Resuscitation
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Multicenter Study Observational Study
Duration of resuscitation efforts for in-hospital cardiac arrest by predicted outcomes: Insights from get with the guidelines-Resuscitation.
The duration of resuscitation efforts has implications for patient survival of in-hospital cardiac arrest (IHCA). It is unknown if patients with better predicted survival of IHCA receive longer attempts at resuscitation. ⋯ The duration of resuscitation efforts in patients with IHCA was generally consistent with their predicted survival. However, nearly a third of patients with above average predicted outcomes received shorter than average (less than 19min) duration of resuscitation efforts.
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It was hypothesized that the pattern of coronary occlusion (thrombus composition) might contribute to the onset of ventricular arrhythmia and sudden cardiac death (SCD) in myocardial infarction (MI). ⋯ Composition of intracoronary thrombi in STEMI patients does not differ between those presenting with and without SCD. Time from symptom onset to coronary reperfusion seems to be the strongest factor influencing thrombus composition in MI.
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Despite its prevalence, survival from out-of-hospital cardiac arrest remains low. High quality CPR has been associated with improved survival in cardiac arrest patients. In early 2014, a program was initiated to provide feedback on CPR quality to prehospital providers after every treated cardiac arrest. ⋯ We found that individual CPR feedback is associated with marginally improved quality of CPR in the prehospital setting. Further investigation with larger samples is warranted to better quantify this effect.
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Sudden cardiac arrest (SCA), confirmed absence of cardiac mechanical activity, is the leading cause of heart-related death in the US. Almost 85% of SCA occur out-of-hospital (OHCA), with very poor rates of return of spontaneous circulation (ROSC) and survival to hospital discharge. We sought to determine if diabetes status was associated with survival or ROSC following an OHCA. ⋯ This is the first Canadian study to examine the association between diabetes status and OHCA outcomes. Our findings suggest that diabetes status prior to arrest is associated with decreased survival. The growing prevalence of diabetes globally suggests a future burden related to OHCAs.
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Amplitude spectral area (AMSA), an index for analysing ventricular fibrillation (VF) waveforms, is thought to predict the return of spontaneous circulation (ROSC) after electric shocks, but its validity is unconfirmed. We developed an equation to predict ROSC, where the change in AMSA (ΔAMSA) is added to AMSA measured immediately before the first shock (AMSA1). We examine the validity of this equation by comparing it with the conventional AMSA1-only equation. ⋯ Post-shock ROSC was accurately predicted by adding ΔAMSA to AMSA1. AMSA-based ROSC prediction enables application of electric shock to only those patients with high probability of ROSC, instead of interrupting chest compressions and delivering unnecessary shocks to patients with low probability of ROSC.