Diagnostic performance of a new multifunctional electrocardiograph during uninterrupted chest compressions in cardiac arrest patients.

BACKGROUND: External chest compression is considered to play a significant role in cardiopulmonary resuscitation (CPR), but during a rhythm check, chest compressions must be discontinued to avoid artifacts. A new multifunctional electrocardiograph (ECG; Radarcirc) has been developed for use in clinical settings. METHODS AND RESULTS: The performance of the Radarcirc and conventional ECG (CoECG) during CPR was compared in a single-center, non-randomized, sequential self-controlled study. CPR was performed on 41 out-of-hospital cardiac arrest patients. Cardiac rhythm with and without chest compressions during a rhythm check was measured using leads I and II. When the rhythm changed during CPR, it was measured as another waveform. Fifty ECG recordings were obtained, of which 27 were asystole, 18 pulseless electrical activity, and 5 ventricular fibrillation (VF). The area under the receiver-operating characteristic curve (AUC) for VF was 0.448 (95% confidence interval (CI) 0.274-0.622) for lead II of the CoECG, and 0.797 (95%CI 0.684-0.910) for lead II of the Radarcirc. The AUC for VF was 0.422 (95%CI 0.219-0.626) for lead I of the CoECG, and 0.987 (95%CI 0.975-1.00) for lead I of the Radarcirc. CONCLUSIONS: Diagnoses based on the data from Radarcirc were more accurate in predicting rhythm during chest compressions than those based on data from the CoECG.

Comparison of the Airway Scope and Macintosh laryngoscope with in-line cervical stabilization by the semisolid neck collar: manikin study.

BACKGROUND: The usefulness of Airway Scope (AWS) and Macintosh direct laryngoscope (ML) for patients with trauma requiring intubation with in-line cervical stabilization for protection of the cervical spine was compared. METHODS: Thirty-three residents performed orotracheal intubation using ML and AWS in an intubation model with in-line cervical stabilization. The tracheal intubation success rate, time required for tracheal intubation, and number of trials of inserting the tracheal tube into the trachea were measured in individual residents. RESULTS: Two residents inserted the tube into the esophagus using ML (success rate: 93.9%), but all residents succeeded in tracheal intubation using AWS (success rate: 100%) (p = 0.492). The time required for intubation was similar using AWS and ML (15 seconds vs. 20 seconds, p = 0.261). The number of trials using AWS was significantly lower (2.0 times vs. 1.0 times, p = 0.001). CONCLUSION: The usefulness of AWS may be comparable with or greater than that of ML for oral intubation in trauma patients with in-line cervical stabilization.

[Evaluation of cardiogenic pulmonary edema by extravascular lung water during noninvasive positive pressure ventilation].

Noninvasive positive pressure ventilation (NPPV) has recently been applied to patients with left ventricular dysfunction. We report a female patient who showed low cardiac output syndrome and pulmonary hypertension after cardiac surgery. After tracheal extubation, she developed cardiogenic pulmonary edema associated with an increase in extravascular lung water (EVLW). NPPV temporally improved pulmonary edema and respiratory distress, and decreased EVLW. However, once we weaned her from NPPV EVLW increased and pulmonary edema was revealed. On post-operative day 9, we finally weaned her from NPPV when baseline value of EVLW became small, probably due to supportive therapy including afterload reduction. We suggest that, in patients with left ventricular dysfunction, NPPV should be considered and EVLW may be a useful parameter to adjust the support.

[A case of Bannayan-Zonana syndrome].

Bannayan Zonana syndrome is a very rare disease. The characteristic of this disease include macrocephaly, multiple benign tumors and various malformations. A 7-month-old baby with Bannayan-Zonana syndrome was scheduled for the repair of cleft lip and plate. The hight was 77 cm and weight was 9.8 kg, and he had macrocephaly with atrial septal defect and bilateral otitis media. No tumors had been detected in the airway by MRI before induction and the vocal cord could be visualized by laryngoscope. Anesthesia was induced with sevoflurane 5% and vecuronium 1 mg, and maintained with sevoflurane 1-2% and fentanyl 150 microg. At the end of the operation, nasal airways were inserted and we extubated in the operation room. He was discharged from ICU on the second postoperative day without complications.