Resuscitation
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Patients with ST-elevation myocardial infarction (STEMI) complicated by an out-of-hospital-cardiac-arrest (OHCA) may vary widely in their probability of dying. Large variation in mortality may have implications for current national efforts to benchmark operator and hospital mortality rates for coronary angiography. We aimed to build a risk-adjustment model of in-hospital mortality among OHCA survivors with concurrent STEMI. ⋯ In a large national registry, we identified 5 key predictors for mortality in patients with STEMI and OHCA and found wide variability in mortality risk. Our findings suggest that current national benchmarking efforts for coronary angiography, which simply adjusts for the presence of OHCA, may not adequately capture patient case-mix severity.
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Observational Study
Feasibility of early waking cardiac arrest patients whilst receiving therapeutic hypothermia: The therapeutic hypothermia and early waking (THAW) trial.
To determine the safety and feasibility of an early (12 h) waking and extubation protocol for out-of-hospital cardiac arrest (OHCA) patients receiving targeted temperature management (TTM). ⋯ It is safe and feasible to wake selected comatose OHCA patients at 12 h, allowing for earlier positive neuro-prognostication and reduced ICU stay.
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To evaluate the association between hyperoxia in the first 24 hours after in-hospital pediatric cardiac arrest and mortality and poor neurological outcome. ⋯ Hyperoxia after pediatric cardiac arrest was common and was not associated with worse in-hospital outcomes.
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There is a need for large-scale epidemiological studies of paediatric out-of-hospital cardiac arrest (POHCA). To enable this, we developed and validated international classification of disease (ICD-10) search algorithms for the identification of POHCA patients from health administrative data. ⋯ It is important that algorithms used for cohort identification are validated prior to use. The ICD-10 code for cardiac arrest alone misses many POHCA cases but the use of additional codes can improve the sensitivity while maintaining specificity.