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Jasmeet Soar

Publications and source records attributed to Jasmeet Soar.

At least 19 recordsLinked to original sources
PubMed2007

The impact of manual defibrillation technique on no-flow time during simulated cardiopulmonary resuscitation.

INTRODUCTION: Rapid defibrillation is the most effective strategy for establishing return of spontaneous circulation following cardiac arrest due to ventricular fibrillation. The aim of this study is to measure the delay due to of charging the defibrillator during chest compression in an attempt to reduce the duration of the pre-shock pause in between cessation of chest compressions and shock delivery as advocated by the American Heart Association (AHA) guidelines compared to charging the defibrillator immediately following rhythm analysis without resuming chest compressions as recommended by the European Resuscitation Council (ERC). METHODS: This was a randomised controlled cross over trial comparing pre-shock pause times when defibrillation was performed on a manikin according to the AHA and ERC guidelines using paddles and hands free defibrillation systems. RESULTS: The pre-shock pause between cessation of chest compression and shock delivery was significantly different between techniques (Friedman test, P<0.0001). ERC paddles technique had the greatest pre-shock pause (7.4 s [6.7-11.2]) followed by ERC hands free (7.0 s [6.5-8.5]) and AHA paddles (1.6 s [1.1-2.3]). AHA hands free took the least amount of time (1.5 s [0.8-1.5]). Extrapolating these data to older defibrillators with longer charge times saw pre-shock pause intervals of 9 s (Codemaster XL) and 12 s (Lifepak 20) with the ERC approach. CONCLUSION: This study demonstrated clinically significant delays to defibrillation by analysing and charging the defibrillator without performing concurrent chest compressions. In a simulated scenario, charging the defibrillator whilst performing chest compressions was perceived as safe and significantly reduced the pre-shock pause between cessation of chest compression and shock delivery.

Adult↗
PubMed2006

The chain of survival.

Explore the source record for details and available documents.

Cardiopulmonary Resuscitation↗
PubMed2006

Radiological assessment of the adult chest: implications for chest compressions.

The recommended depth for chest compression during adult cardiopulmonary resuscitation (CPR) is 4-5 cm, and for children one-third the anterior-posterior (AP) chest diameter. A compression depth of one-third of the AP chest diameter has also been suggested for adult CPR. We have assessed chest CT scans to measure what proportion of the adult AP chest diameter is compressed during CPR. Measurements of AP diameter of chest CT scans were taken from the skin anteriorly at the middle of the lower half of the sternum, perpendicularly to the skin on the posterior thorax. The anatomical structure that would be compressed at this level was also noted. One hundred consecutive CT scans were examined (66 males and 34 females). The age (mean +/- S.D.) was 68+/-12 years. AP chest diameter was 253 +/- 27 mm for males and 235 +/- 30 mm for females. The proportion of total AP chest diameter compressed with current compressions is 15.8-19.8% for males and 17.0-21.3% for females. The commonest anatomical structures that would be compressed are the ascending aorta (38%) and the top of the left atrium (36%). There is also a wide anatomical variation in the shape of the adult chest. A chest compression depth of 4-5 cm in adults equates to approximately one-fifth of the AP diameter of the adult chest.

Adult↗
PubMed2006

The 2005 compression-ventilation ratio in practice: cycles or time?

AIM: The purpose of this study was to determine how long it takes rescuers to complete five cycles of cardiopulmonary resuscitation (CPR) using a compression-ventilation (CV) ratio of 30:2. MATERIALS AND METHODS: Twenty subjects, who were all members of the medical service at a motor racing circuit and trained in basic life support (BLS), were instructed to provide five cycles of CPR with a CV ratio of 30:2 using a manikin (Little Anne Adult CPR Manikin, Laerdal, Stavanger, Norway). The time taken to deliver the first two breaths and to complete all five cycles was recorded. RESULTS: The median time to deliver the first two breaths was 7.3 s (IQR 6.5-9.6 s) and the median time to complete five cycles with a CV ratio of 30:2 was 105.0 s (IQR 92.0-112 s). Many of the subjects found it difficult to count five cycles when using this CV ratio. CONCLUSIONS: Five cycles of CPR using a CV ratio of 30:2 takes approximately 1 min 45 s to complete. Using this CV ratio, trained individuals find it difficult to count out five cycles of CPR. It may be simpler to train individuals to give CPR for a specified time (2 min) instead of a specific number of cycles.

