Resuscitation
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Cerebral edema after cardiac arrest can be quantified by the ratio of grey matter to white matter radiodensity (GWR) on computed tomography (CT). Severe edema predicts worse outcomes. We hypothesized the sensitivity and false positive rate of GWR predicting outcomes change over the first 24 hours post-arrest. ⋯ The sensitivity and FPR of early GWR predicting in-hospital mortality and DNC after resuscitation from cardiac arrest varies over the initial post-arrest period. Reduced GWR on brain CTs is most sensitive for in-hospital mortality when obtained more than four hours post-arrest and for DNC when obtained between four and five hours. However, FPR remained execellent throughout, making early reductions in GWR a specific marker of poor outcome regardless of timing. While brain CTs obtained within the first 24 hours post-arrest may be indicated to evaluate for neurologic etiologies of arrest, they may be less informative as an independent marker of prognosis.
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To summarise evidence on the clinical effectiveness of initial vascular attempts via the intraosseous route compared to the intravenous route in adult cardiac arrest. ⋯ Initial vascular access attempts via the intraosseous, compared with intravenous, route in adult cardiac arrest did not improve 30-day survival and may reduce the odds of a sustained return of spontaneous circulation.