Resuscitation

Many emergency departments have implemented sepsis protocols since the 2001 publication of results from the early goal-directed therapy trial, which showed early targeted resuscitation lowers mortality. As part of an attempt to improve clinical and operational outcomes for emergency departments across British Columbia, we reviewed sepsis management literature and considered sepsis protocol implementation in the province’s emergency departments. During the literature review we found that many observational studies confirmed an association between implementation of emergency sepsis protocols and decreased mortality...

BACKGROUND: Cardiopulmonary resuscitation (CPR) skills decline rapidly and rescuers' physical characteristics could impact on their performance. Our aim was to analyse the effects of deliberate practice using a feedback device (FD) on the CPR performance of nursing students prior to, immediately after, and three months after training, considering their physical characteristics. METHOD: Sixty nursing students participated in this randomized clinical trial (control group n = 28; training group n = 32)...

AIM: of study To investigate whether regional cerebral oxygen saturation (rSO2 ) differs in out-of-hospital cardiac arrest (OHCA) survivors undergoing targeted temperature management (TTM) 36℃ versus 33℃. METHODS: A randomized clinical trial was conducted at intensive care units in two referral hospitals. Fifty-seven comatose OHCA survivors were randomized into either a 36℃ or 33℃ group. Patients were cooled and maintained at an oesophageal temperature of either 36℃ or 33℃ for 24 hours, rewarmed at a rate of 0...

BACKGROUND: Analyses of data recorded by monitor-defibrillators that measure CPR depth with different methods show significant relationships between the process and outcome of CPR. Our objective was to evaluate whether chest compression depth was significantly associated with outcome based on accelerometer-recordings obtained with monitor-defibrillators from a single manufacturer, and to assess whether an accelerometer-based analysis corroborated evidence-based practice guidelines on performance of CPR...

BACKGROUND: The aim of this study is to describe the main causes of admission to a general Pediatric Intensive Care Unit (PICU), as well as main causes of mortality in this population. In addition, we describe the percentage of patients who died following a failed cardiopulmonary resuscitation (CPR) vs. Do Not Resuscitate (DNR) orders METHODS: This is a retrospective cohort study with chart review of admissions and mortality cases that occurred in the pediatric intensive care unit. Mortality rates in the pediatric admissions are reported with description of demographics, diagnosis, length of stay, use of mechanical ventilation, use of vasoactive agents, preexisting comorbidities, the presence of a DNR order, and final cause of mortality...

BACKGROUND: There is a paucity of data on older adults (age ≥65 years) undergoing surgery who had an inpatient do-not-resuscitate (DNR) order, and the association between timing of DNR order and outcomes. METHODS: This was a retrospective analysis of 1976 older adults in the American College of Surgeons National Surgical Quality Improvement Program geriatric-specific database (2014-2018). Patients were stratified by institution of a DNR order during their surgical admission ("new-DNR" vs...

We aimed to investigate whether video-instructed dispatcher-assisted (DA)-cardiopulmonary resuscitation (CPR) improved neurologic recovery and survival to discharge compared to audio-instructed DA-CPR in adult out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city with sufficient experience and facilities. A retrospective cohort study was conducted for adult bystander-witnessed OHCA patients administered DA-CPR due to presumed cardiac etiology between January 1, 2018 and October 31, 2019 in Seoul, Korea...

The American Academy of Pediatrics/American Heart Association Neonatal Resuscitation Program® (NRP®) 8th-Edition materials were released in June 2021 and must be in use by January 1, 2022. Ongoing international review and consensus of resuscitation science since 2015 has yielded no major changes in practice. However, the NRP Steering Committee revised several practices in the interest of patient safety and educational efficiency. The NRP 8th Edition offers NRP Essentials and NRP Advanced levels of learning and 2 recommended Provider Course formats...

AIM: The study aimed to examine the optimal anterior-posterior depth which will reduce the time to return of spontaneous circulation and improve survival during chest compressions. Asphyxiated neonatal piglets receiving chest compression resuscitated with a 40% anterior-posterior chest depth compared with 33%, 25% or 12.5% will have reduced time to return of spontaneous circulation and improved survival. METHODS: Newborn piglets (n=8 per group) were anaesthetised, intubated, instrumented and exposed to 45 min normocapnic hypoxia followed by asphyxia and cardiac arrest...

BACKGROUND: To identify the outcome-associated predictors and develop predictive models for patients receiving targeted temperature management (TTM) by artificial neural network (ANN). METHODS: The derived cohort consisted of 580 patients with cardiac arrest and ROSC treated with TTM between January 2014 and August 2019. We evaluated the predictive value of parameters associated with survival and favorable neurologic outcome. ANN were applied for developing outcome prediction models...

