Resuscitation
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Successful resuscitation from cardiac arrest depends on provision of adequate blood flow to vital organs generated by cardiopulmonary resuscitation (CPR). Measurement of end-tidal expiratory pressure of carbon dioxide (ETCO2) using capnography provides a noninvasive estimate of cardiac output and organ perfusion during cardiac arrest and can therefore be used to monitor the quality of CPR and predict return of spontaneous circulation (ROSC). In clinical observational studies, mean ETCO2 levels in patients with ROSC are higher than those in patients with no ROSC. ⋯ Finally, detection of CO2 in exhaled air following intubation is the most specific criterion for confirming endotracheal tube placement during CPR. The aetiology of cardiac arrest, variations in ventilation patterns during CPR, and the effects of drugs such as adrenaline or sodium bicarbonate administered as a bolus may significantly affect ETCO2 levels and its clinical significance. While identifying ETCO2 as a useful monitoring tool during resuscitation, current guidelines for advanced life support recommend against using ETCO2 values in isolation for decision making in cardiac arrestmanagement.
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The purpose of this systematic review is to provide up-to-date evidence on effectiveness of antiarrhythmic drugs for shockable cardiac arrest to help inform the 2018 International Liaison Committee on Resuscitation Consensus on Science with Treatment Recommendations. ⋯ The high level evidence supporting the use of antiarrhythmic drugs during CPR for shockable cardiac arrest is limited and showed no benefit for critical outcomes of survival at hospital discharge, survival with favorable neurological function and long-term survival. Future high quality research is needed to confirm these findings and also to evaluate the role of administering antiarrhythmic drugs in children with shockable cardiac arrest, and in adults immediately after ROSC.
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The Global Resuscitation Alliance (GRA) was established in 2015 to improve survival for Out- of-Hospital Cardiac Arrest (OHCA) using the best practices developed by the Seattle Resuscitation Academy. However, these 10 programs were recommended in the context of developed Emergency Care Systems (ECS). Implementing these programs can be challenging for ECS at earlier stages of development. We aimed to explore barriers faced by developing ECS and to establish pre-requisites needed. We also developed a framework by which developing ECS may use to build their emergency response capability. ⋯ In this paper, we propose a modified framework of survival for developing ECS systems. There are barriers for developing ECS systems to improve OHCA survival rates. These barriers may be overcome by systematic prioritisation and cost-effective innovative solutions.
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Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome. ⋯ The perception of inappropriate CPR increased when objective indicators of poor prognosis were present and was associated with a low survival to hospital discharge. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.
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Electroencephalography (EEG) is a key modality for assessment of prognosis following cardiac arrest (CA); however, whether continuous EEG (cEEG) is superior to routine intermittent EEG (rEEG) remains debated. We examined the impact of cEEG (>18 h) vs. rEEG (<30 min) on outcome in comatose CA patients as part of multimodal prognostication. ⋯ Our data suggest that cEEG does not confer any advantage over intermittent rEEG regarding outcome in patients with CA, and does not influence the time to death.