Current opinion in critical care
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Refractory cardiac arrest still has a grave prognosis under conventional cardiopulmonary resuscitation (CPR). We present the recent studies in extracorporeal CPR (ECPR) for the treatment of refractory cardiac arrest. ⋯ In this review, survival after ECPR was generally best after pediatric IHCA (38-57%), followed by adult IHCA (34-46%) and then adult OHCA (4-36%). Most studies reported that longer conventional CPR duration was associated with mortality after ECPR; however, there was no consensus on the optimal conventional CPR duration before ECPR initiation. Future studies might focus on the indications for ECPR, which should maximize the survival potential after ECPR while reducing the overuse of this resource-intensive facility.
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To reiterate the necessity of integrating echocardiography in the management of shocked patients and to propose a step-by-step functional evaluation of hemodynamics proven to optimize hemodynamic monitoring and to adapt the treatment. ⋯ Echocardiography has become a hemodynamic monitoring technique used worldwide. It allows to make a quick and simple diagnosis of typical hemodynamic situations, by means of basic CCE, and also to achieve real functional hemodynamic monitoring, through advanced CCE.
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Curr Opin Crit Care · Jun 2013
ReviewRegistries to measure and improve outcomes after cardiac arrest.
Cardiac arrest registries are used to measure and improve the process and outcome of resuscitation care, and can give insight into risk factors, prognosis, and the effectiveness of interventions to mitigate its impact. This review provides an overview of current out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA) registries, with attention to key recent findings and future directions. ⋯ OHCA and IHCA registries are invaluable in advancing our understanding of resuscitation care, as well as variations in international practice. Investigations that compare and contrast outcomes from established and evolving registries will help advance resuscitation science further.
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Cardiopulmonary resuscitation (CPR) is a fundamental component of initial care for the victim of cardiac arrest. In the past few years, increasing quantitative evidence has demonstrated that survival from cardiac arrest is dependent on the quality of delivered CPR. This review will focus on this body of evidence and on a range of practical approaches to improving CPR performance. ⋯ A number of strategies have been evaluated to improve CPR performance. While many questions remain surrounding the relative value of each approach, it is likely that combinations of these methods may be useful in a variety of care settings to improve care for cardiac arrest victims.
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Evidence of suboptimal cardiopulmonary resuscitation (CPR) delivery in practice has driven interest in strategies to improve CPR quality. Early data suggest that debriefing may be an effective strategy. In this review, we analyse types of debriefing and the evidence to support their usage. ⋯ Debriefing is a useful strategy to improve resuscitation performance, but the optimal delivery method remains unclear. Future high-quality research is required to identify the most effective form of debriefing.