Resuscitation
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Early detection of clinical deterioration on the wards may improve outcomes, and most early warning scores only utilize a patient's current vital signs. The added value of vital sign trends over time is poorly characterized. We investigated whether adding trends improves accuracy and which methods are optimal for modelling trends. ⋯ Vital sign trends increased the accuracy of models designed to detect critical illness on the wards. Our findings have important implications for clinicians at the bedside and for the development of early warning scores.
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To examine whether early warning scores (EWS) can accurately predict critical illness in the prehospital setting and affect patient outcomes. ⋯ EWS in the prehospital setting appeared useful in predicting clinically important outcomes, but the significant heterogeneity between different EWS suggests that these positive promising findings may not be generalisable. Adequately powered prospective studies are needed to identify the EWS best suited to the prehospital setting.
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Randomized Controlled Trial Multicenter Study
Association of early withdrawal of life-sustaining therapy for perceived neurological prognosis with mortality after cardiac arrest.
Withdrawing life-sustaining therapy because of perceived poor neurological prognosis (WLST-N) is a common cause of hospital death after out-of-hospital cardiac arrest (OHCA). Although current guidelines recommend against WLST-N before 72h (WLST-N<72), this practice is common and may increase mortality. We sought to quantify these effects. ⋯ After OHCA, death following WLST-N<72 may be common and is potentially avoidable. Reducing WLST-N<72 has national public health implications and may afford an opportunity to decrease mortality after OHCA.
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Randomized Controlled Trial
Cerebral oxygenation in mechanically ventilated early cardiac arrest survivors: The impact of hypercapnia.
Optimal cerebral oxygenation is considered fundamental to cerebral protection in cardiac arrest (CA) patients. Hypercapnia increases cerebral blood flow and may also improve cerebral oxygenation. It is uncertain, however, whether this effect occurs in mechanically ventilated early survivors of CA. ⋯ During the early post-resuscitation period, in mechanically ventilated CA patients, mild hypercapnia increases cerebral oxygenation as assessed by NIRS. Further investigations of the effect of prolonged mild hypercapnia on cerebral oxygenation and patient outcomes appear justified.
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This study aims to test the association between capacity of cardiopulmonary resuscitation (CPR) at community level and survival after out-of-hospital cardiac arrest (OHCA). ⋯ Higher CPR capacity at community level was associated with higher bystander CPR and survival to discharge rates after OHCA.