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EM Critical care

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By Terren Trott terren.trott@gmail.com
https://www.readbyqxmd.com/read/29217394/the-use-of-end-tidal-carbon-dioxide-etco2-measurement-to-guide-management-of-cardiac-arrest-a-systematic-review
#1
REVIEW
Edison F Paiva, James H Paxton, Brian J O'Neil
AIMS: To identify whether any level of end-tidal carbon dioxide (ETCO2) measured during cardiopulmonary resuscitation (CPR) correlates with return of spontaneous circulation (ROSC) or survival in adults experiencing cardiac arrest in any setting. METHODS: Systematic review. We included randomized controlled trials, cohort studies, and case-control studies of adult cardiac arrest in any setting that reported specific (rather than pooled) ETCO2 values and attempted to correlate those values with prognosis...
December 4, 2017: Resuscitation
https://www.readbyqxmd.com/read/21606393/relationship-between-supranormal-oxygen-tension-and-outcome-after-resuscitation-from-cardiac-arrest
#2
J Hope Kilgannon, Alan E Jones, Joseph E Parrillo, R Phillip Dellinger, Barry Milcarek, Krystal Hunter, Nathan I Shapiro, Stephen Trzeciak
BACKGROUND: Laboratory and recent clinical data suggest that hyperoxemia after resuscitation from cardiac arrest is harmful; however, it remains unclear if the risk of adverse outcome is a threshold effect at a specific supranormal oxygen tension, or is a dose-dependent association. We aimed to define the relationship between supranormal oxygen tension and outcome in postresuscitation patients. METHODS AND RESULTS: This was a multicenter cohort study using the Project IMPACT database (intensive care units at 120 US hospitals)...
June 14, 2011: Circulation
https://www.readbyqxmd.com/read/29175085/ventilator-management-and-respiratory-care-after-cardiac-arrest-oxygenation-ventilation-infection-and-injury
#3
REVIEW
Nicholas J Johnson, David J Carlbom, David F Gaieski
Return of spontaneous circulation after cardiac arrest results in a systemic inflammatory state called the post-cardiac arrest syndrome, characterized by oxidative stress, coagulopathy, neuronal injury, and organ dysfunction. Perturbations in oxygenation and ventilation may exacerbate secondary injury after cardiac arrest, and have been shown to be associated with poor outcome. Further, patients who suffer cardiac arrest are at risk for a number of other pulmonary complications. Up to 70% of patients experience early infection after cardiac arrest, and the respiratory tract is the most common source...
November 21, 2017: Chest
https://www.readbyqxmd.com/read/27784613/ventricular-fibrillation-waveform-measures-and-the-etiology-of-cardiac-arrest
#4
Danelle Hidano, Jason Coult, Jennifer Blackwood, Carol Fahrenbruch, Heemun Kwok, Peter Kudenchuk, Thomas Rea
BACKGROUND: Early determination of the acute etiology of cardiac arrest could help guide resuscitation or post-resuscitation care. In experimental studies, quantitative measures of the ventricular fibrillation waveform distinguish ischemic from non-ischemic etiology. METHODS: We investigated whether waveform measures distinguished arrest etiology among adults treated by EMS for out-of-hospital ventricular fibrillation between January 1, 2006-December 31, 2014. Etiology was classified using hospital information into three exclusive groups: acute coronary syndrome (ACS) with ST elevation myocardial infarction (STEMI), ACS without ST elevation (non-STEMI), or non-ischemic arrest...
December 2016: Resuscitation
https://www.readbyqxmd.com/read/28111195/endotracheal-tube-placement-confirmation-100-sensitivity-and-specificity-with-sustained-four-phase-capnographic-waveforms-in-a-cadaveric-experimental-model
#5
Salvatore Silvestri, Jay G Ladde, James F Brown, Jesus V Roa, Christopher Hunter, George A Ralls, Linda Papa
BACKGROUND: Waveform capnography is considered the gold standard for verification of proper endotracheal tube placement, but current guidelines caution that it is unreliable in low-perfusion states such as cardiac arrest. Recent case reports found that long-deceased cadavers can produce capnographic waveforms. The purpose of this study was to determine the predictive value of waveform capnography for endotracheal tube placement verification and detection of misplacement using a cadaveric experimental model...
