Resuscitation
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To determine the association between institutional experience with extracorporeal cardiopulmonary resuscitation (ECPR) and outcomes after out-of-hospital cardiac arrest (OHCA). ⋯ Increasing institutional experience of ECPR did not significantly improve 30-day survival after OHCA but was associated with a shorter interval between hospital arrival and initiation of ECMO. In patients with non-shockable OHCA, increasing experience of ECPR improved 30-day survival. (246/250 words).
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The use of extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) is increasing. Prehospital ECPR (PH-ECPR) for out-of-hospital cardiac arrest (OHCA) may improve both equity of access and outcomes but its cost effectiveness has yet to be determined. ⋯ Initial cost analysis and modelling indicate PH-ECPR service strategies are likely to be cost effective and comparable to other medical interventions. Survival rate and service integration into non ECPR clinical tasks are key aspects contributing to cost effectiveness.
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Limited evidence supports guidelines to perform chest compressions at the lower half of the sternum. Imaging studies suggest this location may obstruct blood flow. Our primary aim was to compare the highest arterial line systolic blood pressure (SBP) during lower-half-of-sternum chest compressions (CC) versus those left-of-sternum, where the left ventricle is more likely located. Secondarily, we compared the highest end-tidal CO2 (ETCO2). ⋯ In our pilot, retrospective, observational study of select ED cardiac arrest patients, left-of-sternum chest compressions are associated with higher SBP than lower-half-of-sternum compressions, while ETCO2 was similar.
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Randomized Controlled Trial
Optimum oxygen concentration for initiation of delivery room stabilization in preterm neonates: A Randomized Controlled Trial.
The ideal choice of initial fraction of inspired oxygen (FiO2) to stabilize preterm neonates in the delivery room (DR) is not well-established. ⋯ A significantly higher number of preterm neonates < 34 weeks' gestation requiring DR stabilization achieved a 5-minute SpO2 of ≥ 80 % with higher minute-specific SpO2 trends when stabilized with an initial FiO2 of 60 % compared to 30 %.