Resuscitation
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Mild hypothermia improves the outcomes of comatose patients after cardiac arrest. Its neuroprotective mechanism is not fully understood. We investigated the effects of mild hypothermia on cerebral cortex microcirculation and cerebral oxygen extraction ratio. ⋯ Mild hypothermia improves the cerebral cortex microcirculatory blood supply/oxygen uptake mismatching after resuscitation. This may provide an additional cerebral protection.
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Review Meta Analysis
The association of gasping and outcome, in out of hospital cardiac arrest: A systematic review and meta-analysis.
Gasping is common after cardiac arrest, and its frequency decreases over time. The aim of this study was to conduct a meta-analysis to evaluate the association of gasping and survival to discharge in patients who suffered out-of-hospital cardiac arrest. ⋯ Findings of this meta-analysis demonstrated that gasping is common after cardiac arrest, and is associated with increased survival to discharge. Patients who are cardiac arrest with gasping should be promptly resuscitated.
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Hypoxic ischaemic brain injury (HIBI) is a major cause of disability after cardiac arrest. HIBI leads to impaired cerebral autoregulation such that adequate cerebral perfusion becomes critically dependent on blood pressure. However, the optimal blood pressure after cardiac arrest remains unclear. Therefore, we conducted a systematic review to investigate the association between blood pressure and neurologic outcome patients after cardiac arrest. ⋯ The included studies suggest improved neurologic outcomes are associated with higher blood pressures in patients after cardiac arrest. This study highlights a need for further research to define the optimal management of blood pressure in this population.
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The discovery that mild, induced hypothermia can improve neurological recovery after global moderate to severe hypoxia-ischemia has been a dramatic validation of the strong foundation of preclinical studies that informed current protocols. The major challenge is to find ways to further improve outcomes. As discussed in this review, the findings from large clinical trials of extended cooling are highly concordant with recent animal studies. These findings support the use of precise, carefully selected animal models to refine our strategies to protect babies with moderate to severe encephalopathy before instigating further large trials.
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Observational Study
The Relationship between Survival after Out-of-hospital Cardiac Arrest and Process Measures for Emergency Medical Service Ambulance Team Performance.
International institutes have developed their own clinical performance indicators for ambulance services. It is unknown whether these process measures are related to survival of patients after out-of-hospital cardiac arrest (OHCA). We aimed to determine whether Emergency Medical Service (EMS)-related ambulance team process measures correlate with patient survival. ⋯ The EMS team-level process measures proposed by international institutes may not predict the risk-adjusted survival rate. Using these measures to motivate EMS teams to improve their quality performance would be questionable. Increased efforts should be devoted to constructing more pivotal EMS team-level process measures that are tightly linked to survival.