Resuscitation
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There remains controversy over the prognostic significance of spontaneous shockable rhythm conversion in out-of-hospital cardiac arrest (OHCA) patients with initial non-shockable heart rhythms (pulseless electrical activity [PEA] or asystole). The aim of this study was to examine the association of shockable rhythm conversion with multiple OHCA outcomes, and to explore effect modifiers. ⋯ Shockable rhythm conversion from initial non-shockable heart rhythms was associated with better OHCA outcomes, depending on the type of initial heart rhythm, and time of rhythm conversion.
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Inpatient peri-intubation cardiac arrest (PICA) following emergent endotracheal intubation (ETI) is an uncommon but potentially preventable type of cardiac arrest (CA). Limited published data exist describing factors associated with inpatient PICA and patient outcomes. This study identifies risk factors associated with PICA among hospitalized patients emergently intubated out of the operating room and compares PICA to other types of inpatient CA. ⋯ Patients outcomes following PICA were comparable to other causes of inpatient CA. Potentially modifiable factors were associated with PICA. Hemodynamic resuscitation, optimized staffing strategies, and possible avoidance of succinylcholine were associated with decreased risk of PICA. Clinical trials testing targeted strategies to optimize peri-intubation care are needed to identify effective interventions to prevent this potentially avoidable type of CA.
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To examine whether introducing a national standard to improve the recognition of and response to clinical deterioration, was associated with a reduction in cardiovascular events in the hospital environment. ⋯ Introduction of a national standard for deteriorating hospitalised patients was associated with a reduction in the rates of in-hospital cardiac arrests and acute coronary syndromes in acute hospitals. Greatest benefit was seen in the elderly, female and surgical patients.
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To develop a simple risk-score model for predicting in-hospital cardiac arrest (CA) among patients hospitalized with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). ⋯ A simple points score containing five variables readily available on admission predicts in-hospital CA for patients with suspected NSTE-ACS.
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Good neurological outcome is a major determinant after cardiac resuscitation. Extracorporeal life support may rapidly stabilize the patient, but cerebral ischemia remains a frequent complication relevant for further therapy. The aim of this study was to prove the value of NSE to indicate cerebral injury in patients with extracorporeal support after CPR. ⋯ NSE monitoring reliably indicates relevant cerebral injury in patients on extracorporeal support after cardiopulmonary resuscitation.