Resuscitation
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Observational Study
Improvement of Consciousness before Initiating Targeted Temperature Management.
Following cardiac arrest, return of spontaneous circulation (ROSC) in patients may be followed by spontaneous neurological recovery, which may decrease the potential adverse effects of treatments in post-cardiac arrest care, including those of Targeted Temperature Management (TTM). We investigated the percentage of post-arrest patients who experienced spontaneous neurological recovery, and the characteristics and neurological outcomes of these patients. ⋯ A significant portion of patients had spontaneous neurological recovery to GCS M6 within 3 h post ROSC, and had a favorable neurological outcome. Close monitoring of GCS and later initiation of TTM should be considered in those patients with a substantial likelihood of neurological recovery.
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Review Meta Analysis
Diagnostic Performance of the Basic and Advanced Life Support Termination of Resuscitation rules: A Systematic Review and Diagnostic Meta-Analysis.
To minimize termination of resuscitation (TOR) in potential survivors, the desired positive predictive value (PPV) for mortality and specificity of universal TOR-rules are ≥99%. In lack of a quantitative summary of the collective evidence, we performed a diagnostic meta-analysis to provide an overall estimate of the performance of the basic and advanced life support (BLS and ALS) termination rules. ⋯ Despite an overall high PPV, this meta-analysis highlights a clinically important variation in diagnostic performance of the BLS and ALS TOR-rules. Lower specificity and PPV were seen in non-Western regions, and populations with lower rates of in-field defibrillation. Improved insight in the varying diagnostic performance is highly needed, and local validation of the rules is warranted to prevent in-field termination of potential survivors.
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Review Meta Analysis
Efficacy of the cooling method for targeted temperature management in post-cardiac arrest patients: a systematic review and meta-analysis.
This review aimed to compare the efficacy of endovascular cooling devices (ECD), such as Thermogard®, with surface cooling devices (SCD), such as Arctic Sun®, in reducing mortality and improving neurological status for patients with post-cardiac arrest undergoing targeted temperature management. ⋯ CRD42019129770.
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Review Meta Analysis
Neuroprognostic accuracy of blood biomarkers for post-cardiac arrest patients: A systematic review and meta-analysis.
To summarise and compare the prognostic accuracy of the blood biomarkers of brain injury, including NSE and S-100B, for neurological outcomes in adult post-cardiac arrest patients. ⋯ The prognostic performance was comparable between NSE and S-100B. Both biomarkers may be integrated into a multimodal neuroprognostication algorithm for post-cardiac arrest patients and institution-specific cut-off points for both biomarkers should be established.
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There are limited data on the timing and outcomes of in-hospital cardiac arrest (IHCA) in patients with ST-elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention (pPCI). This study sought to examine the in-hospital mortality, temporal trends and resource utilization in early vs. delayed IHCA in STEMI. ⋯ Delayed IHCA (on or after hospital day 1) was associated with higher in-hospital mortality and resource utilization compared to early IHCA.