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endpoints resuscitation

Dae-Hee Choi, Youn-Jung Kim, Seung Mok Ryoo, Chang Hwan Sohn, Shin Ahn, Dong-Woo Seo, Ju Yong Lim, Won Young Kim
OBJECTIVE: Extracorporeal cardiopulmonary resuscitation (ECPR) may be considered as a rescue therapy for patients with refractory cardiac arrest. Identifying patients who might benefit from this potential life-saving procedure is crucial for implementation of ECPR. The objective of this study was to estimate the number of patients who fulfilled a hypothetical set of ECPR criteria and to evaluate the outcome of ECPR candidates treated with conventional cardiopulmonary resuscitation. METHODS: We performed an observational study using data from a prospective registry of consecutive adults (≥18 years) with non-traumatic out-of-hospital cardiac arrest in a tertiary hospital between January 2011 and December 2015...
September 2016: Clin Exp Emerg Med
Patrik Gilje, Sasha Koul, Jakob Hartvig Thomsen, Yvan Devaux, Hans Friberg, Michael Kuiper, Janneke Horn, Niklas Nielsen, Tomasso Pellis, Pascal Stammet, Matthew P Wise, Jesper Kjaergaard, Christian Hassager, David Erlinge
AIM OF THE STUDY: Predicting outcome of unconscious patients after successful resuscitation is challenging and better prognostic markers are highly needed. Ischemic heart disease is a common cause of out-of-hospital cardiac arrest (OHCA). Whether or not high-sensitivity troponin T (hs-TnT) is a prognostic marker among survivors of OHCA with both ischemic and non-ischemic aetiologies remains to be determined. We sought to evaluate the ability of hs-TnT to prognosticate all-cause mortality, death due to cardiovascular causes or multi-organ failure and death due to cerebral causes after OHCA...
October 2016: Resuscitation
Young Sun Ro, Sang Do Shin, Yu Jin Lee, Seung Chul Lee, Kyoung Jun Song, Hyun Wook Ryoo, Marcus Eng Hock Ong, Bryan McNally, Bentley Bobrow, Hideharu Tanaka, Helge Myklebust, Tonje Søraas Birkenes
STUDY OBJECTIVE: We study the effect of a nationwide dispatcher-assisted cardiopulmonary resuscitation (CPR) program on out-of-hospital cardiac arrest outcomes by arrest location (public and private settings). METHODS: All emergency medical services (EMS)-treated adults in Korea with out-of-hospital cardiac arrests of cardiac cause were enrolled between 2012 and 2013, excluding cases witnessed by EMS providers and those with unknown outcomes. Exposure was bystander CPR categorized into 3 groups: bystander CPR with dispatcher assistance, bystander CPR without dispatcher assistance, and no bystander CPR...
September 18, 2016: Annals of Emergency Medicine
Akira Funada, Yoshikazu Goto, Hayato Tada, Ryota Teramoto, Masaya Shimojima, Kenshi Hayashi, Masakazu Yamagishi
BACKGROUND: Early rhythm conversion from an initial non-shockable to a shockable rhythm and subsequent shock delivery in patients with out-of-hospital cardiac arrest (OHCA) has been associated with favourable neurological outcome (Cerebral Performance Category score 1 or 2; CPC 1-2). We hypothesized that the prognostic significance of rhythm conversion and subsequent shock delivery differs by age and time from initiation of cardiopulmonary resuscitation (CPR) by emergency medical service (EMS) providers to first defibrillation (shock delivery time)...
September 21, 2016: Resuscitation
Christian S Scheer, Christian Fuchs, Sven-Olaf Kuhn, Marcus Vollmer, Sebastian Rehberg, Sigrun Friesecke, Peter Abel, Veronika Balau, Christoph Bandt, Konrad Meissner, Klaus Hahnenkamp, Matthias Gründling
OBJECTIVE: To investigate the impact of a quality improvement initiative for severe sepsis and septic shock focused on the resuscitation bundle on 90-day mortality. Furthermore, effects on compliance rates for antiinfective therapy within the recommended 1-hour interval are evaluated. DESIGN: Prospective observational before-after cohort study. SETTING: Tertiary university hospital in Germany. PATIENTS: All adult medical and surgical ICU patients with severe sepsis and septic shock...
