Resuscitation
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Observational Study
Use of Automated Chest Compression Devices after Out-of-Hospital Cardiac Arrest in Sweden.
To evaluate the implementation of automated chest compression cardiopulmonary resuscitation (ACC-CPR) after out-of-hospital cardiac arrest (OHCA) in Sweden during the years 2011 through 2015. The association between ACC-CPR and 30-day survival was studied as a secondary objective. ⋯ The use of ACC devices varied significantly between Swedish regions and overall survival to 30days was low among patients receiving ACC-CPR. Although measured and unmeasured confounding might explain our finding of lower survival rates for patients exposed to ACC-CPR, specific guidelines recommending when and how ACC-CPR should be used are warranted as there might be circumstances where these devices do more harm than good.
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Despite increasing use of extracorporeal cardiopulmonary resuscitation (E-CPR) for treatment of refractory cardiac arrest patients, prognosis remains dismal, often resulting in brain-death. However, clinical assessment of brain-death occurence is difficult in post-cardiac arrest patients, sedated, paralyzed, under mild therapeutic hypothermia (MTH). Our objective was to assess the usefulness of Bispectral-Index (BIS) monitoring at bedside for an early detection of brain-death occurrence in refractory cardiac arrest patients treated by E-CPR. ⋯ Initial values of BIS could be used as an assessment tool for early detection of brain-death in refractory cardiac arrest patients treated by mild therapeutic hypothermia and E-CPR.
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Aim of the study was to investigate patient characteristics, survival rates and neurological outcome among hypothermic patients with out-of-hospital cardiac arrest (OHCA) admitted to a trauma center. ⋯ Survival with favourable neurological outcome was found in about a third of all hypothermic non-avalanche patients with OHCA admitted to a trauma center.
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Although hemodynamic instability is expected during the post-cardiac arrest period, the implications of hemodynamic parameters for outcomes remain unclear. Each phase of targeted temperature management (TTM) affects hemodynamic responses differently. This study aims to investigate the association of hemodynamic parameters with outcomes in patients receiving TTM after cardiac arrest. ⋯ Our results indicate that lower MAP and HR more than 93/min are associated with in-hospital mortality during the initial 48h after ROSC. CI at 12h<2.5l/min/m2 is associated with survival but not with neurological outcome. During the course of post-cardiac arrest TTM, these markers of hemodynamic status may be useful predictors of outcomes.
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Cardiac arrest can lead to hypoxic brain injury, which can affect cognitive functioning. ⋯ Cognitive impairments are common in cardiac arrest survivors with executive functioning being mostly affected. Most recovery is seen in the first three months after cardiac arrest. After one year, a substantial number of patients remain impaired, especially in executive functioning. Because of absence of associations between impairments and complaints, cognitive testing using a sensitive test battery is important and should be part of routine follow-up after a cardiac arrest.