Resuscitation
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Outcomes are better when patients resuscitated from out-of-hospital cardiac arrest (OHCA) are treated at specialty centers. The best strategy to transport patients from the scene of resuscitation to specialty care is unknown. ⋯ We did not find strong evidence in favor of a particular strategy for transport to specialty care after OHCA. Population level time to specialty care was shortest with ground ambulance transport to the nearest helicopter landing zone.
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Observational Study
Association Between the Presence of an Advanced Airway and Ventilation Rate during Pediatric CPR: A Report From the Videography in Pediatric Resuscitation (VIPER) Collaborative.
To determine the association between presence of an advanced airway during pediatric cardiopulmonary resuscitation (CPR) and ventilation rates. ⋯ During pediatric CPR, hyperventilation occurs more often with an AA in place than during CPR with NA. Future research should focus on respiratory physiology during pediatric CPR to determine optimal ventilation rate(s) during pediatric cardiac arrest.
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Early identification of brain injury patterns in computerized tomography (CT) imaging is crucial for post-cardiac arrest prognostication. Lack of interpretability of machine learning prediction reduces trustworthiness by clinicians and prevents translation to clinical practice. We aimed to identify CT imaging patterns associated with prognosis with interpretable machine learning. ⋯ We developed an interpretable method to identify patterns of early post-cardiac arrest brain injury on CT imaging and showed these imaging patterns are predictive of patient outcomes (i.e., survival and awakening status).
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Observational Study
Extracorporeal Membrane Oxygenation for the Treatment of Massive Pulmonary Embolism. An Analysis of the ELSO Database.
Extracorporeal membrane oxygenation (ECMO) may be beneficial in treatment of massive pulmonary embolus (PE), however the current evidence to guide its use is limited. We aimed to compare the incidence, characteristics, treatments, and outcomes of patients with massive PE by mode of ECMO from a large international registry. ⋯ ECMO use for massive PE is increasing globally, and overall mortality rates compare favorably with other indications of ECMO. The use of ECPR and worsening metabolic status at initiation were associated with higher in-hospital mortality, suggesting delays in initiating ECMO should be avoided.
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Volunteer responder dispatch to nearby out-of-hospital cardiac arrests using a smartphone application can increase the proportion of patients receiving cardiopulmonary resuscitation. It is unknown how population density is related to the efficacy of a volunteer responder system. This study aimed to compare the response time of volunteer responders and EMS dispatched to suspected OHCAs in areas of different population density. ⋯ Volunteer responders have significantly shorter response time than EMS regardless of population density, with the greatest difference in low population density areas. Although their impact on clinical outcome remains unknown, the benefits of dispatching volunteer responders to OHCAs may be greatest in rural areas.