Resuscitation
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Measuring tidal volumes (TV) during bag-valve ventilation is challenging in the clinical setting. The ventilation waveform amplitude of the transthoracic impedance (TTI-amplitude) correlates well with TV for an individual, but poorer between patients. We hypothesized that TV to TTI-amplitude relations could be improved when adjusted for morphometric variables like body mass index (BMI), gender or age, and that TTI-amplitude cut-offs for ventilations with adequate TV (>400ml) could be established. ⋯ TTI-amplitude to TV relations were established and cut-offs for ventilations with adequate TV determined. Patient morphometric variables related to gender, age and BMI explain part of the variability in the measurements.
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Characterize release and recoil dynamics in chest compressions during prolonged cardiopulmonary resuscitation (CPR) efforts, which are increasingly prevalent. ⋯ Depth waveforms change markedly less than do force waveforms over the course of prolonged CPR. With the benefit of feedback, CPR providers effectively adjust the application of force to compensate for changes in chest stiffness, documented previously. Despite slowing release and quickening recoil, interference between release of force and recoil of depth appears limited. Spontaneous chest recoil is well preserved in prolonged duration manual CPR.
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We aimed to characterize extracorporeal CPR (ECPR) outcomes in our center and to model prediction of severe functional impairment or death at discharge. ⋯ Mortality and functional impairment following ECPR in children remain high. It is possible to model severe functional impairment or death at discharge with high accuracy using daily post-ECPR data up to 28 days. This represents a prognostically valuable tool and may identify endpoints for future interventional trials.
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Observational Study
Fewer Tracheal Intubation Attempts are Associated with Improved Neurologically Intact Survival Following Out-of-Hospital Cardiac Arrest.
International guidelines emphasize advanced airway management during out-of-hospital cardiac arrest (OHCA). We hypothesized that increasing endotracheal intubation attempts during OHCA were associated with a lower likelihood of favorable neurologic survival at discharge. ⋯ Increasing number of intubation attempts during OHCA resuscitation was associated with lower likelihood of favorable neurologic outcome.
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Several prospective studies have demonstrated that the echocardiographic detection of any myocardial activity during PEA is strongly associated with higher rates of return of spontaneous circulation (ROSC). We hypothesized that PEA represents a spectrum of disease in which not only the presence of myocardial activity, but more specifically that the degree of left ventricular (LV) function would be a predictor of outcomes. The purpose of this study was to retrospectively assess the association between LV function and outcomes in patients with OHCA. ⋯ Left ventricular function measured by LVFS is positively correlated with higher probability of ROSC and may be associated with higher chances of survival in patients with PEA arrest.