Resuscitation
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24/7 in house attending staff coverage improves neonatal short-term outcomes: A retrospective study.
to compare short-term outcomes of newborns over 36 weeks with Apgar scores≤3 at 1min, following the adoption of a 24/7 in house coverage schedule STUDY DESIGN: A retrospective chart review comparing two 12-month epochs. Epoch 1: coverage provided by residents with availability on call at home of attending staff. Epoch 2: On site coverage by attending staff. ⋯ Continuous coverage by attending staff decreased the number of admissions to intensive care as well as the duration of hospitalization stay for newborns with low Apgar scores.
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Asystole (ASY) and pulseless electrical activity (PEA) are increasing and ventricular fibrillation (VF) or ventricular tachycardia (VT) declining as presenting rhythms of sudden cardiac arrest (SCA). Since there is limited information on possible differences in the etiology of underlying structural heart disease, we analyzed the clinical and/or autopsy findings of victims with ASY, PEA or VT/VF. ⋯ Asystole and PEA are a more common presenting rhythm than VT/VF at the time of SCA in non-ischemic cardiac disease. The decreasing trend of ischemic heart disease as a cause of SCA may partly explain the increasing trend of ASY/PEA.
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We aim to evaluate if point-of-care ultrasound use in cardiac arrest is associated with CPR pause duration. ⋯ In this prospective cohort trial of 24 patients with CA, POCUS during CPR pauses was associated with longer interruptions in CPR.
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Comparative Study
A Retrospective Comparison of Survivors and Non-Survivors of Massive Pulmonary Embolism Receiving Veno-arterial Extracorporeal Membrane Oxygenation Support.
While the optimal care of patients with massive pulmonary embolism (PE) is unclear, the general goal of therapy is to rapidly correct the physiologic derangements propagated by obstructive clot. Extracorporeal membrane oxygenation (ECMO) in this setting is promising, however the paucity of data limits its routine use. Our institution expanded the role of ECMO as an advanced therapy option in the initial management of massive PE. The purpose of this project was to evaluate ECMO-treated patients with massive PE at an academic medical center and report shortterm mortality outcomes. ⋯ The practical approach of utilizing ECMO for massive PE is to reserve it for those who would receive the greatest benefit. Patients with poor perfusion, for example from cardiac arrest, may gain less benefit from ECMO. Our findings indicate that a serum lactate >6mmol/L may be an indicator of worse prognosis. Finally, in our patient population, catheter-directed thrombolytics was effectively combined with ECMO.