Resuscitation
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Electroencephalography (EEG) has clinical and prognostic importance after cardiac arrest (CA). Recently, interest in quantitative EEG (qEEG) analysis has grown. The qualitative effects of sedation on EEG are well known, but potentially confounding effects of sedatives on qEEG after anoxic injury are poorly characterized. We hypothesize that sedation increases suppression ratio (SR) and decreases alpha/delta ratio (ADR) and amplitude-integrated EEG (aEEG), and that the magnitude of sedation effects will be associated with outcome. ⋯ Higher aEEG and lower SR predict survival after CA. Sedation alters aEEG and SR, but importantly does not appear to affect the relationship between these parameter values and outcome.
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International guidelines recommend administration of 1 mg of intravenous epinephrine every 3-5 min during cardiac arrest. The optimal dose of epinephrine is not known. We evaluated the association of reduced frequency and dose of epinephrine with survival after out-of-hospital cardiac arrest (OHCA). ⋯ Reducing the dose of epinephrine administered during out-of-hospital cardiac arrest was not associated with a change in survival to hospital discharge or favorable neurological outcomes after OHCA.
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Resuscitation on in-hospital cardiac arrest (IHCA) is estimated to occur in 200,000 hospitalised patients annually in the US and short-term survival, i.e. 30 days, is reported to be around 15-20%. Even if 30-day survival is a good measure of successful resuscitation, the number of survivors is quite high and a perspective on longer-term outcomes is relevant. ⋯ In conclusion, long-term survival after an IHCA is quite good irrespective of initial rhythm but is related to the burden of baseline co-morbidities.
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Observational Study
The association between tidal volume and neurological outcome following in-hospital cardiac arrest.
Prior investigation has found that mechanical ventilation with lower tidal volumes (Vt) following out-of-hospital cardiac arrest is associated with better neurologic outcomes. The relationship between Vt and neurologic outcome following in-hospital cardiac arrest (IHCA) has not previously been explored. In the present study, we investigate the association between Vt and neurologic outcome following IHCA. ⋯ This study did not identify a relationship between Vt and neurologic outcome following IHCA. This contrasts with results in OHCA, where higher Vt has been associated with worse neurologic outcome. Additional investigation is needed with respect to other potential benefits of low-Vt post IHCA.
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Observational Study
Palliative care utilization following out-of-hospital cardiac arrest in the United States.
Palliative care (PC) has become an integral component of comprehensive care provided to critically ill patients. Little is known about the utilization of palliative care following Out-of-Hospital Cardiac Arrest (OHCA) in the United States. ⋯ We observed significant increase in the utilization of palliative care consultations following OHCA over the study period. This was influenced by multiple patient and hospital factors. Further investigations are needed to identify the appropriate cost-effective use of palliative care following cardiac arrest.