Allied Health Personnel↗
PubMed2006

Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest.

OBJECTIVE: We sought to evaluate current physician use of therapeutic hypothermia after cardiac arrest, to ascertain reasons for nonadoption of this treatment, and to determine current cooling techniques employed. DESIGN: Web-based survey. SETTING: International physician cohort in the United States, UK, and Finland. SUBJECTS: Physicians (MD or DO) caring for resuscitated cardiac arrest patients. INTERVENTIONS: An anonymous Web-based survey was distributed to physicians identified through United States-based critical care, cardiology, and emergency medicine directories and critical care networks in the UK and Finland. Recipients were queried regarding use of postresuscitation therapeutic hypothermia. MEASUREMENTS AND MAIN RESULTS: Of the final 13,272 surveys actually distributed to physicians, 2,248 (17%) were completed. Most respondents were attending physicians (82%) at teaching hospitals (76%) who practiced critical care (35%), cardiology (20%), or emergency medicine (22%). Of all replies, 74% of United States respondents and 64% of non-United States respondents had never used therapeutic hypothermia. United States emergency medicine physician adoption of cooling was significantly less than that of United States intensivists (16% vs. 34%, p < .05). The most often cited reasons for nonuse by respondents were "not enough data," "not part of Advanced Cardiac Life Support guidelines," and "too technically difficult to use." Factors associated with increased use included non-United States residence, critical care specialty, and larger hospital size. CONCLUSIONS: Physician utilization of cooling after cardiac arrest remains low. For improved adoption of therapeutic hypothermia, our data suggest that development of better cooling methodology and recent incorporation into resuscitation guidelines may improve use.

Attitude of Health Personnel↗
PubMed2006

Therapeutic hypothermia after cardiac arrest: unintentional overcooling is common using ice packs and conventional cooling blankets.

OBJECTIVES: Although therapeutic hypothermia for cardiac arrest survivors has been shown to improve neurologically intact survival, optimal methods to ensure controlled induction and maintenance of cooling are not clearly established. Precise temperature control is important to evaluate because unintentional overcooling below the consensus target range of 32-34 degrees C may place the patient at risk for serious complications. We sought to measure the prevalence of overcooling (<32 degrees C) in postarrest survivors receiving primarily noninvasive cooling. DESIGN: Retrospective chart review of postarrest patients. SETTING: Three large teaching hospitals. PATIENTS: Cardiac arrest survivors receiving therapeutic hypothermia. INTERVENTIONS: Charts were reviewed if primarily surface cooling was used with a target temperature goal between 32 degrees C and 34 degrees C. MEASUREMENTS AND MAIN RESULTS: Of the 32 cases reviewed, overcooling lasting for >1 hr was identified as follows: 20 of 32 patients (63%) reached temperatures of <32 degrees C, 9 of 32 (28%) reached temperatures of <31 degrees C, and 4 of 32 (13%) reached temperatures of <30 degrees C. Of those with overcooling of <32 degrees C, 6 of 20 (30%) survived to hospital discharge, whereas of those without overcooling, 7 of 12 (58%) survived to hospital discharge (p = not significant). CONCLUSIONS: The majority of the cases reviewed demonstrated unintentional overcooling below target temperature. Improved mechanisms for temperature control are required to prevent potentially deleterious complications of more profound hypothermia.

Adolescent↗
PubMed2005

Comparison of sequential and simultaneous breathing and pulse check by healthcare professionals during simulated scenarios.

