Resuscitation
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The incidence and timing of electrographic seizures and epileptiform activity in comatose, adult, post-cardiac arrest syndrome (PCAS) patients treated with therapeutic hypothermia (TH) have not been extensively investigated. We hypothesized that onset most frequently occurs within the first 24 h post-arrest and is associated with poor neurologic outcome. ⋯ Electrographic seizures and epileptiform activity are common cEEG findings in comatose, PCAS patients treated with TH. In this preliminary study, most seizures were status epilepticus, had onset prior to rewarming, evolved from prior interictal epileptiform activity, and were associated with short-term mortality and poor neurologic outcome. Larger, prospective studies are needed to further characterize seizure activity in comatose post-arrest patients.
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To assess differences in cerebral performance category (CPC) in patients who received therapeutic hypothermia post cardiac arrest by time to initiation, time to target temperature, and duration of therapeutic hypothermia (TH). ⋯ In adults undergoing TH post cardiac arrest, delay in initiation of TH and reaching target temperature differentiated poor versus good neurologic outcomes. Randomized trials assessing the range of current recommended guidelines for TH should be conducted to establish optimal treatment protocols.
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Treatment with pharmacological agents is frequently required during cardiopulmonary resuscitation efforts and almost always during the post-resuscitation period. However, the lack of scientific evidence, the potent side effects and the association of resuscitation drugs with poor outcome act as a disincentive for their use. ⋯ In addition, there is evidence that magnetic nanotechnology may be used in the detection of post-cardiac arrest brain injury. In the light of poor survival of cardiac arrest victims, research in cardiopulmonary resuscitation should focus on this promising technology as soon as possible.