Resuscitation
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Review Meta Analysis
Coronary angiography findings in resuscitated and refractory out-of-hospital cardiac arrest: a systematic review and meta-analysis.
Coronary angiography (CAG) frequently reveals coronary artery disease (CAD) after out-of-hospital cardiac arrest (OHCA), but its use is not standardized and often reported in different subpopulations. This systematic review and meta-analysis accurately describes angiographic features in resuscitated and refractory OHCA. ⋯ Patients with OHCA have a high prevalence of significant CAD caused by acute and treatable coronary lesions. Refractory OHCA was associated with more severe coronary lesions. CAD was also present in patients with nonshockable rhythm and without ST elevation. However, heterogeneity of studies and selection of patients undergoing CAG limit the certainty of findings.
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Review Meta Analysis
Blood pressure targets and management during post-cardiac arrest care.
Blood pressure is one modifiable physiological target in patients treated in the intensive care unit after cardiac arrest. Current Guidelines recommend targeting a mean arterial pressure (MAP) of higher than 65-70 mmHg using fluid resuscitation and the use of vasopressors. Management strategies will vary based in the setting, i.e. the pre-hospital compared to the in-hospital phase. ⋯ On the other hand, this analysis also suggests, that the likelihood of harm with a higher MAP target is also low. Noteworthy is that all studies to date have focused mainly on patients with a cardiac cause of the arrest with the majority of patients being resuscitated from a shockable initial rhythm. Future studies should aim to include also non-cardiac causes and aim to target a wider separation in MAP between groups.
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Review Meta Analysis
Global prevalence of basic life support training: A systematic review and meta-analysis.
Out-of-hospital cardiac arrest exerts a large disease burden, which may be mitigated by bystander cardiopulmonary resuscitation and automated external defibrillation. We aimed to estimate the global prevalence and distribution of bystander training among laypersons, which are poorly understood, and to identify their determinants. ⋯ Large regional variation exists in data availability and bystander training prevalence. Socioeconomic status correlated with prevalence of bystander training, and regional disparities were apparent between continents. Bystander training should be promoted, particularly in Asia, Middle East, and low-income regions. Data availability should be encouraged from under-represented regions.
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Editorial Comment Meta Analysis
The urban-rural divide in cardiac arrest survival.
This paper provides a commentary on the recently published "The incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis". The importance of this work due to the systematic search for the evidence and relative consistency of studies in terms of the direction of effect is highlighted. The commentary includes discussion on the variability between studies and the urban-rural differences in clinical care. Opportunities for future research are described, as well as the need to adequately characterise the local conditions and community engagement so that the applicability of research findings can be determined for local contexts.
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Review Meta Analysis
The incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis.
Rurality poses a unique challenge to the management of out-of-hospital cardiac arrest (OHCA) when compared to metropolitan (metro) locations. We conducted a systematic review of published literature to understand how OHCA incidence, management and survival outcomes vary between metro and rural areas. ⋯ Overall, while incidence did not vary, the odds of OHCA survival to hospital discharge were approximately 50% lower in rural areas compared to metro areas. This suggests an opportunity for improvement in the prehospital management of OHCA within rural locations. This review also highlighted major challenges in standardising the definition of rurality in the context of cardiac arrest research.