Resuscitation
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Randomized Controlled Trial
The impact of peri-shock pause on survival from out- of- hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial.
Previous research has demonstrated significant relationships between peri-shock pause and survival to discharge from out-of-hospital shockable cardiac arrest (OHCA). ⋯ In patients with cardiac arrest presenting in a shockable rhythm during the ROC PRIMED trial, shorter pre- and peri-shock pauses were significantly associated with higher odds of survival. Future cardiopulmonary education and technology should focus on minimizing all peri-shock pauses.
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Observational Study
Early microcirculatory impairment during therapeutic hypothermia is associated with poor outcome in post-cardiac arrest children: a prospective observational cohort study.
This study aimed to evaluate if the microcirculation is impaired during and after therapeutic hypothermia (TH) in children with return of spontaneous circulation after cardiac arrest (CA) and to assess if microcirculatory impairment predicts mortality. This has been reported for post-CA adults, but results might be different for children because etiology, pathophysiology, and mortality rate differ. ⋯ The microcirculation is impaired in post-CA children during TH and more severe impairment at TH start was associated with mortality. After the stop of TH, the microcirculation improves rapidly irrespective of outcome.
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Comparative Study
Decision-tree early warning score (DTEWS) validates the design of the National Early Warning Score (NEWS).
To compare the performance of a human-generated, trial and error-optimised early warning score (EWS), i.e., National Early Warning Score (NEWS), with one generated entirely algorithmically using Decision Tree (DT) analysis. ⋯ The decision-tree technique independently validates the composition and weightings of NEWS. The DT approach quickly provided an almost identical EWS to NEWS, although one that admittedly would benefit from fine-tuning using clinical knowledge. We believe that DT analysis could be used to quickly develop candidate models for disease-specific EWSs, which may be required in future.
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Bystander-initiated cardiopulmonary resuscitation (CPR) has been reported to increase the possibility of survival in patients with out-of-hospital cardiopulmonary arrest (OHCA). We evaluated the effects of CPR instructions by emergency medical dispatchers on the frequency of bystander CPR and outcomes, and whether these effects differed between family and non-family bystanders. ⋯ Dispatcher instructions increased the frequency of bystander CPR, but did not improve the rate of neurologically favorable survival in patients with witnessed OHCA. Efforts to enhance the frequency and quality of resuscitation, especially by family members, are required for dispatcher-assisted CPR.
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Therapeutic hypothermia (TH) is one of three interventions that have demonstrated to improve patients' neurological outcome after cardiac arrest. The aim of this study was to investigate the effect of the 2010 resuscitation guidelines on TH implementation in various Italian Intensive Care Units (ICU). ⋯ TH is still under-used in Italy (55.1%) even though the therapy is strongly recommended in the 2010 guidelines. However, the increase in the adoption of hypothermia has been significant in the past 5 years (68%/years) and the awareness of the efficacy is almost consolidated among intensivists, being logistic problems the leading cause for non-adoption.