Resuscitation
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Observational Study
Relationship between age and outcomes of comatose cardiac arrest survivors in a setting without withdrawal of life support.
Previous studies on the relationship between age and outcomes after cardiac arrest were performed in settings where the majority of patients died after the withdrawal of life support (WLS). We examined the association between age and outcomes of comatose cardiac arrest survivors in a setting where WLS was not performed. ⋯ In a setting where WLS is not performed, we found that age was not associated with in-hospital mortality but was independently associated with neurologic outcome at hospital discharge and six-month mortality.
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Delivery room resuscitation of very low birth weight infants can involve use of endotracheal or intravenous epinephrine. Data of the past 19 years were reviewed to identify the usage of epinephrine in delivery room and identify characteristics of these babies. ⋯ Neonates with lower birth weight and younger gestational age were more likely to receive epinephrine during resuscitation at birth. Use of epinephrine in delivery room was associated with lower survival and severe intraventricular hemorrhage among very low birth weight infants.
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Performing advanced cardiac life support (ACLS) in the cardiac catheterization laboratory (CCL) is challenging. Mechanical chest compression (MCC) devices deliver compressions in a small space, allowing for simultaneous percutaneous coronary intervention and reduced radiation exposure to rescuers. In refractory cases, MCC devices allow rescuers to initiate percutaneous mechanical circulatory support (MCS) and extracorporeal life support (ECLS) during resuscitation. This study sought to assess the efficacy and safety of MCC when compared to manual compressions in the CCL. ⋯ Use of MCC during resuscitation of cardiac arrest in the CCL increases the rate of ROSC. Simultaneous implantation of MCS, including percutaneous ECLS, is feasible and safe during MCC-assisted resuscitation in the CCL.
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Early myoclonus after cardiac arrest (CA) is traditionally viewed as a poor prognostic sign (status myoclonus). However, some patients may present early Lance-Adams syndrome (LAS): under appropriate treatment, they can reach a satisfactory functional outcome. Our aim was to describe their profile, focusing on pharmacologic management in the ICU, time to return of awareness, and long-term prognosis. ⋯ Early after CA, myoclonus together with a reactive, epileptiform EEG, preserved evoked potentials and brainstem reflexes suggests LAS. This condition was managed with a combination of highly dosed, large spectrum antiepileptic agents including propofol and midazolam. Even if awakening was at times delayed, good outcome occurred in a substantial proportion of patients.
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The introduction of a paediatric Medical Emergency Team (pMET) was accompanied by weekly in-situ simulation team training. Key ward staff participated in team training, focusing on recognition of the deteriorating child, teamwork and early involvement of senior staff. Following an earlier study [1], this investigation aimed to evaluate the long-term impact of ongoing regular team training on hospital response to deteriorating ward patients, patient outcome and financial implications. ⋯ These results indicate that lessons learnt by ward staff during team training led to sustained improvements in the hospital response to critically deteriorating in-patients, significantly improved patient outcomes and substantial savings. Integration of regular in-situ simulation training of medical emergency teams, including key ward staff, in routine clinical care has potential application in all acute specialties.