Resuscitation
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Randomized Controlled Trial
Impaired β-adrenergic receptor signalling in post-resuscitation myocardial dysfunction.
Post-resuscitation myocardial dysfunction is a major cause of fatality in patients receiving successful cardiopulmonary resuscitation. The mechanism of post-resuscitation myocardial dysfunction is largely unknown, although is generally considered related to ischaemia occurring during cardiac arrest and resuscitation and/or reperfusion injury after restoration of circulation. A key mechanism responsible for reduced contractile reserves in chronic heart failure is impaired β-adrenergic receptor signalling. Thus, we hypothesised that β-adrenergic receptor signalling is markedly abnormal in the post-resuscitation period following cardiopulmonary resuscitation. ⋯ β-Adrenergic receptor signalling is markedly impaired in the post-resuscitation period, which may be a mechanism of post-resuscitation myocardial dysfunction.
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Induced mild therapeutic hypothermia (MTH) is an effective treatment to improve outcome after out-of-hospital resuscitation. Adverse events are rare, but arrhythmias and bleeding complications have been reported. So far, only few data about electrocardiographic changes and associated events have been reported. ⋯ Under strict clinical and laboratory parameter control, induced mild therapeutic hypothermia can be applied to most patients after out-of-hospital cardiac arrest with no increased risk for arrhythmias despite significant electrocardiographic changes.
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Randomized Controlled Trial
Effects of continuous haemofiltration on serum enzyme concentrations, endotoxemia, homeostasis and survival in dogs with severe heat stroke.
To examine the effectiveness of continuous haemofiltration as a treatment for severe heat stroke in dogs. ⋯ Continuous haemofiltration rapidly reduced body temperature, normalised haemodynamics and electrolytes, improved serum enzyme concentrations and increased survival in dogs with heat stroke. Continuous haemofiltration may be an effective treatment for heat stroke.
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Mild therapeutic hypothermia has shown to improve long-time survival as well as favorable functional outcome after cardiac arrest. Animal models suggest that ischemic durations beyond 8 min results in progressively worse neurologic deficits. Based on these considerations, it would be obvious that cardiac arrest survivors would benefit most from mild therapeutic hypothermia if they have reached a complete circulatory standstill of more than 8 min. ⋯ The beneficial effect of mild therapeutic hypothermia increases with cumulative time of complete circulatory standstill in patients with witnessed out-of-hospital cardiac arrest.
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Guidelines for the techniques of resuscitating newly born infants have undergone major revisions over the past 25 years. The International Liaison Committee on Resuscitation (ILCOR) is committed to "periodically developing and publishing a consensus on resuscitation science" every five years with the most recent Consensus on Science and Treatment Recommendations (CoSTR) statement published in 2010. ⋯ It is a goal that identification of these knowledge gaps will stimulate investigators to pursue more targeted studies to help close the gaps. The current document is based on the "gaps in knowledge" summary for neonatal resuscitation that was created at the conclusion of the 2005-2010 ILCOR cycle.