compression rate, insufflation volume and adherence to the CPR sequence. Children's performance was primarily evaluated based on the 2005 AHA standards and secondarily compared to the adults' performance. Results: Schoolchildren did not reach the lower thresholds for depth (28.1 +/- 5.9 vs 38 mm; one-sided p = 1.0). The volume of the recorded insufflations was sufficient (558.6 +/222.8 vs 500 ml; one-sided p = 0.02), but there were a significant number of unsuccessful insufflation attempts not captured by the Skillreporter. The children reached the minimal threshold for rate (113.9 +/-18.3 vs 90/min; one-sided p < 0.001). They did not perform as well as the adults regarding compression depth (p < 0.001), but were comparable for insufflation volume (p = 0.83) and CPR sequence. Conclusions: In this study, schoolchildren aged 10-12 years old did not achieve the standards for compression depth, but achieved adequate compression rate and CPR sequence. When attempts were successful at generating airflow in the Skillreporter, insufflation volume was also adequate. [ABSTRACT FROM AUTHOR]

The liver is currently considered to be one of the first organs to be subjected to the hypoxic insult inflicted by hemorrhagic shock. The oxidative injury caused by resuscitation also targets the liver and can lead to malfunction and the eventual failure of this organ. Each of the various fluids, vasoactive drugs, and pharmacologic substances used for resuscitation has its own distinct effect(s) on the liver, and the anesthetic agents used during surgical resuscitation also have an impact on hepatocytes. The aim of our study was to identify the specific effect of these substances on the liver. To this end, we conducted a literature search of MEDLINE for all types of articles published in English, with a focus on articles published in the last 12 years. Our search terms were 'hemorrhagic shock,' 'liver,' 'resuscitation,' 'vasopressors,' and 'anesthesia.' Experimental studies form the majority of articles found in bibliographic databases. The effect of a specific resuscitation agent on the liver is assessed mainly by measuring apoptotic pathway regulators and inflammation-induced indicators. Apart from a wide range of pharmacological substances, modifications of Ringer's Lactate, colloids, and pyruvate provide protection to the liver after hemorrhage and resuscitation. In this setting, it is of paramount importance that the treating physician recognize those agents that may attenuate liver injury and avoid using those which inflict additional damage. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence suggests that initiating delivery room respiratory support or resuscitation for term infants using lower rather than higher concentrations of oxygen reduces mortality and the risk of serious morbidity. Uncertainty exists with regard to applicability of this strategy for preterm infants who have different underlying reasons for respiratory distress and risks for harm at birth than term infants. Methods: We performed a systematic review and meta-analysis of randomised controlled trials to determine the effect on mortality and morbidity of using lower (21- 50%) versus higher (>50%) oxygen concentrations for delivery room transition support of preterm infants. Results: We identified six randomised controlled trials in which a total of 484 infants participated. Most participants were preterm infants born before 32 weeks' gestation. One trial was quasi-randomised and in one trial allocation concealment was not described. Clinicians and investigators were aware of the interventions in all but one trial. Meta-analyses found a statistically significant reduction in the risk of death pooled risk ratio 0.65 (95% confidence interval 0.43, 0.98), but this effect disappeared when only the four trials with adequate allocation concealment were included [pooled risk ratio 1.0 (95% confidence interval 0.45, 2.24)]. None of the trials has evaluated any neuro-developmental outcomes. Conclusions: The available trial data do not provide strong evidence that using lower versus higher oxygen concentrations for delivery room transition support for preterm infants confers important benefits or harms. Lack of allocation concealment and blinding of clinicians and assessors are the major sources of bias in the existing trials. Further, large, good-quality trials are needed to resolve on-going uncertainties and inform clinical practice. [ABSTRACT FROM AUTHOR]

Aim: To give new insights into how an infant responded to naloxone, given after acquiring a maternal opiate by recording the breathing pattern directly after birth. Method: A respiratory recording is presented of an infant during resuscitation in the delivery room after receiving naloxone for respiratory depression, resulting from maternal remifentanyl use. Results: The infant was born apneic and bradycardic. Normal resuscitation manoeuvres had no effect on the respiratory drive. Directly after administration of naloxone, a tachypneic breathing pattern with sporadic expiratory breaking manoeuvres was observed. Conclusion: The immediate tachypnoea is most likely a direct effect of the naloxone causing an immediate 'rebound response' after the release of the opiate-induced inhibition of the respiratory drive. [ABSTRACT FROM AUTHOR]

