Resuscitation
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Observational Study
Continuous surface EMG power reflects the metabolic cost of shivering during targeted temperature management after cardiac arrest.
Shivering may interfere with targeted temperature management (TTM) after cardiac arrest, contributing to secondary brain injury. Early identification of shivering is challenging with existing tools. We hypothesized that shivering detected by continuous surface sEMG monitoring would be validated with calorimetry and detected earlier than by intermittent clinical observation. ⋯ Shivering was detected by sEMG power earlier than by clinical assessment with BSAS, with similar accuracy compared to the indirect calorimetry gold standard. Continuous sEMG monitoring appears useful for clinical assessment and research for shivering during TTM.
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Observational Study
Relationship between time related serum albumin concentration, optic nerve sheath diameter, cerebrospinal fluid pressure, and neurological prognosis in cardiac arrest survivors.
The optimal time to measure serum albumin concentration (SAC) to predict prognosis in cardiac arrest (CA) survivors has not been elucidated. We aimed to compare the relationships between time-related SAC, optic nerve sheath diameter (ONSD), intracranial pressure (ICP), and neurological prognosis in CA survivors. ⋯ A higher ICP was strongly associated with and seemed predictive of poor outcome. Furthermore, the MSAC24/ONSD combination may be a useful predictor of high ICP and poor neurological outcome. Prospective studies should be conducted to confirm these results.
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Mathematical optimization of automated external defibrillator (AED) placements has the potential to improve out-of-hospital cardiac arrest (OHCA) coverage and reverse the negative effects of limited AED accessibility. However, the generalizability of optimization approaches has not yet been investigated. Our goal is to examine the performance and generalizability of a spatiotemporal AED placement optimization methodology, initially developed for Toronto, Canada, to the new study setting of Copenhagen, Denmark. ⋯ Without modification, a previously developed spatiotemporal AED optimization approach was applied to Copenhagen, resulting in similar OHCA coverage findings as Toronto, despite large geographic and cultural differences between the two cities. In addition to reinforcing the importance of temporal accessibility of AEDs, these similarities demonstrate the generalizability of optimization approaches to improve AED placement and accessibility.
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Chest compression (CC) research primarily focuses on finding the 'optimum' compression waveform using a variety of compression efficacy metrics. Blood flow is rarely measured systematically with high fidelity. Using a programmable mechanical chest compression device, we studied the effect of inter-compression pauses in a swine model of cardiac arrest, testing the hypothesis that a single 'optimal' CC waveform exists based on measurements of resulting blood flow. ⋯ This data challenges the concept of a single optimal CC waveform. Time dependent physiological response to compressions and no single compression waveform optimizing flow in all vessels indicate that current descriptions of CPR don't reflect patient physiology.