Current opinion in critical care
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Prediction of neurological prognosis in patients who are comatose after successful resuscitation from cardiac arrest remains difficult. Previous guidelines recommended ocular reflexes, somatosensory evoked potentials and serum biomarkers for predicting poor outcome within 72 h from cardiac arrest. However, these guidelines were based on patients not treated with targeted temperature management and did not appropriately address important biases in literature. ⋯ No index predicts poor neurological outcome after cardiac arrest with absolute certainty. Prognostic evaluation should start not earlier than 72 h after ROSC and only after major confounders have been excluded so that reliable clinical examination can be made. Multimodality appears to be the most reasonable approach for prognostication after cardiac arrest.
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This review outlines knowledge on the epidemiology of out-of-hospital cardiac arrest (OHCA) internationally and the contribution that resuscitation registries make to OHCA research. The review focuses on recent advances in the European Cardiac Arrest Registry project, EuReCa. ⋯ Data from resuscitation registries are an invaluable source of information on the incidence, management and outcome of OHCA. Registries can be used to generate hypotheses for clinical research and registry data may even be used to facilitate clinical trials. To develop international research collaboration, registries must be based on the same dataset and definitions, and include descriptions of data collection methodologies and emergency medical service (EMS) configurations. If such standardization can be achieved, the possibility of an international resuscitation registry might be realized, leading to important OHCA research opportunities worldwide.
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Temperature management for patients comatose after cardiac arrest has been an integral component of postcardiac arrest care for the last decade. In this review, we present recent findings and discuss implications for future trials. ⋯ Prehospital hypothermia induced by cold crystalloid infusion does not benefit cardiac arrest patients. For patients treated in an intensive care unit targeting a temperature of 36°C provides similar results as targeting 33°C.
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To provide an overview on most recent knowledge on methods currently available for monitoring of recruitment maneuvers at the bedside. ⋯ Several methods offer evaluation of lung recruitability and allow the monitoring of positive and negative effects of recruitment maneuvers. More than the type of method used, a multifaceted approach of monitoring of recruitment maneuvers should be regarded.