Resuscitation
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Review Meta Analysis
Medical futility regarding cardiopulmonary resuscitation in in-hospital cardiac arrests of adult patients: A Systematic Review and Meta-analysis.
For some patients, survival with good neurologic function after cardiopulmonary resuscitation (CPR) is highly unlikely, thus CPR would be considered medically futile. Yet, in clinical practice, there are no well-established criteria, guidelines or measures to determine futility. We aimed to investigate how medical futility for CPR in adult patients is defined, measured, and associated with do-not-resuscitate (DNR) code status as well as to evaluate the predictive value of clinical risk scores through meta-analysis. ⋯ There is no international consensus and a lack of specific definitions of CPR futility in adult patients. Clinical risk scores might aid decision-making when CPR is assumed to be futile. Future studies are needed to assess their clinical value and reliability as a measure of futility regarding CPR.
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This review is the latest in a series of regular annual reviews undertaken by the editors and aims to highlight some of the key papers published in Resuscitation during 2021. ⋯ Resuscitation science continues to evolve and incorporates all links in the chain of survival.
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To introduce and evaluate a new, open-source algorithm to detect chest compression periods automatically by the rhythmic, high amplitude signals from an accelerometer, without processing single chest compression events, and to consecutively calculate the chest compression fraction (CCF). ⋯ The proposed algorithm reliably detects chest compressions in defibrillator recordings. It can markedly reduce the workload for manual annotation, which may facilitate uniform reporting of measured quality of cardiopulmonary resuscitation. The algorithm is made freely available and may be used in big data analysis and machine learning approaches.
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Guidelines recommend use of computerized tomography (CT) and electroencephalography (EEG) in post-arrest prognostication. Strong associations between CT and EEG might obviate the need to acquire both modalities. We quantified these associations via deep learning. ⋯ CT and EEG provide complementary information about post-arrest brain injury. Our results do not support selective acquisition of only one of these modalities, except in the most severely injured patients.
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Practice Guideline Guideline
ERC-ESICM guidelines on temperature control after cardiac arrest in adults.
The aim of these guidelines is to provide evidence‑based guidance for temperature control in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless of the underlying cardiac rhythm. These guidelines replace the recommendations on temperature management after cardiac arrest included in the 2021 post-resuscitation care guidelines co-issued by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM). The guideline panel included thirteen international clinical experts who authored the 2021 ERC-ESICM guidelines and two methodologists who participated in the evidence review completed on behalf of the International Liaison Committee on Resuscitation (ILCOR) of whom ERC is a member society. ⋯ There was insufficient evidence to recommend for or against temperature control at 32-36 °C or early cooling after cardiac arrest. We recommend not actively rewarming comatose patients with mild hypothermia after return of spontaneous circulation (ROSC) to achieve normothermia. We recommend not using prehospital cooling with rapid infusion of large volumes of cold intravenous fluids immediately after ROSC.