Resuscitation
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To identify patients who can obtain the full benefit from targeted temperature management (TTM) after out-of-hospital cardiac arrest. ⋯ The prediction protocol using the 5-R score was associated with good neurological outcome of patients treated with TTM. Therefore, it could be helpful in clinical decision making on whether to initiate cooling.
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Comparative Study
Comparison of defibrillation efficacy between two pads placements in a pediatric porcine model of cardiac arrest.
The placement of defibrillation pads at ideal anatomical sites is one of the major determinants of transthoracic defibrillation success. However, the optimal pads position for ventricular defibrillation is still undetermined. In the present study, we compared the effects of two different pads positions on defibrillation success rate in a pediatric porcine model of cardiac arrest. ⋯ In this pediatric porcine model of cardiac arrest, the anterior-posterior placement of pediatric pads yielded a higher success rate by lowering defibrillation threshold compared to the anterior-lateral position.
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The prognosis of immediate survivors of cardiac arrest remains poor, as the majority of these patients develops an inflammatory disorder known as the post-cardiac arrest syndrome (PCAS). Recently, the endothelial glycocalyx has been shown to be a key modulator of vascular permeability and inflammation, but its role in PCAS remains unknown. ⋯ Our data for the first time demonstrates a perturbation of the endothelial glycocalyx in immediate survivors of cardiac arrest and indicate a potential important role of this endothelial surface layer in the development of post-cardiac arrest syndrome.
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Cardiac arrest (CA) in humans causes warm renal ischemia-reperfusion injury, similar to animal models of ischemic acute kidney injury (AKI). We aimed to investigate the incidence and risk associations of AKI after CA, with or without post-resuscitation cardiogenic shock (PRCS). ⋯ In the absence of PRCS, CA in isolation is uncommonly associated with significant AKI. The human kidney may be more resistant to warm ischemia-reperfusion injury than previously thought.
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Hypothermia is used for brain protection after resuscitation from cardiac arrest and other forms of brain injury, but its impact on systemic and tissue perfusion has not been well defined. The aim of this study was to evaluate the cardiovascular and microvascular responses to mild therapeutic hypothermia (MTH) in an ovine model. ⋯ In this large animal model, MTH was associated with decreased ventricular function, oxygen extraction and microvascular flow compared to normothermia. These changes were associated with increased blood lactate levels. These observations suggest that MTH may impair tissue oxygen delivery through maldistribution of capillary flow.