Resuscitation
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Rearrest occurs when a patient experiences cardiac arrest after successful resuscitation. The incidence and outcomes of rearrest following out-of-hospital cardiac arrest have been estimated in limited local studies. We sought provide a large-scale estimate of rearrest incidence and its effect on survival. ⋯ Rearrest was found to occur frequently after resuscitation and was inversely related to survival.
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Randomized Controlled Trial Comparative Study
Microcirculatory perfusion and vascular reactivity are altered in post cardiac arrest patients, irrespective of target temperature management to 33°C vs 36°C.
In previous reports both microcirculatory alterations and impaired vascular reactivity have been described in post cardiac arrest patients treated with mild therapeutic hypothermia. As of now it is unknown whether these alterations are related to the temperature management or to the cardiac arrest itself. Aim of the present study was to investigate the potential difference in microcirculatory alterations and vascular reactivity in comatose patients after out of hospital cardiac arrest treated with target temperature management of 33 °C (TTM33) in comparison to patients treated with 36 °C (TTM36). ⋯ In this relatively small sample size study microcirculatory blood flow and vascular reactivity did not differ nor change between TTM33 and TTM36.
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While males and females are equally at risk of sudden cardiac arrest (SCA), females are less likely to be resuscitated. Cardiopulmonary Resuscitation (CPR) may be inhibited by socio-cultural norms about exposing female victims' chests. Empirically confirming this hypothesis is limited by lack of patient simulators modeling realistic female physiques. A commercially-available patient simulator was transformed to evaluate how physical attributes of a patient's sex might influence lay participants who were asked to resuscitate a female versus a male during simulated cardiac arrest. ⋯ While rescuers had better hand placement for CPR on the female, both men and women rescuers were reluctant to remove the female's clothing, with men significantly more hesitant. Reticence to remove clothing was often articulated relative to social norms during structured interviews. We suggest that using only male simulators will not allow trainees to experience social differences associated with the care of a female simulated patient. Realistic female patient simulators are needed.
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Observations of cardiopulmonary arrests (CPAs) reveal concerning patterns when clinicians identify a problem, (e.g. loss of pulse) but do not immediately initiate appropriate therapy (e.g. compressions) resulting in delays in life saving therapy. ⋯ Action-Linked Phrases innately used by residents in simulated CPAs were associated with faster initiation of compressions. Action-Linked Phrases were verbalized more frequently if taught as part of a regular BLS or ACLS course. This simple, easy to teach, and easy to implement technique holds promise for impacting cardiac arrest teams' performance of key actions.
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Observational Study
Potential association of bystander-patient relationship with bystander response and patient survival in daytime out-of-hospital cardiac arrest.
To investigate whether the bystander-patient relationship affects bystander response to out-of-hospital cardiac arrest (OHCA) and patient outcomes depending on the time of day. ⋯ Family members are least likely to perform BCPR and OHCAs witnessed by family members are least likely to survive during daytime. Different strategies are required for family-witnessed OHCAs.