Resuscitation
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Observational Study
Impact of pre-hospital vital parameters on the neurological outcome of out-of-hospital cardiac arrest: Results from the French National Cardiac Arrest Registry.
The targets for vital parameters following return of spontaneous circulation (ROSC) from an out-of-hospital cardiac arrest (OHCA) are based on studies carried out predominantly in intensive care units. Therefore, we studied the pre-hospital phase. ⋯ In comatose patients who have achieved ROSC after OHCA, vital parameters in the pre-hospital phase appear to have a real impact on the 30-day neurological outcome. We found that an SpO2 ≥ 94%, an ETCO2 of 30 - 40 mmHg, and an SBP of 100 - 130 mmHg were associated with a better prognosis.
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Observational Study
The association between long-term glycaemic control, glycaemic gap and neurological outcome of in-hospital cardiac arrest in diabetics: A retrospective cohort study.
Resuscitation guidelines do not recommend a target blood glucose (BG) level specifically tailored for diabetics experiencing an in-hospital cardiac arrest (IHCA). The glycosylated haemoglobin (HbA1c) level may be associated with neurological prognosis and used to identify the optimal BG level for diabetic IHCA patients. ⋯ For diabetic patients, poor long-term glycaemic control correlated with worse neurological recovery following an IHCA. The HbA1c-derived average BG level could be used as a reference point for glycaemic management during the early stage of post-cardiac arrest syndrome. The glycaemic gap could be used to identify the optimal glycaemic range around the reference point.
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Recent studies suggest that a 48-h therapeutic hypothermia protocol does not improve outcomes in paediatric out-of-hospital cardiac arrest survivors. The aim of this study was to evaluate the effect of 72-h therapeutic hypothermia at 33 °C compared to normothermia at 35.5 °C-37.5 °C on outcomes and the incidence of adverse events in paediatric asphyxial out-of-hospital cardiac arrest survivors. ⋯ Paediatric asphyxial out-of-hospital cardiac arrest was associated with high mortality and morbidity. Seventy-two-hour therapeutic hypothermia was associated with a better 1-month survival rate and 6-month neurological outcomes than normothermia in our paediatric patients with asphyxial out-of-hospital cardiac arrest.
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Out of Hospital Cardiac Arrest (OHCA) is frequently attributed to coronary artery disease, thus guidelines recommend coronary angiography (CAG) for survivors of OHCA. However, the real-world application of these guidelines is unknown, and we sought to evaluate CAG practices in the contemporary OHCA population. ⋯ Only one-third of patients presenting to PCI-capable hospitals underwent CAG after OHCA. Patient selection for an invasive strategy after OHCA appeared to be heavily influenced by pre-hospital presentation variables.
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Identifying reversible causes of cardiac arrest is challenging. The diagnosis of pulmonary embolism is often missed. Pulmonary embolism increases alveolar dead space resulting in low end-tidal CO2 (EtCO2) relative to arterial CO2 (PaCO2) tension. Thus, a low EtCO2/PaCO2 ratio during resuscitation may be a sign of pulmonary embolism. ⋯ A low EtCO2/PaCO2 ratio during cardiopulmonary resuscitation suggests pulmonary embolism.