Resuscitation
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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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Multicenter Study Observational Study
Deep-learning-based out-of-hospital cardiac arrest prognostic system to predict clinical outcomes.
Out-of-hospital cardiac arrest (OHCA) is a major healthcare burden, and prognosis is critical in decision-making for treatment and the withdrawal of life-sustaining therapy. This study aimed to develop and validate a deep-learning-based out-of-hospital cardiac arrest prognostic system (DCAPS) for predicting neurologic recovery and survival to discharge. ⋯ The DCAPS predicted neurologic recovery and survival to discharge of OHCA patients accurately and outperformed the conventional method and other machine-learning methods.
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Observational Study
Hemodynamic effects of chest compression interruptions during pediatric in-hospital cardiopulmonary resuscitation.
Animal studies have established deleterious hemodynamic effects of interrupting chest compressions. The objective of this study was to evaluate the effect of interruptions on invasively measured blood pressures (BPs) during pediatric in-hospital cardiac arrest (IHCA). ⋯ BPs following chest compression interruptions did not differ from pre-interruption BPs. These findings suggest that in the setting of high-quality in-hospital CPR, brief chest compression interruptions do not have persistent detrimental hemodynamic impact.
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Cerebral oximetry (rSO2) may be useful in assessing the probability of return of spontaneous circulation (ROSC). However, the potential of assessing the trend in the rSO2 value has not been discussed when determining the probability of ROSC. ⋯ The combination of rSO2 (baseline) with the amount of maximum rise in rSO2 value over time might be a new index for the prediction of ROSC that could be useful in guiding cardiopulmonary resuscitation. Further studies are needed to validate these findings.
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The HOPE score, based on covariates available at hospital admission, predicts the probability of in-hospital survival after extracorporeal life support (ECLS) rewarming of a given hypothermic cardiac arrest patient with accidental hypothermia. Our goal was to externally validate the HOPE score. ⋯ This study provides the first external validation of the HOPE score reaching good calibration and excellent discrimination. Clinically, the prediction of the HOPE score remains accurate in the validation sample. The HOPE score may replace serum potassium in the future as the triage tool when considering ECLS rewarming of a hypothermic cardiac arrest victim.