Resuscitation
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Each year, millions of neonates require supportive interventions in the delivery room (DR) during the transition from intrauterine to extrauterine life. Resuscitation guidelines are critical for healthcare providers managing these neonates and rely on current evidence of real-world DR management. However, data on the actual frequency of various supportive interventions are often limited, focused on single centers or outdated. This study aims to describe the current practice of neonatal resuscitation and support in the DR and to provide evidence for the development of clinical guidelines. ⋯ This study provides comprehensive data on the use of supportive interventions in neonatal resuscitation from different countries around the world. The findings can inform the development of future resuscitation guidelines and training programs. In addition, the data highlight the need for improved dissemination of evidence-based practices to ensure consistent and optimal care for neonates in the DR.
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Mitochondrial transplantation (MTx) is an emerging strategy for restoring cellular bioenergetics and mitigating ischemia-reperfusion (IR) injury. We previously demonstrated that MTx improved neurological outcomes and survival in a rat model of cardiac arrest (CA). However, the mechanisms underlying these benefits, particularly regarding immune modulation and transcriptional regulation, remain unclear. ⋯ MTx improves outcomes after CA, accompanied by mitochondrial uptake by immune cells and redistribution to injured tissues. This process likely modulates immune responses, enhances mitochondrial fusion, and activates cytoprotective gene expression.
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Amiodarone is used in shockable out-of-hospital cardiac arrest (OHCA), but the ideal dose is unknown. ⋯ In patients with shockable OHCA who received 5 or more defibrillation attempts, a dose of amiodarone 300 mg was associated with a similar survival compared with a total dose of amiodarone 450 mg. Further study is needed to evaluate the need for a second administration of amiodarone in patients with shockable OHCA.
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The capacity to integrate information across brain regions and sufficient diversity of neural activity is necessary for consciousness. In patients in a post-hypoxic ischemic coma, the integrity of the auditory processing network is indicative of chances of regaining consciousness. However, our understanding of how measures of integration and differentiation of auditory responses manifest across time of coma is limited. ⋯ The complexity of EEG responses was not different between patients who regained consciousness and those who did not, but it significantly diminished over time of coma, irrespective of the patient's outcome. Our findings provide novel insights on the optimal temporal window for assessing auditory functions in post-hypoxic ischemic coma. They are of particular importance for guiding the implementation of quantitative techniques for prognostication and contribute to an evolving understanding of neural functions within the acute comatose state.