Resuscitation
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To determine the effects of anticoagulation with intravenous unfractionated heparin (IVUH) during therapeutic hypothermia (TH) post-cardiac arrest. ⋯ Current dosing protocols for IVUH should not be utilized during TH. Heparin requirements are drastically reduced during TH and prolonged interruptions may be required to allow for adequate clearance of UH.
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One of the major causes of death and neurological injury after cardiac arrest is delayed ischemia combined with oxygen free radical mediated reperfusion injury. Consequently determining the optimal balance between oxygen delivery and uptake in the brain using a reliable non-invasive monitoring system during the post-resuscitation period is of importance. In this observational study, we evaluated the feasibility of using cerebral oximetry during the post-resuscitation period in order to identify changes in regional cerebral oxygen saturation (rSO2) and its association with survival to discharge. ⋯ Our study indicates that the use of cerebral oximetry is feasible during the post resuscitation period after cardiac arrest. Further studies are needed to determine whether cerebral oximetry may be used as a novel non-invasive monitoring system to evaluate changes in the balance between cerebral oxygen delivery and uptake during the post-resuscitation period.
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Although well characterized in animals, brain damage in humans treated with hypothermia after cardiac arrest has not been systematically explored. In this study we aimed to describe the characteristic trait of selective eosinophilic neuronal death (SEND), and its correlation with time to return of spontaneous circulation (ROSC) in cardiac arrest patients who died after hypothermia treatment and were referred for autopsy. ⋯ This is the first study to systematically describe regional SEND in patients treated with hypothermia after cardiac arrest. Hippocampus was the most vulnerable region whereas the brainstem was the most resistant. Although not directly compared here, the regional pattern of SEND seems not to be altered by hypothermia treatment, but maintains its profile distinctive for cardiac arrest pathogenesis.
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Observational Study
Duplex Sonography of Cerebral Blood Flow after Cardiac Arrest-A Prospective Observational Study.
Despite successful resuscitation, cardiac arrest (CA) often has a poor clinical prognosis. Different diagnostic tools have been established to predict patients' outcome. However, their sensitivity remains low. Assessment of cerebral perfusion by duplex ultrasound might provide additional information regarding the extent of neuronal damage. The aim of the present study was to analyse the changes of global cerebral blood flow (CBF) and intracranial blood flow parameters in the acute stage after CA and its correlation with patients' outcome. ⋯ Cerebral perfusion varies widely after CA. Neither hypo- nor hyperperfusion seems to be an independent risk factor for poor outcome. Duplex ultrasound of cerebral haemodynamics after CA is suitable but probably of limited prognostic value.
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To identify the factors associated with good-quality bystander cardiopulmonary resuscitation (BCPR). ⋯ The presence of multiple rescuers and bystander-initiated CPR are predominantly associated with good-quality BCPR.