Articles: cardiac-arrest.
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Critical care medicine · Feb 2024
Meta AnalysisSupraglottic Airway Versus Tracheal Intubation for Airway Management in Out-of-Hospital Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials.
Given the uncertainty regarding the optimal approach for airway management for adult patients with out-of-hospital cardiac arrest (OHCA), we conducted a systematic review and meta-analysis to compare the use of supraglottic airways (SGAs) with tracheal intubation for initial airway management in OHCA. ⋯ In adult patients with OHCA, compared with tracheal intubation, the use of SGA for initial airway management probably leads to more ROSC, and faster time to airway placement, but may have no effect on longer-term survival outcomes or aspiration events.
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The clinical benefits of steroid therapy during cardiac arrest (CA) are unclear. Several recent clinical trials have shown that administering corticosteroid therapy during CA may improve patient outcomes. The purpose of the present study was to determine whether providing corticosteroids improves outcomes for patients following CA. ⋯ High-dose corticosteroid treatment (above 100 mg methylprednisolone) is associated with better overall survival rate at hospital discharge and ROSC outcomes. However, there is uncertainty regarding whether this treatment results in a benefit or harm to the favorable neurological outcomes at hospital discharge.
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Journal of critical care · Dec 2023
Review Meta AnalysisHigh versus low mean arterial pressure targets after out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials.
Targeting a specific mean arterial pressure (MAP) has been evaluated as a treatment strategy after out-of-hospital cardiac arrest (OHCA) resuscitation. However, the current evidence lacks clear guidelines regarding the optimal MAP target after OHCA. ⋯ A high MAP target may reduce ICU stay and mechanical ventilation duration but did not demonstrate improvements in either mortality or favorable neurological recovery. Therefore, the role of high MAP target remains uncertain and requires further RCTs.
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Extracorporeal cardiopulmonary resuscitation (ECPR), has demonstrated promise in the management of refractory out-of-hospital cardiac arrest (OHCA). However, evidence from observational studies and clinical trials are conflicting and the factors influencing outcome have not been well established. ⋯ The findings of this review confirm several clinical concepts wellestablished in the cardiac arrest literature and their applicability to the patient for whom ECPR is considered - that is, the impact of pre-existing patient factors, the benefit of timely and effective CPR, as well as the prognostic importance of minimizing low-flow time. We advocate for the thoughtful consideration of these prognostic factors as part of a risk stratification framework when evaluating a patient's potential candidacy for ECPR.
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Out-of-hospital cardiac arrest (OHCA) contributes to substantial mortality, but its resuscitation status in China is unknown. We aimed to describe and analyze out-of-hospital cardiac arrest in terms of Chain of Survival. ⋯ A low probability of first aid at multiple points is linked to poor survival following OHCA. It is essential to strengthen front links in the Chain of Survival in China, including among witnesses, bystanders, and emergency response.