Resuscitation
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Randomized Controlled Trial
Reduced hands-off-time and time to first shock in CPR according to the ERC Guidelines 2005.
Chest compressions and early defibrillation are crucial in cardiopulmonary resuscitation (CPR). The Guidelines 2005 brought major changes to the basic life support and automated external defibrillator (BLS-AED) algorithm. We compared the European Resuscitation Council's Guidelines 2000 (group '00) and 2005 (group '05) on hands-off-time (HOT) and time to first shock (TTFS) in an experimental model. ⋯ In this manikin setting, HOT and TTFS improved with BLS-AED performed according to Guidelines 2005.
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Randomized Controlled Trial
Effect of cooling after human cardiac arrest on myocardial infarct size.
The Hypothermia after Cardiac Arrest (HACA) trial assessed whether mild therapeutic hypothermia improved the rate of good neurological recovery in patients after ventricular fibrillation cardiac arrest of presumed cardiac origin. We evaluated the impact of hypothermia on myocardial injury. ⋯ Cooling after successful resuscitation for ventricular fibrillation cardiac arrest did not influence infarct size. Cautious interpretation of the subgroup analysis may indicate a favourable trend for early cooling.
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Comparative Study
'Do not attempt resuscitation'--do standardised order forms make a clinical difference above hand-written note entries?
To quantify any effect of Standardised Order Forms (SOFs), versus hand-written note entries for 'Do Not Attempt Resuscitation'--on the selection and survival of remaining cardiopulmonary resuscitation (CPR) attempts. ⋯ The introduction of SOFs for DNAR orders was associated with a significantly longer duration of CPR (on average by 3-4min) but no difference in overall number, demographics or type of arrest or survival in the remaining CPR attempts.
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A growing body of evidence suggests that variability in post-cardiac arrest care contributes to differential outcomes of patients with initial return of spontaneous circulation after cardiac arrest. We examined hospital-level variation in mortality of patients admitted to United States intensive care units (ICUs) with a diagnosis of cardiac arrest. ⋯ We demonstrate hospital-level variation in severity adjusted mortality among patients admitted to the ICU after cardiac arrest. We identify a volume-outcome relationship showing lower mortality among patients admitted to ICUs that treat a high volume of post-cardiac arrest patients. Prospective studies should identify hospital-level and patient care factors that contribute to post-cardiac arrest survival.