Resuscitation
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Review Meta Analysis
Medical futility regarding cardiopulmonary resuscitation in in-hospital cardiac arrests of adult patients: A Systematic Review and Meta-analysis.
For some patients, survival with good neurologic function after cardiopulmonary resuscitation (CPR) is highly unlikely, thus CPR would be considered medically futile. Yet, in clinical practice, there are no well-established criteria, guidelines or measures to determine futility. We aimed to investigate how medical futility for CPR in adult patients is defined, measured, and associated with do-not-resuscitate (DNR) code status as well as to evaluate the predictive value of clinical risk scores through meta-analysis. ⋯ There is no international consensus and a lack of specific definitions of CPR futility in adult patients. Clinical risk scores might aid decision-making when CPR is assumed to be futile. Future studies are needed to assess their clinical value and reliability as a measure of futility regarding CPR.
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Out-of-hospital cardiac arrest (OHCA) investigations may elect to exclude cases with resuscitation terminated for reasons other than a full resuscitative attempt. We sought to examine characteristics of these cases and regional variability in classification. ⋯ There is significant variation in the rationale and interval until termination of resuscitation between regions. Cases terminated due to obvious death or DNR orders/verbal directives are often treated with similar durations of resuscitation as survivors. These data highlight a considerable risk of bias in between-region comparisons or observational analyses.
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Randomized Controlled Trial
Physiological effects of providing supplemental air for avalanche victims. A randomised trial.
Survival from avalanche burial is dependent on time to extraction, breathing ability, air pocket oxygen content, and avoiding rebreathing of carbon dioxide (CO2). Mortality from asphyxia increases rapidly after burial. Rescue services often arrive too late. Our objective was to evaluate the physiological effects of providing personal air supply in a simulated avalanche scenario as a possible concept to delay asphyxia. We hypothesize that supplemental air toward victim's face into the air pocket will prolong the window of potential survival. ⋯ Participants subject to simulated avalanche burial can maintain physiologic parameters within normal levels for a significantly longer period if they receive supplemental air in front of their mouth/nose into the air pocket. This may extend the time for potential rescue and lead to increased survival.
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Guidelines recommend use of computerized tomography (CT) and electroencephalography (EEG) in post-arrest prognostication. Strong associations between CT and EEG might obviate the need to acquire both modalities. We quantified these associations via deep learning. ⋯ CT and EEG provide complementary information about post-arrest brain injury. Our results do not support selective acquisition of only one of these modalities, except in the most severely injured patients.