September 22, 2016: Critical Care Medicine
Stinne Eika Rasmussen, Mette Amalie Nebsbjerg, Lise Qvirin Krogh, Katrine Bjørnshave, Kristian Krogh, Jonas Agerlund Povlsen, Ingunn Skogstad Riddervold, Thorbjørn Grøfte, Hans Kirkegaard, Bo Løfgren
BACKGROUND: Emergency dispatchers use protocols to instruct bystanders in cardiopulmonary resuscitation (CPR). Studies changing one element in the dispatcher's protocol report improved CPR quality. Whether several changes interact is unknown and the effect of combining multiple changes previously reported to improve CPR quality into one protocol remains to be investigated. We hypothesize that a novel dispatch protocol, combining multiple beneficial elements improves CPR quality compared with a standard protocol...
September 19, 2016: Resuscitation
Leopoldo C Cancio, Jose Salinas, George C Kramer
Fluid resuscitation of burn patients is commonly initiated using modified Brooke or Parkland formula. The fluid infusion rate is titrated up or down hourly to maintain adequate urine output and other endpoints. Over-resuscitation leads to morbid complications. Adherence to paper-based protocols, flow sheets, and clinical practice guidelines is associated with decreased fluid resuscitation volumes and complications. Computerized tools assist providers. Although completely autonomous closed-loop control of resuscitation has been demonstrated in animal models of burn shock, the major advantages of open-loop and decision-support systems are identifying trends, enhancing situational awareness, and encouraging burn team communication...
October 2016: Critical Care Clinics
Young Sun Ro, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong, Ki Ok Ahn, Do Kyun Kim, Young Ho Kwak
OBJECTIVE: We studied the effect of a dispatcher-assisted cardiopulmonary resuscitation (CPR) program on paediatric out-of-hospital cardiac arrest (OHCA) outcomes by age groups. METHODS: All emergency medical services (EMS)-treated paediatric OHCAs in Korea were enrolled between 2012 and 2014, excluding cases witnessed by EMS providers and those with unknown outcomes. The cases were divided into three groups: bystander CPR with dispatcher assistance, bystander CPR without dispatcher assistance, and no-bystander CPR...
August 31, 2016: Resuscitation
Jeong Ho Park, Ki Ok Ahn, Sang Do Shin, Kyoung Jun Song, Young Sun Ro, Joo Yong Kim, Eui Jung Lee, Yu Jin Lee
AIM: To provide therapeutic hypothermia (TH) to survivors after out-of-hospital cardiac arrest (OHCA), inter-hospital transfers (IHT) are frequently required. The safety of IHT remains controversial. The aim of this study was to investigate whether the effect of TH on brain recovery after OHCA differs between IHT and direct arrival groups. METHODS: We identified patients with OHCA of presumed cardiac aetiology who were resuscitated by emergency medical services and experienced return-of-spontaneous circulation in 27 hospitals between January and December 2014...
August 31, 2016: Resuscitation
Tom Peachey, Andrew Tang, Elinor C Baker, Jason Pott, Yonathan Freund, Tim Harris
BACKGROUND: Assessment of circulating volume and the requirement for fluid replacement are fundamental to resuscitation but remain largely empirical. Passive leg raise (PLR) may determine fluid responders while avoiding potential fluid overload. We hypothesised that inferior vena cava collapse index (IVCCI) and carotid artery blood flow would change predictably in response to PLR, potentially providing a non-invasive tool to assess circulating volume and identifying fluid responsive patients...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Stefanie Beck, Vivian Meier-Klages, Maria Michaelis, Susanne Sehner, Sigrid Harendza, Christian Zöllner, Jens Christian Kubitz
BACKGROUND: The "kids save lives" joint-statement highlights the effectiveness of training all school children worldwide in cardiopulmonary resuscitation (CPR) to improve survival after cardiac arrest. The personnel requirement to implement this statement is high. Until now, no randomised controlled trial investigated if medical students benefit from their engagement in the BLS-education of school children regarding their later roles as physicians. The objective of the present study is to evaluate if medical students improve their teaching behaviour and CPR-skills by teaching school children in basic life support...
