Resuscitation
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Multicenter Study Observational Study
Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest.
Point-of-care ultrasound has been suggested to improve outcomes from advanced cardiac life support (ACLS), but no large studies have explored how it should be incorporated into ACLS. Our aim was to determine whether cardiac activity on ultrasound during ACLS is associated with improved survival. ⋯ Cardiac activity on ultrasound was the variable most associated with survival following cardiac arrest. Ultrasound during cardiac arrest identifies interventions outside of the standard ACLS algorithm.
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Hypoxic brain injury is the largest contributor to disability and mortality after cardiac arrest. We aim to identify electroencephalogram (EEG) characteristics that can predict outcome on cardiac arrest patients treated with targeted temperature management (TTM). ⋯ An unreactive EEG background and SE predicted poor functional outcome and in-hospital mortality in cardiac arrest patients undergoing TTM. Prognostic value of pure SB is confounded by use of sedative agents, and its use on prognostication decisions should be made with caution.
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Observational Study
Recognition of out-of-hospital cardiac arrest by medical dispatchers in emergency medical dispatch centres in two countries.
Survival after out-of-hospital cardiac arrest (OHCA) remains low. Early recognition by emergency medical dispatchers is essential for an effective chain of actions, leading to early cardiopulmonary resuscitation, use of an automated external defibrillator and rapid dispatching of the emergency medical services. ⋯ The accuracy of OHCA recognition was high and comparable. We identified large differences in data registration practices despite the use of similar dispatch tools. This raises a discussion of definitions and transparency in general in scientific reporting of OHCA recognition, which is essential if used as quality indicator in emergency medical services.
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Randomized Controlled Trial Multicenter Study
Exploring the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to apparent life threatening events.
To explore the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to an apparent life threatening event (ALTE) recruited to the Therapeutic Hypothermia after Paediatric Cardiac Arrest Out-of-Hospital trial. ⋯ Mortality was high amongst infants that were comatose after out-of-hospital cardiac arrest due to ALTE in both therapeutic hypothermia and therapeutic normothermia treated groups. Functional status was markedly reduced among survivors. (ClinicalTrials.gov, NCT00878644).
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Quantitative waveform measures of the ventricular fibrillation (VF) electrocardiogram (ECG) predict defibrillation outcome. Calculation requires an ECG epoch without chest compression artifact. However, pauses in CPR can adversely affect survival. Thus the potential use of waveform measures is limited by the need to pause CPR. We sought to characterize the relationship between the length of the CPR-free epoch and the ability to predict outcome. ⋯ Waveform measures predict defibrillation outcome using very brief ECG epochs, a quality that may enable their use in current resuscitation algorithms designed to limit CPR interruption.