Resuscitation
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Multicenter Study
Identifying barriers to the provision of bystander cardiopulmonary resuscitation (CPR) in high-risk regions: A qualitative review of emergency calls.
Understanding regional variation in bystander cardiopulmonary resuscitation (CPR) is important to improving out-of-hospital cardiac arrest (OHCA) survival. In this study we aimed to identify barriers to providing bystander CPR in regions with low rates of bystander CPR and where OHCA was recognised in the emergency call. ⋯ A range of factors are associated with barriers to delivering bystander CPR even in the presence of dispatcher instructions - some of which are modifiable. To overcome these barriers in high-risk regions, targeted public education needs to provide information about what occurs in an emergency call, how to recognise an OHCA and to improve CPR knowledge and skills.
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Randomized Controlled Trial Multicenter Study Pragmatic Clinical Trial
The introduction of a rapid response system in acute hospitals: A pragmatic stepped wedge cluster randomised controlled trial.
Deterioration of hospitalised patients is often missed, misinterpreted, and mismanaged. Rapid Response Systems (RRSs) have been proposed to solve this problem. This study aimed to investigate the effect of an RRS on the incidence of unexpected death, cardiac arrest with cardiopulmonary resuscitation (CPR), and unplanned intensive care unit (ICU) admission. ⋯ Our intervention had no significant effect on the incidence of unexpected death, cardiac arrest or unplanned ICU admission when adjusted for clustering and study time. We found a lower than expected baseline incidence of unexpected death and cardiac arrest rates which reduced the statistical power significantly in this study.
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Randomized Controlled Trial Multicenter Study
Practice of mechanical ventilation in cardiac arrest patients and effects of targeted temperature management: A substudy of the targeted temperature management trial.
Mechanical ventilation practices in patients with cardiac arrest are not well described. Also, the effect of temperature on mechanical ventilation settings is not known. The aims of this study were 1) to describe practice of mechanical ventilation and its relation with outcome 2) to determine effects of different target temperatures strategies (33 °C versus 36 °C) on mechanical ventilation settings. ⋯ In the majority of the cardiac arrest patients, protective ventilation settings are applied, including low tidal volumes and driving pressures. High respiratory rate was associated with mortality. TTM33 results in lower end-tidal CO2 levels and a higher alveolar dead space fraction compared to TTTM36.
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Multicenter Study
Long-term risk of seizures among cardiac arrest survivors.
The long-term risk of seizures in cardiac arrest survivors is not established. We hypothesized that survivors of cardiac arrest face an increased long-term risk for seizures. ⋯ The long-term risk of seizures was not elevated in patients with cardiac arrest who survived to hospital discharge without a seizure.
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Multicenter Study Observational Study
Manual centile-based early warning scores derived from statistical distributions of observational vital-sign data.
To develop and validate a centile-based early warning score using manually-recorded data (mCEWS). To compare mCEWS performance with a centile-based early warning score derived from continuously-acquired data (from bedside monitors, cCEWS), and with other published early warning scores. ⋯ Performance of an EWS is highly dependent on the database from which itis derived. Our unsupervised statistical approach provides a straightforward, reproducible method to enable the rapid development of candidate EWS systems.