Resuscitation
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Letter Retraction Of Publication
Out-of-hospital cardiac arrest in the Crimea: A snapshot of the problem in the post-Soviet space.
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Fifty years ago, the ad hoc committee of the Harvard medical school provided the influential first guidance on confirming death using neurological criteria (DNC). Now 70% of countries have a legal or professional framework enabling DNC. ⋯ The legacy of the Harvard ad hoc committee has been a continuing development of our concepts of human death. There is a growing acceptance that ultimately all human death is brain based whether diagnosed using neurological criteria or using circulatory criteria after cardiac arrest.
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Extracorporeal cardiopulmonaryresuscitation (ECPR) is emerging as a viable rescue strategy for refractory out-of-hospital cardiac arrest. In the U.S., limited training of emergency medicine providers is a barrier to widespread implementation. ⋯ High fidelity simulation training is effective in preparing emergency medicine physicians and nurses to rapidly and safely initiate ECPR in a simulated cardiac arrest scenario, and should be considered when implementing an ED-based ECPR program.
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Multicenter Study
Time of on-scene resuscitation in out of-hospital cardiac arrest patients transported without return of spontaneous circulation.
In out-of-hospital cardiac arrest (OHCA), return of spontaneous circulation (ROSC) on scene occurs only in a minority of patients. The optimal duration of resuscitation on scene before transport with ongoing cardiopulmonary resuscitation (CPR) is unknown. ⋯ In OHCA patients transported with ongoing CPR the survival rate significantly declines when time on scene increases.
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Multicenter Study
International variation in survival after out-of-hospital cardiac arrest: a validation study of the Utstein template.
Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. ⋯ The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.