![]() REBOA placement in Zone 3, by contrast, allows perfusion of the abdominal organs which are critical to life if ROSC is achieved, but may not provide beneficial hemodynamic support during CPR. In a human case series of the use of REBOA during cardiac arrest, one patient had favorable cardiac and neurologic outcome after ROSC, but required a hemicolectomy due to significant intestinal ischemia. Although these organs are poorly perfused during cardiac arrest and CPR under any circumstances, Zone 1 REBOA further increases the risk of clinically significant ischemia of the liver, intestines, and kidneys. However, Zone 1 occlusion also results in ischemic injury to abdominal organs. This has the greatest effect on reducing circulating volume and theoretically would provide the maximal benefit for coronary and cerebral perfusion. To date, all of the prior studies involving REBOA and cardiac arrest have used Zone 1 aortic occlusion during CPR. REBOA can be placed into one of three zones of the aorta: Zone 1, the descending thoracic aorta between the left subclavian artery and the coeliac axis Zone 2, the paravisceral aorta from the coeliac axis to the renal arteries and Zone 3, the infrarenal aorta. REBOA improves cerebral and coronary perfusion pressure during cardiac arrest as well as increases the rate of return of spontaneous circulation (ROSC) and overall mortality in animals, , ]. This physiologic shunting of blood flow may be ideal during cardiac arrest, as the limited cardiac output generated with CPR will preferentially flow towards the heart and brain. Balloon inflation results in aortic occlusion and redistribution of any remaining cardiac output to the heart and brain. A REBOA catheter is placed percutaneously through the femoral artery and advanced retrograde into the aorta. Resuscitative endovascular balloon occlusion of the aorta (REBOA), an approach currently used in trauma patients to control noncompressible truncal hemorrhage, may be a novel intervention to improve CPR quality. ![]() Cardiopulmonary resuscitation (CPR) is inherently inefficient and generates only 20–30% of baseline cardiac output despite proper technique. ![]() Despite decades of research, improved access to automated external defibrillators, refinement of cardiac life support algorithms, and implementation of therapeutic hypothermia, only 5.5–10.4% of patients who suffer out of hospital cardiac arrest survive to hospital discharge. Every level will challenge you.Each year in the United States there are an estimated 356,000 nontraumatic, out of hospital cardiac arrests. You’ll never get bored by too-easy gameplay. Thanks to the stunning, detailed landscapes, painstakingly drawn towers, and incredible special effect, you won’t be able to take your eyes off the screen.Īll aspects of the game have been meticulously balanced, including tower statistics, enemy strength, terrain characteristics, and special weapons. If you’re a new player, you’ll easily be able to train and prepare yourself for serious battles.Įither way, the thoughtfully designed maps and wide range of available turrets will provide you with virtually endless tactical options. If you’re an experienced commander, you’ll love the merciless, intense battles where the countdown where even a fraction of a second is vital to success and everything hinges on your ability to choose and arrange your turrets wisely. The flexible difficulty settings will allow every player to get as much enjoyment out of the game as possible. The only way to win is to combine them so that they complement and strengthen one another. Should you build new towers or upgrade and fortify the ones you already have? Turrets vary in terms of their attack range, firing speed, and damage type. It’s up to you to decide how to spend your available budget. You’ll have access to older, time-tested turrets, as well as completely new types of weapons. But now they’re even more powerful and madder than ever. The core of the game is still the same: entire armies of enemies rush at your defenses, trying to destroy them by any means necessary. Welcome to the long-awaited sequel to the popular action/strategy game! New weapons, landscapes, and options galore! Every game session is now even more dynamic and amazing. Version games in high detail graphics Ultra HD (4K)
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