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endpoints resuscitation

Olivier Nardi, Elizabeth Zavala, Claude Martin, Serafim Nanas, Thomas Scheeren, Andrea Polito, Xavi Borrat, Djillali Annane
OBJECTIVE: Evaluation of the ratio of oxyhaemoglobin to total haemoglobin in skeletal muscle (StO2 ) using near-infrared spectroscopy may aid in the monitoring of patients with sepsis. This study assessed the benefits and risks of targeting StO2 in adults with severe sepsis or septic shock. DESIGN: A European randomised controlled trial was performed on two parallel groups. SETTING: Five intensive care units (ICU) in France, Greece, Spain and Germany were used for the study...
March 19, 2018: BMJ Open
Zachary D W Dezman, Angela C Comer, Gordon S Smith, Peter F Hu, Colin F Mackenzie, Thomas M Scalea, Jon Mark Hirshon
BACKGROUND: Lactate clearance has been developed into a marker of resuscitation in trauma, but no study has compared the predictive power of the various clearance calculations. Our objective was to determine which method of calculating lactate clearance best predicted 24-hour and in-hospital mortality after injury. STUDY DESIGN: Retrospective chart review of patients admitted to a Level-1 trauma center directly from the scene of injury from 2010 to 2013 who survived >15min, had an elevated lactate at admission (≥3mmol/L), followed by another measurement within 24h of admission...
March 7, 2018: American Journal of Emergency Medicine
P J Secombe, R Sutherland, R Johnson
Adequate cardiopulmonary resuscitation is an important predictor of survival, however, obesity provides a significant physical barrier to thoracic compressions. This study explores the effect of morbid obesity on compression adequacy. We performed a prospective randomised controlled crossover study, assessing the adequacy of thoracic compressions on a manikin modified to emulate a morbidly obese patient. Participants recruited from critical care departments were randomised to perform continuous compressions for two minutes on each manikin...
March 2018: Anaesthesia and Intensive Care
Déborah Jaeger, Florence Dumas, Josephine Escutnaire, Sonia Sadoune, Adrien Lauvray, Carlos Elkhoury, Adrien Bassand, Nicolas Girerd, Pierre Yves Gueugniaud, Karim Tazarourte, Hervé Hubert, Alain Cariou, Tahar Chouihed
BACKGROUND: The survival rate of out-of-hospital cardiac arrest (OHCA) remains extremely low, generally under 10%. Post-resuscitation care, and particularly early coronary reperfusion, may improve this outcome. The main objective of the present study was to determine whether patients with immediate coronary angiography at hospital admission (CAA) had a better outcome than patients without immediate CAA. METHODS: This cohort analysis study was based on data extracted from the French National Cardiac Arrest registry (RéAC)...
March 5, 2018: Resuscitation
Kiavash R Koko, Brian D McCauley, John P Gaughan, Marc W Fromer, Ryan S Nolan, Ashleigh L Hagaman, Spencer A Brown, Joshua P Hazelton
BACKGROUND: Spectral analysis of continuous blood pressure and heart rate variability provides a quantitative assessment of autonomic response to hemorrhage. This may reveal markers of mortality as well as endpoints of resuscitation. METHODS: Fourteen male Yorkshire pigs, ranging in weight from 33 to 36 kg, were included in the analysis. All pigs underwent laparotomy and then sustained a standardized retrohepatic inferior vena cava injury. Animals were then allowed to progress to class 3 hemorrhagic shock and where then treated with abdominal sponge packing followed by 6 h of crystalloid resuscitation...
April 2018: Journal of Surgical Research
Seo Young Ko, Young Sun Ro, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong, So Yeon Kong
INTRODUCTION: The deployment of first responders in a public place is one of the interventions that is used for increasing bystander cardiopulmonary resuscitation (CPR) of out-of-hospital cardiac arrests (OHCA). We studied the association between the presence of a first responder and the survival of OHCA that occurred during a period of exercise in a public place. METHODS: All of the adult OHCAs of a presumed cardiac etiology that occurred during a period of exercise in a public place and that were witnessed by a bystander between 2013 and 2015 were analyzed...
2018: PloS One
Karl Kuckuck, Hanna Schröder, Rolf Rossaint, Lina Stieger, Stefan K Beckers, Sasa Sopka
OBJECTIVE: The study objective was to implement two strategies (short emotional stimulus vs announced practical assessment) in the teaching of resuscitation skills in order to evaluate whether one led to superior outcomes. SETTING: This study is an educational intervention provided in one German academic university hospital. PARTICIPANTS: First-yearmedical students (n=271) during the first3 weeks of their studies. INTERVENTIONS: Participants were randomly assigned to one of two groups following a sequence of random numbers: the emotional stimulus group (EG) and the assessment group (AG)...
