Resuscitation
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Clinical staging of accidental hypothermia is used to guide out-of-hospital treatment and transport decisions. Most clinical systems utilize core temperature, by measurement or estimation, to stage hypothermia, despite the challenge of obtaining accurate field measurements. ⋯ The revised system uses the risk of cardiac arrest, instead of core temperature, to determine the staging level. Our revised system simplifies assessment by using the level of responsiveness, based on the AVPU scale, and by removing shivering as a stage-defining sign.
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In this study, we examine the impact of a trauma-focused resuscitation protocol on survival outcomes following adult traumatic out-of-hospital cardiac arrest (OHCA). ⋯ Despite an increase in trauma-based interventions and a reduction in the time to their administration, our study did not find a survival benefit from a trauma-focused resuscitation protocol over initial conventional CPR. However, survival was low with both approaches.
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Many emergency medical service (EMS) agencies are implementing programmes to improve the quality and performance of resuscitation. We sought to examine the impact of a resuscitation quality improvement programme on outcomes following OHCA. ⋯ A resuscitation quality improvement programme consisting of high-performance CPR was associated with a significant increase in survival following OHCA.
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Randomized Controlled Trial
Biomarker prognostication of cognitive impairment may be feasible even in out-of hospital cardical arrest survivors with good neurological outcome.
Patients surviving out-of hospital cardicac arrest, with good neurological outcome according to Cerebral Performance Category, frequently have neuropsychological impairment. We studied whether biomarker data (S-100b and neuron-specific enolase) obtained during the ICU stay predicted cognitive impairment 6 months after resuscitation. ⋯ Early biomarker prognostication of cognitive impairment is feasible even in OHCA survivors with good neurological outcome as defined by CPC. NSE at 48 h predicted cognitive impairment.
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To calculate and compare the National Institutes of Health (NIH) research investment for cardiac arrest (CA) to other leading causes of disability-adjusted life years (DALY) in the United States (U.S.). ⋯ The NIH investment into CA research is far less than other comparable causes of death and disability in the U.S. These results should help inform utilization of limited resources to improve public health.