Resuscitation
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Cardiac arrest etiology is often assigned according to the Utstein template, which differentiates medical (formerly "presumed cardiac") from other causes. These categories are poorly defined, contain within them many clinically distinct etiologies, and are rarely based on diagnostic testing. Optimal clinical care and research require more rigorous characterization of arrest etiology. ⋯ Arrest etiology was identifiable in the majority cases via systematic chart review. "Cardiac" etiologies may be less common than previously thought. Substantial clinical heterogeneity exists across etiologies, suggesting previous classification systems may be insufficient.
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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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The study aimed to determine the effect of community implementation of a bundles of cardiopulmonary resuscitation (CPR) programs on outcomes in out-of-hospital cardiac arrest (OHCA). ⋯ The citywide implementation of a bundle of UTIS CPR programs was associated with significantly better OHCA outcomes.
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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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Animal studies have demonstrated that hemodynamic-directed cardiopulmonary resuscitation (CPR) improves outcomes following cardiac arrest compared with the "one-size-fits-all" algorithm. We investigated whether body size of patients is correlated with outcomes of in-hospital cardiac arrest (IHCA). ⋯ Higher BMI and thoracic APD was correlated with worse outcomes following IHCA. For those patients, it might be better to perform CPR under guidance of physiological parameters rather than a "one-size-fits-all" resuscitation algorithm to improve outcomes.