Resuscitation
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Letter Meta Analysis
Achieved glucose level and mortality risk in randomized clinical trials.
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Historically, reported survival from traumatic cardiac arrest (TCA) was extremely low. More recent publications have recorded survival to discharge of up to 8%. This improvement is likely to be multi-factorial; however, there are currently no published data describing the epidemiology or aetiology of TCA in England and Wales to guide future practice improvement. ⋯ This study has shown that short-term survival from TCA in this large civilian registry is 7.5%. Early and aggressive management of patients with TCA, using protocols that target the reversible causes of TCA, should be initiated. Further work to establish novel ways to manage patients with reversible causes of TCA is indicated. Resuscitation in this patient group is not futile.
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Previous research demonstrates that results from observational research correlate well with results from clinical trials, and if the former are well designed these can guide clinical practice. Observational studies in cardiac arrest research are beset by confounding due to illness severity and comorbidity. We aimed to count the number of studies that utilize comorbidity and illness severity scores and indices, and to measure the change in results across analyses that adjust for scores and indices. ⋯ A small proportion of cardiac arrest studies account for illness severity and comorbidity with scores and indices, and such adjustment tend to drive estimates towards the null (no difference in groups being compared). Confounding by illness severity and comorbidity is a significant source of bias in non-randomized cardiac arrest studies.
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Prognosticating outcome following cardiac arrest is challenging and requires a multimodal approach. We tested the hypothesis that the combination of initial neurologic examination, quantitative analysis of head computed tomography (CT) and continuous EEG (cEEG) improve outcome prediction after cardiac arrest. ⋯ Combining GWR with cEEG was superior to any individual test for predicting mortality and neurologic outcome. Addition of clinical variables further improved prognostication for mortality but not neurologic outcome. These preliminary data support a multi-modal prognostic workup in this population.