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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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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Multicenter Study Observational Study
Incidence and outcome of adult in-hospital cardiac arrest in Beijing, China.
To assess the incidence and outcome of in-hospital cardiac arrests (IHCAs) in Beijing, China. ⋯ The incidence of IHCA in Beijing hospitals is high and the survival is poor compared to other industrialized countries.
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Multicenter Study
Long-Term Neurologic Outcomes following Paediatric Out-of-Hospital Cardiac Arrest.
Evaluate long-term neurologic outcome for paediatric survivors of OHCA. ⋯ In this cohort study of neurologic outcomes for paediatric OHCA survivors, a favorable initial PCPC score was highly associated with stable long-term neurological outcomes. Those with poor neurologic status at initial discharge were unlikely to improve and were at greatest risk to die in follow-up. Future studies should focus on improving neurologic outcomes and prospectively evaluating the long-term neurologic course.
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Multicenter Study Clinical Trial
A before-after interventional trial of dispatcher-assisted cardio-pulmonary resuscitation for out-of-hospital cardiac arrests in Singapore.
To evaluate the effects of a comprehensive dispatcher-assisted CPR (DACPR) training program on bystander CPR (BCPR) rate and the outcomes of out-of-hospital cardiac arrest (OHCA) in Singapore. ⋯ A significant increase in BCPR and ROSC was observed after the intervention. There was a trend to suggest improved survival outcomes with the intervention pending further results from the trial.