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https://www.readbyqxmd.com/read/28586081/bed%C3%A3-mning-av-neuro%C3%A2-logisk-prognos-efter-hj%C3%A3-rtstopp-uppdaterade-rekommendationer-fr%C3%A3-n-svenska-hlr-r%C3%A3-dets-expertgrupp
#1
Christian Rylander, Hans Friberg, Elna-Marie Larsson, Lars Johan Liedholm, Sten Rubertsson, Tobias Cronberg
Assessment of neurologic prognosis after cardiac arrest. Updated recommendations from the Swedish CPR Council Expert Group European Resuscitation Council (ERC) issued updated guidelines for postresuscitation care in 2015. This paper provides updated Swedish recommendations for neurological prognostication of patients remaining unconscious after cardiac arrest (CA). The prognostication should be based on independent methods; clinical and neurophysiological examinations, imaging and biomarkers. It should not be performed earlier than three days after CA and any influence from sedatives must be negligible...
June 2, 2017: Läkartidningen
https://www.readbyqxmd.com/read/28584512/civilian-penetrating-gunshot-injury-to-the-neurocranium-in-enugu
#2
Ephraim Eziechina Onyia, Mark C Chikani, Wilfred C Mezue, Enoch O Uche, Izuchukwu Iloabachie, Matthew Mesi, Sunday Ejembi, Chuka Agunwa
INTRODUCTION: Civilian penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria. Such injuries are however poorly reported. They are associated with poor outcome and, at close range, are frequently fatal, especially when inflicted by high-velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those that are not mortally wounded. MATERIALS AND METHODS: Fifty-two patients with civilian penetrating gunshot wounds seen over a 10-year period (2004-2014) at the University of Nigeria Teaching Hospital and Memfys Hospital for Neurosurgery Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impacted on outcome...
January 2017: Nigerian Journal of Surgery: Official Publication of the Nigerian Surgical Research Society
https://www.readbyqxmd.com/read/28584212/variations-of-postresuscitation-lung-function-after-thrombolysis-therapy-in-a-cardiac-arrest-porcine-model-caused-by-pulmonary-thromboembolism
#3
Jun Yang, Lian-Xing Zhao, Chun-Sheng Li, Nan Tong, Hong-Li Xiao, Le An
BACKGROUND: Study of lung function in survivor from cardiac arrest (CA) caused by pulmonary thromboembolism (PTE) was rare. The aim of this study was to investigate the variations of postresuscitation lung function after thrombolysis treatment in a CA porcine model caused by PTE. METHODS: After 2 min of untreated CA, pigs of 10-12 weeks with a weight of 30 ± 2 kg (n = 24) were treated with recombinant human tissue plasminogen activator (50 mg). Cardiopulmonary resuscitation (CPR) and ventilation were initiated after drug administration...
June 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28582003/controversies-in-out-of-hospital-cardiac-arrest
#4
REVIEW
Rahul P Sharma, Dion Stub
Cardiac arrest is a major cause of morbidity and mortality and accounts for nearly 500,000 deaths annually in the United States. In patients suffering out-of-hospital cardiac arrest, survival is less than 15%, with considerable regional variation. Although most deaths occur during the initial resuscitation, an increasing proportion occur in patients hospitalized after initially successful resuscitation. In these patients, the significant subsequent morbidity and mortality is due to "post cardiac arrest syndrome...
October 2016: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28471147/clinical-cardiac-imaging-in-cardiac-arrest-and-periarrest
#5
Antonio F Amico
Echocardiography during preresuscitation care, cardiopulmonary resuscitation and postresuscitation is suggested to be an important tool in critical care medicine. At present a structured process integrating advanced life support and transtoracic echocardiography is not included in guidelines of cardiac resuscitation. However identification and treatment of reversible causes or complicating factors during cardiopulmonary resuscitation is rational and aimed to improve the outcomes. Furthermore, echocardiography has the potential to define the efficiency of the chest compressions and the optimal duration of the resuscitation maneuvers and/or the right time to switch to extracorporeal resuscitation...
May 3, 2017: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/28419016/an-evaluation-of-a-new-debriefing-framework-reflect
#6
Lauren E Zinns, Paul C Mullan, Karen J OʼConnell, Leticia M Ryan, Angela T Wratney
BACKGROUND: Postresuscitation debriefing (PRD) is recommended by the American Heart Association guidelines but is infrequently performed. Prior studies have identified barriers for pediatric emergency medicine (PEM) fellows including lack of a standardized curriculum. OBJECTIVE: Our objective was to create and assess the feasibility of a time-limited, structured PRD framework entitled REFLECT: Review the event, Encourage team participation, Focused feedback, Listen to each other, Emphasize key points, Communicate clearly, and Transform the future...
