Resuscitation
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Multicenter Study
Outcomes of extracorporeal life support in hypothermic cardiac arrest: Revisiting ELSO guidelines.
Predictive factors for poor outcomes in hypothermic cardiac arrest (HCA) differ from those in normothermic out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the outcomes of extracorporeal life support (ECLS) in HCA patients who may not be considered eligible based on the guidelines set by the Extracorporeal Life Support Organization (ELSO). ⋯ Qualification of patients with hypothermic cardiac arrest for ECLS rewarming should not be strictly based on guidelines for normothermic cardiac arrest, as this may result in not initiating potentially life-saving treatment for patients who could have favourable prognoses for survival with good neurological outcomes.
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Multicenter Study
Lung parenchymal and pleural findings on computed tomography after out-of-hospital cardiac arrest.
Lung injury and the acute respiratory distress syndrome (ARDS) are common after out-of-hospital cardiac arrest (OHCA), but the imaging characteristics of lung parenchymal and pleural abnormalities in these patients have not been well-characterized. We aimed to describe the incidence of lung parenchymal and pleural findings among patients who had return of spontaneous circulation (ROSC) and who underwent computed tomography (CT) of the chest after OHCA. ⋯ Over three-quarters of patients who survived to the hospital post OHCA and received a chest CT had lung parenchymal or pleural abnormalities, the most common of which were aspiration, pulmonary edema, and consolidation/pneumonia. Future planned research will characterize the clinical impact of these findings and whether early chest CT could identify patients at risk for ARDS or other pulmonary complications.
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Randomized Controlled Trial Pragmatic Clinical Trial
Vasopressor or advanced airway first in cardiac arrest?
While resuscitation guidelines emphasize early vasopressor administration and advanced airway management, their optimal sequence remains unclear. We sought to determine the associations between vasopressor-airway resuscitation sequence and out-of-hospital cardiac arrest (OHCA) outcomes in the Pragmatic Airway Resuscitation Trial (PART). ⋯ Vasopressor-airway resuscitation sequence was not associated with OHCA outcomes or CPR quality.
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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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Dispatcher-assisted cardiopulmonary resuscitation (DACPR) significantly improves the survival of out-of-hospital cardiac arrest (OHCA) patients. However, the effectiveness of DACPR may vary depending on the location of the cardiac arrest. This study compares DACPR outcomes in private homes versus public places. ⋯ This study demonstrated reduced DACPR effectiveness in public places compared to private homes, potentially influenced by caller factors, environmental conditions, and the caller-patient relationship. Developing location-specific strategies is essential to enhance DACPR effectiveness.