Resuscitation
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To examine whether TTM treatment was aligned with predicted mortality risk in patients with resuscitated OHCA during a period when it was a class I guideline-recommended therapy. ⋯ TTM treatment patterns were not well-aligned with patients' mortality risk during a period when it was a guideline-recommended treatment for OHCA. Identifying strategies to better align guideline-recommended treatments with patients' mortality risk is critical for efforts to improve OHCA survival.
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Randomized Controlled Trial
Effect of Calcium in Patients with Pulseless Electrical Activity and Electrocardiographic Characteristics Potentially Associated with Hyperkalemia and Ischemia-Sub-study of the Calcium for Out-of-hospital Cardiac Arrest (COCA) trial.
The Calcium for Out-of-hospital Cardiac Arrest (COCA) trial was recently conducted and published. This pre-planned sub-study evaluated the effect of calcium in patients with pulseless electrical activity (PEA) including subgroup analyses based on electrocardiographic characteristics potentially associated with hyperkalemia and ischemia. ⋯ In adults with out-of-hospital cardiac arrest presenting with PEA, effect estimates suggested harm of calcium administration as compared to placebo but with wide confidence intervals. Results were consistent for patients with electrocardiographic characteristics potentially associated with hyperkalemia and ischemia. The results do not support calcium administration based strictly on electrocardiographic findings seen during out-of-hospital cardiac arrest.
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Observational Study
Outcomes Associated with Intra-Arrest Hyperoxaemia in Out-of-Hospital Cardiac Arrest: A Registry-Based Cohort Study.
An association between post-arrest hyperoxaemia and worse outcomes has been reported for out-of-hospital cardiac arrest (OHCA) patients, but little is known about the relationship between intra-arrest hyperoxaemia and clinically relevant outcomes. This study aimed to investigate the association between intra-arrest hyperoxaemia and outcomes for OHCA patients. ⋯ In this observational study of adult OHCA patients, intra-arrest normoxaemia and hyperoxaemia were associated with better functional survival, compared to hypoxaemia.
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We sought to determine if the difference between PaCO2 and ETCO2 is associated with hospital mortality and neurologic outcome following out-of-hospital cardiac arrest (OHCA). ⋯ Neither PaCO2-ETCO2 nor ETCO2 were strong predictors of survival or neurologic status at hospital discharge. While they may be useful to guide ventilation and resuscitation, these measures should not be used for prognostication after OHCA.
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Observational Study
Increase in End-Tidal Carbon Dioxide after Defibrillation Predicts Sustained Return of Spontaneous Circulation During Out-of-Hospital Cardiac Arrest.
Guidelines recommend monitoring end-tidal carbon dioxide (ETCO2) during out-of-hospital cardiac arrest (OHCA), though its prognostic value is poorly understood. This study investigated the relationship between ETCO2 and return of spontaneous circulation (ROSC) after defibrillation in intubated non-traumatic OHCA patients. ⋯ ETCO2 rises after defibrillation in most patients during cardiac arrest. Patients with sustained ROSC experience larger rises, though the majority experience rises of less than 10 mmHg.