Resuscitation
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Randomized Controlled Trial
Early targeted brain COOLing in the cardiac CATHeterisation laboratory following cardiac arrest (COOLCATH).
Trials demonstrate significant clinical benefit in patients receiving therapeutic hypothermia (TH) after cardiac arrest. However, incidence of mortality and morbidity remains high in this patient group. Rapid targeted brain hypothermia induction, together with prompt correction of the underlying cause may improve outcomes in these patients. This study investigates the efficacy of Rhinochill, an intranasal cooling device over Blanketrol, a surface cooling device in inducing TH in cardiac arrest patients within the cardiac catheter laboratory. ⋯ In this study, Rhinochill was not found to be more efficient than Blanketrol for TH induction, although there was a non-significant trend in favour of Rhinochill that potentially warrants further investigation with a larger trial.
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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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Randomized Controlled Trial
Effect of intrapartum oropharyngeal (IP-OP) suction on meconium aspiration syndrome in developing country: A RCT.
Evidence about IP-OP suction and selective tracheal intubation in meconium stained neonates is from developed countries. Little information is available about their role in developing countries with high incidence of meconium staining and MAS. This randomized trial was planned to evaluate the effectiveness of IP-OP suction in meconium stained term neonates on prevention of MAS and reduction of its severity. ⋯ IP-OP suctioning did not reduce the incidence or severity of MAS even in a setting of high incidence of MAS in a developing country. The mortality in two groups was comparable.
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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.