April 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28387644/medical-necessity-of-routine-admission-of-children-with-mild-traumatic-brain-injury-to-the-intensive-care-unit
#7
Jared D Ament, Krista N Greenan, Patrick Tertulien, Joseph M Galante, Daniel K Nishijima, Marike Zwienenberg
OBJECTIVE Approximately 475,000 children are treated for traumatic brain injury (TBI) in the US each year; most are classified as mild TBI (Glasgow Coma Scale [GCS] Score 13-15). Patients with positive findings on head CT, defined as either intracranial hemorrhage or skull fracture, regardless of severity, are often transferred to tertiary care centers for intensive care unit (ICU) monitoring. This practice creates a significant burden on the health care system. The purpose of this investigation was to derive a clinical decision rule (CDR) to determine which children can safely avoid ICU care...
June 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28380491/association-between-brain-and-kidney-near-infrared-spectroscopy-and-early-postresuscitation-mortality-in-asphyxiated-newborn-piglets
#8
Anne Lee Solevåg, Georg M Schmölzer, Britt Nakstad, Ola Didrik Saugstad, Po-Yin Cheung
BACKGROUND: Early outcome predictors after delivery room cardiopulmonary resuscitation (CPR) of asphyxiated newborns are needed. OBJECTIVES: To investigate if cerebral (rScO2) and renal (rSrO2) tissue oxygen saturation 30 min after return of spontaneous circulation (ROSC) are different between surviving versus nonsurviving piglets with asphyxia-induced cardiac arrest and CPR. Further, to investigate the relationship of rScO2 and rSrO2 to cardiac output (CO), blood pressure (BP), and biochemical variables 30 min and 4 h after ROSC...
2017: Neonatology
https://www.readbyqxmd.com/read/28323720/neuroprognostication-after-cardiac-arrest-in-the-light-of-targeted-temperature-management
#9
Mauro Oddo, Hans Friberg
PURPOSE OF REVIEW: Delayed awakening after targeted temperature management (TTM) and sedation is frequent among cardiac arrest patients. Differentiating between prolonged coma and irreversible cerebral damage can be challenging, therefore the utilization of a multimodal approach is recommended by international guidelines. Here, we discuss indications and advantages/disadvantages of available modalities for coma prognostication and describe new tools to improve our accuracy for outcome prediction...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28286775/demographics-and-clinical-features-of-postresuscitation-comorbidities-in-long-term-survivors-of-out-of-hospital-cardiac-arrest-a-national-follow-up-study
#10
Chih-Pei Su, Jr-Hau Wu, Mei-Chueh Yang, Ching-Hui Liao, Hsiu-Ying Hsu, Chin-Fu Chang, Shou-Jen Lan, Chiao-Lee Chu, Yan-Ren Lin
The outcome of patients suffering from out-of-hospital cardiac arrest (OHCA) is very poor, and postresuscitation comorbidities increase long-term mortality. This study aims to analyze new-onset postresuscitation comorbidities in patients who survived from OHCA for over one year. The Taiwan National Health Insurance (NHI) Database was used in this study. Study and comparison groups were created to analyze the risk of suffering from new-onset postresuscitation comorbidities from 2011 to 2012 (until December 31, 2013)...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28259482/accuracy-of-postresuscitation-team-debriefings-in-a-pediatric-emergency-department
#11
Paul C Mullan, Niall H Cochrane, James M Chamberlain, Randall S Burd, Fawn D Brown, Lauren E Zinns, Kristen M Crandall, Karen J O'Connell
STUDY OBJECTIVE: Guideline committees recommend postresuscitation debriefings to improve performance. "Hot" postresuscitation debriefings occur immediately after the event and rely on team recall. We assessed the ability of resuscitation teams to recall their performance in team-based, hot debriefings in a pediatric emergency department (ED), using video review as the criterion standard. We hypothesized that debriefing accuracy will improve during the course of the study. METHODS: Resuscitation physician and nurse leaders cofacilitated debriefings after ED resuscitations involving cardiopulmonary resuscitation (CPR) or intubation...
March 1, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28198552/cortical-spreading-depolarizations-in-the-postresuscitation-period-in-a-cardiac-arrest-male-rat-model
#12
Frederik Boe Hansen, Niels Secher, Morten Skovgaard Jensen, Leif Østergaard, Else Tønnesen, Asger Granfeldt
Neurological injury develops over days following cardiac arrest (CA); however, the exact mechanisms remain unknown. After stroke or trauma, the progression of neurological injury is associated with cortical-spreading depolarizations (CSDs). The objective was to investigate whether CA and subsequent resuscitation in rats are associated with 1) the development of spontaneous negative direct current (DC) shifts indicative of CSDs, and 2) changes in artificially induced CSDs in the postresuscitation period. Male Sprague-Dawley rats were randomized into four groups: 1) CA 90, 2) Control 90, 3) CA 360, and 4) Control 360...
