Resuscitation
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Identifying reversible causes of cardiac arrest is challenging. The diagnosis of pulmonary embolism is often missed. Pulmonary embolism increases alveolar dead space resulting in low end-tidal CO2 (EtCO2) relative to arterial CO2 (PaCO2) tension. Thus, a low EtCO2/PaCO2 ratio during resuscitation may be a sign of pulmonary embolism. ⋯ A low EtCO2/PaCO2 ratio during cardiopulmonary resuscitation suggests pulmonary embolism.
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Only up to 20% of patients with out-of-hospital cardiac arrest (OHCA) receive immediate and optimal initial cardiac resuscitation and consequently regain consciousness soon after return of spontaneous circulation (ROSC). In the present study, we compared the outcome of conscious survivors of OHCA presenting with ST-elevation myocardial infarction (STEMI) in post-resuscitation electrocardiogram undergoing immediate invasive coronary strategy with randomly selected STEMI patients without preceding OHCA undergoing primary PCI. ⋯ Conscious survivors of OHCA with STEMI have excellent survival if they undergo immediate invasive coronary strategy. Since there is no obvious post-resuscitation brain injury in this subgroup of OHCA patients, it is probably shorter duration of myocardial ischemia driven by shorter delay from symptoms to EMS arrival that contributes to the good outcome, which is at least similar to STEMI patients without OHCA.
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Comment Letter
Out-of-hospital cardiac arrest termination of resuscitation.
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Hypoxic-ischemic brain injury is the main cause of death and disability of comatose patients after cardiac arrest. Early and reliable prognostication is challenging. Common prognostic tools include clinical neurological examination and electrophysiological measures. Brain imaging is well established for diagnosis of focal cerebral ischemia but has so far not found worldwide application in this patient group. ⋯ CT derived grey-white matter ratio and MRI based measures of diffusivity and connectivity hold promise to improve outcome prediction after cardiac arrest. Prospective validation studies in a multivariable approach are needed to determine the additional value for the individual patient.
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Observational Study
Pulseless electrical activity is associated with improved survival in out-of-hospital cardiac arrest with initial non-shockable rhythm.
To describe the prevalence, baseline characteristics and factors associated with survival in out-of-hospital cardiac arrest (OHCA) with initial non-shockable rhythm sub-grouped into pulseless electrical activity (PEA) and asystole as presenting rhythm. ⋯ Between 1990 and 2016, the proportion of PEA as the first recorded rhythm doubled with a five-fold increase in 30-day survival, while survival among patients with asystole remained at low levels. PEA and asystole should be considered separate entities in clinical decision-making and be reported separately in observational studies and clinical trials.