Resuscitation
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Review Meta Analysis
The use of end-tidal carbon dioxide (ETCO2) measurement to guide management of cardiac arrest: A systematic review.
To identify whether any level of end-tidal carbon dioxide (ETCO2) measured during cardiopulmonary resuscitation (CPR) correlates with return of spontaneous circulation (ROSC) or survival in adults experiencing cardiac arrest in any setting. ⋯ Based upon existing evidence, ETCO2 levels do seem to provide limited prognostic information for patients who have experienced cardiac arrest. Given the many potential confounders that can influence initial ETCO2 levels, extreme or trending values may be more useful than static mid-range levels. Additional well-designed studies are needed to define optimal timing for the measurement of ETCO2 for prognostic purposes.
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Although rates of survival to hospital discharge after in-hospital cardiac arrest (IHCA) have improved over the last decade, it is unknown if these survival gains are sustained after hospital discharge. ⋯ Among Medicare beneficiaries in the GWTG-Resuscitation registry, 1-year survival after IHCA has increased for over the past decade. Temporal improvements in survival were noted for both shockable and non-shockable presenting arrest rhythms.
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Multicenter Study Observational Study
Early coronary angiography and percutaneous coronary intervention are associated with improved outcomes after out of hospital cardiac arrest.
Early coronary angiography (CAG) and percutaneous coronary intervention (PCI) are associated with better outcomes in subjects resuscitated from out-of-hospital cardiac arrest (OHCA). We sought to determine the relative contributions of early CAG and PCI to outcomes and adverse events after OHCA. ⋯ Early CAG and PCI are associated with improved survival and functional outcomes after OHCA, but only early PCI was associated with a significant benefit after statistical adjustment. Our analysis supports the performance of immediate CAG to determine the need for PCI in selected patients following resuscitation from OHCA.
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Observational Study
Hunt-Hess 5 subarachnoid haemorrhage presenting with cardiac arrest is associated with larger volume bleeds.
The mechanism, effects, and outcomes of cardiac arrest (CA) caused by subarachnoid haemorrhage (SAH) remain unclear. We compared SAH patients presenting with CA to other high-grade SAH patients presenting without CA in order to better understand (1) the cause of CA, (2) cerebral pathophysiology following CA, and (3) outcomes of CA in patients with SAH. ⋯ CA in SAH is associated with larger volume bleeds. Despite normal cerebral perfusion pressures, CA patients show compromised cerebral physiology.
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Identify EEG patterns that predict or preclude favorable response in comatose post-arrest patients receiving neurostimulants. ⋯ EEG patterns described as ominous after cardiac arrest did not preclude survival or awakening after neurostimulant administration. These data are limited by their observational nature and potential for selection bias, but suggest that EEG patterns alone should not affect consideration of neurostimulant use.