Resuscitation
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Randomized Controlled Trial
Interleukin 6 blockage alters the plasma metabolome in out-of-hospital cardiac arrest.
Comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA) exhibit a systemic inflammatory response, as indicated by elevated interleukin-6 (IL-6) levels, which is associated with increased mortality. Tocilizumab, an IL-6 receptor antagonist that reduced C-reactive protein response and markers of myocardial injury in a phase II OHCA trial. ⋯ Blocking the IL-6 receptor with tocilizumab early after OHCA impacts circulating metabolites, particularly those within the glycine, serine, and threonine pathways, highlighting the connection between acute systemic inflammation and metabolism. Further, early levels of TCA metabolites are independently associated with early inflammatory response and early medium-chain acylcarnitine with later markers of neurological injury.
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Multicenter Study
Outcomes of extracorporeal life support in hypothermic cardiac arrest: Revisiting ELSO guidelines.
Predictive factors for poor outcomes in hypothermic cardiac arrest (HCA) differ from those in normothermic out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the outcomes of extracorporeal life support (ECLS) in HCA patients who may not be considered eligible based on the guidelines set by the Extracorporeal Life Support Organization (ELSO). ⋯ Qualification of patients with hypothermic cardiac arrest for ECLS rewarming should not be strictly based on guidelines for normothermic cardiac arrest, as this may result in not initiating potentially life-saving treatment for patients who could have favourable prognoses for survival with good neurological outcomes.
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Multicenter Study
Lung parenchymal and pleural findings on computed tomography after out-of-hospital cardiac arrest.
Lung injury and the acute respiratory distress syndrome (ARDS) are common after out-of-hospital cardiac arrest (OHCA), but the imaging characteristics of lung parenchymal and pleural abnormalities in these patients have not been well-characterized. We aimed to describe the incidence of lung parenchymal and pleural findings among patients who had return of spontaneous circulation (ROSC) and who underwent computed tomography (CT) of the chest after OHCA. ⋯ Over three-quarters of patients who survived to the hospital post OHCA and received a chest CT had lung parenchymal or pleural abnormalities, the most common of which were aspiration, pulmonary edema, and consolidation/pneumonia. Future planned research will characterize the clinical impact of these findings and whether early chest CT could identify patients at risk for ARDS or other pulmonary complications.
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This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. ⋯ Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.
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Whether targeted temperature management (TTM) might improve neurologic prognosis in patients after cardiac arrest is currently under debate. Data concerning sedation depth during TTM is rare. This study aimed to compare the impact of different sedation depths on neurological outcomes in post-cardiac arrest patients undergoing TTM. ⋯ Lighter sedation strategies during TTM after cardiac arrest might improve outcome and should be further investigated.