The goal of this work was to describe a horn adapter providing extremely high frequency (EHF) modification of blood. The device is used in combination with the Gemos apparatus for plasmapheresis and hemosorption to provide detoxication in patients with various pathologies. The horn adapter can be used in clinical transfusiology, gravitation blood surgery, resuscitation, etc. [ABSTRACT FROM AUTHOR]

Traumatic intracranial vertebral artery injury is a relatively rare but potentially fatal disease. We present a case of a 63-year-old man who presented with sudden onset of loss of consciousness after hitting his head. After immediate resuscitation, he showed quadriplegia and absence of spontaneous breathing. Brain and cervical spine magnetic resonance imaging revealed an atlantoaxial subluxation, fractured C2 odontoid process, left vertebral artery occlusion, and bilateral extensive ischemia in the medulla oblongata and high cervical spinal cord. Digital subtraction angiography demonstrated left vertebral artery dissection just below the level of vertebral body C2. [ABSTRACT FROM AUTHOR]

Background: Optimal acceptable time intervals from collapse to bystander cardiopulmonary resuscitation (CPR) for neurologically favorable outcome among adults with witnessed out-of-hospital cardiopulmonary arrest (CPA) have been unclear. Our aim was to assess the optimal acceptable thresholds of the time intervals of CPR for neurologically favorable outcome and survival using a recursive partitioning model. Methods and Findings: From January 1, 2005 through December 31, 2009, we conducted a prospective population-based observational study across Japan involving consecutive out-of-hospital CPA patients (N = 69,648) who received a witnessed bystander CPR. Of 69,648 patients, 34,605 were assigned to the derivation data set and 35,043 to the validation data set. Time factors associated with better outcomes: the better outcomes were survival and neurologically favorable outcome at one month, defined as category one (good cerebral performance) or two (moderate cerebral disability) of the cerebral performance categories. Based on the recursive partitioning model from the derivation dataset (n = 34,605) to predict the neurologically favorable outcome at one month, 5 min threshold was the acceptable time interval from collapse to CPR initiation; 11 min from collapse to ambulance arrival; 18 min from collapse to return of spontaneous circulation (ROSC); and 19 min from collapse to hospital arrival. Among the validation dataset (n = 35,043), 209/2,292 (9.1%) in all patients with the acceptable time intervals and 1,388/2,706 (52.1%) in the subgroup with the acceptable time intervals and pre-hospital ROSC showed neurologically favorable outcome. Conclusions: Initiation of CPR should be within 5 min for obtaining neurologically favorable outcome among adults with witnessed out-of-hospital CPA. Patients with the acceptable time intervals of bystander CPR and pre-hospital ROSC within 18 min could have 50% chance of neurologically favorable outcome. [ABSTRACT FROM AUTHOR]

In this article we rejoin Gerald Woerlee's response in this issue to Smit's (2008) article, "Corroboration of the Dentures Anecdote Involving Veridical Perception in a Near-Death Experience." We show the untenability of his claim that the man whose dentures were lost before his resuscitation in the hospital was initiated had been conscious virtually all the way from the moment he was found in the meadow up to his transport to the hospital's cardiac care unit. Also, we question Woerlee's claim that the patient constructed an accurate mental picture of objects and persons in the resuscitation room simply by listening to the sounds caused by the actions around his body. In all, we question Woerlee's materialistic explanations of the out-of-body experience that occurred in this patient's near-death experience. Our conclusion is straightforward: We consider Woerlee's claims to be wrong. [ABSTRACT FROM AUTHOR]

In this article, I address some of what I consider the inaccuracies and false assumptions in a recent article in this Journal entitled "Corroboration of the Dentures Anecdote Involving Veridical Perception in a Near-Death Experience" (Smit, 2008). I provide a medical explanation of how it was possible for the man reporting this remarkable NDE to have survived his period of cardiac arrest and how it was possible for him to have undergone an NDE. More importantly, I discuss how it was possible for this man to have undergone the truly unusual perceptions of feeling pain in his chest due to cardiac massage at the same time as his consciousness was displaced out of his body during an out- of-body experience. [ABSTRACT FROM AUTHOR]

The article discusses the Remote Damage Control Resuscitation (RDCR) Symposium. The Haukeland Hospital in Bergen, Norway, is testing refrigerated PLTs in PLT additive solution after hearing results from the Coagulation and Blood Research group at the US Army Institute of Surgical Research in San Antonio, Texas. In Lund, Sweden, increased point-of-care testing to assess coagulopathy and orthogonal spectroscopy to evaluate perfusion was introduced in emergency room settings.

