Resuscitation
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Multicenter Study
Outcomes of extracorporeal life support in hypothermic cardiac arrest: Revisiting ELSO guidelines.
Predictive factors for poor outcomes in hypothermic cardiac arrest (HCA) differ from those in normothermic out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the outcomes of extracorporeal life support (ECLS) in HCA patients who may not be considered eligible based on the guidelines set by the Extracorporeal Life Support Organization (ELSO). ⋯ Qualification of patients with hypothermic cardiac arrest for ECLS rewarming should not be strictly based on guidelines for normothermic cardiac arrest, as this may result in not initiating potentially life-saving treatment for patients who could have favourable prognoses for survival with good neurological outcomes.
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Observational Study
The association between intra-arrest arterial blood pressure and return of spontaneous circulation in out-of-hospital cardiac arrest.
The optimal haemodynamic parameter for goal-directed resuscitation in out-of-hospital cardiac arrest (OHCA) remains uncertain. This study aimed to characterise the association between invasive blood pressure (IBP) measurements and return of spontaneous circulation (ROSC) in adult OHCA patients, to identify this parameter. ⋯ This study supports the use of arterial DBP as an important haemodynamic parameter for goal-directed resuscitation in adult OHCA. Maximising DBP may increase the chances of ROSC. These data suggest that a DBP threshold of 35 mmHg is optimal for identifying patients who may achieve ROSC with continued resuscitation.
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To investigate the characteristics, outcomes, and prognostic factors of patients with hanging-induced out-of-hospital cardiac arrest (OHCA). ⋯ Prognosis following hanging-induced OHCAs was significantly worse compared to OHCAs of other causes. While some patients with initial non-asystole rhythm and prehospital ROSC may benefit from cardiopulmonary resuscitation, most lack these favourable features and have an exceedingly low chance of achieving favourable neurological outcomes at 1-month post-arrest.
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Meta Analysis
Drug therapy versus placebo or usual care for comatose survivors of cardiac arrest; a systematic review with meta-analysis.
In Europe, approximately 291,000 cardiac arrests occur annually. Despite critical care therapy, hospital mortality remains high. This systematic review assessed whether, in comatose survivors of cardiac arrest, any drug therapy, compared to placebo or usual care, improves outcomes. ⋯ In comatose survivors of cardiac arrest, the majority of trials of drug therapy reported no effect on mortality. Meta-analyses of steroids, coenzyme Q10 and thiamine demonstrated no evidence of an effect on mortality. However, the low certainty of evidence warrants further research.
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Randomized Controlled Trial
Interleukin 6 blockage alters the plasma metabolome in out-of-hospital cardiac arrest.
Comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA) exhibit a systemic inflammatory response, as indicated by elevated interleukin-6 (IL-6) levels, which is associated with increased mortality. Tocilizumab, an IL-6 receptor antagonist that reduced C-reactive protein response and markers of myocardial injury in a phase II OHCA trial. ⋯ Blocking the IL-6 receptor with tocilizumab early after OHCA impacts circulating metabolites, particularly those within the glycine, serine, and threonine pathways, highlighting the connection between acute systemic inflammation and metabolism. Further, early levels of TCA metabolites are independently associated with early inflammatory response and early medium-chain acylcarnitine with later markers of neurological injury.