Resuscitation
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Correct defibrillation pad positioning optimises the chances of successful defibrillation. AEDs have pictoral representation to guide untrained bystanders in correct pad positioning. There is a wide variation in this pictoral guidance and evidence suggests that correct anatomical pad placement is poor. We reviewed all currently available diagrams and assessed the resultant pad placement achieved by untrained bystanders following these instructions. ⋯ All current defibrillation pad diagrams fail to achieve accurate defibrillation pad placement. A clearer, more effective diagram, such as the one we designed, is urgently needed to ensure bystander defibrillation is effective as possible.
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Observational Study
Vital Sign Patterns Before Shock-Related Cardiopulmonary Arrest.
Traditional vital sign thresholds reflect an increased risk of mortality, which may occur hours, days, or weeks following illness/injury, limiting immediate clinical significance to guide rescue therapy to avoid arrest. Our objective is to explore vital sign patterns prior to arrest due to shock. ⋯ Vital sign patterns were defined for SBP, MAP, HR, shock index, and EtCO2 with clear inflection points identified 2-5 min prior to arrest. These patterns may help guide therapy to reverse deterioration and prevent arrest.
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Observational Study
Effect of vertical location on survival outcomes for out-of-hospital cardiac arrest in Singapore.
A large proportion of out-of-hospital cardiac arrest (OHCA) cases occur in high-rise residential buildings. This study aims to investigate the effect of vertical location on survival outcomes and response times. ⋯ Vertical location is associated with OHCA survival probability with a U-shaped response, and this significance remained after adjustment for other significant OHCA variables. This relationship is likely multifactorial and more research is needed to elucidate the various factors.
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Observational Study
Sports activity and paediatric out-of-hospital cardiac arrest at schools in Japan.
Sudden cardiac death during exercise or sports is an important problem among young athletes and non-athletes. An understanding of the epidemiological features of sports-related out-of-hospital cardiac arrest (OHCA) among children is crucial for planning approaches for prevention and better outcomes of paediatric OHCAs. We assessed the characteristics and outcomes of sports-related OHCA among children at schools in Japan to prevent sports-related paediatric OHCA at schools. ⋯ In Japan, 188 schoolchildren experienced OHCAs of cardiac origin occurring during or after sports activity at schools during the 8-year period. Increasing PAD is essential to enhance better neurological outcome after sports-related OHCA among students.
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To assess the performance of neuroprognostic guidelines proposed by the American Academy of Neurology (AAN), European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM), and American Heart Association (AHA) in predicting outcomes of patients who remain unconscious after cardiac arrest. ⋯ Though each guideline had components that performed well, only the ERC/ESICM guideline yielded a 0% FPR. Amongst the AAN and AHA guidelines, false positives emerged more readily at 6 months, reflective of continuing recovery after discharge, even in a cohort inevitably biased by WLST. Further assessment of predictive modalities is needed to improve neuroprognostic accuracy.