Resuscitation
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Post-resuscitation care of out-of-hospital cardiac arrest (OHCA) patients often involves inter-hospital transfer (IHT). We aimed to determine the association between IHT and outcomes of OHCA. ⋯ IHT should be considered when treating OHCA patients in LVEDs.
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Experimental and observational research suggests hyperoxia following resuscitation from cardiac arrest is associated with neurological injury and worse clinical outcomes. This paper describes the rationale and design of the EXACT trial. EXACT aims to determine whether reducing oxygen in the acute phase of post-resuscitation care for out-of-hospital cardiac arrest (OHCA) improves survival. ⋯ This study will determine if early reduction of oxygen leads to improved outcomes in OHCA. Such a finding may potentially change clinical practice with implications on future OHCA survival outcomes.
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Correct defibrillation pad positioning optimises the chances of successful defibrillation. AEDs have pictoral representation to guide untrained bystanders in correct pad positioning. There is a wide variation in this pictoral guidance and evidence suggests that correct anatomical pad placement is poor. We reviewed all currently available diagrams and assessed the resultant pad placement achieved by untrained bystanders following these instructions. ⋯ All current defibrillation pad diagrams fail to achieve accurate defibrillation pad placement. A clearer, more effective diagram, such as the one we designed, is urgently needed to ensure bystander defibrillation is effective as possible.
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Observational Study
Vital Sign Patterns Before Shock-Related Cardiopulmonary Arrest.
Traditional vital sign thresholds reflect an increased risk of mortality, which may occur hours, days, or weeks following illness/injury, limiting immediate clinical significance to guide rescue therapy to avoid arrest. Our objective is to explore vital sign patterns prior to arrest due to shock. ⋯ Vital sign patterns were defined for SBP, MAP, HR, shock index, and EtCO2 with clear inflection points identified 2-5 min prior to arrest. These patterns may help guide therapy to reverse deterioration and prevent arrest.
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Associations between neighbourhood environments and survival outcomes after out-of-hospital cardiac arrests (OHCAs) have been proposed. The purpose of this study was to examine the association between county-level cardiopulmonary resuscitation (CPR) training rates and improvements in survival outcomes after OHCA over 5 years. ⋯ There were moderate associations between county-level CPR training and improvements in good neurological recovery rates over 5 years in the counties.