General Critical Care

Death Foretold: Are We Truly Improving Outcome Prediction Af... : Critical Care Medicine (lww.com)

Electroencephalography (EEG) reveals suppressed background with triphasic waves demonstrating diffuse cerebral disease.

Epinephrine in Out-of-Hospital Cardiac Arrest

A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms

Standard-dose epinephrine, high-dose epinephrine, and the combination of epinephrine with vasopressin are associated with increased ROSC and survival to hospital admission post-OHCA compared to placebo or no treatment. However, these agents don't necessarily enhance survival to discharge or ensure a good functional outcome. Notably, standard-dose epinephrine does improve survival to discharge for patients with a nonshockable rhythm but not for those with a shockable rhythm.

Epinephrine in Out-of-Hospital Cardiac Arrest - CHEST (chestnet.org)

Effects of Hypothermia vs Normothermia on Societal Participation and Cognitive Function at 6 Months in Survivors After Out-of-Hospital Cardiac Arrest

The "TTM2" trial compared the effects of cooling (hypothermia) and maintaining normal temperature (normothermia) in people who survived out-of-hospital cardiac arrest (OHCA). The study aimed to see if these approaches had different impacts on functional outcomes and cognitive function after six months.

The trial involved 1861 comatose adult OHCA patients, split into hypothermia and normothermia groups. After six months, 836 survivors participated in the follow-up.

Results showed no significant difference between the two groups in terms of societal participation or cognitive function. Many survivors faced limitations in daily activities, and cognitive issues were common regardless of treatment.

In a recent trial published at the Revista Española de Cardiología (English Edition), the researchers aimed to determine whether emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) following out-of-hospital cardiac arrest (OHCA) in patients without ST-segment elevation myocardial infarction (STEMI) would improve survival with good neurological outcome. In this open-label, randomized trial, 69 OHCA survivors without STEMI were randomly assigned to undergo immediate CAG or deferred CAG. The primary efficacy endpoint was in-hospital survival without severe dependence. The results showed no significant difference in the primary endpoint between the two groups, with in-hospital survival being 62.5% in the immediate CAG group and 58.8% in the delayed CAG group.

There were some differences in secondary endpoints, such as the incidence of acute kidney failure, which was more frequent in the immediate CAG group and infections, which were higher in the delayed CAG group. However, these differences were not enough to…

Extracorporeal Cardiopulmonary Resuscitation (CPR) is a method used to restore perfusion and oxygenation in patients who do not have spontaneous circulation. A recent study was conducted in the Netherlands to evaluate the effectiveness of extracorporeal CPR compared to conventional CPR in patients with refractory out-of-hospital cardiac arrest. The study enrolled 160 patients between 18 and 70 years of age who had received bystander CPR and had an initial ventricular arrhythmia but did not have a return of spontaneous circulation within 15 minutes.

The results of the study showed that 20% of patients who received extracorporeal CPR were alive with a favorable neurologic outcome at 30 days, compared to 16% of patients who received conventional CPR. The odds ratio for survival with a favorable neurologic outcome was 1.4, with a 95% confidence interval of 0.5 to 3.5 and a P value of 0.52. The number of serious adverse events was similar…