Resuscitation
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Guidelines recommend constant or escalating energy levels for shocks after the initial defibrillation attempt. Studies comparing survival to hospital discharge with escalating vs fixed high energy level shocks are lacking. We compared survival to hospital discharge for 200 J escalating to 360 J vs fixed 360 J in patients with initial ventricular fibrillation/pulseless ventricular tachycardia in a post-hoc analysis of the Circulation Improving Resuscitation Care trial database. ⋯ There was no difference in survival to hospital discharge or the frequency of TOF between escalating energy and fixed-high energy group. ClinicalTrials.gov Identifier: NCT00597207.
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Observational Study
Reasons for death in patients successfully resuscitated from out-of-hospital and in-hospital cardiac arrest.
There is no standard for categorizing reasons for death in those who achieve return of spontaneous circulation (ROSC) after cardiac arrest but die before hospital discharge. Categorization is important for comparing outcomes across studies, assessing benefits of interventions, and developing quality-improvement initiatives. We developed and tested a method for categorizing reasons for death after cardiac arrest in both in-hospital (IHCA) and out-of-hospital (OHCA) arrests. ⋯ Categorizing reasons for death after cardiac arrest with ROSC is feasible using our proposed categories, with substantial inter-rater agreement. Neurologic withdrawal of care is much less common in IHCA than OHCA, which may have implications for further research.
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Observational Study
Platelet dysfunction after out of hospital cardiac arrest. Results from POHCAR: a prospective observational, cohort study.
Coagulation and platelet function following out of hospital cardiac arrest (OHCA) at admission to a UK cardiology centre were investigated prospectively in this observational feasibility study, and compared to that of patients receiving percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). ⋯ OHCA patients demonstrated reduced thrombin receptor function at hospital admission but overall clot formation dynamics comparable to STEMI patients, indicating no gross coagulopathy post OHCA in our cohort. Hyperfibrinolysis was common both post OHCA and after STEMI. The results of this small feasibility study cannot draw clinical conclusions but will inform power calculations for future studies.
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Sudden cardiac arrest (SCA) is a major public health challenge in the United States (US). At present, the existence of limited literature on psychological sequelae post-cardiac arrest is a challenge in providing optimal care to survivors. ⋯ Comorbid psychiatric disorders are prevalent in SCA survivors, especially younger, white, female patients. However, CAPD did not have higher all-cause mortality as compared to CANPD. It is imperative to identify, assess, treat, and monitor high-risk SCA patients for associated psychiatric comorbidities.
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Observational Study
Effectiveness of Intubating Laryngeal Mask Airway in managing out-of-hospital cardiac arrest by non-physicians.
The role of supraglottic devices in airway management in out-of-hospital cardiac arrest (OHCA) remains controversial. The aim of this study was to evaluate the feasibility and effectiveness of intubation through the Intubating Laryngeal Mask Airway (ILMA) when used by prehospital emergency nurses in the setting of OHCA. ⋯ The success rate of intubation through the ILMA was high. After ILMA placement, ventilation was possible in 1250 patients (85.38%) and in 1078 patients (73.63%) after intubation.