Resuscitation
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There is no up-to-date literature review of physiologically-based, single-parameter weighted "track and trigger" systems (SPTTS) and little data on their sensitivity and specificity to predict adverse outcomes. The aim of this study was to describe the SPTTS in clinical use and measure their sensitivity and specificity when using admission vital signs data for predicting in-hospital mortality. ⋯ There is a wide range of unique, but very similar, SPTTS in clinical use. Although specificities were high, sensitivities were too low to provide institutions with confidence that these SPTTS could identify patients at risk of in-hospital death using admission vital signs. Institutions may wish to consider these data when selecting which, if any, single-parameter track and trigger systems to introduce.
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Increased serum concentrations of brain-derived proteins neuron-specific enolase (NSE) and protein S-100beta (S-100b) are used as early predictors of long-term outcome in unconscious survivors after cardiopulmonary resuscitation (CPR). We investigated whether use of short-term Left Ventricular Assist Devices (LVAD) in patients undergoing percutaneous coronary intervention (PCI) effect serum concentrations of NSE and S-100b, because use of such devices in resuscitated cardiogenic shock patients increased during the last years. ⋯ LVAD support after PCI is associated with a significant increase in NSE serum concentration as well as in S-100b. We therefore postulate an overestimation of the extent of hypoxic brain damage in unconscious survivors after CPR if treatment include LVAD support or PCI or both procedures. The increase in NSE can be partly explained by alteration of thrombocytes and other blood cells. However, the increase in S-100b remains unexplained since S-100b does not occur in peripheral blood cells. An additional release of both biomarkers from ischemic myocardium or cerebral microembolism should be drawn into consideration.