Resuscitation
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Randomized Controlled Trial Multicenter Study
Feasibility study of immediate pharyngeal cooling initiation in cardiac arrest patients after arrival at the emergency room.
Cooling the pharynx and upper oesophagus would be more advantageous for rapid induction of therapeutic hypothermia since the carotid arteries run in their vicinity. The aim of this study was to determine the effects of pharyngeal cooling on brain temperature and the safety and feasibility for patients under resuscitation. ⋯ Initiation of pharyngeal cooling before or immediately after the return of spontaneous circulation is safe and feasible. Pharyngeal cooling can rapidly decrease tympanic temperature without adverse effects on circulation or the pharyngeal epithelium.
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Randomized Controlled Trial Multicenter Study
CPR-related injuries after manual or mechanical chest compressions with the LUCAS™ device. A multicentre study of victims after unsuccessful resuscitation.
The reported incidence of injuries due to cardiopulmonary resuscitation using manual chest compressions (manual CPR) varies greatly. Our aim was to elucidate the incidence of CPR-related injuries by manual chest compressions compared to mechanical chest compressions with the LUCAS device (mechanical CPR) in non-survivors after out-of-hospital cardiac arrest. ⋯ In patients with unsuccessful CPR after out-of-hospital cardiac arrest, rib fractures were more frequent after mechanical CPR but there was no difference in the incidence of sternal fractures. No injury was deemed fatal by the pathologist.
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Multicenter Study
Neurological prognostication by gender in out-of-hospital cardiac arrest patients receiving hypothermia treatment.
This study examined whether the extent to which out-of-hospital cardiac arrest (OHCA) patients recover neurological function after therapeutic hypothermia (TH) is augmented in specific gender, age, and primary ECG group. ⋯ TH was the strongest indicator for good neurological recovery in <45-year old men with shockable cardiac rhythm. Across all age groups, women were less likely to benefit from TH than men.
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Multicenter Study Observational Study
Systematic downloading and analysis of data from automated external defibrillators used in out-of-hospital cardiac arrest.
Valuable information can be retrieved from automated external defibrillators (AEDs) used in victims of out-of-hospital cardiac arrest (OHCA). We describe our experience with systematic downloading of data from deployed AEDs. The primary aim was to compare the proportion of shockable rhythm from AEDs used by laypersons with the corresponding proportion recorded by the Emergency Medical Services (EMS) on arrival. ⋯ AEDs used by laypersons revealed a higher proportion of shockable rhythms compared to the EMS rhythm analyses.
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To review and update the evidence on predictors of poor outcome (death, persistent vegetative state or severe neurological disability) in adult comatose survivors of cardiac arrest, either treated or not treated with controlled temperature, to identify knowledge gaps and to suggest a reliable prognostication strategy. ⋯ Evidence from a total of 73 studies was reviewed. The quality of evidence was low or very low for almost all studies. In patients who are comatose with absent or extensor motor response at ≥72 h from arrest, either treated or not treated with controlled temperature, bilateral absence of either pupillary and corneal reflexes or N20 wave of short-latency somatosensory evoked potentials were identified as the most robust predictors. Early status myoclonus, elevated values of neuron specific enolase at 48 72 h from arrest, unreactive malignant EEG patterns after rewarming, and presence of diffuse signs of postanoxic injury on either computed tomography or magnetic resonance imaging were identified as useful but less robust predictors. Prolonged observation and repeated assessments should be considered when results of initial assessment are inconclusive. Although no specific combination of predictors is sufficiently supported by available evidence, a multimodal prognostication approach is recommended in all patients.