Resuscitation
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Review Meta Analysis
A systematic review and meta-analysis of the association between arterial carbon dioxide tension and outcomes after cardiac arrest.
Arterial carbon dioxide tension (PaCO2) abnormalities are common after cardiac arrest (CA). Maintaining a normal PaCO2 makes physiological sense and is recommended as a therapeutic target after CA, but few studies have examined the association between PaCO2 and patient outcomes. This systematic review and meta-analysis aimed to assess the effect of a low or high PaCO2 on patient outcomes after CA. ⋯ From the limited data it appears PaCO2 has an important U-shape association with survival and outcomes after CA, consistent with international resuscitation guidelines' recommendation that normocarbia be targeted during post-resuscitation care.
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Comparative Study
A hemodynamic-directed approach to pediatric cardiopulmonary resuscitation (HD-CPR) improves survival.
Most pediatric in-hospital cardiac arrests (IHCAs) occur in ICUs where invasive hemodynamic monitoring is frequently available. Titrating cardiopulmonary resuscitation (CPR) to the hemodynamic response of the individual improves survival in preclinical models of adult cardiac arrest. The objective of this study was to determine if titrating CPR to systolic blood pressure (SBP) and coronary perfusion pressure (CoPP) in a pediatric porcine model of asphyxia-associated ventricular fibrillation (VF) IHCA would improve survival as compared to traditional CPR. ⋯ Hemodynamic-directed CPR improves short-term survival compared to standard depth-targeted CPR in a porcine model of pediatric asphyxia-associated VF IHCA.
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Randomized Controlled Trial
Prophylactic versus clinically-driven antibiotics in comatose survivors of out-of-hospital cardiac arrest-A randomized pilot study.
To investigate benefits of prophylactic antibiotics in comatose survivors of out-of-hospital cardiac arrest (OHCA). ⋯ Bronchoscopy on admission documented tracheobronchial aspiration in 28% of comatose survivors of OHCA. In the absence of aspiration, prophylactic antibiotics did not significantly alter systemic inflammatory response, postresuscitation pneumonia, ICU treatment and outcome (ClinicalTrials.gov Identifier: NCT02899507).
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To examine patient- and arrest-level factors associated with the incidence of re-arrest in the hospital setting, and to measure the association between re-arrest and survival to discharge. ⋯ Re-arrest is a common complication experienced by cardiac arrest patients that achieve ROSC, and occurs early in the course of their post-arrest care. Moreover, re-arrest is associated with a decreased likelihood of survival to discharge, even after adjustments for relevant covariates.