Should relatives be made welcome in a resuscitation room to witness emergency medical treatment of a family member? This is a major issue in emergency departments worldwide. Attitudes of staff and relatives are mixed, and the benefits suggest further long-term research is needed to review the psychological effects on loved ones. This article will considers the background of witnessed resuscitation, as well as the views of both staff and relatives involved. The research will be evaluated and implications for practice explored. [ABSTRACT FROM AUTHOR]

AIM: The Royal College of Nursing recommends that appropriately trained healthcare professionals should support relatives who express a wish to witness resuscitation. The aim of this research was to identify the knowledge and experience of family-witnessed resuscitation of children's nurses. METHODS: A postal questionnaire was used to collect data from a non-probability convenience sample of 94 children's nurses working in three acute paediatric areas in one hospital trust. A total of 32 nurses responded. FINDINGS: Two thirds of respondents expressed a positive attitude towards family-witnessed resuscitation. Twenty four had been involved in the resuscitation of a child; family members had been present in 20 of these cases. Most of these children's nurses felt able to be 'the experienced support person' required in the national guidance. Irrespective of seniority, the nurses who responded reported a lack of education and knowledge about family-witnessed resuscitation, but this was more apparent among the more junior staff. Nurses also reported an increased stress during a family-witnessed resuscitation situation and suggested formal counselling and informal discussions/debriefing sessions should be provided for staff and parents. CONCLUSION: Recommendations related to staff who support family members during resuscitation attempts need to be more widely implemented. In particular, the lack of education of children's nurses about family-witnessed resuscitation should be addressed to help improve the care of parents who witness resuscitation of their child. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Describe the epidemiology and the survival of patients with traumatic cardiac arrest (CA), and compare them to those with nontraumatic CA. Highlight the weaknesses in their care and consider ways to improve their survival. Method: Traumatic and nontraumatic CA are described using the Utstein style in the “réseau nord-alpin des urgences” registry. Regarding the traumatic CA, we focus on circumstances, types of injuries and specific resuscitation techniques used. Results: From 1st January 2004 to 31st December 2005, prehospital medical teams provided care to 1552 victims of CA, 129 of whom were trauma patients (8.3%). Average age was 47.1 years; 74.4% were males. Blunt trauma occurred in 94.6%. None of the patients had chest tube insertion or thoracotomy on the scene. A return of spontaneous circulation was observed in 24.8%, the survival after 24h was of 3.9%, and 0.8% of patients remained alive 1 year following the accident. The topography of lesions responsible for the CA as well as the fact that these lesions are limited or multiorgan influence the survival. Conclusion: The survival of patients with prehospital traumatic CA is catastrophic and it is worse than that of patients with nontraumatic CA. However, a specific earlier and more adapted prehospital resuscitation could help improve this survival. [Copyright &y& Elsevier]

Cross face nerve grafting followed by free muscle transfer has become a standard of care in rehabilitation of the paralyzed face. In an effort to address the surgical morbidity of sural nerve harvest, multiple groups have attempted to minimize lower extremity trauma from sural nerve harvest. In very preliminary studies, investigators have adapted the use of vein harvesting equipment for harvest of the sural nerve. In this article we describe the use of endoscopic vein harvesting equipment for sural nerve harvest in a series of eight patients undergoing facial reanimation, in which a single distal incision is made posterior to the lateral malleolus. Eight patients presented for first-stage cross face nerve grafting for facial reanimation over a 6-month period. Each patient was operated on using a two-team approach. One team exposed the donor branches of the facial nerve on the healthy side while the endoscopic harvest was simultaneously executed in the lower limb by the second team. In each case, the sural nerve graft >?20 cm in length was removed through a single 1.5-cm incision. There were no complications. Operative times decreased steadily throughout the period examined and were

One of the most striking examples of near-death experience stories is the account of a clinically dead patient whose dentures were removed from his mouth prior to resuscitation, and which dentures were then lost. Days later the patient saw a nurse and told him that it was he who had removed those dentures. The patient was right, but he should not have known this information, because at the time the nurse had removed his dentures, the patient was clinically dead. Since publication of this account in a prestigious mainstream medical journal, speculations have abounded. In this article I describe the investigation I undertook to put these speculations to rest and the outcome of that investigation. [ABSTRACT FROM AUTHOR]

