Resuscitation
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Randomized Controlled Trial
Neurobehavioural outcomes in children after In-Hospital cardiac arrest.
Children who remain comatose after in-hospital cardiac arrest (IH-CA) resuscitation are at risk for poor neurological outcome. We report results of detailed neurobehavioural testing in paediatric IH-CA survivors, initially comatose after return of circulation, and enrolled in THAPCA-IH, a clinical trial that evaluated two targeted temperature management interventions (hypothermia, 33.0 °C or normothermia, 36.8 °C; NCT00880087). ⋯ In paediatric IH-CA survivors at high risk for unfavorable outcomes, the majority demonstrated significant declines in neurobehavioural functioning, across multiple functional domains, with similar functioning at 3 and 12 months. About three-quarters attained VABS-II functional performance composite scores within the broadly normal range.
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Randomized Controlled Trial
Can rescuers accurately deliver subtle changes to chest compression depth if recommended by future guidelines?
A recent study reported that a compression depth of 4.56 cm optimised survival following cardiac arrest, which is at variance with the current guidelines of 5.0-6.0 cm. A reduction in recommended compression depth is only likely to improve survival if healthcare professionals can accurately deliver a relatively small change in target depth. This study aimed to determine if healthcare professionals could accurately judge their delivered compression depth by 0.5 cm increments. ⋯ Rescuers are able to judge 0.5 cm differences in compression depth with precision, but remain unable to accurately judge overall target depth. Reducing the current recommended compression depth to 4.56 cm is likely to result in delivered compressions significantly below the optimal depth.
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Randomized Controlled Trial
Hemodynamic effects of IV sodium nitrite in hospitalized comatose survivors of out of hospital cardiac arrest.
Patients resuscitated from cardiac arrest have brain and cardiac injury. Recent animal studies suggest that the administration of sodium nitrite after resuscitation from 12min of asystole limits acute cardiac dysfunction and improves survival and neurologic outcomes. It has been hypothesized that low doses of IV sodium nitrite given during resuscitation of out of hospital cardiac arrest (OHCA) will improve survival. Low doses of sodium nitrite (e.g., 9.6mg of sodium nitrite) are safe in healthy individuals, however the effect of nitrite on blood pressure in resuscitated cardiac arrest patients is unknown. ⋯ Low dose sodium nitrite does not cause significant hemodynamic effect in patients with OHCA, which suggests that nitrite can be delivered safely in this critically ill patient population. Higher doses of sodium nitrite are necessary in order to achieve target serum level of 10μM.
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Randomized Controlled Trial Multicenter Study
Neuron-specific enolase and S-100b in prolonged targeted temperature management after cardiac arrest: A randomised study.
We aimed to investigate the impact of prolonged targeted temperature management (TTM) in cardiac arrest patients on release of serum levels of NSE and S-100b and their prognostic performances. ⋯ No clinically relevant differences were found in the levels of NSE or S-100b between standard and prolonged TTM. Prognostic reliability of NSE and S-100b was unaltered by prolonged TTM.
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Randomized Controlled Trial Multicenter Study
Prehospital cooling to improve successful targeted temperature management after cardiac arrest: A randomized controlled trial.
Targeted temperature management (TTM) improves survival with good neurological outcome after out-of-hospital cardiac arrest (OHCA), but is delivered inconsistently and often with delay. ⋯ Prehospital cooling initiated 5min after ROSC did not increase rates of achieving a target temperature of 32-34°C within 6h of hospital arrival but was safe and increased application of TTM in hospital.