Resuscitation
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Early bystander cardiopulmonary resuscitation (CPR) is a key factor in improving survival from out-of-hospital cardiac arrest (OHCA). The ALERT (Algorithme Liégeois d'Encadrement à la Réanimation par Téléphone) algorithm has the potential to help bystanders initiate CPR. This study evaluates the effectiveness of the implementation of this protocol in a non-Advanced Medical Priority Dispatch System area. ⋯ From the beginning and despite its under-utilisation, the ALERT protocol significantly improved the number of patients in whom bystander CPR was attempted.
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As organ demand outpaces supply in the United States, donation after cardiac death (DCD) is increasing, and the leading cause of death among donors is now cardiovascular/cerebrovascular disease. Selected patients resuscitated from cardiac arrest may be an under-recognized donor pool. Regional cardiac arrest centers are expected to address organ donation, but there are few guidelines available and the yield from this population is not fully known. ⋯ Post-cardiac arrest patients represent a potential donor pool to help fill the widening gap between organ supply and demand in the United States. Formal multi-modal neurologic assessment may expedite referral to an organ procurement organization. These components should be considered as cardiac arrest center designation criteria.
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Observational Study
An observational study of paediatric pre-hospital intubation and anaesthesia in 1933 children attended by a physician-led, pre-hospital trauma service.
Trauma accounts for 16-44% of childhood deaths. The number of severely injured children who require pre-hospital advanced airway intervention is thought to be small but there is little published data detailing the epidemiology of these interventions. This study was designed to evaluate the children who received pre-hospital intubation (with or without anaesthesia) in a high volume, physician-led, pre-hospital trauma service and the circumstances surrounding the intervention. ⋯ Pre-hospital paediatric intubation is not infrequent in this high-volume trauma service. The majority of patients received a rapid sequence induction. The commonest injury mechanisms were RTCs and 'falls from height'. Pre-hospital paediatric intubation is associated with a high success rate in this physician-led service.
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Time to awakening after out-of-hospital cardiac arrest (OHCA) and post-resuscitation therapeutic hypothermia (TH) varies widely. We examined the time interval from when comatose OHCA patients were rewarmed to 37°C to when they showed definitive signs of neurological recovery and tried to identify potential predictors of awakening. ⋯ Following OHCA and TH, arbitrary withdrawal of life support <48h after rewarming may prematurely terminate life in many patients with the potential for full neurological recovery. Additional clinical markers that correlate with late awakening are needed to better determine when withdrawal of support is appropriate in OHCA patients who remain comatose >48h after rewarming.
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The most common etiology of cardiac arrest is presumed of myocardial origin. Recent retrospective studies indicate that preexisting pneumonia, a form of sepsis, is frequent in patients who decompensate with abrupt cardiac arrest without preceding signs of septic shock, respiratory failure or severe metabolic disorders shortly after hospitalization. The contribution of pre-existing infection on pre and post cardiac arrest events remains unknown and has not been studied in a prospective fashion. We sought to examine the incidence of pre-existing infection in out-of hospital cardiac arrest (OHCA) and assess characteristics associated with bacteremia, the goal standard for presence of infection. ⋯ Over one-third of OHCA adults were bacteremic upon presentation. These patients have greater hemodynamic instability and significantly increased short-term mortality. Further studies are warranted to address the epidemiology of infection as possible cause of cardiac arrest.