February 15, 2017: Journal of Neuroscience Research
https://www.readbyqxmd.com/read/28190437/neurology-of-cardiopulmonary-resuscitation
#13
REVIEW
M Mulder, R G Geocadin
This chapter aims to provide an up-to-date review of the science and clinical practice pertaining to neurologic injury after successful cardiopulmonary resuscitation. The past two decades have seen a major shift in the science and practice of cardiopulmonary resuscitation, with a major emphasis on postresuscitation neurologic care. This chapter provides a nuanced and thoughtful historic and bench-to-bedside overview of the neurologic aspects of cardiopulmonary resuscitation. A particular emphasis is made on the anatomy and pathophysiology of hypoxic-ischemic encephalopathy, up-to-date management of survivors of cardiopulmonary resuscitation, and a careful discussion on neurologic outcome prediction...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28147413/cardiac-issues-in-cardiac-arrest
#14
Wulfran Bougouin, Alain Cariou
The prognosis of cardiac arrest (CA) remains poor, with a survival rate at hospital discharge between 6 and 10%. To improve this disappointing outcome, efforts are needed regarding each step in the chain of survival. In this review, the authors focus on cardiac issues, as the heart itself could be both a cause and a target in this setting. Acute myocardial infarction is very illustrative of this duality. As it is a frequent cause of CA, an early invasive strategy (through immediate coronary angiography) has been proposed by several teams and is now recommended in specific situations...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28141610/initiation-of-therapeutic-hypothermia-in-the-emergency-department-a-quality-improvement-project
#15
Cody Yochum, Rose Utley
Therapeutic hypothermia (TH) postresuscitation has been recommended by the American Heart Association (AHA) since 2005. Early initiation of TH and fast achievement of goal temperatures have been associated with better neurological outcomes. The objective of this study was to evaluate the effectiveness of a specific TH protocol for the emergency department (ED) in increasing ED use of TH and decreasing the time from return of spontaneous circulation (ROSC) to initiation of cooling measures. An ED protocol for TH as recommended by the AHA was implemented...
January 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/28098670/understanding-therapeutic-hypothermia
#16
Christian S Yacono, Stephanie Eider
Therapeutic hypothermia is a relatively new protocol that can improve patients' chances of favorable neurologic outcomes after cardiac arrest. However, implementation rates remain low nationwide. This article describes recommendations for and benefits of therapeutic hypothermia in postresuscitation care.
February 2017: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/28074817/extracorporeal-membrane-oxygenation-for-refractory-cardiac-arrest
#17
REVIEW
Steven A Conrad, Peter T Rycus
Extracorporeal cardiopulmonary resuscitation (ECPR) is the use of rapid deployment venoarterial (VA) extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR). Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/27987397/prophylactic-versus-clinically-driven-antibiotics-in-comatose-survivors-of-out-of-hospital-cardiac-arrest-a-randomized-pilot-study
#18
Suada Filekovic Ribaric, Matjaz Turel, Rihard Knafelj, Vojka Gorjup, Rade Stanic, Primoz Gradisek, Ognjen Cerovic, Tomislav Mirkovic, Marko Noc
AIM: To investigate benefits of prophylactic antibiotics in comatose survivors of out-of-hospital cardiac arrest (OHCA). METHODS: Patients without evidence of tracheobronchial aspiration on admission bronchoscopy were randomized to prophylactic Amoxicillin-Clavulanic acid 1.2g every 8h (P) or clinically-driven antibiotics (C) administered if signs of infection developed during initial 7days of intensive care unit (ICU) stay. RESULTS: Among 83 patients enrolled between September 2013 and February 2015, tracheobronchial aspiration was documented in 23 (28%)...
February 2017: Resuscitation
https://www.readbyqxmd.com/read/27966313/neurological-outcome-after-cardiac-arrest-a-prospective-study-of-the-predictive-ability-of-prognostic-biomarkers-neuron-specific-enolase-glial-fibrillary-acidic-protein-s-100b-and-procalcitonin
#19
Gülay Ok, Demet Aydın, Koray Erbüyün, Canan Gürsoy, Fatma Taneli, Sema Bilge, Gönül Dinç Horasan
BACKGROUND/AIM: Factors affecting neurological outcome and the usefulness of neuron-specific enolase (NSE), S-100B, glial fibrillary acidic protein (GFAP), and procalcitonin (PCT) in predicting neurological outcomes were assessed in patients who survived at least 24 h after cardiopulmonary resuscitation (CPR). MATERIALS AND METHODS: Thirty successfully resuscitated cardiac arrest patients were included in this prospective clinical study. The initial cardiac arrest rhythm, duration of CPR, return of spontaneous circulation time, administered doses of adrenaline, base excess, blood sugar, and hemodynamic parameters were recorded...
November 17, 2016: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/27866109/magnitude-of-temperature-elevation-is-associated-with-neurologic-and-survival-outcomes-in-resuscitated-cardiac-arrest-patients-with-postrewarming-pyrexia
#20
Anne V Grossestreuer, David F Gaieski, Michael W Donnino, Douglas J Wiebe, Benjamin S Abella
PURPOSE: Avoidance of pyrexia is recommended in resuscitation guidelines, including after treatment with targeted temperature management (TTM). Which aspects of postresuscitation pyrexia are harmful and modifiable have not been conclusively determined. MATERIALS AND METHODS: This retrospective multicenter registry study collected serial temperatures during 72 hours postrewarming to assess the relationship between 3 aspects of pyrexia (maximum temperature, pyrexia duration, timing of first pyrexia) and neurologic outcome (primary) and survival (secondary) at hospital discharge...
April 2017: Journal of Critical Care
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