Resuscitation
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The management of non-compressible torso hemorrhage can be problematic. Current therapy requires either open or interventional radiologic control of bleeding vessels and/or organs. ⋯ REBOA is applicable by trauma professionals, including emergency physicians, at the bedside in the emergency department, but its use needs to be considered within the context of available evidence and a robust system encompassing training, accreditation, multidisciplinary involvement and quality assurance. We review the evolving role of REBOA and discuss unanswered questions and future applications.
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Multicenter Study
Advantage of CPR-first over call-first actions for out-of-hospital cardiac arrests in nonelderly.
To assess the benefit of immediate call or cardiopulmonary resuscitation (CPR) for survival from out-of-hospital cardiac arrests (OHCAs). ⋯ Immediate CPR-first action followed by an emergency call without a large delay may be recommended when a bystander with sufficient skills to perform CPR witnesses OHCAs in nonelderly people and of noncardiac aetiology.
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Spontaneous alterations in temperature homeostasis after cardiac arrest (CA) are associated with worse outcome. However, it remains unclear the prognostic role of temperature variability (TV) during cooling procedures. We hypothesized that low TV during targeted temperature management (TTM) would be associated with a favourable neurological outcome after CA. ⋯ Among comatose survivors treated with TTM after CA, 25% of patients had high TV; however, this was not associated with a worse neurologic outcome.
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Multicenter Study
The daily incidence of out-of-hospital cardiac arrest unexpectedly increases around New Year's Day in Japan.
Over 100,000 patients are diagnosed every year as out-of-hospital cardiac arrest (OHCA) cases in Japan and their number has continued to rise for the last decade, presenting a challenge for preventive public health research as well as emergency medical care. The purpose of this study was to identify whether there are any temporal patterns in daily OHCA presentations in Japan. ⋯ Our analysis revealed the increased daily incidence of OHCA around every New Year's Day in Japan.
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To investigate the association between impaired cerebrovascular autoregulation (CVAR) and outcome in comatose survivors of cardiac arrest. ⋯ Early impairment of CVAR following cardiac arrest is independently associated with mortality at three months follow-up. Assessments of CVAR could add to the management and prognostication during post-resuscitation care and should be further investigated as a guide to optimise cerebral perfusion pressure.