Resuscitation
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Randomized Controlled Trial
aOutcomes of Delivery Room Resuscitation of Bradycardic Preterm Infants: A Retrospective Cohort Study of Randomised Trials of High vs Low Initial Oxygen Concentration and an Individual Patient Data Analysis.
To determine whether hospital mortality (primary outcome) is associated with duration of bradycardia without chest compressions during delivery room (DR) resuscitation in a retrospective cohort study of randomized controlled trials (RCTs) in preterm infants assigned low versus high initial oxygen concentration. ⋯ In preterm infants who did not receive chest compressions in the DR, prolonged bradycardia is associated with hospital mortality.
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The International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support forms the basis for guidelines developed by regional councils such as the American Heart Association (AHA) and the European Resuscitation Council (ERC). We aimed to determine if the updated guidelines are congruent, identify the source of variation, and score their quality. ⋯ AHA and ERC guidelines are predominantly based on the ILCOR CoSTR. Differences in recommendations between the two were largely related to the evidence gathering process for questions not reviewed by ILCOR, paucity of evidence for some recommendations based on existing regional practices and supported by expert opinion, and different interpretation or application of same evidence. Overall, both guidelines scored well on the AGREE II assessment, but each had domains that could be improved in future editions.
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Randomized Controlled Trial Observational Study
An Exploratory Assessment of Serum Biomarkers of Post-Cardiac Arrest Syndrome in Children.
We hypothesized that serum biomarkers of inflammation including chemokine, cytokine, pituitary hormones, and growth factors following cardiac arrest in children would independently associate with 6-month neurologic outcome. ⋯ Increased serum concentrations of CNTF and IL-17 associated with unfavorable 6-month neurologic outcome of children surviving cardiac arrest. Further investigation of the prognostic utility and roles of CNTF and IL-17 in the pathophysiology of post-cardiac arrest syndrome are warranted. This project is registered with clinicaltrials.gov (NCT00797680) as "Duration of Hypothermia for Neuroprotection after Pediatric Cardiac Arrest: A Randomized, Controlled Trial".
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Characterize release and recoil dynamics in chest compressions during prolonged cardiopulmonary resuscitation (CPR) efforts, which are increasingly prevalent. ⋯ Depth waveforms change markedly less than do force waveforms over the course of prolonged CPR. With the benefit of feedback, CPR providers effectively adjust the application of force to compensate for changes in chest stiffness, documented previously. Despite slowing release and quickening recoil, interference between release of force and recoil of depth appears limited. Spontaneous chest recoil is well preserved in prolonged duration manual CPR.
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Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival among patients with refractory out-of-hospital cardiac arrest (OHCA). We evaluated outcomes after incorporating ECPR into a conventional resuscitation system. ⋯ In this prematurely-terminated study of ECPR for refractory OHCA, we did not detect an association between a regional ECPR protocol and neurologically favorable outcomes. However, our data suggests that outcomes owing to conventional resuscitation were similar, with the potential for additional survivors due to ECPR therapies.