Resuscitation
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Randomized Controlled Trial
Pharmacotherapy and hospital admissions before out-of-hospital cardiac arrest: a nationwide study.
For out-of-hospital cardiac arrest (OHCA) to be predicted and prevented, it is imperative the healthcare system has access to those vulnerable before the event occurs. We aimed to determine the extent of contact to the healthcare system before OHCA. ⋯ Contrary to general belief, the majority of OHCA patients are in contact with the healthcare system shortly before OHCA.
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Improvement in the quality of cardiopulmonary resuscitation (CPR) may improve the survival rate following cardiac arrest. The aims of our study were to describe how recording of CPR maneuvers performed in our emergency department with real-time video and regular feedback learning may improve CPR. ⋯ We analyzed 45 cases, divided into three groups of 15 consecutive patients. Instantaneous rates of chest compression showed variation with 75% exceeding 110 cpm. There was a significant difference in instantaneous rates among groups (135 [112-150] in group 1, 123 [110-136] in group 2 and 124 [111-137] cpm in group 3, P<0.001). Ratio of hands-off time to total manual compression time (%) significantly decreased over time (Spearman correlation=-0.30, P=0.04). There were significant differences in hands-off time per minute among the groups (11 [3-28], 6 [2-21] and 7 [2-19] s min(-1), P<0.001). There was a significant improvement in time delay to first chest compression (11 [5-50], 20 [8-68] and 0 [0-12] s, P=0.01), but not in time delay to first ventilation (91 [31-190], 65 [17-121] and 24 [9-64] s, P=0.08). Data are median [25-75% interquartile]. Regular feedback learning from real-time video recording may improve the quality of major CPR variables.
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Previous data indicate that 100% O(2) ventilation during early reperfusion after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) increases neuronal death. However, current guidelines encourage the use of 100% O(2) during resuscitation and for an undefined period thereafter. We retrospectively analyzed data from a porcine CA model and hypothesized that prolonged hyperoxic reperfusion would be associated with increased neurohistopathological damage and impaired neurological recovery. ⋯ In this retrospective analysis prolonged hyperoxia after CA aggravated necrotic brain damage and perivascular inflammation in the striatum of pigs.
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Editorial Comment
Oxygen therapy post-cardiac arrest: the 'Goldilocks' principle?