Resuscitation
-
Despite their wide use in the prehospital setting, randomized control trials (RCTs) have failed to demonstrate that any antiarrhythmic agent improves survival to hospital discharge following out-of-hospital cardiac arrest. ⋯ Amiodarone and lidocaine were the only agents associated with improved survival to hospital admission in the NMA. For the outcomes most important to patients, survival to hospital discharge and neurologically intact survival, no antiarrhythmic was convincingly superior to any other or to placebo.
-
Randomized Controlled Trial Multicenter Study
Prehospital cooling to improve successful targeted temperature management after cardiac arrest: A randomized controlled trial.
Targeted temperature management (TTM) improves survival with good neurological outcome after out-of-hospital cardiac arrest (OHCA), but is delivered inconsistently and often with delay. ⋯ Prehospital cooling initiated 5min after ROSC did not increase rates of achieving a target temperature of 32-34°C within 6h of hospital arrival but was safe and increased application of TTM in hospital.
-
Multicenter Study
Impact of Timing of Cardiac Arrest During Hospitalization on Survival Outcomes and Subsequent Length of Stay.
In-hospital cardiac arrest (IHCA) is common and often fatal. However, the association between timing of cardiac arrest and likelihood of survival to discharge, neurological status, and subsequent hospital length of stay (LOS) is unknown. ⋯ Most IHCA occur after 3 hospitalization days. Patients with IHCA after 3 hospital days had lower rates of survival to discharge, and, among survivors, lower rates of favorable neurological survival and longer duration of hospitalization from the time of cardiac arrest.
-
Mobile extracorporeal life support (ECLS) may soon be on the verge to become a fundamental part of emergency medicine. Here, we report on our four-year experience of providing advanced mechanical circulatory support for out-of-center patients within the Düsseldorf ECLS Network (DELSN). ⋯ This study illustrates that regional mobile ECLS rescue therapy can be provided with encouraging outcomes, although patient selection criteria and early outcome parameters reflecting on therapy success or futility still need to be refined.
-
Survival rates after cardiac arrest have shown minimal improvement in the last 60 years. However, in some forward-thinking cities and hospitals, out-of and in-hospital cardiac arrest survival rates exceed 20% and 40% respectively. These beacons of hope can enlighten us, providing a clearer vision of what it takes to provide Ideal cardiopulmonary resuscitation. To make progress in a field that has seemingly stagnated for too many decades, we must be open to new ideas and develop bundles of care that work in communities with varying EMS systems and various existing infrastructure to bring the best practices to the rest of the country.