Resuscitation
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Multicenter Study
Neonates with a 10-min Apgar score of zero: Outcomes by gestational age.
The current resuscitation guidelines for neonates recommend considering stopping resuscitation efforts if the heart rate remains undetectable after 10 min of adequate resuscitation. However, this recommendation does not take into account the gestational age (GA) of the neonates. We determined the outcomes of neonates with a 10-min Apgar score of zero (Apgar10 = 0) with respect to their GA. ⋯ Neonates with Apgar10 = 0 had different outcomes depending on their GA. Less than half of neonates born at <32 weeks GA survived; however, a majority of neonates born at 320/7-356/7 weeks' and ≥36 weeks' GA survived at similar rates than their matched neonates with Apgar10 = 1-2.
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Multicenter Study Observational Study
Long-term survival in out-of-hospital cardiac arrest patients treated with targeted temperature control at 33 °C or 36 °C: A national registry study.
There are limited data on long-term outcome in out-of-hospital cardiac arrest patients following the treatment shift of target temperature management (TTM) from 33 °C to 36 °C outside the controlled settings of randomised trials. The aim of this study was to evaluate the adherence to TTM guidelines after the publication of the TTM trial and if the change in temperature level influence six-month survival. ⋯ The proportion of patients receiving therapeutic hypothermia in Sweden has decreased significantly since the publication of the TTM-trial indicating lower adherence to guidelines. This was not associated with any significant difference in long term outcome.
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Multicenter Study
The Association of Immediate Post Cardiac Arrest Diastolic Hypertension and Survival following Pediatric Cardiac Arrest.
In-hospital cardiac arrest occurs in >5000 children each year in the US and almost half will not survive to discharge. Animal data demonstrate that an immediate post-resuscitation burst of hypertension is associated with improved survival. We aimed to determine if systolic and diastolic invasive arterial blood pressures immediately (0-20 min) after return of spontaneous circulation (ROSC) are associated with survival and neurologic outcomes at hospital discharge. ⋯ In this post hoc secondary analysis of the PICqCPR study, 68.6% of subjects had diastolic hypertension within 20 min of ROSC. Immediate post-ROSC hypertension was associated with increased odds of survival to discharge, even after adjusting for covariates of interest.
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To determine whether the urine biomarkers tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) can identify patients who will develop severe acute kidney injury (AKI) soon after cardiac arrest. ⋯ Urine [TIMP-2]*[IGFBP7] effectively identify patients with a risk of severe AKI. Below a cut-off of 0.39 (ng/ml)2/1000, the risk of severe AKI is low.
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Multicenter Study
Outcome prediction of out-of-hospital cardiac arrest with presumed cardiac aetiology using an advanced machine learning technique.
Outcome prediction for patients with out-of-hospital cardiac arrest (OHCA) has the possibility to detect patients who could have been potentially saved. Advanced machine learning techniques have recently been developed and employed for clinical studies. In this study, we aimed to establish a prognostication model for OHCA with presumed cardiac aetiology using an advanced machine learning technique. ⋯ The advanced machine learning technique showed favourable prediction capability for 1-year survival of OHCA with presumed cardiac aetiology. These models can be useful for detecting patients who could have been potentially saved.