Critical care medicine
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Critical care medicine · Jul 2009
ReviewTherapeutic hypothermia for acute myocardial infarction: past, present, and future.
Therapeutic hypothermia has been shown in randomized clinical trials to improve neurologic outcomes following cardiac arrest. Whether therapeutic hypothermia improves important outcomes after acute myocardial infarction is an area of active research. Here we review recent experimental and clinical data that examine whether therapeutic hypothermia can improve functional outcomes or mortality rate in acute myocardial infarction. We conclude that the available clinical evidence does not support therapeutic hypothermia as standard therapy for acute myocardial infarction.
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In this article, the role of modest hypothermia for the treatment of experimental and clinical spinal cord injury (SCI) is discussed. While early investigations evaluated the beneficial effects of more profound levels of local hypothermia treatment following SCI, recent studies have concentrated on the benefits of mild hypothermia in protecting and promoting functional recovery in established animal models. ⋯ Modest systemic hypothermia was reported to be both safe and achievable in severely injured SCI patients. This evidence-based review summarizes both experimental and clinical data to support the use of modest hypothermia in the acute SCI setting.
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Critical care medicine · Jul 2009
Multicenter StudyIn-hospital versus out-of-hospital pediatric cardiac arrest: a multicenter cohort study.
: To describe a large multicenter cohort of pediatric cardiac arrest (CA) with return of circulation (ROC) from either the in-hospital (IH) or the out-of-hospital (OH) setting and to determine whether significant differences related to pre-event, arrest event, early postarrest event characteristics, and outcomes exist that would be critical in planning a clinical trial of therapeutic hypothermia (TH). ⋯ : For pediatric CA with ROC, several major differences exist between IH and OH cohorts. The finding that the etiology of death was attributed to neurologic indications much more frequently in OH arrests has important implications for future research. Investigators planning to evaluate the efficacy of new interventions, such as TH, should be aware that the IH and OH populations differ greatly and require independent clinical trials.
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Critical care medicine · Jul 2009
Randomized Controlled Trial Comparative StudyIntravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation.
To compare the clinical efficacy of intravenous diltiazem, digoxin, and amiodarone for acute ventricular rate (VR) control in patients with acute symptomatic atrial fibrillation (AF) necessitating hospitalization. ⋯ As compared with digoxin and amiodarone, intravenous diltiazem was safe and effective in achieving VR control to improve symptoms and to reduce hospital stay in patients with acute AF.