Resuscitation
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Observational Study
Effect of cancer history on post-resuscitation treatments in out-of-hospital cardiac arrest.
There is growing evidence that optimal post-resuscitation treatment is a significant factor for overall survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA). However, there is also growing evidence of disparities in treatments in vulnerable populations such as elderly individuals or patients with underlying diseases, including cancer. ⋯ The results of this study suggest that a prior history of cancer may be associated with lower probability to receive potentially beneficial post-resuscitation treatments.
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Although survival from out-of-hospital cardiac arrest (OHCA) is improving, little is known about the long-term outcome of survivors. In this study, we assess the impact of sex on 12 month functional recovery and health-related quality-of-life (HRQoL) outcomes in OHCA survivors. ⋯ Women report poorer functional recovery and HRQoL after OHCA. Further research is needed to better understand the reasons for these disparities.
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Prognostic tools typically combine several time-invariant clinical predictors using regression models that yield a single, time-invariant outcome prediction. This results in considerable information loss as repeatedly or continuously sampled data are aggregated into single summary measures. We describe a method for real-time multivariate outcome prediction that accommodates both longitudinal data and time-invariant clinical characteristics. ⋯ We describe a novel methodology for combining GBTM output and clinical covariates to estimate patient-specific prognosis over time. Refinement of such methods should form the basis for new avenues of prognostication research that minimize loss of clinically important information.
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The out-of-hospital cardiac arrest (OHCA) and cardiac arrest hospital prognosis (CAHP) scores were developed for early neuroprognostication after OHCA. Calculation of both scores requires estimation of the no-flow interval, which may be imprecise. We aimed to validate simplified OHCA and CAHP scores, which exclude the no-flow interval, in an East Asian cohort. ⋯ The simplified OHCA and CAHP scores predicted neurological outcomes in successfully resuscitated East Asian OHCA patients with similar and excellent accuracy. The simplified OHCA and CAHP scores could potentially serve alongside the original scores as risk-adjustment tools for comparison of outcomes between regional OHCA registries worldwide.
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Observational Study
Evaluation of Out-of-Hospital Cardiac Arrest using Transesophageal Echocardiography in the Emergency Department.
Transesophageal echocardiography (TEE) has been proposed as a modality to assess patients in the setting of cardiac arrest, both during resuscitation care and following return of spontaneous circulation (ROSC). In this study we aimed to assess the feasibility and clinical impact of TEE during the emergency department (ED) evaluation during out-of-hospital cardiac arrest (OHCA). ⋯ TEE is feasible and clinically impactful during OHCA management. Resuscitative TEE may allow for characterization of cardiac activity, including identification of pseudo-PEA and fine VF, determination of reversible pathology, and optimization of CPR quality.