Resuscitation
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Randomized Controlled Trial
Early-onset pneumonia following bag-mask ventilation versus endotracheal intubation during cardiopulmonary resuscitation: A substudy of the CAAM trial.
Early-onset pneumonia (EOP) is a common in-hospital complication in survivors of out-of-hospital cardiac arrest. In this substudy of the CAAM trial, we aimed to compare whether bag mask ventilation (BMV) compared to endotracheal intubation (ETI) performed during cardiopulmonary resuscitation increases the risk of developing EOP. ⋯ In this substudy of the CAAM trial, development of early-onset pneumonia in out-of-hospital cardiac arrest survivors did not depend on airway management technique during CPR.
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We tested the consistency of ventricular characteristics measurement on brain computed tomography (CT) and investigated the prognostic performance of ventricular characteristics by sex, age, and time of brain CT in out-of-hospital cardiac arrest (OHCA) survivors. ⋯ The measurement of ventricular characteristics on brain CT was consistent in OHCA survivors. The prognostic performance of ventricular characteristics was best for brain CT 6-24 h after CA and differed according to age and sex sub-groups.
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Neurological outcome prediction is crucial early after cardiac arrest. Serum biomarkers released from brain cells after hypoxic-ischaemic injury may aid in outcome prediction. The only serum biomarker presently recommended in the European Resuscitation Council prognostication guidelines is neuron-specific enolase (NSE), but NSE has limitations. In this study, we therefore analyzed the outcome predictive accuracy of the serum biomarkers glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) in patients after cardiac arrest. ⋯ GFAP and UCH-L1 predicted poor neurological outcome with high accuracy. Their combination may be of special interest for early prognostication after cardiac arrest where it performed significantly better than the currently recommended biomarker NSE.
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Resuscitation research is inconsistent in how emergency department (ED) arrests are classified. We tested whether clinical features of ED arrests more closely resembled out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). ⋯ Across multiple aggregated measures, ED arrests resemble IHCA more than OHCA.
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To quantitatively assess the severity of anoxic-ischemic brain injury early after cardiac arrest (CA) using a novel automated method applied to head computed tomography (HCT). ⋯ In comatose survivors of CA, automated quantitative analysis of HCT revealed very early multifocal changes in brain tissue density which are mostly overlooked on conventional neuroradiologic interpretation and are associated with neurological outcome.