June 2017: Resuscitation
https://www.readbyqxmd.com/read/28916478/a-retrospective-study-of-pulseless-electrical-activity-bedside-ultrasound-identifies-interventions-during-resuscitation-associated-with-improved-survival-to-hospital-admission-a-reason-study
#6
Romolo Gaspari, Anthony Weekes, Srikar Adhikari, Vicki Noble, Jason T Nomura, Daniel Theodoro, Michael Woo, Paul Atkinson, David Blehar, Samuel Brown, Terrell Caffery, Emily Douglass, Jacqueline Fraser, Christine Haines, Samuel Lam, Michael Lanspa, Margaret Lewis, Otto Liebmann, Alexander Limkakeng, Fernando Lopez, Elke Platz, Michelle Mendoza, Hal Minnigan, Christopher Moore, Joseph Novik, Louise Rang, Will Scruggs, Christopher Raio
OBJECTIVE: Our objective was to determine whether organized or disorganized cardiac activity is associated with increased survival in patients who present in pulseless electrical activity (PEA) treated with either 1) standard advanced cardiac life support (ACLS) medications or 2) other interventions. METHODS: This was a secondary analysis of a prospective, multi-center observational study utilizing ultrasound in out-of-hospital or inemergency department PEA arrest...
November 2017: Resuscitation
https://www.readbyqxmd.com/read/28923988/contemporary-management-of-cardiogenic-shock-a-scientific-statement-from-the-american-heart-association
#7
REVIEW
Sean van Diepen, Jason N Katz, Nancy M Albert, Timothy D Henry, Alice K Jacobs, Navin K Kapur, Ahmet Kilic, Venu Menon, E Magnus Ohman, Nancy K Sweitzer, Holger Thiele, Jeffrey B Washam, Mauricio G Cohen
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities...
October 17, 2017: Circulation
https://www.readbyqxmd.com/read/28701178/the-future-of-mechanical-ventilation-lessons-from-the-present-and-the-past
#8
REVIEW
Luciano Gattinoni, John J Marini, Francesca Collino, Giorgia Maiolo, Francesca Rapetti, Tommaso Tonetti, Francesco Vasques, Michael Quintel
The adverse effects of mechanical ventilation in acute respiratory distress syndrome (ARDS) arise from two main causes: unphysiological increases of transpulmonary pressure and unphysiological increases/decreases of pleural pressure during positive or negative pressure ventilation. The transpulmonary pressure-related side effects primarily account for ventilator-induced lung injury (VILI) while the pleural pressure-related side effects primarily account for hemodynamic alterations. The changes of transpulmonary pressure and pleural pressure resulting from a given applied driving pressure depend on the relative elastances of the lung and chest wall...
July 12, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28792873/acute-respiratory-distress-syndrome
#9
REVIEW
B Taylor Thompson, Rachel C Chambers, Kathleen D Liu
New England Journal of Medicine, Volume 377, Issue 6, Page 562-572, August 2017.
August 10, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28754527/ultrasound-use-during-cardiopulmonary-resuscitation-is-associated-with-delays-in-chest-compressions
#10
Maite A Huis In 't Veld, Michael G Allison, David S Bostick, Kiondra R Fisher, Olga G Goloubeva, Michael D Witting, Michael E Winters
AIM: High-quality chest compressions are a critical component of the resuscitation of patients in cardiopulmonary arrest. Point-of-care ultrasound (POCUS) is used frequently during emergency department (ED) resuscitations, but there has been limited research assessing its benefits and harms during the delivery of cardiopulmonary resuscitation (CPR). We hypothesized that use of POCUS during cardiac arrest resuscitation adversely affects high-quality CPR by lengthening the duration of pulse checks beyond the current cardiopulmonary resuscitation guidelines recommendation of 10s...
