Resuscitation
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Randomized Controlled Trial Multicenter Study Comparative Study
TARGET TEMPERATURE MANAGEMENT OF 33°C AND 36°C IN PATIENTS WITH OUT-OF-HOSPITAL CARDIAC ARREST WITH INITIAL NON-SHOCKABLE RHYTHM - A TTM SUB-STUDY.
Despite a lack of randomized trials in comatose survivors of out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm (NSR), guidelines recommend induced hypothermia to be considered in these patients. We assessed the effect on outcome of two levels of induced hypothermia in comatose patient resuscitated from NSR. ⋯ Comatose patients after OHCA with initial NSR continue to have a poor prognosis. We found no effect of targeted temperature management at 33°C compared to 36°C in these patients.
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Multicenter Study
Quantitative relationship between end-tidal carbon dioxide and CPR quality during both in-hospital and out-of-hospital cardiac arrest.
Cardiopulmonary resuscitation (CPR) guidelines recommend the administration of chest compressions (CC) at a standardized rate and depth without guidance from patient physiologic output. The relationship between CC performance and actual CPR-generated blood flow is poorly understood, limiting the ability to define "optimal" CPR delivery. End-tidal carbon dioxide (ETCO2) has been proposed as a surrogate measure of blood flow during CPR, and has been suggested as a tool to guide CPR despite a paucity of clinical data. We sought to quantify the relationship between ETCO2 and CPR characteristics during clinical resuscitation care. ⋯ ETCO2 values generated during CPR were statistically associated with CC depth and ventilation rate. Further studies are needed to assess ETCO2 as a potential tool to guide care.
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Multicenter Study
Shorter time to target temperature is associated with poor neurologic outcome in post-arrest patients treated with targeted temperature management.
Time to achieve target temperature varies substantially for patients who undergo targeted temperature management (TTM) after cardiac arrest. The association between arrival at target temperature and neurologic outcome is poorly understood. We hypothesized that shorter time from initiation of cooling to target temperature ("induction") will be associated with worse neurologic outcome, reflecting more profound underlying brain injury and impaired thermoregulatory control. ⋯ In this multicenter cohort of post-arrest TTM patients, shorter induction time was associated with poor neurologic outcome.
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Multicenter Study Observational Study
Correlation between initial serum levels of lactate after return of spontaneous circulation and survival and neurological outcomes in patients who undergo therapeutic hypothermia after cardiac arrest.
We analysed the relationship between serum levels of lactate within 1h of return of spontaneous circulation (ROSC) and survival and neurological outcomes in patients who underwent therapeutic hypothermia (TH). ⋯ High levels of lactate in serum measured within 1h of ROSC are associated with hospital mortality and high CPC scores in cardiac arrest patients treated with TH.
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Multicenter Study
Do early emergency calls before patient collapse improve survival after out-of-hospital cardiac arrests?
Some out-of-hospital cardiac arrests (OHCAs) are witnessed after emergency calls. This study aimed to confirm the benefit of early emergency calls before patient collapse on survival after OHCAs witnessed by bystanders and/or emergency medical technicians (EMTs). ⋯ Early emergency calls before patient collapse efficiently increases the proportion of EMT-witnessed cases and promotes survival after witnessed OHCAs. However, early emergency call before collapse may worsen the outcome when the patient's condition deteriorates to cardiac arrest before EMT arrival.