Resuscitation
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Observational Study
Serum Tau as a predictor for neurological outcome after cardiopulmonary resuscitation.
We evaluated serum tau protein as biomarker for poor neurological outcome over an extended observation period in patients after successful cardiopulmonary resuscitation (CPR) treated with mild therapeutic hypothermia (MTH) or normothermia (NT). ⋯ Serum tau showed highest values and the best prognostic discrimination of poor neurological outcome at 72-96 h after CPR. Prolonged elevation may indicate ongoing axonal damage in patients with hypoxic encephalopathy.
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Predicting outcome after cardiac arrest is challenging. We previously tested group-based trajectory modeling (GBTM) for prognostication based on baseline characteristics and quantitative electroencephalographic (EEG) trajectories. Here, we describe implementation of this method in a freely available software package and test its performance against alternative options. ⋯ We explored fundamentally different tools for patient-level predictions based on longitudinal and time-invariant patient data. Of the evaluated methods, GBTM resulted in optimal sensitivity while maintaining a false positive rate <1%. The provided code and software of this method provides an easy-to-use implementation for outcome prediction based on GBTMs.
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Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapies. Many institutions are interested in developing their own ECPR program. However, there may be challenges in logistics and implementation. ⋯ ECPR is an infrequent occurrence in EMS practice. Most apparently eligible patients did not get ECPR, highlighting the need for ongoing programmatic development, provider education, and qualitative work exploring barriers to implementation.
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Infectious complications frequently occur in intensive care unit patients admitted after out-of-hospital cardiac arrest. There is debate on the effects of temperature management on the incidence of infections, as well as on the efficacy and choice of antibiotic prophylaxis. In this substudy of the targeted temperature management (TTM) trial, we describe the microbiological profile of infectious complications in patients with cardiac arrest and examined the impact of TTM at 33 °C compared to TTM at 36 °C. Furthermore we aimed to determine the association between antibiotic prophylaxis and the incidence of infections. ⋯ Gram-negative pathogens are the most common causes of nosocomial infections following cardiac arrest. TTM does not impact the microbiological profile. It remains unclear whether patients in ICUs using antibiotic prophylaxis have a reduced risk of pneumonia and bacteremia that is unrelated to center effects.
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To investigate the association between consciousness status at hospital arrival and long-term outcomes in out-of-hospital cardiac arrest (OHCA) patients. ⋯ Consciousness status at hospital arrival was strongly associated with 30-day survival in OHCA patients. Among 30-day survivors, a minority was diagnosed with anoxic brain damage or admitted to a nursing home and the majority returned to work independent of consciousness status at hospital arrival.