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https://www.readbyqxmd.com/read/27908340/end-points-of-sepsis-resuscitation
#1
REVIEW
John C Greenwood, Clinton J Orloski
Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable and reproducible. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient's overall response to therapy...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27894909/characteristics-of-bystander-cardiopulmonary-resuscitation-for-paediatric-out-of-hospital-cardiac-arrests-a-national-observational-study-from-2012-to-2014
#2
Ikwan Chang, Young Ho Kwak, Sang Do Shin, Young Sun Ro, Do Kyun Kim
OBJECTIVES: This study evaluated the associations between the provision of bystander cardiopulmonary resuscitation (BCPR) and both the relationship of bystanders with paediatric out-of-hospital cardiac arrest (OHCA) victims and the community educational level. METHODS: This observational study was conducted using the Korean national OHCA registry of paediatric OHCAs (<19years old) between 2012 and 2014. The main factor was the relationship between the bystander and the OHCA victim...
November 25, 2016: Resuscitation
https://www.readbyqxmd.com/read/27877067/similar-long-term-survival-of-consecutive-in-hospital-and-out-of-hospital-cardiac-arrest-patients-treated-with-targeted-temperature-management
#3
Magaly Engsig, Helle Søholm, Fredrik Folke, Peter J Gadegaard, Julie Therese Wiis, Rune Molin, Thomas Mohr, Frederik N Engsig
OBJECTIVE: The long-term survival of in-hospital cardiac arrest (IHCA) patients treated with targeted temperature management (TTM) is poorly described. The aim of this study was to compare the outcomes of consecutive IHCA with out-of-hospital cardiac arrest (OHCA) patients treated with TTM. DESIGN SETTING AND PATIENTS: Retrospectively collected data on all consecutive adult patients treated with TTM at a university tertiary heart center between 2005 and 2011 were analyzed...
2016: Clinical Epidemiology
https://www.readbyqxmd.com/read/27876325/does-early-goal-directed-therapy-decrease-mortality-compared-with-standard-care-in-patients-with-septic-shock
#4
Michael E Winters, Robert Sherwin, Gary M Vilke, Gabriel Wardi
BACKGROUND: Current international guidelines for the treatment of patients with severe sepsis and septic shock recommend that patients receive targeted care to various physiologic endpoints, thereby optimizing tissue perfusion and oxygenation. These recommendations are primarily derived from a protocol published >15 years ago, which was viewed by many as complex and was therefore not widely adopted. Instead, many emergency physicians focused on the administration of early antibiotics, source control, aggressive fluid resuscitation, vasoactive medications as needed to maintain mean arterial blood pressure, and careful monitoring of these patients...
November 19, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27876084/a-trial-to-determine-whether-septic-shock-reversal-is-quicker-in-pediatric-patients-randomized-to-an-early-goal-directed-fluid-sparing-strategy-versus-usual-care-squeeze-study-protocol-for-a-pilot-randomized-controlled-trial
#5
Melissa J Parker, Lehana Thabane, Alison Fox-Robichaud, Patricia Liaw, Karen Choong
BACKGROUND: Current pediatric septic shock resuscitation guidelines from the American College of Critical Care Medicine focus on the early and goal-directed administration of intravascular fluid followed by vasoactive medication infusions for persistent and fluid-refractory shock. However, accumulating adult and pediatric data suggest that excessive fluid administration is associated with worse patient outcomes and even increased risk of death. The optimal amount of intravascular fluid required in early pediatric septic shock resuscitation prior to the initiation of vasoactive support remains unanswered...
November 22, 2016: Trials
https://www.readbyqxmd.com/read/27811958/dha-supplemented-diet-increases-the-survival-of-rats-following-asphyxia-induced-cardiac-arrest-and-cardiopulmonary-bypass-resuscitation
#6
Junhwan Kim, Tai Yin, Koichiro Shinozaki, Joshua W Lampe, Lance B Becker
Accumulating evidence illustrates the beneficial effects of dietary docosahexaenoic acid (DHA) on cardiovascular diseases. However, its effects on cardiac arrest (CA) remain controversial in epidemiological studies and have not been reported in controlled animal studies. Here, we examined whether dietary DHA can improve survival, the most important endpoint in CA. Male Sprague-Dawley rats were randomized into two groups and received either a control diet or a DHA-supplemented diet for 7-8 weeks. Rats were then subjected to 20 min asphyxia-induced cardiac arrest followed by 30 min cardiopulmonary bypass resuscitation...
