Resuscitation
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Review Meta Analysis
Predictors of favourable outcome after in-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis.
To identify the predictors of survival to discharge in adults resuscitated with extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest (IHCA). ⋯ In adult IHCA treated with ECPR a shockable initial rhythm, a lower low-flow time, lower blood lactate levels before ECPR start or on ICU admission, and a lower SOFA score or creatinine levels in the first 24h after ICU admission were associated with a higher likelihood of survival. These factors could help identifying patients who are eligible for ECPR.
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Review Meta Analysis
The accuracy of the Broselow tape as a weight estimation tool and a drug-dosing guide - A systematic review and meta-analysis.
The Broselow tape is widely used as a weight-estimation device and drug-dosing guide aid, but concerns about its accuracy and its efficacy have emerged in the last decade. The aim of this study was to systematically review the literature to analyse the accuracy of the Broselow tape as a weight estimation device and review evidence of its utility as a drug-dosing guide. ⋯ The Broselow tape lacked sufficient accuracy as a weight estimation and drug-dosing tool when compared to other available techniques. In addition, the Broselow tape contains insufficient drug-dosing information to function as a complete resuscitation aid without additional material. The frequent rate of incorrect usage of the tape indicated that appropriate training with the tape is mandatory to reduce errors.
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Review Meta Analysis
Early coronary angiography in patients resuscitated from out of hospital cardiac arrest without ST-segment elevation: A systematic review and meta-analysis.
A meta-analysis of published studies was performed to determine the impact of performing early versus delayed or no coronary angiography in patients without ST-segment elevation myocardial infarction following out of hospital cardiac arrest. ⋯ The results of our meta-analysis support the use of early coronary angiography in out of hospital cardiac-arrest patients presenting without ST-segment elevation on the post-resuscitation electrocardiogram. However, given the low level of evidence of available studies, future guideline changes should be directed by the results of large-scale randomized clinical trials on the subject matter.
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Randomized Controlled Trial
Level of systemic inflammation and endothelial injury is associated with cardiovascular dysfunction and vasopressor support in post cardiac arrest patients.
Post-cardiac arrest syndrome (PCAS) is characterized by a sepsis-like inflammatory response and hemodynamic instability. We investigated the associations between systemic inflammation, endothelial damage and hemodynamic parameters including vasopressor support in patients with out-of-hospital cardiac arrest (OHCA). ⋯ In comatose survivors after OHCA, increasing systemic inflammation and endothelial injury was associated with increased need of vasopressor support. Systemic inflammation, in particular IL-6, was consistently associated with vasopressor support, however endothelial injury may also play a role in PCAS associated cardiovascular dysfunction after OHCA.