Resuscitation
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The aim of this study was to evaluate the changing pattern and prognostic values of diffusion-weighted imaging (DWI) at two time points in cardiac arrest patients treated with therapeutic hypothermia. ⋯ The changing pattern of ADC values after cardiac arrest is different according to anatomic region and neurologic status. The DWI after 48h has a better association with neurological outcome of cardiac arrest patients in both quantitative and qualitative analysis.
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The aim of this study was to explore challenges in recognition and initial treatment of out-of-hospital cardiac arrest (OHCA) by using closed-circuit television (CCTV) recordings combined with audio recordings from emergency medical calls. ⋯ CCTV combined with audio recordings from emergency calls can provide unique insights into the challenges of recognition and initial treatment of OHCA and can improve understanding of the situation. The main barriers to effective intervention were situation awareness, communication and attitude/approach. Potentially, some of these challenges could be minimized if the dispatcher was able to see the victim and the bystanders at the scene. A team approach, with the dispatcher responsible for the role as team leader of a remote resuscitation team of a caller and bystanders, may potentially improve treatment of OHCA.
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Observational Study
The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest.
To assess the impact of a pre-hospital critical care team (CCT) on survival from out-of-hospital cardiac arrest (OHCA). ⋯ Pre-hospital critical care for OHCA was not associated with significantly improved rates of survival to hospital discharge. These results are in keeping with previously published studies. Further research with a larger sample size is required to determine whether CCTs can improve outcome in OHCA.
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Infants with birth asphyxia frequently require resuscitation. Current guidance is to start newborn resuscitation in 21% oxygen. However, infants with severe hypoxia-ischaemia may require prolonged resuscitation with oxygen. To date, no study has looked at the effect of resuscitation in 100% oxygen following a severe hypoxic-ischaemic insult. ⋯ Resuscitation in 100% oxygen does not cause a deleterious effect on brain injury following a severe hypoxic-ischaemic insult in a rat model of hypoxia-ischaemia. Further work investigating the effects of resuscitation in 100% oxygen is warranted, especially for newborn infants with severe hypoxic-ischaemic encephalopathy.
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Editorial Comment
All [post-cardiac arrest patients] are [not] created equal.