October 2017: Resuscitation
https://www.readbyqxmd.com/read/28811122/acute-kidney-injury-after-computed-tomography-a-meta-analysis
#11
REVIEW
Ryan D Aycock, Lauren M Westafer, Jennifer L Boxen, Nima Majlesi, Elizabeth M Schoenfeld, Raveendhara R Bannuru
STUDY OBJECTIVE: Computed tomography (CT) is an important imaging modality used in the diagnosis of a variety of disorders. Imaging quality may be improved if intravenous contrast is added, but there is a concern for potential renal injury. Our goal is to perform a meta-analysis to compare the risk of acute kidney injury, need for renal replacement, and total mortality after contrast-enhanced CT versus noncontrast CT. METHODS: We searched MEDLINE (PubMed), the Cochrane Library, CINAHL, Web of Science, ProQuest, and Academic Search Premier for relevant articles...
August 12, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/21890890/arterial-waveform-analysis-for-the-anesthesiologist-past-present-and-future-concepts
#12
REVIEW
Robert H Thiele, Marcel E Durieux
Qualitative arterial waveform analysis has been in existence for millennia; quantitative arterial waveform analysis techniques, which can be traced back to Euler's work in the 18th century, have not been widely used by anesthesiologists and other clinicians. This is likely attributable, in part, to the widespread use of the sphygmomanometer, which allows the practitioner to assess arterial blood pressure without having to develop a sense for the higher-order characteristics of the arterial waveform. The 20-year delay in the development of devices that measure these traits is a testament to the primitiveness of our appreciation for this information...
October 2011: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28624593/double-sequential-defibrillation-therapy-for-out-of-hospital-cardiac-arrests-the-london-experience
#13
Amber C Emmerson, Mark Whitbread, Rachael T Fothergill
BACKGROUND: Despite advances in treatment for out-of-hospital cardiac arrest (OHCA), a subgroup of patients remain in refractory ventricular fibrillation (RVF) during resuscitation. Recent evidence suggests that double sequential defibrillation (DSD), where two shocks are delivered to the patient in quick succession, may provide an effective therapy for RVF. This study describes the characteristics and survival outcomes of OHCA patients treated by ambulance clinicians using a local DSD protocol in an attempt to resolve RVF...
August 2017: Resuscitation
https://www.readbyqxmd.com/read/7497049/colorimetric-end-tidal-co2-detector-for-verification-of-endotracheal-tube-placement-in-out-of-hospital-cardiac-arrest
#14
S R Hayden, J Sciammarella, P Viccellio, H Thode, R Delagi
OBJECTIVE: To evaluate the ability of a disposable, colorimetric end-tidal CO2 detector to verify proper endotracheal (ET) tube placement in out-of-hospital cardiac arrest, and to correlate semiquantitative CO2 measurements with the rate of return of spontaneous circulation (ROSC). METHODS: Prospective, observational study using a convenience sample of intubated out-of-hospital cardiac arrest patients. A disposable, colorimetric end-tidal CO2 detector was attached to the ET tube after intubation...
June 1995: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/2115315/end-tidal-co2-measurement-in-the-detection-of-esophageal-intubation-during-cardiac-arrest
#15
COMPARATIVE STUDY
A J Sayah, W F Peacock, D T Overton
Measurement of end-tidal carbon dioxide (ETCO2) has been used to detect accidental esophageal tube placement in noncardiac arrest situations. The purpose of our study was to determine whether ETCO2 measurement could distinguish tracheal from esophageal tube placement during closed-chest massage (CCM). Twelve large dogs were anesthetized, and endotracheal tubes were placed in both the trachea and the esophagus. Placement was verified by fiberoptic endoscopy. Ventricular fibrillation was induced by a 60-Hz discharge through a right ventricular pacemaker...
