Resuscitation
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Observational Study
Relationship between timing of cooling and outcomes in adult comatose cardiac arrest patients treated with targeted temperature management.
Studies examining associations between time to target temperature and outcomes in cardiac arrest patients who underwent targeted temperature management (TTM) have shown inconsistent results. We examined these associations separately for time from restoration of spontaneous circulation to TTM initiation (pre-induction time) and time from TTM initiation to target temperature (induction time). Furthermore, we examined whether critical time thresholds exist if there is an association. ⋯ We found that a shorter pre-induction time was independently associated with a favorable neurologic outcome at hospital discharge, whereas induction time was not. We also found two time thresholds at 120 and 360min, after which initiation of cooling was associated with a worse neurologic outcome.
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We sought to assess the relationship between mean arterial pressure (MAP) and clinical outcomes in comatose survivors of out-of-hospital cardiac arrest (OHCA). ⋯ In comatose survivors of OHCA treated with target temperature management, a higher mean MAP during the first 96h of admission is associated with increased survival. The association between mean MAP and clinical outcomes appears to be attenuated by increased age.
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Observational Study
Factors associated with the outcome of out-of-hospital cardiopulmonary arrest among people over 80 years old in Japan.
To determine if termination of resuscitation should be considered for older individuals, we sought to identify factors associated with clinical outcome following out-of-hospital cardiac arrest (OHCA) in people ≥80 years old and over. ⋯ ROSC was the most significant predictor of 1-month survival among patients with cardiac and non-cardiac OHCA who were ≥80 years old. Absence of ROSC might be an important factor to the termination of resuscitation rule for OHCA in individuals who are ≥80years old.
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In December 2013, our institution changed the target temperature management (TTM) for the first 24h in ventricular fibrillation out-of-hospital cardiac arrest (VF-OHCA) patients from 33°C to 36°C. This study aimed to examine the impact this change had on measured temperatures and patient outcomes. ⋯ After the change from a TTM target of 33°C to 36°C, we report low compliance with target temperature, higher rates of fever, and a trend towards clinical worsening in patient outcomes. Hospitals adopting a 36°C target temperature to need to be aware that this target may not be easy to achieve, and requires adequate sedation and muscle-relaxant to avoid fever.
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Most survival outcomes in out-of-hospital cardiac arrest (OHCA) are provided by emergency medical services (EMS) without a doctor on board. Our objective was to determine such outcomes in a whole country with public physician-led EMS.