Resuscitation
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Randomized Controlled Trial
Can rescuers accurately deliver subtle changes to chest compression depth if recommended by future guidelines?
A recent study reported that a compression depth of 4.56 cm optimised survival following cardiac arrest, which is at variance with the current guidelines of 5.0-6.0 cm. A reduction in recommended compression depth is only likely to improve survival if healthcare professionals can accurately deliver a relatively small change in target depth. This study aimed to determine if healthcare professionals could accurately judge their delivered compression depth by 0.5 cm increments. ⋯ Rescuers are able to judge 0.5 cm differences in compression depth with precision, but remain unable to accurately judge overall target depth. Reducing the current recommended compression depth to 4.56 cm is likely to result in delivered compressions significantly below the optimal depth.
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Comparative Study Observational Study
Endovascular cooling versus standard femoral catheters and intravascular complications: A propensity-matched cohort study.
Targeted temperature management (TTM) contributes to improved neurological outcome in adults who have been successfully resuscitated after cardiac arrest with shockable rhythm. Endovascular cooling catheters are widely used to induce and maintain targeted temperature in the ICU. The aim of the study was to compare the risk of complications with cooling catheters and standard central venous catheters. ⋯ In our propensity-score matched study, endovascular cooling catheters were associated with an increased risk of venous catheter-related thrombosis compared to standard central venous catheters.
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The relationship between duration of cardiopulmonary resuscitation (CPR) and post-arrest outcomes based on severity stratification in out-of-hospital cardiac arrest (OHCA) patients without prehospital return of spontaneous circulation (ROSC) remains unclear. ⋯ In OHCA patients without prehospital ROSC, those aged <75 years with initial shockable rhythm had acceptable 1-month CPC 1-2 rate. However, CPR efforts lasting 26 min or over before hospital arrival could be futile.
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Co-morbidities affect survival after in-hospital cardiac arrests (IHCA). The risk population for IHCA, i.e. the hospitalised patients, have a doubled increase in co-morbidities over time. A similar increase in co-morbidities among IHCAs might explain the relatively poor survival ratios despite improved care. ⋯ This cohort study illuminates an almost constant burden of co-morbidities over time among patients suffering an IHCA. Further, the study highlights that 30-day survival has almost doubled from 2007 to 2009 to 2013-2015 among those with low to moderate AccI.
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Electroencephalography (EEG) has clinical and prognostic importance after cardiac arrest (CA). Recently, interest in quantitative EEG (qEEG) analysis has grown. The qualitative effects of sedation on EEG are well known, but potentially confounding effects of sedatives on qEEG after anoxic injury are poorly characterized. We hypothesize that sedation increases suppression ratio (SR) and decreases alpha/delta ratio (ADR) and amplitude-integrated EEG (aEEG), and that the magnitude of sedation effects will be associated with outcome. ⋯ Higher aEEG and lower SR predict survival after CA. Sedation alters aEEG and SR, but importantly does not appear to affect the relationship between these parameter values and outcome.