Resuscitation
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Cardiac arrest (CA) triggers neuroinflammation that could play a role in a delayed neuronal death. In our previously established rat model of ventricular fibrillation (VF) CA characterized by extensive neuronal death, we tested the hypothesis that individual brain regions have specific neuroinflammatory responses, as reflected by regional brain tissue levels of tumor necrosis factor (TNF)α and other cytokines. In a prospective study, rats were randomized to 6min (CA6), 8min (CA8) or 10min (CA10) of VF CA, or sham group. ⋯ This TNFα surge contrasts the lack of an acute increase in other cytokines in brain after CA. Given that striatum is a selectively vulnerable brain region, our data suggest possible role of neuronal TNFα in striatum after CA and identify therapeutic targets for future experiments. This study was approved by the University of Pittsburgh IACUC 1002340A-3.
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Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopressor support and mortality. ⋯ In survivors after OHCA treated with TH the induced hemodynamic changes reversed after normothermia, while the need for vasopressor support persisted. Patients requiring addition of norepinephrine/epinephrine on top of dopamine had an increased 30-day all-cause mortality, as well as death from neurological injury.
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Sudden cardiac arrest remains an important health care problem. If survival rates of all regions would equal those of the best performers, literally thousands of lives would be saved. Similar to injury, there is a need for an epidemiology-based approach for planning and execution of countermeasures. ⋯ We advocate for a more community-centred 'public health' approach, with a crucial role for policy-level executives. There is a large potential gain in outcome by implementing 'passive' - not requiring individual action - measures. As happened for injury, 'Cardiac Arrest Academies' should be created to facilitate and coordinate this process.
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Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders have been in use since the 1990s. The Resuscitation Council UK (RCUK) provides guidance on the content and use of such forms in the UK but there is no national policy. ⋯ There is wide variation in the forms used for indicating DNACPR decisions. Documentation is rapidly evolving to meet the needs of patients and to respond to new evidence.
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To evaluate changes in characteristics and survival over time in out-of-hospital cardiac arrest (OHCA) due to drowning and describe factors of importance for survival. ⋯ In OHCA due to drowning, over a period of 20 years, bystanders have called for help at an earlier stage and administered CPR more frequently in the past few years. Survival to hospital admission has increased, while shockable rhythm and early arrival of the EMS appear to be the most important factors for survival to one month.