Resuscitation
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Review Meta Analysis
Patients without ST elevation after return of spontaneous circulation may benefit from emergent percutaneous intervention: a systematic review and meta-analysis.
The American Heart Association recommends that post-arrest patients with evidence of ST elevation myocardial infarction (STEMI) on electrocardiogram (ECG) be emergently taken to the catheterization lab for percutaneous coronary intervention (PCI). However, recommendations regarding the utility of emergent PCI for patients without ST elevation are less specific. This review examined the literature on the utility of PCI in post-arrest patients without ST elevation compared to patients with STEMI. ⋯ The results of this systematic review demonstrate that nearly one third of patients who have been successfully resuscitated from cardiopulmonary arrest without ST elevation on ECG have an acute lesion that would benefit from emergent percutaneous coronary intervention.
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We aimed to determine the benefit of an expanded use of TH. We also described the impact of a targeted temperature management on outcomes at discharge. ⋯ The use of TH after OHCA is associated with a survival and neuroprotective benefit, even when including patients with non-shockable rhythms, more lenient downtimes, unwitnessed arrest and/or persistent shock. We found no evidence to support one specific temperature over another during hypothermia.
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Multicenter Study
Long-term survival benefit from treatment at a specialty center after cardiac arrest.
The Institute of Medicine and American Heart Association have called for tiered accreditation standards and regionalization of post-cardiac arrest care, but there is little data to support that regionalization has a durable effect on patient outcomes. We tested the effect of treatment at a high-volume center on long-term outcome after sudden cardiac arrest (SCA). ⋯ Treatment at a high-volume cardiac arrest center with organized systems for post-arrest care is associated with a substantial long-term survival benefit after hospital discharge.
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Multicenter Study Observational Study
A multicentre observational study of inter-hospital transfer for post-resuscitation care after out-of-hospital cardiac arrest.
To provide therapeutic hypothermia (TH) to survivors after out-of-hospital cardiac arrest (OHCA), inter-hospital transfers (IHT) are frequently required. The safety of IHT remains controversial. The aim of this study was to investigate whether the effect of TH on brain recovery after OHCA differs between IHT and direct arrival groups. ⋯ IHT modified the effect of TH on neurological recovery for survivors of OHCA. TH is significantly less beneficial for good neurological recovery in patients who arrive via IHT than for those who arrive directly.
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To identify reports of patients who underwent cardiopulmonary resuscitation (CPR) prior to solid organ donation and compare recipient and organ function outcomes to those that did not undergo CPR. Donation after restoration of circulation then progressing to death and those donating with on-going CPR who would have otherwise have termination of efforts were both included. ⋯ CPR does not appear to adversely affect graft function. Patients who have restored circulation after resuscitation and subsequently progress to death should be evaluated for organ donation. Those with on-going CPR should be considered for hepatic and renal transplantation but there may be worse initial graft function.