Articles: out-of-hospital-cardiac-arrest.
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Randomized Controlled Trial Multicenter Study Pragmatic Clinical Trial
Time-differentiated target temperature management after out-of-hospital cardiac arrest: a multicentre, randomised, parallel-group, assessor-blinded clinical trial (the TTH48 trial): study protocol for a randomised controlled trial.
The application of therapeutic hypothermia (TH) for 12 to 24 hours following out-of-hospital cardiac arrest (OHCA) has been associated with decreased mortality and improved neurological function. However, the optimal duration of cooling is not known. We aimed to investigate whether targeted temperature management (TTM) at 33 ± 1 °C for 48 hours compared to 24 hours results in a better long-term neurological outcome. ⋯ This is the first randomised trial to investigate the effect of the duration of TTM at 33 ± 1 °C in adult OHCA patients. We anticipate that the results of this trial will add significant knowledge regarding the management of cooling procedures in OHCA patients.
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Randomized Controlled Trial Multicenter Study
Association of early withdrawal of life-sustaining therapy for perceived neurological prognosis with mortality after cardiac arrest.
Withdrawing life-sustaining therapy because of perceived poor neurological prognosis (WLST-N) is a common cause of hospital death after out-of-hospital cardiac arrest (OHCA). Although current guidelines recommend against WLST-N before 72h (WLST-N<72), this practice is common and may increase mortality. We sought to quantify these effects. ⋯ After OHCA, death following WLST-N<72 may be common and is potentially avoidable. Reducing WLST-N<72 has national public health implications and may afford an opportunity to decrease mortality after OHCA.
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Multicenter Study
Long-Term Neurologic Outcomes following Paediatric Out-of-Hospital Cardiac Arrest.
Evaluate long-term neurologic outcome for paediatric survivors of OHCA. ⋯ In this cohort study of neurologic outcomes for paediatric OHCA survivors, a favorable initial PCPC score was highly associated with stable long-term neurological outcomes. Those with poor neurologic status at initial discharge were unlikely to improve and were at greatest risk to die in follow-up. Future studies should focus on improving neurologic outcomes and prospectively evaluating the long-term neurologic course.
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Multicenter Study Clinical Trial
A before-after interventional trial of dispatcher-assisted cardio-pulmonary resuscitation for out-of-hospital cardiac arrests in Singapore.
To evaluate the effects of a comprehensive dispatcher-assisted CPR (DACPR) training program on bystander CPR (BCPR) rate and the outcomes of out-of-hospital cardiac arrest (OHCA) in Singapore. ⋯ A significant increase in BCPR and ROSC was observed after the intervention. There was a trend to suggest improved survival outcomes with the intervention pending further results from the trial.
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Target temperature management (TTM) after cardiac arrest (CA) improves outcome in patients with acute coronary syndrome (ACS). Previous data point to an interaction between hypothermia and drug metabolism, potentially impacting on platelet function in patients on antiplatelet therapy. ⋯ Inhibition of platelet function is significantly lessened in TTM at 33°C, likely due to reduced clopidogrel absorption. Patients with TTM might thus have a higher risk for further cardiovascular events despite antiplatelet therapy with clopidogrel.