Resuscitation
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Randomized Controlled Trial
North American validation of the Bokutoh criteria for withholding professional resuscitation in non-traumatic out-of-hospital cardiac arrest.
Certain subgroups of patients with out-of-hospital cardiac arrest (OHCA) may not benefit from treatment. Early identification of this cohort in the prehospital (EMS) setting prior to any resuscitative efforts would prevent futile medical therapy and more appropriately allocate EMS and hospital resources. We sought to validate a clinical criteria from Bokutoh, Japan that identified a subgroup of OHCAs for whom withholding resuscitation may be appropriate. ⋯ In this validation of the Bokutoh criteria in a large North American cohort of OHCA patients, 0.51% meeting criteria had favourable neurological outcomes. This may rapidly and reliably identify the one-fifth of OHCA who are very unlikely to benefit from resuscitation.
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To define the incidence of the acute respiratory distress syndrome (ARDS) following out-of-hospital cardiac arrest (OHCA) and characterize its impact on outcome. ⋯ Nearly half of initial OHCA survivors develop ARDS within 48 h of hospital admission. ARDS was associated with poor outcome and increased resource utilization. OHCA should be considered among the traditional ARDS risk factors.
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Multicenter Study Observational Study
Immediate versus early coronary angiography with targeted temperature management in out-of-hospital cardiac arrest survivors without ST-segment elevation: A propensity score-matched analysis from a multicenter registry.
The optimal coronary angiography (CAG) timing in out-of-hospital cardiac arrest (OHCA) survivors without ST-segment elevation (STE) for good neurologic outcome remains unknown. This study aimed to evaluate whether immediate versus early CAG impacts neurological outcomes of OHCA survivors without STE. ⋯ Coronary artery stenosis was found in 42.7% of TTM-treated non-STE OHCA patients with CAG within 24 h, but there was no clear neurological benefit of immediate versus early CAG.
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Data demonstrating benefit of advanced life support (ALS) practitioners for out-of-hospital cardiac arrest (OHCA) is conflicting. In our tiered emergency medical services (EMS) system, we sought to determine if the ALS response interval was associated with patient outcomes. ⋯ In our tiered EMS system, earlier ALS arrival was associated with improved survival and favorable neurological outcomes. ALS attendance within 10 min of the 9-1-1 call in tiered systems of prehospital care may improve patient outcomes and serve as a quality metric.
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The first clinical re-assessment after admission to hospital probably provides the best opportunity to detect clinical deterioration or failure to improve, and decide if care should be intensified. ⋯ NEWS and gait stability on admission, MUAC, a subjective feeling of improvement, and change in NEWS the day after admission are all clinically significant predictors of in-hospital mortality.