November 4, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27777278/duration-of-prehospital-cardiopulmonary-resuscitation-and-favorable-neurological-outcomes-for-pediatric-out-of-hospital-cardiac-arrests-a-nationwide-population-based-cohort-study
#7
Yoshikazu Goto, Akira Funada, Yumiko Goto
BACKGROUND: -The appropriate duration of cardiopulmonary resuscitation (CPR) for pediatric out-of-hospital cardiac arrests (OHCAs) remains unclear and may differ based on initial rhythm. We aimed to determine the relationship between the duration of prehospital CPR by emergency medical services (EMS) personnel and post-OHCA outcomes. METHODS: -We analyzed the records of 12,877 pediatric patients who experienced OHCAs (aged <18 years). Data were recorded in a nationwide Japanese database between 2005 and 2012...
October 24, 2016: Circulation
https://www.readbyqxmd.com/read/27771299/sodium-nitroprusside-enhanced-cardiopulmonary-resuscitation-improves-short-term-survival-in-a-porcine-model-of-ischemic-refractory-ventricular-fibrillation
#8
Demetris Yannopoulos, Jason A Bartos, Stephen A George, George Sideris, Sebastian Voicu, Brett Oestreich, Timothy Matsuura, Kadambari Shekar, Jennifer Rees, Tom P Aufderheide
INTRODUCTION: Sodium nitroprusside (SNP) enhanced CPR (SNPeCPR) demonstrates increased vital organ blood flow and survival in multiple porcine models. We developed a new, coronary occlusion/ischemia model of prolonged resuscitation, mimicking the majority of out-of-hospital cardiac arrests presenting with shockable rhythms. HYPOTHESIS: SNPeCPR will increase short term (4-h) survival compared to standard 2015 Advanced Cardiac Life Support (ACLS) guidelines in an ischemic refractory ventricular fibrillation (VF), prolonged CPR model...
October 19, 2016: Resuscitation
https://www.readbyqxmd.com/read/27752631/extracorporeal-cardiopulmonary-resuscitation-among-patients-with-out-of-hospital-cardiac-arrest
#9
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
https://www.readbyqxmd.com/read/27667713/high-sensitivity-troponin-t-as-a-prognostic-marker-after-out-of-hospital-cardiac-arrest-a-targeted-temperature-management-ttm-trial-substudy
#10
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
https://www.readbyqxmd.com/read/27665488/effect-of-dispatcher-assisted-cardiopulmonary-resuscitation-program-and-location-of-out-of-hospital-cardiac-arrest-on-survival-and-neurologic-outcome
#11
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
https://www.readbyqxmd.com/read/27664844/age-specific-differences-in-prognostic-significance-of-rhythm-conversion-from-initial-non-shockable-to-shockable-rhythm-and-subsequent-shock-delivery-in-out-of-hospital-cardiac-arrest
#12
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
https://www.readbyqxmd.com/read/27661863/quality-improvement-initiative-for-severe-sepsis-and-septic-shock-reduces-90-day-mortality-a-7-5-year-observational-study
#13
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
https://www.readbyqxmd.com/read/27658651/a-novel-protocol-for-dispatcher-assisted-cpr-improves-cpr-quality-and-motivation-among-rescuers-a-randomized-controlled-simulation-study
#14
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
https://www.readbyqxmd.com/read/27600131/protocolized-resuscitation-of-burn-patients
#15
REVIEW
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
https://www.readbyqxmd.com/read/27592157/effects-of-dispatcher-assisted-cardiopulmonary-resuscitation-on-survival-outcomes-in-infants-children-and-adolescents-with-out-of-hospital-cardiac-arrests
#16
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...
November 2016: Resuscitation
https://www.readbyqxmd.com/read/27591054/a-multicentre-observational-study-of-inter-hospital-transfer-for-post-resuscitation-care-after-out-of-hospital-cardiac-arrest
#17
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
https://www.readbyqxmd.com/read/27590048/the-assessment-of-circulating-volume-using-inferior-vena-cava-collapse-index-and-carotid-doppler-velocity-time-integral-in-healthy-volunteers-a-pilot-study
#18
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
https://www.readbyqxmd.com/read/27576085/teaching-school-children-basic-life-support-improves-teaching-and-basic-life-support-skills-of-medical-students-a-randomised-controlled-trial
#19
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
https://www.readbyqxmd.com/read/27537510/inducing-metabolic-suppression-in-severe-hemorrhagic-shock-pilot-study-results-from-the-biochronicity-project
#20
George E Black, Kyle K Sokol, Robert R Shawhan, Matthew J Eckert, Shashikumar Salgar, Shannon T Marko, Zachary S Hoffer, Christopher C Keyes, Mark B Roth, 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 phosphoinositol-3-kinase inhibition would produce metabolic suppression without worsening organ injury or systemic physiology. METHODS: Twenty swine were studied using LY294002 (LY), a nonselective phosphoinositol-3-kinase inhibitor...
December 2016: Journal of Trauma and Acute Care Surgery
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