Resuscitation
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Prognostic tools typically combine several time-invariant clinical predictors using regression models that yield a single, time-invariant outcome prediction. This results in considerable information loss as repeatedly or continuously sampled data are aggregated into single summary measures. We describe a method for real-time multivariate outcome prediction that accommodates both longitudinal data and time-invariant clinical characteristics. ⋯ We describe a novel methodology for combining GBTM output and clinical covariates to estimate patient-specific prognosis over time. Refinement of such methods should form the basis for new avenues of prognostication research that minimize loss of clinically important information.
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The out-of-hospital cardiac arrest (OHCA) and cardiac arrest hospital prognosis (CAHP) scores were developed for early neuroprognostication after OHCA. Calculation of both scores requires estimation of the no-flow interval, which may be imprecise. We aimed to validate simplified OHCA and CAHP scores, which exclude the no-flow interval, in an East Asian cohort. ⋯ The simplified OHCA and CAHP scores predicted neurological outcomes in successfully resuscitated East Asian OHCA patients with similar and excellent accuracy. The simplified OHCA and CAHP scores could potentially serve alongside the original scores as risk-adjustment tools for comparison of outcomes between regional OHCA registries worldwide.
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Observational Study
Evaluation of Out-of-Hospital Cardiac Arrest using Transesophageal Echocardiography in the Emergency Department.
Transesophageal echocardiography (TEE) has been proposed as a modality to assess patients in the setting of cardiac arrest, both during resuscitation care and following return of spontaneous circulation (ROSC). In this study we aimed to assess the feasibility and clinical impact of TEE during the emergency department (ED) evaluation during out-of-hospital cardiac arrest (OHCA). ⋯ TEE is feasible and clinically impactful during OHCA management. Resuscitative TEE may allow for characterization of cardiac activity, including identification of pseudo-PEA and fine VF, determination of reversible pathology, and optimization of CPR quality.
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Observational Study
Impact of right ventricular dysfunction on mortality in adults with cardiac arrest undergoing coronary angiogram.
We sought to identify the impact of echocardiographic right ventricular (RV) systolic dysfunction on mortality in adults with cardiac arrest (CA). ⋯ In this observational contemporary study, RV dysfunction was independently associated with higher mortality in adults with CA undergoing coronary angiogram. RV dysfunction may be useful for risk stratification and management in this high-mortality population.