Abstract: The two most recent Confidential Enquiries into Maternal and Child Health reports, examining Maternal Mortality in the UK, demonstrate that haemorrhage, hypertensive disease, amniotic fluid embolus and sepsis remain the most important direct causes of death after thromboembolic disease. Cardiac disease is the most important indirect cause of maternal death. Substandard care is adjudged to have contributed to more than 50% of all maternal deaths, and the reports highlight the importance of multidisciplinary care. This article addresses some of the key issues in the management of obstetric emergencies and emphasizes the importance of multidisciplinary teamwork and fire drills. [Copyright &y& Elsevier]

Summary: Aim of the study: To evaluate quality of cardiopulmonary resuscitation (CPR) performed during transport after out-of-hospital cardiac arrest. Materials and methods: Retrospective, observational study of all non-traumatic cardiac arrest patients older than 18 years who received CPR both before and during transport between May 2003 and December 2006 from the community run EMS system in Oslo. Chest compressions and ventilations were detected from impedance changes in routinely collected ECG signals, and hands-off ratio calculated as time without chest compressions divided by total CPR time. Results: Seventy-five of 787 consecutive out-of-hospital cardiac arrest patients met the inclusion criteria. Quality data were available from 36 of 66 patients receiving manual CPR and 7 of 9 receiving mechanical CPR. CPR was performed for mean 21±11min before and 12±8min during transport. With manual CPR hands-off ratio increased from 0.19±0.09 on-scene to 0.27±0.15 (p =0.002) during transport. Compression and ventilation rates were unchanged causing a reduction in compressions per minute from 94±14min−1 to 82±19min−1 (p =0.001). Quality was significantly better with mechanical than manual CPR. Four patients (5%) survived to hospital discharge; two with manual CPR (Cerebral performance categories (CPC) 1 and 2), and two with mechanical CPR (CPC scores 3 and 4). No discharged patients had any spontaneous circulation during transport. Conclusions: The fraction of time without chest compressions increased during transport of out-of-hospital cardiac arrest patients. Every effort should therefore be made to stabilise patients on-scene before transport to hospital, but all transport with ongoing CPR is not futile. [Copyright &y& Elsevier]

Summary: Background: Undetected malpositioned or dislodged ventilation tubes during cardiac arrest have fatal consequences, and no single method can detect the tube position reliably during such low-flow states. We wanted to test the ability of impedance changes as measured across the chest via the standard defibrillation pads to distinguish between oesophageal and tracheal ventilations in non-circulated patients. Materials and methods: After the end of futile resuscitation transthoracic impedance was measured with a prototype defibrillator, and ventilation variables were collected with a spirometer-capnography unit during tracheal ventilations and after repositioning of the tube; during oesophageal ventilations for paired comparisons. Results: We registered 123 oesophageal and 178 tracheal ventilations in nine patients. Transthoracic impedance changes associated with ventilations were always larger during tracheal than oesophageal ventilations (mean difference 1.3Ω (95% CI 1.0, 1.5), P <0.001), and all such changes above 1.2Ω were associated with tracheal ventilations, while changes below 0.4Ω always were associated with oesophageal ventilations. By subtracting 0.5Ω from the individual mean transthoracic change associated with tracheal ventilations, tube position was predicted with sensitivity 0.99 and specificity 0.97. Conclusion: Transthoracic impedance changes may be used to detect malpositioned and dislodged tubes also during situations without spontaneous circulation. Our predictive values must be retested in another population. [Copyright &y& Elsevier]

Summary: Objective: To study the reliability and validity of a scoring instrument for the assessment of neonatal resuscitation skills in a training setting. Methods: Fourteen paediatric residents performed a neonatal resuscitation on a manikin, while being recorded with a video camera. The videotapes were analysed using an existing scoring instrument with an established face and content validity, adjusted for use in a training setting. Intra- and inter-rater reliability were assessed by comparing the ratings of the videotapes of three raters, one of who rated the videotapes twice. Intra-class coefficients (ICC) were calculated for the sum score, percentages of agreement and kappa coefficients for the individual items. To study construct validity, the performance of a second resuscitation of by residents was assessed after they had received feedback on their first performance. Results: The ICC were 0.95 and 0.77 for intra- and inter-rater reliability, respectively. The median percentage of intra-rater agreement was 100%; inter-rater agreement 78.6–84.0%. The median kappa was 0.85 for intra-rater reliability, and 0.42–0.59 for inter-rater reliability. Residents showed a 10% improvement (95% confidence interval −4; 23%) on performance of a second resuscitation, which supports the instrument''s construct validity. Conclusion: A useful and valid instrument with good intra-rater and reasonable inter-rater reliability is now available for the assessment of neonatal resuscitation skills in a training setting. Its reliability can be improved by using a more advanced manikin and by training of the raters. [Copyright &y& Elsevier]

