Resuscitation
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Most cardiac arrest (CA) patients remain comatose post-resuscitation, prompting goals-of-care (GOC) conversations. The impact of these conversations on patient outcomes has not been well described. ⋯ Most survivors due to family wishes despite poor neurological prognosis die or have poor outcomes at one-year. However, a small number achieve favorable recovery, demonstrating limitations with current prognostication methods. Among nonsurvivors, most WLST occurs while medically unstable, suggesting an overestimation of WLST due to unfavorable neurological prognosis.
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Public Access Defibrillation - the use of Automated External Defibrillators (AEDs) by lay bystanders before the arrival of Emergency Medical Services - is an important strategy in delivering prompt defibrillation to victims of out-of-hospital cardiac arrest and can greatly improve survival rates. Such public-access AEDs are used rarely: one barrier might be poor understanding and content of current signage to indicate their presence. The aim of this project was to develop a sign, with public consultation, that better indicated the function of an AED, and an associated poster to encourage its use. ⋯ This is the first time that public consultation has been used to design a public AED location sign. Effective signage has the potential to help break down the barriers to more widespread use of AEDs in public places.
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Observational Study
Increasing or fluctuating bispectral index values during post-resuscitation targeted temperature management can predict clinical seizures after rewarming.
To investigate whether an increasing bispectral index (BIS) value during targeted temperature management (TTM) correlates with increased clinical seizures after TTM or worse neurological prognoses after TTM. ⋯ An increase of, or greater fluctuation in, BIS during hypothermia may predict clinical seizures after TTM.
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Extracorporeal cardiopulmonary resuscitation (ECPR) is a lifesaving rescue therapy for patients with refractory cardiac arrest. Previous studies suggest that maintaining a 24/7 in-house surgical team may reduce ECPR initiation time and improve survival in adult patients. However, an association between cardiac arrest occurring during off-hours and ECPR outcome has not been established in children. ⋯ Cardiac arrest occurring at night or during weekend hours is associated with a longer ECPR initiation time and higher rates of CNS injury. However, prolonged pre-ECPR support associated with off-hours cardiac arrest does not appear to impact survival or functional outcome in pediatric patients.
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To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender. ⋯ Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.