Resuscitation
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More than two failed intubation attempts and failed endotracheal intubations (ETIs) are associated with severe complications and death. The aim of this review was to determine the number of ETIs a health care provider in training needs to perform to achieve proficiency within two attempts. A systematic search of the literature was conducted covering the time frame of January 1990 through July 2014. ⋯ This review shows that in mostly elective circumstances, at least 50 ETIs with no more than two intubation attempts need to be performed to reach a success rate of at least 90%. However, the evidence is heterogeneous, and the incidence of difficult airways in non-elective settings is up to 20 times higher compared to elective settings. Taking this factor into account, training should include a variety of exposures and should probably exceed 50 ETIs to successfully serve the most vulnerable patients.
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The frequency of lethal overdose due to prescription and non-prescription drugs is increasing in North America. The aim of this study was to estimate overall and regional variation in incidence and outcomes of out-of-hospital cardiac arrest due to overdose across North America. ⋯ Overdose made up 2.4% of all out-of-hospital cardiac arrest, although incidence varied up to 5-fold across regions. Overdose cases were more likely to survive than non-overdose cases.
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In-hospital cardiac arrest (IHCA) has a poor prognosis and clinicians often write "Do-Not-Attempt-Resuscitation" (DNAR) orders based on co-morbidities. ⋯ Patients with a moderate or severe burden of ACCI have a minor chance of surviving an IHCA. This information could be used as part of the decision tools during ongoing CPR, and could be an aid for clinicians in planning care and discussing DNAR orders.
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to explore the association between post return of spontaneous circulation (ROSC) hemoglobin level and survival with good neurological outcome following out-of-hospital cardiac arrest. ⋯ Post ROSC hemoglobin level ≥10gdl(-1) is associated with survival with good neurological outcome. The importance of time to achieve such level and the role of blood transfusion warrants further investigation.