August 1990: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28509668/norepinephrine-in-septic-shock-when-and-how-much
#16
Olfa Hamzaoui, Thomas W L Scheeren, Jean-Louis Teboul
PURPOSE OF REVIEW: Norepinephrine is the first-line agent recommended during resuscitation of septic shock to correct hypotension due to depressed vascular tone. Important clinical issues are the best timing to start norepinephrine, the optimal blood pressure target, and the best therapeutic options to face refractory hypotension when high doses of norepinephrine are required to reach the target. RECENT FINDINGS: Recent literature has reported benefits of early administration of norepinephrine because of the following reasons: profound and durable hypotension is an independent factor of increased mortality, early administration of norepinephrine increases cardiac output, improves microcirculation and avoids fluid overload...
August 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28499516/improving-cpr-performance
#17
REVIEW
Boulos S Nassar, Richard Kerber
Cardiac arrest continues to represent a public health burden with most patients having dismal outcomes. CPR is a complex set of interventions requiring leadership, coordination, and best practices. Despite the widespread adoption of new evidence in various guidelines, the provision of CPR remains variable with poor adherence to published recommendations. Key steps health-care systems can take to enhance the quality of CPR and, potentially, to improve outcomes, include optimizing chest compressions, avoiding hyperventilation, encouraging intraosseous access, and monitoring capnography...
November 2017: Chest
https://www.readbyqxmd.com/read/27618681/early-identification-of-patients-with-out-of-hospital-cardiac-arrest-with-no-chance-of-survival-and-consideration-for-organ-donation
#18
Patricia Jabre, Wulfran Bougouin, Florence Dumas, Pierre Carli, Corinne Antoine, Laurent Jacob, Benjamin Dahan, Frankie Beganton, Jean-Philippe Empana, Eloi Marijon, Nicole Karam, Alexandre Loupy, Carmen Lefaucheur, Daniel Jost, Alain Cariou, Frédéric Adnet, Thomas D Rea, Xavier Jouven
Background: In patients with out-of-hospital cardiac arrest (OHCA), care requirements can conflict with the need to promptly focus efforts on organ donation in patients who are pronounced dead. Objective: To evaluate objective criteria for identifying patients with OHCA with no chance of survival during the first minutes of cardiopulmonary resuscitation to enable prompt orientation toward organ donation. Design: Retrospective assessment using OHCA data from 2 registries and 1 trial...
December 6, 2016: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27666168/association-between-chest-compression-rates-and-clinical-outcomes-following-in-hospital-cardiac-arrest-at-an-academic-tertiary-hospital
#19
J Hope Kilgannon, Michael Kirchhoff, Lisa Pierce, Nicholas Aunchman, Stephen Trzeciak, Brian W Roberts
AIMS: Recent guidelines for management of cardiac arrest recommend chest compression rates of 100-120 compressions/min. However, animal studies have found cardiac output to increase with rates up to 150 compressions/min. The objective of this study was to test the association between chest compression rates during cardiopulmonary resuscitation for in-hospital cardiac arrest (IHCA) and outcome. METHODS: We conducted a prospective observational study at a single academic medical center...
January 2017: Resuscitation
https://www.readbyqxmd.com/read/28232056/prophylactic-corticosteroids-for-prevention-of-postextubation-stridor-and-reintubation-in-adults-a-systematic-review-and-meta-analysis
#20
REVIEW
Akira Kuriyama, Noriyuki Umakoshi, Rao Sun
BACKGROUND: Corticosteroid administration before elective extubation has been used to prevent postextubation stridor and reintubation. We updated a systematic review to identify which patients would benefit from prophylactic corticosteroid administration before elective extubation. METHODS: We searched PubMed, EMBASE, the Wanfang Database, the China Academic Journal Network Publishing Database, and the Cochrane Central Register of Controlled Trials for eligible trials from inception through February 29, 2016...
May 2017: Chest
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