August 27, 2016: Resuscitation
George E Black, Kyle K Sokol, Robert Shawhan, Matthew J Eckert, Shashikumar Salgar, Shannon T Marko, Zachary S Hoffer, Matthew J Martin
BACKGROUND: Suspended animation-like states have been achieved in small animal models, but not in larger species. Inducing metabolic suppression and temporary oxygen-independence could enhance survivability of massive injury. Based on prior analyses of key pathways, we hypothesized that PI3-kinase inhibition (PI3-KI) would produce metabolic suppression without worsening organ injury or systemic physiology. METHODS: Twenty swine were studied using LY294002 (LY), a non-selective PI3-KI: Animals were assigned to Trauma only (TO, N=3); DMSO only (DMSO, N=4), LY drug only (LYO, N=3); and Drug + trauma (LY+T , N=10) groups...
August 18, 2016: Journal of Trauma and Acute Care Surgery
Jakob Hartvig Thomsen, Christian Hassager, David Erlinge, Niklas Nielsen, Janneke Horn, Jan Hovdenes, John Bro-Jeppesen, Michael Wanscher, Steen Pehrson, Lars Køber, Jesper Kjaergaard
OBJECTIVES: Atrial fibrillation has been associated with increased mortality in the general population and mixed populations of critical ill. Atrial fibrillation can also affect patients during post-cardiac arrest care. We sought to assess the prognostic implications of atrial fibrillation following out-of-hospital cardiac arrest, including relation to the level of targeted temperature management. DESIGN: A post hoc analysis of a prospective randomized trial. SETTING: Thirty-six ICUs...
August 4, 2016: Critical Care Medicine
Jeremy M Bennett, Eric S Wise, Kyle M Hocking, Colleen M Brophy, Susan S Eagle
OBJECTIVE: Inspired by the limited facility of the Penn classification, the authors aimed to determine a rapid and optimal preoperative assessment tool to predict surgical mortality after acute Stanford type-A aortic dissection (AAAD) repair. DESIGN: Patients who underwent an attempted surgical repair of AAAD were determined using a de-identified single institution database. The charts of 144 patients were reviewed retrospectively for preoperative demographics and surrogates for disease severity and malperfusion...
March 16, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Anna Sina P Meyer, Sisse R Ostrowski, Jesper Kjaergaard, Pär I Johansson, Christian Hassager
BACKGROUND: Morbidity and mortality following initial survival of cardiac arrest remain high despite great efforts to improve resuscitation techniques and post-resuscitation care, in part due to the ischemia-reperfusion injury secondary to the restoration of the blood circulation. Patients resuscitated from cardiac arrest display evidence of endothelial injury and coagulopathy (hypocoagulability, hyperfibrinolysis), which in associated with poor outcome. Recent randomized controlled trials have revealed that treatment with infusion of prostacyclin reduces endothelial damage after major surgery and AMI...
2016: Trials
David N Naumann, Alastair Beaven, Janine Dretzke, Sam Hutchings, Mark J Midwinter
BACKGROUND: Increased microcirculatory flow and perfusion has been reported to improve clinical outcomes following shock. The optimal resuscitation fluid to restore the flow dynamics of the microcirculation is unknown. This review summarises the preclinical literature in order to inform the direction and most important hypotheses for future clinical interventional studies. METHODS: Standard systematic review methodology was utilized, and registered with the Collaborative Approach to Meta Analysis and Review of Animal Data from Experimental Studies (CAMARADES)...
