Resuscitation
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Current resuscitation guidelines advise a single biphasic shock followed by chest compressions; however, it is unclear if this applies to all waveforms and energy levels. We conducted a systematic review of the literature to determine the comparative success rates for single-shock defibrillation across waveforms evaluated in out-of-hospital cardiac arrest patients. ⋯ This systematic review suggests that evaluated biphasic waveforms have similar first-shock success as measured by the three outcomes of interest and all are superior to monophasic shocks.
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Multicenter Study
Association between angiographic culprit lesion and out-of-hospital cardiac arrest in ST-elevation myocardial infarction patients.
Factors related to the occurrence of out-of-hospital cardiac arrest (OHCA) in ST-elevation myocardial infarction (STEMI) are still poorly understood. The current study sought to compare STEMI patients presenting with and without OHCA to identify angiographic factors related to OHCA. ⋯ In the present STEMI population, coronary culprit lesion was associated with the occurrence of OHCA. Moreover, culprit lesion influenced the risk of cardiogenic shock and success of reperfusion, both of which were related to prognosis of OHCA patients.
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Randomized Controlled Trial
A stabilization device to improve the quality of cardiopulmonary resuscitation during ambulance transportation: A randomized crossover trial.
The quality of cardiopulmonary resuscitation (CPR) during ambulance transportation is suboptimal, and therefore measures that can improve the quality are desirable. ⋯ The use of a stabilization device can improve the quality of CPR and posture stability during ambulance transportation, although the effects on the severity of back pain were not significant.
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Cardiac arrest is a common presentation to the emergency care system. The decision to terminate CPR is often challenging to heath care providers. An accurate, early predictor of the outcome of resuscitation is needed. The purpose of this systematic review is to evaluate the prognostic value of ETCO2 during cardiac arrest and to explore whether ETCO2 values could be utilised as a tool to predict the outcome of resuscitation. ⋯ ETCO2 values during CPR do correlate with the likelihood of ROSC and survival and therefore have prognostic value. Although certain ETCO2 cut-off values appears to be a strong predictor of mortality, the utility of ETCO2 cut-off values during CPR to accurately predict the outcome of resuscitation is not fully established. Therefore, ETCO2 values cannot be used as a mortality predictor in isolation.
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Improving cerebral perfusion is an essential component of post-resuscitation care after cardiac arrest (CA), however precise recommendations in this setting are limited. We aimed to examine the effect of moderate hyperventilation (HV) and induced hypertension (IH) on non-invasive cerebral tissue oxygenation (SctO2) in patients with coma after CA monitored with near-infrared spectroscopy (NIRS) during therapeutic hypothermia (TH). ⋯ Moderate hyperventilation was associated with a significant reduction in SctO2, while increasing MAP to supra-normal levels with vasopressors had no effect on cerebral tissue oxygenation. Our study suggests that maintenance of strictly normal PaCO2 levels and MAP targets of 70mmHg may provide optimal cerebral perfusion during TH in comatose CA patients.