Resuscitation
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Traditional predictors of neurological prognosis after cardiac arrest are unreliable after targeted temperature management. Absence of pupillary reflexes remains a reliable predictor of poor outcome. Diffusion-weighted imaging has emerged as a potential predictor of recovery, and here we compare imaging characteristics to pupillary exam. ⋯ Post-anoxic diffusion changes using quantitative brain MRI may aid in predicting persistent coma and poor functional outcomes at hospital discharge.
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Observational Study
The relation between given volume and heart rate during newborn resuscitation.
During delivery room resuscitation of depressed newborns, provision of appropriate tidal volume (TV) with establishment of functional residual capacity (FRC) is essential for circulatory recovery. Effective positive pressure ventilation (PPV) is associated with a rapid increase in heart rate (HR). The relationship between delivery of TV and HR responses remains unclear. ⋯ There was a consistent positive relationship between HR increase and delivered TV. The unanticipated finding of a further increase in HR with PPV pauses to provide stimulation/suctioning suggests that most newborns were in primary rather than secondary apnea.
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Observational Study
"Presumed cardiac" arrest in children and young adults: A misnomer?
To use a novel methodology to assess the incidence and specific causes of Out-of-Hospital Cardiac Arrest (OHCA) within a young urban cohort. ⋯ In young adults with OHCA, confirmed cardiac causes were responsible in a minority of cases, and they differed in presentation from those with confirmed non- cardiac causes. Establishing rigorous case ascertainment strategies with linkage to multiple data sources will facilitate a more reliable evaluation of the causes of these events.
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Combining xenon and mild therapeutic hypothermia (MTH) after cardiac arrest (CA) confers a degree of protection that is greater than either of the two interventions alone. However, xenon is very costly which might preclude a widespread use. We investigated whether the inexpensive gas argon would enhance hypothermia induced neurologic recovery in a similar manner. ⋯ Our study demonstrates that argon augmented MTH does not improve functional recovery after CA in rats, but may even worsen neurologic function in this model.
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Current guidelines recommend epinephrine every 3-5min during cardiopulmonary resuscitation. For adults with in-hospital cardiac arrest (IHCA), longer dosing intervals are associated with improved survival to discharge. This study investigates whether longer epinephrine dosing intervals were associated with improved survival to discharge during pediatric IHCA. ⋯ Longer average dosing intervals than currently recommended for epinephrine administration during pediatric IHCA were associated with improved survival to hospital discharge.