Resuscitation
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Review Meta Analysis
Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: A systematic review and meta-analysis. Part 1: Patients not treated with therapeutic hypothermia.
To systematically review the accuracy of early (≤7 days) predictors of poor outcome defined as death or vegetative state (Cerebral Performance Categories [CPC] 4-5) or death, vegetative state or severe disability (CPC 3-5) in comatose survivors from cardiac arrest not treated using therapeutic hypothermia (TH). PubMed, Scopus and the Cochrane Database of Systematic reviews were searched for eligible studies. Sensitivity, specificity, false positive rates (FPR) for each predictor were calculated and results of predictors with similar time points and outcome definitions were pooled. Quality of evidence (QOE) was evaluated according to the GRADE guidelines. ⋯ In comatose resuscitated patients not treated with TH presence of myoclonus, absence of pupillary reflex, bilateral absence of N20 SSEP wave and low EEG voltage each predicted poor outcome early and accurately, but with a relevant risk of bias.
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To analyze the feasibility of extracting the circulation component from the thoracic impedance acquired by defibrillation pads. The impedance circulation component (ICC) would permit detection of pulse-generating rhythms (PRs) during the analysis intervals of an automated external defibrillator when a non-shockable rhythm with QRS complexes is detected. ⋯ A reliable method to extract the ICC of the thoracic impedance is feasible. Waveform features of the ICC or its first derivative show a high discriminative power to differentiate PR from PEA rhythms (area under the curve higher than 0.96 for any feature).
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Comparative Study Observational Study
Combining brain computed tomography and serum neuron specific enolase improves the prognostic performance compared to either alone in comatose cardiac arrest survivors treated with therapeutic hypothermia.
We determined whether combining the grey-to-white matter ratio (GWR) on brain computed tomography (CT) and serum neuron specific enolase (NSE) improves the prognostic performance when compared to either alone in cardiac arrest patients treated with therapeutic hypothermia (TH). ⋯ Combining brain CT and serum NSE improves the prognostic performance when compared to either alone in predicting poor neurologic outcome in cardiac arrest patients treated with TH.
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Practice Guideline
Evidence-based recommendations on automated external defibrillator training for children and young people in Flanders-Belgium.
The aim of the study was to identify the most relevant literature on skills, attitude and behaviour of children and young people towards the use of an automated external defibrillator (AED) and then develop recommendations according to the principles of evidence-based practice. These recommendations were to serve as a basis for educational materials which would ensure that the implementation of AED-training within schools and youth organisations would be a simple process. ⋯ Based on these recommendations, an education programme and new educational materials have been developed by the Belgian Red Cross-Flanders. In this way school staff and youth leaders are properly supported to teach first aid techniques to children and young people (6-18 years).
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Prognostication of cardiac arrest survivors is challenging since therapeutic hypothermia (TH) has been introduced. We evaluated serum biomarkers and motor response. ⋯ Although NSE and S-100B levels are associated with the outcome, the use of previously described cut-off values was insufficiently predictive of neurologic outcome. Caution should be exercised in the use of these tests to provide neuroprognostication.