Resuscitation
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Hemoglobin (Hb) is a main determinant of tissue oxygen delivery and anemia could be particularly harmful in post-anoxic brain injury. The aim of this study was to evaluate the association of Hb and venous Hb oxygen saturation (SvO2/ScvO2) with long-term neurological outcome in patients admitted after cardiac arrest (CA). ⋯ Low hemoglobin values and low values of oxygen venous saturation are significantly associated with unfavorable neurological outcome in adult patients resuscitated from cardiac arrest.
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Observational Study
Establishment of functional residual capacity at birth; observational study of 821 neonatal resuscitations.
Establishing functional residual capacity (FRC) during positive pressure ventilation (PPV) of apnoeic neonates is critical for survival. This may be difficult due to liquid-filled airways contributing to low lung compliance. The objectives were to describe initial PPV, changes in lung compliance and establishment of FRC in near-term/term neonates ≥36 weeks gestation at birth. ⋯ The combination of increasing expired volumes, ECO2, and heart rate with decreasing inflation/expired volume ratios and constant PIP, suggests establishment of FRC during the first 20 PPVs in near-term/term neonates using a self-inflating bag-mask without PEEP, the most common device worldwide for ventilating non-breathing neonates. Initial lung compliance is low, and with short inflation times, higher than recommended PIP seem necessary to deliver adequate tidal volumes.
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To test the diagnostic accuracy of ECG-gated coronary computed tomography angiography (CCTA) to detect coronary artery disease (CAD) among survivors of out-of-hospital circulatory arrest (OHCA). ⋯ NCT03111043 https://clinicaltrials.gov/ct2/show/record/NCT03111043.
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In hospital cardiac arrests occur at a rate of 1-5 per 1000 admissions and are associated with significant morbidity and mortality. We aimed to investigate the association between deviations from ACLS protocol and patient outcomes. ⋯ Our findings highlight the importance of adherence to the ACLS protocol. We found that deviations from the algorithm are associated with decreased rates of ROSC and survival to discharge. Additionally, higher rates of protocol deviations may be associated with higher rates of neurological impairments after cardiac arrest.
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Cardiac arrest recognition, ambulance dispatch and dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) by emergency medical dispatch (EMD) are crucial for an optimal outcome of out-of-hospital cardiac arrest (OHCA). In EMD, crowding is caused by a mismatch between the number of emergency calls and the number of dispatchers available per shift. Crowding in the emergency department has been shown to decrease performance and outcomes; however, little is known about the effect of crowding in EMD. We aimed to evaluate the incidence of crowding in the EMD and the effect of emergency call crowding on dispatcher-assisted CPR instruction performance in OHCA calls. ⋯ Crowding in emergency medicine dispatch caused by increased hourly call volume was associated with delayed dispatcher-assisted CPR instruction provision. Medical directors might consider a strategic approach to addressing crowding in EMD according to the crowding distribution.