Resuscitation
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Review Meta Analysis
Prevalence of intracranial hemorrhage amongst patients presenting with out-of-hospital cardiac arrest: A systematic review and meta-analysis.
An unknown proportion of out-of-hospital cardiac arrest (OHCA) is caused by intracranial hemorrhage (ICH). There is uncertainty over the role of early head computed tomography (CT) in non-traumatic OHCA due to uncertain diagnostic yield and ways to identify high-risk patients. This study aimed to identify the prevalence of ICH in non-traumatic OHCA and possible predictors. ⋯ One in twenty OHCA have ICH at the time of presentation. An early head CT scan should be strongly considered after return of spontaneous circulation (ROSC), especially in patients who are female, with non-shockable rhythm and did not attain ROSC prior to arrival. These finding should influence clinical protocols to favor routine scans especially in Asia where prevalence is higher.
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Review Meta Analysis
Long term risk of recurrence among survivors of sudden cardiac arrest: a systematic review and meta-analysis.
With a growing number of survivors of sudden cardiac arrest globally, their natural disease progression is of interest. This systematic review and meta-analysis aimed to determine the risk of recurrence after sudden cardiac arrest and its associated risk factors. ⋯ 15.24% of sudden cardiac arrest survivors experienced a recurrence, and of these, 35.03% experienced a second recurrence. Most recurrences occurred in the first year. Initial shockable rhythm increased this risk. Despite the limitations of inter-study heterogeneity, these findings can still guide intervention and follow-up of sudden cardiac arrest survivors.
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Patients admitted with return of spontaneous circulation (ROSC) following out of hospital cardiac arrest (OHCA) are often sedated to facilitate care. Volatile anaesthetics have been proposed as alternative sedatives because of their rapid offset. We performed a systematic review and meta-analysis comparing the use of volatile anaesthetics to conventional sedation in this population. ⋯ Volatile anaesthetics may be associated with a decreased duration of mechanical ventilation in patients admitted with ROSC however this is based on low-certainty evidence. Further data are needed to assess their role in this population.
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Little is known about automated external defibrillator (AED) functionality in real-life settings. We aimed to assess the functionality of all registered AEDs in a geographically selected area and calculate the proportion of historical out-of-hospital cardiac arrests (OHCAs) covered by non-functioning AEDs. ⋯ Almost one-fifth of all registered and publicly available AEDs were not functional, primarily due to expired electrodes, failed self-tests or obstacles to retrieving AEDs. One in twenty historical OHCA was covered by a non-functional AED. Although general AED functionality was high, this finding underlines the importance of regular AED maintenance.
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Multicenter Study Observational Study
In-hospital versus out-of-hospital cardiac arrest: Characteristics and outcomes in patients admitted to intensive care after return of spontaneous circulation.
Cardiac arrest is characterized depending on location as in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA). Strategies for Post Cardiac Arrest Care were developed based on evidence from OHCA. The aim of this study was to compare characteristics and outcomes in patients admitted to intensive care after IHCA and OHCA. ⋯ In patients admitted to intensive care after cardiac arrest, patients who suffered IHCA vs OHCA differed in demographics, co-morbidities, cardiac arrest characteristics and outcomes. In multivariable analyses, cardiac arrest characteristics were independent predictors of outcome, whereas location of arrest (IHCA vs OHCA) was not.