Resuscitation
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Prognostication following out-of-hospital cardiac arrest (OHCA) remains challenging. A multimodal approach is favoured, including consideration of the biomarker neuron-specific enolase (NSE) (Sandroni et al., 2014). Our objective was to investigate the utility of serial NSE measurements and to determine an appropriate cut-off value for prediction of death before hospital discharge using data from our tertiary care center. ⋯ Serial measurement of NSE levels (at 0 and 48 h after admission) provides a useful tool to aid prognostication following out-of-hospital cardiac arrest.
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Cardiopulmonary resuscitation guidelines suggest the lower sternal half be compressed. However, stroke volume has been assumed to be maximized by compressing the 'point' (P_max.LV) beneath which the left ventricle (LV) is at its maximum diameter. Identifying 'personalized' P_max.LV on computed tomography (CT), we derived and validated rules to estimate P_max.LV using posteroanterior chest radiography (chest_PA). ⋯ Personalized P_max.LV, which is potentially superior to the lower sternal half and feasible in CA, is estimable with chest_PA.
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To determine the optimal mean arterial pressure (MAP) during the early-to-intermediate phase care of comatose survivors of out-of-hospital cardiac arrest (OHCA). ⋯ In comatose survivors of OHCA with an initial shockable rhythm, higher ABT is associated with increased rates of severe neurological dysfunction when MAP thresholds <75 mmHg are used. The current findings support the hypothesis that higher MAP targets (≥75 mmHg) may be indicated in this patient population.
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The incidence of cardiac arrest is high, with a poor survival rate of 8-14%. Currently, only limited evidence is available about long-term consequences of cardiac arrest on quality of life of caregivers. ⋯ Two years after the cardiac arrest, quality of life of caregivers is quite good, but almost one third of the caregivers still experience a high level of trauma-related stress, especially in those that witnessed the resuscitation. Future research will have to focus on the effectiveness of support programs for caregivers of survivors of cardiac arrest.
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Observational Study
Presetting ECG electrodes for earlier heart rate detection in the delivery room.
To determine whether heart rate (HR) could be detected earlier than by pulse oximeter (POX), using a novel method of application of electrocardiogram (ECG) electrodes during neonatal resuscitation in the delivery room. ⋯ In the delivery room, electrodes applied by the study method are more effective than pulse oximetry in providing the neonatal team with timely HR information that is necessary for proper resuscitative actions.