BACKGROUND: Basic life support guidelines for healthcare professionals recommend a sequential breathing and carotid pulse check allowing up to 10 s for each assessment. Life support providers are sometimes taught to do a simultaneous assessment of breathing and pulse check for up to 10 s. It is not clear whether this assessment improves diagnostic accuracy. METHODS: We recruited 119 healthcare professionals. The SIM-Man was used to develop 10 simulated cases scenarios. To assess performance, 89 participants did 10 simultaneous assessments followed by 10 sequential assessments, and 29 participants did the assessment techniques in reverse order. The primary outcome of the study was the number of correct diagnoses made with each assessment method. RESULTS: There were more correct diagnoses with a sequential assessment; 48.2% (569 out of 1180) compared to 33.5% (395 out of 1180) for the simultaneous method. Only 26.3% (n=31) had more than five accurate diagnoses with a simultaneous assessment, compared to 44.1% (n=52) for sequential assessments. Those performing sequential assessment achieved a median score of 5/10 correct diagnoses compared to a median score of 2.5/10 for the simultaneous method (Wilcoxon Z=-4.63, p<0.001). Sensitivity for the pulse check was 99% for both assessments; specificity was 48.9% for a simultaneous assessment and 61.9% for the sequential approach. For breathing check, specificity, sensitivity and accuracy were also higher with the latter method (sensitivity 99.6%, specificity 70.6% and accuracy 88%) CONCLUSION: A sequential assessment of breathing and pulse by healthcare professionals has greater diagnostic accuracy in simulated case scenarios.

Cardiopulmonary Resuscitation↗
PubMed2005

Cerebral infarction following thrombolysis for massive pulmonary embolism.

A 29-year-old male developed a fatal stroke 6 h after successful thrombolysis for massive pulmonary embolism. Autopsy showed thrombus protruding through a patent foramen ovale (PFO). A strand of thrombus extended from the aortic arch into the left common carotid artery. The brain showed extensive infarction of the left fronto-parietal area. Thrombolysis caused initial disintegration of the embolism. It is likely that thrombolysis caused fragments of clot to later break lose and embolise into the cerebral circulation. We discuss the need for risk stratification in patients who present with massive pulmonary embolism and PFO.

Adult↗
PubMed2005

Cardiopulmonary resuscitation standards for clinical practice and training in the UK.

The Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council (UK) have published new resuscitation standards. The document provides advice to UK healthcare organisations, resuscitation committees and resuscitation officers on all aspects of the resuscitation service. It includes sections on resuscitation training, resuscitation equipment, the cardiac arrest team, cardiac arrest prevention, patient transfer, post-resuscitation care, audit and research. The document makes several recommendations. Healthcare institutions should have, or be represented on, a resuscitation committee that is responsible for all resuscitation issues. Every institution should have at least one resuscitation officer responsible for teaching and conducting training in resuscitation techniques. Staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles. Clinical staff should receive regular training in the recognition of patients at risk of cardiopulmonary arrest and the measures required for the prevention of cardiopulmonary arrest. Healthcare institutions admitting acutely ill patients should have a resuscitation team, or its equivalent, available at all times. Clear guidelines should be available indicating how and when to call for the resuscitation team. Cardiopulmonary arrest should be managed according to current national guidelines. Resuscitation equipment should be available throughout the institution for clinical use and for training. The practice of resuscitation should be audited to maintain and improve standards of care. A do not attempt resuscitation (DNAR) policy should be compiled, communicated to relevant members of staff, used and audited regularly. Funding must be provided to support an effective resuscitation service.

Cardiopulmonary Resuscitation↗
PubMed2005

Cardiopulmonary resuscitation standards for clinical practice and training in the UK.

The Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council (UK) have published new resuscitation standards. The document provides advice to UK healthcare organisations, resuscitation committees and resuscitation officers on all aspects of the resuscitation service. It includes sections on resuscitation training, resuscitation equipment, the cardiac arrest team, cardiac arrest prevention, patient transfer, post resuscitation care, audit and research. The document makes several recommendations. Healthcare institutions should have, or be represented on, a resuscitation committee that is responsible for all resuscitation issues. Every institution should have at least one resuscitation officer responsible for teaching and conducting training in resuscitation techniques. Staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles. Clinical staff should receive regular training in the recognition of patients at risk of cardiopulmonary arrest and the measures required for the prevention of cardiopulmonary arrest. Healthcare institutions admitting acutely ill patients should have a resuscitation team, or its equivalent, available at all times. Clear guidelines should be available indicating how and when to call for the resuscitation team. Cardiopulmonary arrest should be managed according to current national guidelines. Resuscitation equipment should be available throughout the institution for clinical use and for training. The practice of resuscitation should be audited to maintain and improve standards of care. A do not attempt resuscitation (DNAR) policy should be compiled, communicated to relevant members of staff, used and audited regularly. Funding must be provided to support an effective resuscitation service.

Adult↗