Background: Conventional resuscitation (CR) from hemorrhagic shock (HS) often restores and maintains hemodynamics but fails to restore intestinal perfusion. Post-CR intestinal ischemia has been implicated in the initiation of a gut-derived exaggerated systemic inflammatory response and in the progressive organ failure following HS. We propose that intestinal ischemia can be prevented with hypertonic saline resuscitation (HTSR). Methods: Anesthetized male Sprague-Dawley rats (200 to 215 g) were hemorrhaged to 50% of mean arterial pressure (MAP) for 60 minutes and randomly assigned to 1 of the resuscitation groups (n = 7 each): Group I: sham operation and no HS; Group II: HS + CR with the return of the shed blood + 2 volumes of normal saline (NS); Group III: HS + return of the shed blood + hypertonic saline (HTS); (7.5 % NaCl, 4 ml/kg); Group IV: HS + HTS, then return of the shed blood after 60 minutes; Group V: HS + HTS, then 1 volume of NS after 60 minutes. Microvascular diameters of inflow (A1) and proximal and distal premucosal arterioles (A3) in terminal ileum and flow in A1 were measured using in vivo videomicroscopy and optical Doppler velocimetry. Hematocrit, plasma osmolarity, and electrolytes were measured in Groups II and III. Results: HS caused a selective vasoconstriction in A1 arterioles that was not seen in the premucosal arterioles. CR restored and maintained MAP and caused generalized, progressive vasoconstriction at all intestinal arteriolar levels that is associated with hypoperfusion. HTSR failed to restore or maintain MAP or intestinal A1 arteriolar blood flow until the shed blood was returned. However, HTSR prevented the post-resuscitation, premucosal vasoconstriction and produced an insidious selective vasodilation in the A3 arterioles, which was most significant with early blood return (Group III). This selective arteriolar vasoactivity was associated with a significant improvement of endothelial cell function. Plasma hyperosmolality and hypernatremia persisted during the entire 2 hours post-resuscitation with HTS. Conclusions: Small-volume HTSR can be used as a resuscitation regimen at the trauma scene and for selective clinical conditions where hypotensive resuscitation is indicated. HTSR improves intestinal perfusion by selective vasodilation of the precapillary arterioles even at MAP close to shock levels. [Copyright &y& Elsevier]

Summary: Objective: To evaluate new instructional methods for teaching high school students cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) knowledge, actions and skills. Methods: We conducted a cluster-controlled trial of 3 instructional interventions among Seattle area high school students, with random allocation based on classrooms, during 2003–04. We examined two new instructional methods: interactive-computer training and interactive-computer training plus instructor-led (hands-on) practice, and compared them with traditional classroom instruction that included video, teacher demonstration and instructor-led (hands-on) practice, and with a control group. We assessed CPR and AED knowledge, performance of key AED and CPR actions, and essential CPR ventilation and compressions skills 2 days and 2 months after training. All outcomes were transformed to a scale of 0–100%. Results: For all outcome measures mean scores were higher in the instructional groups than in the control group. Two days after training all instructional groups had mean CPR and AED knowledge scores above 75%, with use of the computer program scores were above 80%. Mean scores for key AED actions were above 80% for all groups with training, with hands-on practice enhancing students’ positive outcomes for AED pad placement. Students who received hands-on practice more successfully performed CPR actions than those in the computer program only group. In the 2 hands-on practice groups the scores for 3 of the outcomes ranged from 57 to 74%; they were 32 to 54% in the computer only group. For the outcome of continuing CPR until the AED was available scores were high, 89 to 100% in all 3 training groups. Mean CPR skill scores were low in all groups. The highest mean score for successful ventilations was 15% and for compressions, 29%. The pattern of results was similar after 2 months. Conclusions: We found evidence that interactive computer based self instruction alone was sufficient to teach CPR and AED knowledge and AED actions to high school students. All forms of instruction were highly effective in teaching AED use. In contrast to AED skills, CPR remains a set of difficult psychomotor skills that is challenging to teach to high school students as well as other members of the lay public. [Copyright &y& Elsevier]