Over the past 65 years, kidney transplantation has evolved into the optimal treatment for patients with kidney failure, dramatically reducing suffering through improved survival and quality of life. However, access to transplant is still limited by organ supply, opportunities for transplant are inequitably distributed, and lifelong transplant survival remains elusive. To address these persistent needs, the National Kidney Foundation convened an expert panel to define an agenda for future research. The key priorities identified by the panel center on the needs to develop and evaluate strategies to expand living donation, improve waitlist management and transplant readiness, maximize use of available deceased donor organs, and extend allograft longevity...

Giant cell myocarditis (GCM) is a rare condition. Its association with SARS-CoV-2 has not been described before. The 46-year-old female patient was admitted to the clinic on September 2020. She had 7 year adrenal insufficiency history and infarct-like debut of myocardial disease in November 2019. After COVID-19 in April 2020, cardiac disease progressed. The examination showed low QRS voltage, QS complexes in V1 -V5 leads, atrial standstill, left ventricular systolic and restrictive dysfunction, elevated anti-heart antibodies, and subepicardial late gadolinium enhancement by magnetic resonance imaging...

OBJECTIVE:  Neonatal gastric perforations (NGPs) are rare and account for 7 to 12% of all gastrointestinal perforations in the neonatal period. The etiology and prognostic factors associated with NGP remain unclear. The aim of this study is to review the cases of NGP in our neonatal intensive care unit (NICU) in the past 14 years and describe the risk factors, clinical presentation, and outcomes associated with it. STUDY DESIGN:  A retrospective chart review of neonates with gastric perforation admitted to the NICU between June 2006 and December 2020 was performed...

INTRODUCTION: In recent U.S. Military conflicts, hemorrhage remains the leading cause of preventable death with 30%-40% mortality rates. Management consists of effective bleeding control and rapid resuscitation with blood products. Rapid and accurate circulatory access is crucial in battlefield trauma management. This study evaluates the insertion success rate and time to successfully insert the NIO automatic intraosseous (IO) device and the Tactical Advanced Lifesaving IO Needle (TALON) manual IO device...

Background Lactate levels predict mortality in a wide range of patients presenting to the Emergency Department (ED); however, the effect of co-existing acidosis is unknown. Here, we investigated the effect of acidosis on in-hospital mortality for patients with hyperlactataemia. Methodology This is a retrospective cohort study of adults cared for in the resuscitation area of one ED who received a metabolic panel on arrival. The primary outcome was in-hospital mortality for patients with normal lactate (0.0-2...

BACKGROUND: Simulation-based technologies are emerging to enhance medical education in the digital era. However, there is limited data for the use of virtual reality simulation in pediatric medical education. We developed Virtual Doc as a highly immersive virtual reality simulation to teach pediatric cardiopulmonary resuscitation skills to medical students. OBJECTIVE: The primary objectives of this study were to evaluate participant satisfaction and perceived educational efficacy of Virtual Doc...

BACKGROUND: Sepsis-related hypotension in hospital patients is a common reason for rapid response team (RRT) attendance and transfer to intensive care, but little is known about the duration and management of hypotension during these RRT call-outs. OBJECTIVES: We aimed to describe the duration and management of hypotension during RRT call-outs to patients with sepsis-related hypotension who required transfer to intensive care. METHODS: RRT call-outs during 2018 for hypotension with transfer to intensive care were identified from a prospectively maintained database of RRT call-outs at a single tertiary hospital...

BACKGROUND: Adequate fluid resuscitation is paramount in the management of acute pancreatitis (AP). The aim of this study is to assess benefits and harms of fluid therapy protocols in patients with AP. METHODS: MEDLINE, Embase, Science Citation Index and clinical trial registries were searched for randomised clinical trials published before May 2020, assessing types of fluids, routes and rates of administration. RESULTS: A total 15 trials (1073 participants) were included...

BACKGROUND: Hyperchloremia and chloride load have been associated with worse clinical outcomes in critically ill patients. We sought to evaluate the electrolyte profile and clinical outcomes associated with a unit-wide transition from saline to balanced fluids for resuscitation and maintenance fluids in a pediatric intensive care unit (PICU). METHODS: A before and after analysis of all patients admitted to the PICU in a large, urban, academic hospital between August 2018 and March 2020...

BACKGROUND: Perioperative cardiac arrest is a rare complication with an incidence of around 1 in 1400 cases, but it carries a high burden of mortality reaching up to 70% at 30 days. Despite its specificities, guidelines for treatment of perioperative cardiac arrest are lacking. Gathering the available literature may improve quality of care and outcome of patients. METHODS: The PERIOPCA Task Force identified major clinical questions about the management of perioperative cardiac arrest and framed them into the therapy population [P], intervention [I], comparator [C], and outcome [O] (PICO) format...