Resuscitation
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Review Meta Analysis
First aid cooling techniques for heat stroke and exertional hyperthermia: a systematic review and meta-analysis.
Heat stroke is an emergent condition characterized by hyperthermia (>40 °C/>104 °F) and nervous system dysregulation. There are two primary etiologies: exertional which occurs during physical activity and non-exertional which occurs during extreme heat events without physical exertion. Left untreated, both may lead to significant morbidity, are considered a special circumstance for cardiac arrest, and cause of mortality. ⋯ Water immersion techniques (using 1-17 °C water) more effectively lowered core body temperatures when compared with passive cooling, in hyperthermic adults. The available evidence suggests water immersion can rapidly reduce core body temperature in settings where it is feasible.
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Review Meta Analysis
Efficacy of the cooling method for targeted temperature management in post-cardiac arrest patients: a systematic review and meta-analysis.
This review aimed to compare the efficacy of endovascular cooling devices (ECD), such as Thermogard®, with surface cooling devices (SCD), such as Arctic Sun®, in reducing mortality and improving neurological status for patients with post-cardiac arrest undergoing targeted temperature management. ⋯ CRD42019129770.
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Randomized Controlled Trial
Cold fluids for induction of targeted temperature management: A sub-study of the TTH48 trial.
Pre-intensive care unit (ICU) induction of targeted temperature management (TTM) with cold intravenous (i.v.) fluids does not appear to improve outcomes after in out-of-hospital cardiac arrest (OHCA). We hypothesized that this may be due to ineffective cooling and side effects. ⋯ The initiation of TTM with cold i.v. fluids before ICU arrival did not decrease the TTT. We detected no significant between-group difference in mortality or the incidence of side effects according to the administration or not of pre-ICU cold i.v fluids.
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Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapies. Many institutions are interested in developing their own ECPR program. However, there may be challenges in logistics and implementation. ⋯ ECPR is an infrequent occurrence in EMS practice. Most apparently eligible patients did not get ECPR, highlighting the need for ongoing programmatic development, provider education, and qualitative work exploring barriers to implementation.