Resuscitation
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Multicenter Study
ECMO Cardio-Pulmonary Resuscitation (ECPR), trends in survival from an international multicentre cohort study over 12-years.
Use of Extracorporeal Membrane Oxygenation during cardiopulmonary resuscitation (ECPR) is increasingly being deployed as an adjunct to conventional CPR. It is unknown if this has been associated with improved outcomes. ⋯ Over the period 2003-2014, survival to hospital discharge was 29% for patients who require ECPR. Despite advances in provision of ECMO care and increasing co-morbidities of patients, there has been no change in risk-adjusted survival over time.
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Observational Study
Introduction of paramedic led Echo in Life Support into the pre-hospital environment: The PUCA study.
Can pre-hospital paramedic responders perform satisfactory pre-hospital Echo in Life Support (ELS) during the 10-s pulse check window, and does pre-hospital ELS adversely affect the delivery of cardiac arrest care. ⋯ Paramedics are able to obtain good ELS views in the pre-hospital environment but this may lead to longer hands off the chest time and possibly less pulse and monitor checking than is recommended. Future studies will need to demonstrate either improved outcomes or a benefit from identifying patients in whom further resuscitation and transportation is futile, before ELS is widely adopted in most pre-hospital systems.
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Case Reports
The Impella CP device for acute mechanical circulatory support in refractory cardiac arrest.
Mechanical circulatory support may be considered as a therapeutic option in selected patients with refractory cardiac arrest (rCA). Animal studies suggest a potential role for the Impella® left ventricular assist device in this setting, but so far no human data have been published. ⋯ Mechanical support with the Impella CP® device is a feasible and promising treatment option for selected patients with rCA. Further studies are warranted to determine the full potential and optimal patient selection compared to other modalities of mechanical circulatory support.
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Observational Study
Utilization of palliative care services for cardiac arrest patients undergoing therapeutic hypothermia: A retrospective analysis.
Palliative care (PC) services are integral to the care of patients with advanced medical illnesses. Given the significant morbidity and mortality associated with cardiac arrest, we sought to measure the use and impact of PC in the care of patients treated with therapeutic hypothermia (TH). ⋯ In our population of cardiac arrest patients undergoing TH, the utilization of PC services has increased over time, particularly for those patients with high morbidity and mortality. Future randomized studies may further delineate optimal patient selection for PC consultation to better facilitate goals of care discussions and timely medical decision-making.