July 25, 2016: Shock
Fabio Rigamonti, Baris Gencer, Florian Rey, Jawad Chaara, Elena Tessitore, Sholan Bunwaree, Pascal Meier, Stéphane Noble, Olivier Grosgurin, Robert Larribeau, Stephan Windecker, Federico Carbone, Fabrizio Montecucco, Nicolas Rodondi, Christian M Matter, Thomas F Luscher, François Mach, Marco Roffi
BACKGROUND: Transradial access (TRA) improves outcome compared with trans-femoral access for the management of patients with acute coronary syndromes. In this setting, it is unknown whether the activation of a pre-hospital alarm system (PHAS) confers additional benefit for the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: We retrospectively analyzed a cohort of patients with a first STEMI who underwent a primary percutaneous coronary intervention (PPCI) at a single center within a prospective cohort of acute coronary syndrome patients (SPUM-ACS)...
July 16, 2016: European Journal of Internal Medicine
Alain Cariou, Nicolas Deye, Benoît Vivien, Olivier Richard, Nicolas Pichon, Angèle Bourg, Loïc Huet, Clément Buleon, Jérôme Frey, Pierre Asfar, Stéphane Legriel, Sophie Narcisse, Armelle Mathonnet, Aurélie Cravoisy, Pierre-François Dequin, Eric Wiel, Keyvan Razazi, Cédric Daubin, Antoine Kimmoun, Lionel Lamhaut, Jean-Sébastien Marx, Didier Payen de la Garanderie, Patrick Ecollan, Alain Combes, Christian Spaulding, Florence Barat, Myriam Ben Boutieb, Joël Coste, Jean-Daniel Chiche, Frédéric Pène, Jean-Paul Mira, Jean-Marc Treluyer, Olivier Hermine, Pierre Carli
BACKGROUND: Preliminary data suggested a clinical benefit in treating out-of-hospital cardiac arrest (OHCA) patients with a high dose of erythropoietin (Epo) analogs. OBJECTIVES: The authors aimed to evaluate the efficacy of epoetin alfa treatment on the outcome of OHCA patients in a phase 3 trial. METHODS: The authors performed a multicenter, single-blind, randomized controlled trial. Patients still comatose after a witnessed OHCA of presumed cardiac origin were eligible...
July 5, 2016: Journal of the American College of Cardiology
Sebastian Wiberg, Christian Hassager, Jakob Hartvig Thomsen, Martin Frydland, Dan Eik Høfsten, Thomas Engstrøm, Lars Køber, Henrik Schmidt, Jacob Eifer Møller, Jesper Kjaergaard
BACKGROUND: Attenuating the neurological damage occurring after out-of-hospital cardiac arrest is an ongoing research effort. This dual-centre study investigates the neuroprotective effects of the glucagon-like-peptide-1 analogue Exenatide administered within 4 hours from the return of spontaneous circulation to comatose patients resuscitated from out-of-hospital cardiac arrest. METHODS/DESIGN: This pilot study will randomize a total of 120 unconscious patients with sustained return of spontaneous circulation after out-of-hospital cardiac arrest undergoing targeted temperature management in a blinded one-to-one fashion to a 6-hour and 15-minute infusion of either Exenatide or placebo...
2016: Trials
Steve Lin, Damon C Scales
High-quality cardiopulmonary resuscitation (CPR) has been shown to improve survival outcomes after cardiac arrest. The current standard in studies evaluating CPR quality is to measure CPR process measures-for example, chest compression rate, depth, and fraction. Published studies evaluating CPR feedback devices have yielded mixed results. Newer approaches that seek to optimize CPR by measuring physiological endpoints during the resuscitation may lead to individualized patient care and improved patient outcomes...
2016: Critical Care: the Official Journal of the Critical Care Forum
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