Resuscitation
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Meta Analysis
Drug therapy versus placebo or usual care for comatose survivors of cardiac arrest; a systematic review with meta-analysis.
In Europe, approximately 291,000 cardiac arrests occur annually. Despite critical care therapy, hospital mortality remains high. This systematic review assessed whether, in comatose survivors of cardiac arrest, any drug therapy, compared to placebo or usual care, improves outcomes. ⋯ In comatose survivors of cardiac arrest, the majority of trials of drug therapy reported no effect on mortality. Meta-analyses of steroids, coenzyme Q10 and thiamine demonstrated no evidence of an effect on mortality. However, the low certainty of evidence warrants further research.
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Abnormal serum potassium levels are commonly found in the intensive care unit (ICU) population. We aimed to determine the prevalence of potassium disorders at ICU admission and its association with functional outcomes in comatose patients resuscitated from cardiac arrest. ⋯ Of the comatose patients admitted to ICU after cardiac arrest, one in five experienced a potassium disorder on ICU admission. Hyperkalaemia was associated with unfavourable functional outcomes at 180 days, while hypokalaemia was not.
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Supraglottic airway devices such as the laryngeal tube (LT) are recommended in current guidelines for simplified airway management in patients during and immediately after out-of-hospital cardiac arrest (OHCA). Trials evaluating LTs included predominantly OHCA patients with non-shockable rhythms and low survival rates. Hence, LTs are widely used, but their impact on preventing hypoxic brain damage during resuscitation has not been evaluated yet. ⋯ While the original prehospital pragmatic trials comparing LT to ETI mostly included patients with non-shockable rhythm in settings with high mortality, our analysis is based on a real-world registry and focuses on successfully resuscitated patients, whose cause of arrest was most probably not due to hypoxia. In this cohort, use of LT was associated with a higher rate of anoxic brain damage and worse functional neurological outcome compared to use of ETI.
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This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. ⋯ Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.
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Intra-aortic balloon pump (IABP) and resuscitative endovascular balloon occlusion of the aorta (REBOA) are two endovascular intervention methods for circulatory support. The aim of this study was to compare the hemodynamic effects of simultaneous mechanical chest compressions (MCC) with IABP, REBOA and those with only MCC (overall and detailed in the MCC cycle) and return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR) in experimental non-traumatic cardiac arrests (CA). ⋯ Both IABP and REBOA increased the proportion of ROSC compared to controls. However, REBOA occluded distal blood flow, while IABP maintained it. This study suggests that MCC synchronized IABP could be an adjunct in the treatment of non-traumatic CA.