Resuscitation
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Multicenter Study
Prognostic value of cell-free DNA in plasma of out-of-hospital cardiac arrest survivors at ICU admission and 24hours post-admission.
Cell-free DNA has been associated with outcome in several acute conditions including two reports concerning the outcomes after cardiac arrest that found association of circulating DNA quantities at admission with mortality. The origins of cell-free DNA are primarily necrosis and apoptosis, which in cardiac arrest occur during ischaemia ("no-flow" and "low-flow" period), during reperfusion injury and as a consequence of post-arrest inflammatory response. Respecting the facts that significant cellular damage may occur during the post-arrest period, and that damage might be reduced by mild therapeutic hypothermia, we investigated the prognostic value of cell free DNA at ICU admission and 24h after admission. ⋯ Cell free DNA showed different dynamics in patients who were and who were not treated with mild therapeutic hypothermia: it decreased in treated patients and slightly increased in non-treated patients. Cell-free DNA quantity at ICU admission and 24h after admission is associated with hospital mortality. Further studies will need to additionally investigate possible practical use of this new laboratory marker in patients resuscitated from cardiac arrest.
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Observational Study
An observational study of paediatric pre-hospital intubation and anaesthesia in 1933 children attended by a physician-led, pre-hospital trauma service.
Trauma accounts for 16-44% of childhood deaths. The number of severely injured children who require pre-hospital advanced airway intervention is thought to be small but there is little published data detailing the epidemiology of these interventions. This study was designed to evaluate the children who received pre-hospital intubation (with or without anaesthesia) in a high volume, physician-led, pre-hospital trauma service and the circumstances surrounding the intervention. ⋯ Pre-hospital paediatric intubation is not infrequent in this high-volume trauma service. The majority of patients received a rapid sequence induction. The commonest injury mechanisms were RTCs and 'falls from height'. Pre-hospital paediatric intubation is associated with a high success rate in this physician-led service.