February 22, 2018: BMJ Open
Jeong Ho Park, Young Sun Ro, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong, So Yeon Kong
OBJECTIVES: We investigated the impact of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) on survival outcomes after out-of-hospital cardiac arrests (OHCAs) that occurred in rural and urban areas. METHODS: This study was a cross-sectional study using nationwide emergency medical services (EMS)-based OHCA registry in Korea. All EMS-treated adults with OHCAs and with presumed cardiac etiology were enrolled between 2012 and 2015, excluding cases witnessed by an EMS provider...
February 1, 2018: Resuscitation
Mark J Russell, Hari Krishnan Kanthimathinathan
OBJECTIVES: To review the findings and discuss the implications of a longer duration for fluid boluses in the resuscitation of children with septic shock. DATA SOURCES: We performed a search using the criteria "Fluid Bolus" and "Children" and "Septic Shock," which yielded 29 references. STUDY SELECTION: One trial compared different durations of fluid boluses in pediatric septic shock and was therefore selected for critical appraisal...
January 23, 2018: Pediatric Critical Care Medicine
Katharine D Harper, Paul Navo, Frederick Ramsey, Sainabou Jallow, Saqib Rehman
Purpose: Excessive blood loss with hip fracture management has been shown to result in increased rates of complications. Our goal is to compare blood loss and transfusion rates between patients with intracapsular and extracapsular (both intertrochanteric (IT) and subtrochanteric (ST)) hip fractures. Methods: 472 patients were evaluated over a five-year period. Those who presented to the hospital with a proximal femur fracture (femoral neck, IT or ST) were considered for the study...
December 2017: Geriatric Orthopaedic Surgery & Rehabilitation
Sabine Wingen, Daniel C Schroeder, Hannes Ecker, Susanne Steinhauser, Sibel Altin, Stephanie Stock, Alex Lechleuthner, Andreas Hohn, Bernd W Böttiger
BACKGROUND: Education of schoolchildren in cardiopulmonary resuscitation (CPR) is a strategic goal for improvement of bystander CPR in society. OBJECTIVE(S): The primary objective was to analyse the impact of CPR training on the resuscitation knowledge and self-confidence of secondary schoolchildren. In addition, independent predictors of improved CPR knowledge and self-confidence were investigated. DESIGN: Prospective, randomised-interventional controlled study...
January 2, 2018: European Journal of Anaesthesiology
Audrey Pieper, Frédéric Thony, Julien Brun, Mathieu Rodière, Bastien Boussat, Catherine Arvieux, Jérôme Tonetti, Jean-François Payen, Pierre Bouzat
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used as a noninvasive clamp of the aorta after diverse posttraumatic injuries. Balloon inflation in zone 3 (from the lower renal artery to the aortic bifurcation) can be performed to stop ongoing bleeding after severe pelvic trauma with life-threatening hemorrhage. The aim of our study was to describe our 20-year experience with REBOA in terms of efficacy and safety in patients with a suspicion of severe pelvic trauma and extreme hemorrhagic shock...
March 2018: Journal of Trauma and Acute Care Surgery
Sudha P Jayaraman, Rahul J Anand, Jonathan H DeAntonio, Martin Mangino, Michel B Aboutanos, Vigneshwar Kasirajan, Rao Ivatury, Alex B Valadka, Olena Glushakova, Ronald L Hayes, Lorin M Bachmann, Gretchen M Brophy, Daniel Contaifer, Urszula O Warncke, Donald F Brophy, Dayanjan S Wijesinghe
Trauma is a major problem in the United States. Mortality from trauma is the number one cause of death under the age of 45 in the US and is the third leading cause of death for all age groups. There are nearly 200,000 deaths per year due to trauma in the US at a cost of over $671 billion in combined health care costs and lost productivity. Unsurprisingly, trauma accounts for about 30% of all life-years lost in the US. Due to immense development of trauma systems, a large majority of trauma patients survive the injury but then go on to die from complications arising from the injury...
December 26, 2017: Shock
D Garrigue, A Godier, A Glacet, J Labreuche, E Kipnis, C Paris, A Duhamel, E Resch, A Bauters, F Machuron, P Renom, P Goldstein, B Tavernier, A Sailliol, S Susen
Essentials An immediate supply of plasma in case of trauma-induced coagulopathy is required. The Traucc trial compared French Lyophilised Plasma (FLyP) and Fresh Frozen Plasma (FFP). FLyP achieved higher fibrinogen concentrations compared with FFP. FLyP led to a more rapid coagulopathy improvement than FFP. SUMMARY: Background Guidelines recommend beginning hemostatic resuscitation immediately in trauma patients. We aimed to investigate if French lyophilized plasma (FLyP) was more effective than fresh frozen plasma (FFP) for the initial management of trauma-induced coagulopathy...
