Resuscitation
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Across the world, many systems have implemented extracorporeal cardiopulmonary resuscitation (ECPR) as a potential treatment strategy for patients in refractory cardiac arrest. To date, there are no universally accepted criteria for patient selection for ECPR. We conducted a systematic review to explore the variability in patient eligibility criteria for ECPR across systems. ⋯ PROSPERO (CRD42023451109).
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Review
EEG reactivity in neurologic prognostication in post-cardiac arrest patients: A narrative review.
Electroencephalographic reactivity (EEG-R) is a promising early predictor of arousal in comatose patients after cardiac arrest. Despite recent guidelines advocating for the integration of EEG-R into the multimodal prognostication model, EEG-R testing methods remain heterogeneous across studies. ⋯ In this narrative review, we explore the value and possible mechanisms of EEG-R, focusing on post-cardiac arrest comatose patients. We aim to discuss the current standard of knowledge and future directions, as well as elucidate possible implications for patient care and research.
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Comparative Study
Comparison of end tidal CO2 levels between automated head up and conventional cardiopulmonary resuscitation: A pre-post intervention trial.
The combination of controlled automated head/thorax elevation, active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), and an impedance threshold device (ITD-16), termed AHUP-CPR, lowers intracranial pressure and increases circulation and neurologically-sound survival in pigs versus conventional (C) CPR. This study examined whether AHUP-CPR increased end tidal (ET) CO2, a non-invasive marker of cardiac output and organ perfusion, compared with C-CPR in witnessed out-of-hospital cardiac arrest patients. ⋯ ETCO2 values during AHUP-CPR reached the range of non-arrest normal physiological levels and were significantly higher than with C-CPR, regardless of the presenting cardiac rhythm.
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EEG is considered in guidelines for poor outcome prognostication in comatose patients after cardiac arrest (CA), but elements related to favorable prognosis have also been increasingly described. While spindle EEG activity is known to herald good outcome in critically ill patients, its occurrence in CA has received limited attention, essentially in pediatric cohorts. We postulated that this feature is related to favorable outcome in adults. ⋯ Spindle-like EEG activity may orient on prognostication of favorable outcome in adult post CA patients, and correlates with lower neuronal damage.
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Observational Study
Heart rhythm at hospital admission: A factor for survival and neurological outcome among ECPR recipients?
The initial rhythm is a known predictor of survival in extracorporeal cardiopulmonary resuscitation (ECPR) patients. However, the effect of the rhythm at hospital admission on outcomes in these patients is less clear. ⋯ The rhythm at hospital admission affects ECPR outcomes. Patients presenting with and maintaining ventricular fibrillation have a higher chance of favorable neurological survival, whereas those presenting with or converting to asystole have poor outcomes. The rhythm at hospital admission appears to be a valuable criterion for deciding on ECPR initiation.