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https://www.readbyqxmd.com/read/28419016/an-evaluation-of-a-new-debriefing-framework-reflect
#1
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
#2
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...
April 7, 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
#3
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...
April 6, 2017: Neonatology
https://www.readbyqxmd.com/read/28323720/neuroprognostication-after-cardiac-arrest-in-the-light-of-targeted-temperature-management
#4
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...
March 20, 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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
https://www.readbyqxmd.com/read/27847811/effect-of-erythropoietin-on-postresuscitation-renal-function-in-a-swine-model-of-ventricular-fibrillation
#16
Charalampos Pantazopoulos, Nicoletta Iacovidou, Evangelia Kouskouni, Paraskevi Pliatsika, Apostolos Papalois, Georgios Kaparos, Dimitrios Barouxis, Panagiotis Vasileiou, Pavlos Lelovas, Olympia Kotsilianou, Ioannis Pantazopoulos, Georgios Gkiokas, Clara Garosa, Gavino Faa, Theodoros Xanthos
Purpose. To investigate the effect of EPO administration on postresuscitation renal function. Methods. Twenty-four female Landrace/Large-White piglets aged 10-15 weeks with average weight of 19 ± 2 kg were randomly assigned to 2 different groups of 12 subjects each. After the end of an 8-minute ventricular fibrillation, the control group (Group C) received saline as placebo, whereas the EPO group (Group E) received EPO 5000 U/kg. The animals were resuscitated according to the 2010 European Resuscitation Council Guidelines for Resuscitation...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27802958/the-evolving-paradigm-of-individualized-postresuscitation-care-after-cardiac-arrest
#17
REVIEW
David B Seder, Christine Lord, David J Gagnon
The postresuscitation period after a cardiac arrest is characterized by a wide range of physiological derangements. Variations between patients include preexisting medical problems, the underlying cause of the cardiac arrest, presence or absence of hemodynamic and circulatory instability, severity of the ischemia-reperfusion injury, and resuscitation-related injuries such as pulmonary aspiration and rib or sternal fractures. Although protocols can be applied to many elements of postresuscitation care, the widely disparate clinical condition of cardiac arrest survivors requires an individualized approach that stratifies patients according to their clinical profile and targets specific treatments to patients most likely to benefit...
November 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/27768665/lack-of-species-specific-difference-in-pulmonary-function-when-using-mouse-versus-human-plasma-in-a-mouse-model-of-hemorrhagic-shock
#18
Zhanglong Peng, Shibani Pati, Magali J Fontaine, Kelly Hall, Anthony V Herrera, Rosemary A Kozar
BACKGROUND: Clinical studies have demonstrated that the early and empiric use of plasma improves survival after hemorrhagic shock. We have demonstrated in rodent models of hemorrhagic shock that resuscitation with plasma is protective to the lungs compared with lactated Ringer's solution. As our long-term objective is to determine the molecular mechanisms that modulate plasma's protective effects in injured bleeding patients, we have used human plasma in a mouse model of hemorrhagic shock...
November 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27714400/-technical-assist-devices-perspectives-and-new-developments
#19
C Wallmüller, P Stratil, A Schober
The development of technical assist devices in the context of cardiopulmonary resuscitation (CPR) reaches back to the early roots of modern resuscitation research. This article covers the subjects of extracorporeal CPR (ECPR), including extracorporeal life support (ECLS), emergency ECLS (EECLS) and mechanical resuscitation devices. Specifically, the potential use of active compression-decompression CPR (ACD-CPR), impedance threshold devices (ITD) and capnography as additional measures during resuscitation are described in detail...
November 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/27648441/diazoxide-attenuates-postresuscitation-brain-injury-in-a-rat-model-of-asphyxial-cardiac-arrest-by-opening-mitochondrial-atp-sensitive-potassium-channels
#20
Haidong Wu, Peng Wang, Yi Li, Manhui Wu, Jiali Lin, Zitong Huang
Objective. We investigated whether and how diazoxide can attenuate brain injury after cardiopulmonary resuscitation (CPR) by selective opening of mitochondrial ATP-sensitive potassium (mitoKATP) channels. Methods. Adult male Sprague-Dawley rats with induced cerebral ischemia (n = 10 per group) received an intraperitoneal injection of 0.1% dimethyl sulfoxide (1 mL; vehicle group), diazoxide (10 mg/kg; DZ group), or diazoxide (10 mg/kg) plus 5-hydroxydecanoate (5 mg/kg; DZ + 5-HD group) 30 min after CPR...
2016: BioMed Research International
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