December 23, 2017: Journal of Thrombosis and Haemostasis: JTH
Forest R Sheppard, Thomas A Mitchell, Antoni R Macko, Darren M Fryer, Leasha J Schaub, Kassandra M Ozuna, Jacob J Glaser
BACKGROUND: Hemorrhage is the leading cause of preventable death in traumatically injured civilian and military populations. Pre-hospital resuscitation largely relies on crystalloid and colloid intra-vascular expansion, as whole blood and component blood therapy are logistically arduous. In this experiment, we evaluated the bookends of Tactical Combat Casualty Care Guidelines recommendations of pre-hospital resuscitation with Hextend and whole blood in a controlled hemorrhagic shock model within non-human primates, as means of a multi-functional resuscitative fluid development...
December 20, 2017: Journal of Trauma and Acute Care Surgery
Seng Chua, Sarika Gupta, Jennifer Curnow, Beata Gidaszewski, Marjan Khajehei, Hayley Diplock
BACKGROUND: Acute post-partum anaemia can be associated with significant morbidity including a predisposition for postnatal depression. Lack of clear practice guidelines means a number of women are treated with multiple blood transfusions. Intravenous iron has the potential to limit the need for multiple blood transfusions but its role in the post-partum setting is unclear. METHODS/DESIGN: IIBAPPA is a multi-centre randomised non-inferiority trial. Women with a primary post-partum haemorrhage (PPH) >1000 mL and resultant haemoglobin (Hb) 5...
December 19, 2017: BMC Pregnancy and Childbirth
Young Erben, Gerardo Trejo, Adam J Brownstein, Raymond A Jean, Bulat A Ziganshin, Davide Carino, John A Elefteriades, Adrian A Maung
BACKGROUND: Blunt thoracic aortic injury (BTAI) is highly lethal and its management has evolved with the advent of endovascular approaches. We hypothesized that endovascular repair (ER) would have equivalent/improved survival compared to open repair (OR). The aim of our study was to review our center's morbidity and mortality after BTAI. METHODS: Our Level I trauma center registry was queried for BTAI between 2002-2015. This cohort was stratified into three groups: ER, OR and those patients managed non-operatively (NOP)...
December 13, 2017: International Angiology: a Journal of the International Union of Angiology
Steven Hendrickx, Karen Van Vlimmeren, Ingrid Baar, Walter Verbrugghe, Karolien Dams, Sophie Van Cromphaut, Ella Roelant, Bart Embrecht, Anouk Wittock, Pieter Mertens, Jeroen M Hendriks, Patrick Lauwers, Paul E Van Schil, Amaryllis H Van Craenenbroeck, Tim Van den Wyngaert, Philippe Jorens, Niels Van Regenmortel
BACKGROUND: Although prescribed to every patient undergoing surgery, maintenance fluid therapy is a poorly researched part of perioperative fluid therapy. The tonicity of the chosen solutions, could be an important cause of morbidity, with hyponatremia being a potential side effect of hypotonic solutions, where isotonic solution could lead to fluid overload. METHODS: The TOPMAST-trial is an ongoing prospective single-center double-blind randomized trial comparing an isotonic and a hypotonic maintenance fluid strategy during and after surgery in patients undergoing different types of major thoracic surgery...
2017: Anaesthesiology Intensive Therapy
M A Nebsbjerg, S E Rasmussen, K B Bomholt, L Q Krogh, K Krogh, J A Povlsen, I S Riddervold, T Grøfte, H Kirkegaard, B Løfgren
BACKGROUND: Dispatcher assisted cardiopulmonary resuscitation (DA-CPR) increase the rate of bystander CPR. The aim of the study was to compare the performance of DA-CPR and attainable skills following CPR training between young and elderly laypersons. METHODS: Volunteer laypersons (young: 18-40 years; elderly: > 65 years) participated. Single rescuer CPR was performed in a simulated DA-CPR cardiac arrest scenario and after CPR training. Data were obtained from a manikin and from video recordings...
January 2018: Acta Anaesthesiologica Scandinavica
Jelena P Seferovic, Marc A Pfeffer, Brian Claggett, Akshay S Desai, Dick de Zeeuw, Steven M Haffner, John J V McMurray, Hans-Henrik Parving, Scott D Solomon, Nish Chaturvedi
AIMS/HYPOTHESIS: The self-administered Michigan Neuropathy Screening Instrument (MNSI) is used to diagnose diabetic peripheral neuropathy. We examined whether the MNSI might also provide information on risk of death and cardiovascular outcomes. METHODS: In this post hoc analysis of the Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE) trial, we divided 8463 participants with type 2 diabetes and chronic kidney disease (CKD) and/or cardiovascular disease (CVD) into independent training (n = 3252) and validation (n = 5211) sets...
November 3, 2017: Diabetologia
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