Resuscitation
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Randomized Controlled Trial Multicenter Study
Association between hospital post-resuscitative performance and clinical outcomes after out-of-hospital cardiac arrest.
Survival varies among those resuscitated from out-of-hospital cardiac arrest (OHCA). Evidence-based performance measures have been used to describe hospital quality of care in conditions such as acute coronary syndrome and major trauma. It remains unclear if adherence to performance measures is associated with better outcome in patients hospitalized after OHCA. ⋯ Greater survival and favorable neurologic status at discharge were associated with greater adherence to recommended hospital based post-resuscitative care guidelines. Consideration should be given to measuring, reporting and improving hospital adherence to guideline-based performance measures, which could improve outcomes following OHCA.
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Randomized Controlled Trial Multicenter Study
Prophylactic antibiotics are associated with a lower incidence of pneumonia in cardiac arrest survivors treated with targeted temperature management.
Prophylactic antibiotics (PRO) reduce the incidence of early-onset pneumonia in comatose patients with structural brain injury, but have not been examined in cardiac arrest survivors undergoing targeted temperature management (TTM). We investigated the effect of PRO on the development of pneumonia in that population. ⋯ Prophylactic antibiotics were associated with a reduced incidence of pneumonia but a similar rate of good functional outcome.
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To determine the ability of readily available prehospital variables to predict acute coronary artery disease (CAD) as the cause of arrest in failed out-of hospital cardiac arrest (OHCA) resuscitations. ⋯ As hospital-based salvage therapies offer opportunities to extend survival for victims of OHCA who fail prehospital treatment, an ability to predict CAD may help guide protocols for appropriate use. In this derivation analysis, a simple set of variables available on scene can be used to predict CAD with good accuracy among OHCA victims who fail prehospital resuscitation attempts. An initial shockable rhythm should still be considered the result of acute coronary artery disease until proven otherwise.
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In the event of cardiac arrest, cardiopulmonary resuscitation (CPR) is a well-established technique to maintain oxygenation of tissues and organs until medical equipment and staff are available. During CPR, chest compressions help circulate blood and have been shown in animal models to be a means of short-term oxygenation. In this study, we tested whether gentle chest pressure can generate meaningful tidal volume in paediatric subjects. ⋯ Using gentle chest pressure, we were able to generate over 20% of the tidal volume achieved with mechanical ventilation. Our results suggest that gentle chest pressure may be a means to support temporary airflow in children.
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The aim of this prospective, single-center, observational study was to investigate the accuracy of modeling and reproduction of human anatomical dimensions in manikins by comparing radiographic upper airway measurements of 13 different models with humans. ⋯ This investigation showed that all of the examined manikins did not replicate human anatomy. Manikins should therefore be selected cautiously, depending on the type of airway securing procedure. Their widespread use as a replacement for in vivo trials in the field of airway management needs to be reconsidered.