Resuscitation
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Early initiation of hypothermia is recommended in the setting of cardiac arrest. Current hypothermia methods are invasive and expensive and not applicable in ambulatory settings. We investigated the evaporative cooling effect of high flow transnasal dry air on core esophageal temperature in human volunteers. ⋯ Transnasal high flow dry air through the nasopharynx reduces core body temperature. This mechanism can be harnessed to induce hypothermia in patients where clinically indicated without any deleteriouseffects in a short time exposure.
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Early EEG patterns and SSEP responses are associated with neurological recovery of comatose patients with postanoxic encephalopathy after cardiac arrest. However, the nature and distribution of brain damage underlying the characteristic EEG and SSEP patterns are unknown. We relate EEG and SSEP findings with results from histological analyses of the brains of eleven non-survivors. ⋯ Absent SSEP responses were always accompanied by thalamic damage. Pathological burst suppression patterns were associated with a variable degree of neuronal damage to cortex, cerebellum and hippocampus. In patients with additional thalamic involvement, burst-suppression with identical bursts was observed, a characteristic EEG pattern presumably reflecting residual activity from a relatively isolated and severely compromised cortex.
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Multicenter Study Observational Study
A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: a multi-centre database study.
To compare the ability of the National Early Warning Score (NEWS) and the National Early Warning Score 2 (NEWS2) to identify patients at risk of in-hospital mortality and other adverse outcomes. ⋯ NEWS2 modifications to NEWS do not improve discrimination of adverse outcomes in patients with documented T2RF and decrease discrimination in patients at risk of T2RF. Further evaluation of the relationship between SpO2 values, oxygen therapy and risk should be investigated further before wide-scale adoption of NEWS2.
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Practice Guideline
European Resuscitation Council Guidelines for Resuscitation: 2018 Update - Antiarrhythmic drugs for cardiac arrest.
This European Resuscitation Council (ERC) Guidelines for Resuscitation 2018 update is focused on the role of antiarrhythmic drugs during advanced life support for cardiac arrest with shock refractory ventricular fibrillation/pulseless ventricular tachycardia in adults, children and infants. This update follows the publication of the International Liaison Committee on Resuscitation (ILCOR) 2018 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR). The ILCOR CoSTR suggests that any beneficial effects of amiodarone or lidocaine are similar. This ERC update does not make any major changes to the recommendations for the use of antiarrhythmic drugs during advanced life support for shock refractory cardiac arrest.
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Comparative Study Observational Study
Intraosseous versus Intravenous access in Patients with Out-of-Hospital Cardiac Arrest: Insights from the Resuscitation Outcomes Consortium Continuous Chest Compression Trial.
To examine outcomes associated with intraosseous access route attempt for delivery of medications during out-of-hospital cardiac arrest (OHCA) resuscitation. ⋯ Among patients with OHCA, intraosseous access attempt was associated with worse ROSC rates but no difference in survival. Further studies are necessary to elucidate the optimal access route among OHCA patients.