Resuscitation
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Sex differences exist in the diagnosis and treatment of several cardiovascular diseases. Our objective was to determine whether sex differences exist in the use of guideline-recommended treatments in out-of-hospital cardiac arrest (OHCA). ⋯ Women were less likely than men to receive guideline-recommended treatments for OHCA. The reasons for these differences require further exploration, and EMS provider education and training should specifically address these sex differences in the treatment of OHCA.
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To prospectively investigate cognitive recovery from 3 to 12 months after resuscitation from out-of-hospital cardiac arrest (OHCA) and the associations between cognitive performance at 3 months and health-related quality of life (HRQL), psychological distress and work status after 12 months. ⋯ The current data describe stability in results from 3 to 12 months. A worse cognitive performance at 3 months and higher reports of psychological distress were associated with lower HRQL.
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Time without ventilation is often much longer than an intubation attempt, yet patient stability relies on effective gas exchange. We argue that in addition to existing performance criteria, intubation performance measures should include interruption to effective ventilation. ⋯ Time without ventilation is a more physiologically important measure of a resuscitation team's intubation expertise than laryngoscope duration. Since successful attempts took longer than failed attempts, emphasising haste during vocal cord visualisation and tube insertion may reduce success rates. Reducing the time without ventilation at either end of the procedure may be achievable with better team coordination and could be just as important to patient wellbeing as technical precision.
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Unrecognised endotracheal tube misplacement in emergency intubations has a reported incidence of up to 17%. Current detection methods have many limitations restricting their reliability and availability in these circumstances. There is therefore a clinical need for a device that is small enough to be practical in emergency situations and that can detect oesophageal intubation within seconds. In a first reported evaluation, we demonstrated an algorithm based on pressure waveform analysis, able to determine tube location with high reliability in healthy patients. The aim of this study was to validate the specificity of the algorithm in patients with abnormal pulmonary compliance, and to demonstrate the reliability of a newly developed small device that incorporates the technology. ⋯ The algorithm retained its specificity in patients with decreased pulmonary compliance. We also demonstrated the feasibility to integrate sensors and diagnostic hardware in a small, portable hand-held device for convenient use in emergency situations.
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Observational Study
Therapeutic hypothermia and outcomes in paediatric out-of-hospital cardiac arrest: A nationwide observational study.
This study aimed to analyse the association between mild therapeutic hypothermia (MTH) and outcomes in paediatric patients who survived out-of-hospital cardiac arrest (OHCA) by using their initial electrocardiogram (ECG) rhythm, which is the key factor used to predict prognosis in paediatric OHCA. ⋯ MTH and the effect of MTH across the initial ECG at the scene were not significantly associated with survival or good neurologic recovery in paediatric OHCA survivors.