Resuscitation
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Multicenter Study Comparative Study
Efficacy of different cooling technologies for therapeutic temperature management: A prospective intervention study.
Mild therapeutic hypothermia (32-36 °C) is associated with improved outcomes in patients with brain injury after cardiac arrest (CA). Various devices are available to induce and maintain hypothermia, but few studies have compared the performance of these devices. We performed a prospective study to compare four frequently used cooling systems in inducing and maintaining hypothermia followed by controlled rewarming. ⋯ Endovascular cooling and gel-adhesive pads provide more rapid hypothermia induction and more effective temperature maintenance compared to water-circulating cooling blankets. This applied to induction speed, but (more importantly) also to time within target range during maintenance.
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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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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.
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International guidelines recommend administration of 1 mg of intravenous epinephrine every 3-5 min during cardiac arrest. The optimal dose of epinephrine is not known. We evaluated the association of reduced frequency and dose of epinephrine with survival after out-of-hospital cardiac arrest (OHCA). ⋯ Reducing the dose of epinephrine administered during out-of-hospital cardiac arrest was not associated with a change in survival to hospital discharge or favorable neurological outcomes after OHCA.
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Resuscitation on in-hospital cardiac arrest (IHCA) is estimated to occur in 200,000 hospitalised patients annually in the US and short-term survival, i.e. 30 days, is reported to be around 15-20%. Even if 30-day survival is a good measure of successful resuscitation, the number of survivors is quite high and a perspective on longer-term outcomes is relevant. ⋯ In conclusion, long-term survival after an IHCA is quite good irrespective of initial rhythm but is related to the burden of baseline co-morbidities.