Resuscitation
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Randomized Controlled Trial Multicenter Study
Osborn waves following out-of-hospital cardiac arrest-Effect of level of temperature management and risk of arrhythmia and death.
The Osborn or J-wave, an upright deflection of the J-point on the electrocardiogram (ECG), is often observed during severe hypothermia. A possible relation between Osborn waves (OW) and increased risk of ventricular arrhythmia has been reported. We sought to determine whether the level of targeted temperature management (TTM) following out-of-hospital cardiac arrest (OHCA) affects the prevalence of OW and to assess the associations between OW and risk of ventricular arrhythmia and death. ⋯ OW are frequent during TTM, particularly in patients treated with 33 °C. OW are not associated with increased risk of ventricular arrhythmia, and may be considered a benign physiological phenomenon, associated with lower mortality in univariable analyses.
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Multicenter Study
Direct transport to a PCI-capable hospital is associated with improved survival after adult out-of-hospital cardiac arrest of medical aetiology.
To compare survival outcomes of adults with out-of-hospital cardiac arrest (OHCA) of medical aetiology directly transported to a percutaneous-coronary-intervention capable (PCI-capable) hospital (direct transport) with patients transferred to a PCI-capable hospital via another hospital without PCI services available (indirect transport) by emergency medical services (EMS). ⋯ Direct transport to a PCI-capable hospital for post-resuscitation care is associated with a survival advantage for adults with OHCA of medical aetiology. This has implications for EMS transport protocols for patients with OHCA.
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Multicenter Study Observational Study
Optic nerve sheath diameter measured using early unenhanced brain computed tomography shows no correlation with neurological outcomes in patients undergoing targeted temperature management after cardiac arrest.
Previous studies indicated that the optic nerve sheath diameter (ONSD) measured using brain computed tomography (CT) is a prognostic factor for poor neurological outcome after cardiac arrest. However, these studies were retrospective or included a small sample size. We performed a prospective multi-centre observational study to investigate the correlation between the ONSD on early brain CT and neurological outcomes in patients undergoing targeted temperature management (TTM). ⋯ The ONSD on initial brain CT after ROSC was not correlated with neurological outcome at 6 months in patients who underwent TTM.
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Multicenter Study Observational Study
Differential effect of mild therapeutic hypothermia depending on the findings of hypoxic encephalopathy on early CT images in patients with post-cardiac arrest syndrome.
The aim of this study was to evaluate the differential effects of mild therapeutic hypothermia (MTH) in post-cardiac arrest syndrome (PCAS) patients depending on the presence/absence of hypoxic encephalopathy (HE) in the early brain CT images obtained before the initiation of MTH. ⋯ The effect of MTH in patients with PCAS differed depending on the presence/absence of evidence of HE on the early CT images.
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Multicenter Study Comparative Study Observational Study
Advanced vs. Basic Life Support in the Treatment of Out-of-Hospital Cardiopulmonary Arrest in the Resuscitation Outcomes Consortium.
Prior observational studies suggest no additional benefit from advanced life support (ALS) when compared with providing basic life support (BLS) for patients with out-of-hospital cardiac arrest (OHCA). We compared the association of ALS care with OHCA outcomes using prospective clinical data from the Resuscitation Outcomes Consortium (ROC). ⋯ ALS care was associated with survival to hospital discharge when provided initially or within six minutes of BLS arrival. ALS care, with or without initial BLS care, was associated with increased ROSC, however it was not associated with functional outcome.