Resuscitation
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Early bystander cardiopulmonary resuscitation (CPR) has been associated with better patient outcomes in cardiac arrest. Despite this, not all cases of cardiac arrest receive bystander intervention. Reasons for this gap include disparities in provision of bystander CPR between race, gender and age groups. Concern of legal liability for responders has also been described. We propose that bystanders are more likely to face litigation for lack of intervention compared to providing bystander CPR due to the presence of 'Good Samaritan' statutes in all 50 states. This review of the legal literature seeks to quantify the number of cases brought against bystanders in the US over the past 30 years and explore the reasons behind them. ⋯ This study represents the largest single study of legal cases involving bystander CPR in the medical literature. The likelihood of litigation is significantly higher in cases with bystander CPR absent or delayed. The authors propose the inclusion of this data and reiteration of 'Good Samaritan' statutes in all 50 states during CPR training to reassure and encourage public response to cardiac arrests.
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Observational Study
Nationwide trends in residential and non-residential out-of-hospital cardiac arrest and differences in bystander cardiopulmonary resuscitation.
Singapore is highly-urbanized, with >90% of the population living in high-rise apartments. She has implemented several city-wide interventions such as dispatcher-assisted CPR, community CPR training and smartphone activation of volunteers to increase bystander CPR (BCPR) rates for out-of-hospital cardiac arrest (OHCA). These may have different impact on residential and non-residential OHCA. We aimed to evaluate the characteristics, processes-of-care and outcome differences between residential and non-residential OHCA and study the differences in temporal trends of BCPR rates. ⋯ Residential cardiac arrests had poorer bystander intervention and survival from 2010 to 2016 in Singapore. BCPR had improved more in residential arrests compared to non-residential arrests over a period of city-wide interventions to improve BCPR.
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Randomized Controlled Trial
The influence of prolonged temperature management on acute kidney injury after out-of-hospital cardiac arrest: A post-hoc analysis of the TTH48 trial.
Acute kidney injury (AKI) is common after cardiac arrest and targeted temperature management (TTM). The impact of different lengths of cooling on the development of AKI has not been well studied. In this study of patients included in a randomised controlled trial of TTM at 33 °C for 24 versus 48 h after cardiac arrest (TTH48 trial), we examined the influence of prolonged TTM on AKI and the incidence and factors associated with the development of AKI. We also examined the impact of AKI on survival. ⋯ We did not find any association between prolonged TTM at 33 °C and the risk of AKI during the first seven days in the ICU. AKI is prevalent after cardiac arrest and TTM and occurs in almost half of all ICU admitted patients and more commonly in the elderly, with an increasing BMI and longer arrest duration. AKI after cardiac arrest is an independent predictor of time to death.
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We aimed to investigate whether the effect of moderate hypothermia compared to normothermia on survival outcomes after out-of-hospital cardiac arrest (OHCA) patients who underwent targeted temperature management (TTM) differed between patients with and without initial spontaneous hypothermia. ⋯ The effect of moderate hypothermia was modified by the initial temperature of OHCA survivors who underwent TTM. The positive effect of moderate hypothermia was increased in patients with initial spontaneous hypothermia.
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Cardiac arrests are associated with poor outcomes. The International Liaison Committee on Resuscitation (ILCOR) evaluates resuscitation science and produced, until 2015, five-yearly consensus on science and treatment recommendations (CoSTRs), informing global resuscitation guidelines. We aimed to identify similarities/differences in resuscitation guidelines from ILCOR members, noting concurrence over time, and CoSTRs influence on these guidelines. ⋯ The improved concurrence across the resuscitation guidelines with the CoSTRs suggests that ILCOR members accept and hence incorporate CoSTRs recommendations to inform their own resuscitation guidelines. This is one step towards the development of international universal guidelines for adult and paediatric resuscitation.