Resuscitation
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Early determination of the acute etiology of cardiac arrest could help guide resuscitation or post-resuscitation care. In experimental studies, quantitative measures of the ventricular fibrillation waveform distinguish ischemic from non-ischemic etiology. ⋯ This clinical investigation suggests that waveform measures may not be useful in distinguishing cardiac arrest etiology.
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Comparative Study
Amiodarone or nifekalant upon hospital arrival for refractory ventricular fibrillation after out-of-hospital cardiac arrest.
We evaluated the association between nifekalant or amiodarone on hospital admission and in-hospital mortality for cardiac arrest patients with persistent ventricular fibrillation on hospital arrival. ⋯ This nationwide study suggested no significant in-hospital mortality association between nifekalant and amiodarone for cardiogenic out-of-hospital cardiac arrest patients with ventricular fibrillation/persistent ventricular tachycardia on hospital arrival. Although nifekalant may potentially improve hospital admission rates compared with amiodarone for these patients, further studies are required to confirm our results.
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Epinephrine has been presumed to improve cerebral oxygen delivery during cardiopulmonary resuscitation (CPR), but animal and registry studies suggest that epinephrine-induced capillary vasoconstriction may decrease cerebral capillary blood flow and worsen neurological outcome. The effect of epinephrine on cerebral oxygenation (rSO2) during CPR has not been documented in the clinical setting. ⋯ A bolus of 1mg epinephrine IV during CPR produced a small but clinically insignificant increase in rSO2 in the five minutes after administration. This is the first clinical data to demonstrate the effects of epinephrine on cerebral rSO2 during CPR.
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Comparative Study
Determining witnessed status for out-of-hospital cardiac arrest.
Witnessed status is considered a core variable in reporting cardiac arrest data and can be ascertained from either the emergency dispatch recording or the pre-hospital record. The purpose of this study is to compare and assess the quality and consistency of these information sources. ⋯ The determination of witnessed status in out-of-hospital cardiac arrest may be challenging, as evidenced by the discrepancies in witnessed status when comparing different sources of information. The large number of cases where the witnessed status could not be determined from the emergency dispatch recording precludes its use as the sole source of information. It is reasonable to use the patient care record alone, however it should be recognized that there is misclassification of witnessed status regardless of the method used and this may affect the strength of association between witnessed status and survival.
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Observational Study
The effect of atmosphere temperature on out-of-hospital cardiac arrest outcomes.
It is unclear whether the atmosphere temperature is associated with outcomes after out-of-hospital cardiac arrest (OHCA). ⋯ The temperature at the time of the OHCA event was associated with outcomes after OHCA in a nationwide observational study in Korea.