Resuscitation
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The epidemiology and outcomes for patients with an out-of-hospital cardiac arrest (OHCA) caused by poisoning are largely unknown and may differ from OHCA of other causes. The study's aim is to compare key characteristics and outcomes between OHCA caused by poisoning vs. other causes. ⋯ Patients with an OHCA caused by poisoning were younger, a larger proportion of men and had several predictors for increased mortality, yet still had a lower 30-day mortality rate when compared to other causes.
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Prehospital airway management is essential in resuscitation from out-of-hospital cardiac arrest (OHCA). No longitudinal national studies have described longitudinal trends in airway device choice. We sought to evaluate secular trends of OHCA endotracheal intubation (ETI) and supraglottic airway (SGA) in the United States (US). ⋯ Over ten years, rates of advanced airway use have increased, with ETI remaining the predominant airway for adults in OHCA. Interestingly, ETI choice decreased as SGA increased over the study period. SGA use distinctly differed in urban settings, increasing concerns for disparities in care provision among communities. With the increased use of SGA over time, further evaluation of patient outcomes is required in datasets with robust linkage to Utstein variables.
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Epinephrine has been recommended for several decades for the treatment of cardiac arrest. However, although this potent medicament has a documented impact on the return of spontaneous circulation, it does not improve long-term survival. Decreased cerebral blood flow, one of the side effects of epinephrine, indicates that the use of this drug is a two-edged sword. Despite clinical recommendations, no study has investigated epinephrine pharmacokinetics in a setting of cardiac arrest. Therefore, in a pilot setting, we measured the plasma concentrations of epinephrine following a single administration. ⋯ Our study indicates that elimination of epinephrine during cardiac arrest is prolonged and that repeated doses of epinephrine may lead to increased plasma levels. Further and larger studies are warranted to determine the optimal plasma concentration during resuscitation.
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Do-not-resuscitate (DNR) orders allow competent individuals to state their wishes to not receive resuscitation. Despite the existence of a DNR order, resuscitative efforts may still occur. ⋯ Approximately 5% of EMS-attended OHCAs in ≥60-year-olds involve a patient with a DNR order, with low rates of awareness of DNR orders. Resuscitation is commenced in 47% of patients, and 4% are transported to hospital with very poor outcomes. Strategies to communicate DNR status and respect patients' autonomy are extremely important.
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The data is evolving on exhaled carbon dioxide (ECO2) levels for preterm infants requiring stabilisation. ⋯ We have provided trends of ECO2 in preterm infants needing stabilisation during the first 10 minutes of life. ECO2 appeared at least as early as any valid PR and earlier than SpO2.