Resuscitation
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Multicenter Study
Early ECPR for out-of-hospital cardiac arrest: Best practice in 2018.
Extracorporeal CPR is a second line treatment for refractory cardiac arrest, as written in the latest International Guidelines. Optimal timing, patient selection, location and method of implementation vary across the world. ⋯ The major aspect the group agrees on in that ECPR should be implemented within 60 minutes of collapse. With this in mind, the program should be built according to local resources knowing that the optimal team will require pre-established specific roles with personnel dedicated to resuscitation and others to ECPR.
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Randomized Controlled Trial
Umbilical cord milking in preterm neonates requiring resuscitation: A randomized controlled trial.
To evaluate the effect of cord milking on short term morbidity and hematologic parameters at 6 weeks in preterm neonates requiring resuscitation. ⋯ Clinical trials registry -India CTRI/2015/01/005436, www.ctri.nic.in.
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In clinical practice, do-not-intubate (DNI) orders are generally accompanied by do-not-resuscitate (DNR) orders. Use of do-not-resuscitate (DNR) orders is associated with older patient age, more comorbid conditions, and the withholding of treatments outside of the cardiac arrest setting. Previous studies have not unpacked the factors independently associated with DNI orders. ⋯ Compared with DNR orders alone, combined DNR/DNI orders are more strongly associated with many of the same factors that have been linked to DNR orders. Awareness of the extent to which the two directives may be conflated during code status discussions is needed to promote patient-centered application of these interventions.
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Observational Study
Medical facilities in the neighborhood and incidence of sudden cardiac arrest.
Medical establishments in the neighborhood, such as pharmacies and primary care clinics, may play a role in improving access to preventive care and treatment and could explain previously reported neighborhood variations in sudden cardiac arrest (SCA) incidence and survival. ⋯ We did not observe a protective association between medical facilities in the home census tract and SCA risk, orbetween major medical centers in the event census tract and survival.
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While S-100B protein and Neuron-Specific Enolase (NSE) dosages have been extensively investigated for neurological prognostication after cardiac arrest (CA), there is no data about their ability to detect a cerebrovascular cause of CA. We assessed the utility of plasma S-100B protein and NSE measurements for early diagnosis of primary neurological cause in resuscitated CA patients. ⋯ Even if S-100B protein dosage performs slightly better than NSE, early dosages of these biomarkers are poorly predictive of a cerebrovascular etiology of CA. Our results suggest that early measurement of brain biomarkers should not be recommended to tailor the imaging strategy employed to investigate the CA cause.