Resuscitation
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Neurological prognostication following cardiac arrest (CA) is complex and sedative agents may significantly impair responses to clinical examination. This study investigates the elimination of fentanyl in patients treated with targeted temperature management (TTM). ⋯ There is marked variation in the clearance of fentanyl following continuous infusion during TTM after CA which correlates with illness severity, lactate concentration and genetic polymorphisms of the cytochrome p450 liver enzymes. Sustained presence of fentanyl may influence response to neurological examination at 12 h post discontinuation in patients receiving the drug as an infusion as part of TTM.
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Multimodal prognostication in comatose patients after cardiac arrest (CA) is complicated by the fact that different modalities are usually not independent. Here we set out to systematically correlate early EEG and MRI findings. ⋯ The MRI lesions are highly correlated with the EEG pattern. Our results suggest that performing MRI in comatose patients after CA with either highly malignant or with a benign EEG pattern is unlikely to yield additional useful information for prognostication, and should therefore be performed in priority in patients with intermediate EEG patterns ("malignant pattern").
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The use of transthoracic echocardiography (TTE) is common during cardiopulmonary resuscitation (CPR) from cardiac arrest, but logistic and practical challenges of obtaining satisfactory images without sacrificing the quality of CPR have resulted in some centers utilizing transesophageal echocardiography (TEE) during CPR. Although TEE avoids many of the downsides of TTE, several challenges exist in routine deployment. An alternative approach, intracardiac echocardiography (ICE), is routinely used by electrophysiologists during regular cardiac electrophysiologic procedures, such as atrial ablation for the treatment of atrial fibrillation. In this review, we evaluate various considerations in the potential for use of ICE as a novel means of enhancing resuscitation during CPR.