Resuscitation
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Randomized Controlled Trial
Protocol-driven neurological prognostication and withdrawal of life-sustaining therapy after cardiac arrest and targeted temperature management.
Brain injury is reportedly the main cause of death for patients resuscitated after out-of-hospital cardiac arrest (OHCA). However, the majority may actually die following withdrawal of life-sustaining therapy (WLST) with a presumption of poor neurological recovery. We investigated how the protocol for neurological prognostication was used and how related treatment recommendations might have affected WLST decision-making and outcome after OHCA in the targeted temperature management (TTM) trial. ⋯ Delayed prognostication was relevant for a minority of patients and related to subsequent decisions on level-of-care with effects on ICU length-of-stay, survival time and outcome.
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Current guidelines recommend epinephrine every 3-5min during cardiopulmonary resuscitation. For adults with in-hospital cardiac arrest (IHCA), longer dosing intervals are associated with improved survival to discharge. This study investigates whether longer epinephrine dosing intervals were associated with improved survival to discharge during pediatric IHCA. ⋯ Longer average dosing intervals than currently recommended for epinephrine administration during pediatric IHCA were associated with improved survival to hospital discharge.
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In sick children who are unable to be weighed estimation of weight is often required, but the routinely used equations lack accuracy and precision. This study aimed to develop a novel equation (Children's European Estimator of Weight-CEEW) using measurements of mid-upper arm circumference (MUAC) and other predictors in multinational groups of sick children in Europe. ⋯ The CEEW equations performed substantially better than other routinely used equations for weight estimation. An electronic application for mobile use is presented.
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Respective proportions of final etiologies are disparate in cohorts of cardiac arrest patients, depending on examined population and diagnostic algorithms. In particular, prevalence and characteristics of sudden unexplained death syndrome (SUDS) are debated. We aimed at describing etiologies in a large cohort of aborted out-of-hospital cardiac arrest (OHCA) patients, in order to assess prevalence and outcome of SUDS. ⋯ We observed that ischemic heart disease was by far the most common cause of cardiac arrest, while primary electrical diseases were much less frequent. SUDS accounted for a very small proportion of patients who suffered an aborted OHCA.