Summary: Background: Good scientific evidence is scarce in relation to the effectiveness of different methods of teaching basic life support (BLS) to the general public. In order to test new courses or methods a reference course is needed as a comparative standard. Objective: To propose a reference BLS provider course that can be used as a comparator when testing new courses or teaching methods. Methods: All national resuscitation councils that are represented in the European Resuscitation Council (ERC) were sent a questionnaire about the BLS provider courses run by them or under their auspices. Results: Sixteen national resuscitation councils responded to the enquiry. Their responses regarding organisation, structure, content and methods of the courses were found to be remarkably consistent between European countries. Few issues had a high variance. Conclusions: Based on the responses received, a reference BLS provider course for lay persons is suggested as a tool for research. The course duration is 3h 15min (excluding breaks), with 2h 15min practice time for the participants, 30min for theory and 20min for practical demonstrations by the instructor. A manual is distributed at the start of the course. The ratio of instructors to participants is one to six. The lectures are interactive between the instructor and the participants. Cardiopulmonary resuscitation (CPR) is practised on manikins in groups of six. A formal BLS scenario test may be held at the end of the course as part of a research study or if the candidates so request. It is suggested that by using this reference course during research into lay person BLS teaching, it will be easier to make comparisons between different studies. [Copyright &y& Elsevier]

Dystocia, with the potential for mare and foal morbidity and mortality, contributes significantly to reproductive loss. Mare recovery and foal survival rates may be improved with knowledge of normal parturition and early recognition of dystocia. Through this, prompt veterinary intervention and dystocia resolution is facilitated. Foal compromise is common with prolonged second stage labor, necessitating medical resuscitation and stabilization. In the following article, dystocia survey results are reviewed and intervention methods are discussed. [Copyright &y& Elsevier]

Summary: The resuscitation of babies at birth is different from the resuscitation of all other age groups, and knowledge of the relevant physiology and pathophysiology is essential. Although the majority of babies will establish normal respiration and circulation without help after delivery, those babies who do not establish adequate regular normal breathing, or who have a heart rate of less than 100 beats per minute, require assistance. Despite the limitation of the available evidence, an international body of experts has provided guidelines for neonatal resuscitation. [Copyright &y& Elsevier]

Copyright of Rechtsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: DNA transcription is regulated, in part, by acetylation of nuclear histones that are controlled by 2 groups of enzymes: histone deacetylases (HDAC) and histone acetyl transferases (HAT). Whether an imbalance in HDAC/HAT system plays a role in hemorrhage/resuscitation is unknown. The goals of this study were to determine whether hemorrhage results in deacetylation of cardiac histones and whether this can be corrected through the application of different resuscitation strategies or specific HDAC inhibitors. Methods: In the first experiment, rats (n = 6 per group) were subjected to volume-controlled hemorrhage and resuscitated with racemic lactated Ringer’s solution, L-lactated Ringer’s solution, 7.5% hypertonic saline solution, ketone Ringer’s solution, and pyruvate Ringer’s solution. Control groups included no hemorrhage (sham) and hemorrhage with no resuscitation. In the second experiment (n = 5 per group), 3 HDAC inhibitors (valproic acid, trichostatin A, and suberoylanilide hydroxamic acid) were added to saline solution resuscitation. Heart tissue was collected at the end of resuscitation. Isolated subcellular protein fractions were used in Western blotting to analyze the patterns of total protein acetylation and histone acetylation specifically. HDAC and HAT activity was measured in tissue extracts. Results: Hemorrhage led to partial histone deacetylation. Resuscitation resulted in protein hyperacetylation in nuclear fractions only. A detailed analysis of histones (on 10 acetylation sites) revealed that ketone Ringer’s solution hyperacetylated histones H2B, H3, and H4. The addition of suberoylanilide hydroxamic acid hyperacetylated histones more effectively than other resuscitation strategies, presumably by direct inhibition of HDAC activity. Conclusion: Hemorrhage/resuscitation is associated with HDAC/HAT activity misbalance, and the acetylation status of cardiac histones is influenced by the choice of resuscitation strategy. Shock-induced changes can be reversed through the infusion of pharmacologic HDAC inhibitor, even when it is administered after the insult for a limited period of time. [Copyright &y& Elsevier]