Resuscitation
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Multicenter Study
Bougie-Assisted Endotracheal Intubation in the Pragmatic Airway Resuscitation Trial.
Paramedics may perform endotracheal intubation (ETI) while treating patients with out-of-hospital cardiac arrest (OHCA). The gum elastic Bougie (Bougie) is an intubation adjunct that may optimize intubation success. There are few reports of Bougie-assisted intubation in OHCA nor its association with outcomes. We compared intubation success rates and OHCA outcomes between Bougie-assisted and non-Bougie ETI in the out-of-hospital Pragmatic Airway Resuscitation Trial (PART). ⋯ While exhibiting slightly higher ETI overall success rates, Bougie-assisted ETI entailed longer airway placement times and potentially lower survival. The role of the Bougie assistance in ETI of OHCA remains unclear.
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Multicenter Study
Airway Insertion First Pass Success and Patient Outcomes in Adult Out-of-Hospital Cardiac Arrest: The Pragmatic Airway Resuscitation Trial.
While emphasized in clinical practice, the association between advanced airway insertion first-pass success (FPS) and patient outcomes is incompletely understood. We sought to determine the association of airway insertion FPS with adult out-of-hospital cardiac arrest (OHCA) outcomes in the Pragmatic Airway Resuscitation Trial (PART). ⋯ In adult OHCA, airway insertion FPS was associated with increased ROSC but not other OHCA outcomes. The influence of airway insertion FPS upon OHCA outcomes is unclear.
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Multicenter Study Observational Study
Non-linear association between arterial oxygen tension and survival after out-of-hospital cardiac arrest: a multicentre observational study.
Studies to identify safe oxygenation targets after out-of-hospital cardiac arrest (OHCA) have often assumed a linear relationship between arterial oxygen tension (PaO2) and survival, or have dichotomised PaO2 at a supra-physiological level. We hypothesised that abnormalities in mean PaO2 (both high and low) would be associated with decreased survival after OHCA. ⋯ The mean PaO2 within the first 24-hs after admission for OHCA has a non-linear association with the highest STHD seen between 100 and 180 mmHg. Randomised controlled trials are now needed to validate the optimal oxygenation targets in mechanically ventilated OHCA patients.
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Out-of-hospital cardiac arrest (OHCA) and chronic liver disease (CLD) are global health issues. The purpose of this study is to evaluate the association between chronic liver disease and clinical outcomes in OHCA. ⋯ OHCA patients with liver cirrhosis showed poor clinical outcomes and CLD had no negative association unless they progressed to cirrhotic status.
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Randomized Controlled Trial
The Design of an Adaptive Clinical Trial to Evaluate the Efficacy of Extra-Corporeal Membrane Oxygenation for Out-of-Hospital Cardiac Arrest.
Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising therapy for out-of-hospital cardiac arrest (OHCA) that is refractory to standard therapy, but no multicenter randomized clinical trials have been conducted to establish its efficacy. We report the design and operating characteristics of a proposed randomized Bayesian adaptive "enrichment" clinical trial designed to determine whether ECPR is effective for refractory OHCA and, if effective, to define the interval after arrest during which patients derive benefit. ⋯ This proposed adaptive trial design helps to ensure the population of patients who are most likely to benefit from treatment-as defined both by rhythm subgroup and estimated CA-to-ECPR interval-is enrolled. The design promotes early termination of the trial if continuation is likely to be futile.