Resuscitation
-
For critical care to be effective it must have a system in place to achieve optimal care for the deteriorating ward patient. ⋯ Much of the available evidence is of poor quality. It is clear that a 'whole system' approach should be adopted and that AWSS appear to be more effective than single parameter systems. The response to deterioration appears most effective when a clinician with critical care skills leads it. The need for service improvement differs between health care systems.
-
Time to awakening and neurologic outcome in therapeutic hypothermia-treated cardiac arrest patients.
Therapeutic hypothermia (TH) has been shown to improve outcomes in comatose Post-Cardiac Arrest Syndrome (PCAS) patients. It is unclear how long it takes these patients to regain neurologic responsiveness post-arrest. We sought to determine the duration to post-arrest awakening and factors associated with times to such responsiveness. ⋯ In TH-treated PCAS patients, time to awakening after resuscitation was highly variable and often longer than three days. Earlier awakening was associated with better neurologic status at hospital discharge.
-
Therapeutic Hypothermia (TH) has become a standard of care in improving neurological outcomes in cardiac arrest (CA) survivors. Previous studies have defined severe acidemia as plasma pH<7.20. We investigated the influence of severe acidemia at the time of initiation of TH on neurological outcome in CA survivors. ⋯ Presence of severe acidemia at initiation of TH in shockable CA survivors is significantly associated with poor neurological outcomes. This effect was not observed in the non-shockable CA survivors.
-
The possibility of successful defibrillation decreases with an increased duration of ventricular fibrillation (VF). Futile electrical shocks are inversely correlated with myocardial contractile function and long-term survival. Previous studies have demonstrated that various ECG waveform analyses predict the success of defibrillation. This study investigated whether the absolute amplitude of pre-shock VF waveform is likely to predict the success of defibrillation. ⋯ Signal integral predicted successful electrical shocks on patients with ventricular fibrillation and have potential to optimize the timing of defibrillation and reduce the number of electrical shocks.