Resuscitation
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Respective proportions of final etiologies are disparate in cohorts of cardiac arrest patients, depending on examined population and diagnostic algorithms. In particular, prevalence and characteristics of sudden unexplained death syndrome (SUDS) are debated. We aimed at describing etiologies in a large cohort of aborted out-of-hospital cardiac arrest (OHCA) patients, in order to assess prevalence and outcome of SUDS. ⋯ We observed that ischemic heart disease was by far the most common cause of cardiac arrest, while primary electrical diseases were much less frequent. SUDS accounted for a very small proportion of patients who suffered an aborted OHCA.
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Clear and efficient communication between emergency caller and call-taker is crucial to timely ambulance dispatch. We aimed to explore the impact of linguistic variation in the delivery of the prompt "okay, tell me exactly what happened" on the way callers describe the emergency in the Medical Priority Dispatch System®. ⋯ These results suggest that linguistic variations in the way the scripted sentences of a protocol are delivered can have an impact on the efficiency with which call-takers process emergency calls. A better understanding of interactional dynamics between caller and call-taker may translate into improvements of dispatch performance.
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Observational Study
Epileptiform discharge detection with the 4-channel frontal electroencephalography during post-resuscitation care.
We performed this study to investigate whether the SEDline system, a 4-channel-processed electroencephalography (EEG) monitoring device in the frontal area, can detect epileptiform discharges accurately during post-resuscitation care in comatose cardiac arrest survivors. ⋯ The SEDline system detected epileptiform discharges accurately in comatose cardiac arrest survivors during post-resuscitation care.
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Some patients with out-of-hospital cardiac arrest (OHCA) assessed by emergency medical services (EMS) do not receive attempts at resuscitation on the basis of perceived futility. ⋯ The proportion of patients with OHCA who receive resuscitation attempts is variable across EMS agencies and is associated with EMS response interval, ALS unit availability and geographic region. On average, survival was higher among EMS agencies more likely to initiate resuscitation.
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Traditional predictors of neurological prognosis after cardiac arrest are unreliable after targeted temperature management. Absence of pupillary reflexes remains a reliable predictor of poor outcome. Diffusion-weighted imaging has emerged as a potential predictor of recovery, and here we compare imaging characteristics to pupillary exam. ⋯ Post-anoxic diffusion changes using quantitative brain MRI may aid in predicting persistent coma and poor functional outcomes at hospital discharge.