Resuscitation
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This study aimed at evaluating (I) the impact of different intra-arrest hypothermia levels on the expression of selected cytokines and (II) their prognostic value for 9-day survival. ⋯ The systemic inflammatory response syndrome after cardiac arrest was reflected by a remarkable increase of plasma IL-6 and TNF-alpha levels. Intra-arrest hypothermia levels did not influence the expression of selected cytokines. As prognostic marker for survival IL-10 was identified with decreasing mRNA levels during cardiac arrest in survivors.
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We have previously demonstrated that early intra-nasal cooling improved post-resuscitation neurological outcomes. The present study utilizing a porcine model of prolonged cardiac arrest investigated the effects of intra-nasal cooling initiated at the start of cardiopulmonary resuscitation (CPR) on resuscitation success. Our hypothesis was that rapid nasal cooling initiated during "low-flow" improves return of spontaneous resuscitation (ROSC). ⋯ Intra-nasal cooling initiated at the start of CPR significantly improves the success of resuscitation in a porcine model of prolonged cardiac arrest. This may have occurred by preventing brain hyperthermia.
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Randomized Controlled Trial Comparative Study
Rapid sequence airway vs rapid sequence intubation in a simulated trauma airway by flight crew.
Rapid sequence airway (RSA) utilizes rapid sequence intubation (RSI) pharmacology followed by the placement of an extraglottic airway without direct laryngoscopy. ⋯ In a simulated moderately difficult trauma airway managed by FC, RSA results in a significantly shorter time to secure the airway and less hypoxemia compared to RSI.
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Randomized Controlled Trial Comparative Study
Rescuer fatigue and cardiopulmonary resuscitation positions: A randomized controlled crossover trial.
During cardiopulmonary resuscitation (CPR), it is recommended to alternate rescuers every 2 min when two or more rescuers are available, regardless of the rescuer's position. It is unclear, however, whether rescuer fatigue depends on the rescuer's position. ⋯ CPR is best performed in a kneeling position. In order to minimize rescuer fatigue, we recommend alternating rescuers every 2 min while kneeling or standing on a taboret, and every 1 min while standing on the floor.
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National leaders have suggested that patients with an out of hospital cardiac arrest (OOHCA) may benefit from transport to specialized hospitals. We sought to assess the survival of OOHCA patients by transport distance and hospital proximity. ⋯ Survival to discharge was higher in OOHCA patients taken to hospitals located further than the closest hospital while transport distance was not associated with survival. This suggests that longer transport distance/time might not adversely affect outcome. Further studies are needed to inform policy decisions regarding best destination post-cardiac arrest.