Resuscitation
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To determine if controlled head and thorax elevation, active compression-decompression cardiopulmonary resuscitation (CPR), and an impedance threshold device combined, termed automated head-up positioning CPR (AHUP-CPR), should be initiated early, as a basic (BLS) intervention, or later, as an advanced (ALS) intervention, in a severe porcine model of cardiac arrest. ⋯ When delivered early rather than late, AHUP-CPR resulted in significantly increased hemodynamics, 24-hour survival, and improved neurological function in pigs after prolonged cardiac arrest. Based on these findings, AHUP-CPR should be considered a BLS intervention.
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Randomized Controlled Trial Multicenter Study
Impact of Blood Pressure Targets on Central Hemodynamics during intensive care after Out-of-Hospital Cardiac Arrest.
The aim was to investigate the advanced hemodynamic effects of the two MAP-targets during intensive care on systemic hemodynamics in comatose patients after cardiac arrest. ⋯ Targeted MAP at 77 mmHg compared to 63 mmHg resulted in a higher dose of norepinephrine, increased cardiac index and SVRI. Heart rate was also increased, but stroke volume index was not affected by a higher blood pressure target.
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Randomized Controlled Trial
Postresuscitation oxygen reserve index-guided oxygen titration in out-of-hospital cardiac arrest survivors: a randomised controlled trial.
Hyperoxia after return of spontaneous circulation is potentially harmful, and oxygen titration in a prehospital setting is challenging. This study aimed to compare outcomes of oxygen reserve index-supported prehospital oxygen titration during prehospital transport with those of standard oxygen titration. ⋯ Oxygen reserve index- combined with pulse oximetry-based prehospital oxygen titration did not significantly improve the normoxia index compared with standard oxygen titration based on pulse oximetry alone (NCT03653325).
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Randomized Controlled Trial
Treatment Effects of Blood Pressure Targets and Hemodynamics According to Initial Blood Lactate Levels in Comatose Out-of-hospital Cardiac Arrest Patients - A Sub Study of the BOX Trial.
Out-of-hospital cardiac arrest (OHCA) survivors remaining comatose are often circulatory unstable with high mortality in the first days following resuscitation. Elevated lactate will reflect the severity and duration of hypoperfusion in cardiac arrest. Further, the severity of hypoperfusion could modify the effect on survival of different mean arterial blood pressure (MAP) targets. ⋯ Comatose OHCA patients with high initial lactate levels required more vasoactive drugs on the first two days of ICU admission to meet the blood pressure target and had a poorer prognosis. No indication that aiming for a higher MAP target is beneficial in patients with an initial high lactate level was found, however, given the post-hoc nature of this study, these results should be considered hypothesis-generating.
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Randomized Controlled Trial
Extracorporeal Cardiopulmonary Resuscitation-Based Approach to Refractory Out-of-Hospital Cardiac Arrest: a Focus on Organ Donation, a Secondary Analysis of a Prague OHCA Randomized Study.
Refractory out-of-hospital cardiac arrest (OHCA) has a poor outcome. In patients, who cannot be rescued despite using advanced techniques like extracorporeal cardiopulmonary resuscitation (ECPR), organ donation may be considered. This study aims to evaluate, in refractory OHCA, how ECPR versus a standard-based approach allows organ donorship. ⋯ The ECPR-based approach in the refractory OHCA trial is associated with increased organ donorship and an excellent outcome of transplanted organs.