Resuscitation
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Review Meta Analysis
Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis.
Association estimates between baseline characteristics and outcomes are imprecise and inconsistent among extracorporeal cardiopulmonary resuscitation (ECPR) recipients following refractory out-of-hospital cardiac arrest (OHCA). This systematic review and meta-analysis aimed to investigate the prognostic significance of pre-specified characteristics for OHCA treated with ECPR. ⋯ Observational evidence from published primary studies indicates that shorter low-flow duration, shockable cardiac rhythm, higher arterial pH value and lower serum lactate concentration on hospital admission are associated with better outcomes for ECPR recipients after OHCA.
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Review Meta Analysis
A systematic review and meta-analysis of the association between arterial carbon dioxide tension and outcomes after cardiac arrest.
Arterial carbon dioxide tension (PaCO2) abnormalities are common after cardiac arrest (CA). Maintaining a normal PaCO2 makes physiological sense and is recommended as a therapeutic target after CA, but few studies have examined the association between PaCO2 and patient outcomes. This systematic review and meta-analysis aimed to assess the effect of a low or high PaCO2 on patient outcomes after CA. ⋯ From the limited data it appears PaCO2 has an important U-shape association with survival and outcomes after CA, consistent with international resuscitation guidelines' recommendation that normocarbia be targeted during post-resuscitation care.
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Letter Meta Analysis
Achieved glucose level and mortality risk in randomized clinical trials.
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Review Meta Analysis
Patients without ST elevation after return of spontaneous circulation may benefit from emergent percutaneous intervention: a systematic review and meta-analysis.
The American Heart Association recommends that post-arrest patients with evidence of ST elevation myocardial infarction (STEMI) on electrocardiogram (ECG) be emergently taken to the catheterization lab for percutaneous coronary intervention (PCI). However, recommendations regarding the utility of emergent PCI for patients without ST elevation are less specific. This review examined the literature on the utility of PCI in post-arrest patients without ST elevation compared to patients with STEMI. ⋯ The results of this systematic review demonstrate that nearly one third of patients who have been successfully resuscitated from cardiopulmonary arrest without ST elevation on ECG have an acute lesion that would benefit from emergent percutaneous coronary intervention.
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Review Meta Analysis
Amiodarone or lidocaine for cardiac arrest: A systematic review and meta-analysis.
Guidelines for treatment of out-of-hospital cardiac arrest (OOH-CA) with shockable rhythm recommend amiodarone, while lidocaine may be used if amiodarone is not available. Recent underpowered evidence suggests that amiodarone, lidocaine or placebo are equivalent with respect to survival at hospital discharge, but amiodarone and lidocaine showed higher hospital admission rates. We undertook a systematic review and meta-analysis to assess efficacy of amiodarone vs lidocaine vs placebo. ⋯ Amiodarone and lidocaine equally improve survival at hospital admission as compared with placebo. However, neither amiodarone nor lidocaine improve long-term outcome.