Part 4: Advanced life support

doi:10.1016/j.resuscitation.2005.09.018

Cited by 119 publications

(14 citation statements)

References 564 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some authors have found no benefits of TH in patients with non-shockable rhythm [26,27] while others have concluded that a positive impact on survival is likely [23,25,28,29]. The use of TH in such patients was recommended by ILCOR both in 2005 and 2010 [30,31]. In Norway, the use of TH in patients with an initial non-shockable rhythm has been recommended since 2004 [8], but only 50% of such patients were actually cooled in our study.…”

Section: Discussionmentioning

confidence: 99%

Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU

et al. 2013

View full text Add to dashboard Cite

IntroductionTherapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was adopted early in Norway. Since 2004 the general recommendation has been to cool all unconscious OHCA patients treated in the intensive care unit (ICU), but the decision to cool individual patients was left to the responsible physician. We assessed factors that were associated with use of TH and predicted survival.MethodWe conducted a retrospective observational study of prospectively collected cardiac arrest and ICU registry data from 2004 to 2008 at three university hospitals.ResultsA total of 715 unconscious patients older than 18 years of age, who suffered OHCA of both cardiac and non-cardiac causes, were included. With an overall TH use of 70%, the survival to discharge was 42%, with 90% of the survivors having a favourable cerebral outcome. Known positive prognostic factors such as witnessed arrest, bystander cardio pulmonary resuscitation (CPR), shockable rhythm and cardiac origin were all positive predictors of TH use and survival. On the other side, increasing age predicted a lower utilisation of TH: Odds Ratio (OR), 0.96 (95% CI, 0.94 to 0.97); as well as a lower survival: OR 0.96 (95% CI, 0.94 to 0.97). Female gender was also associated with a lower use of TH: OR 0.65 (95% CI, 0.43 to 0.97); and a poorer survival: OR 0.57 (95% CI, 0.36 to 0.92). After correcting for other prognostic factors, use of TH remained an independent predictor of improved survival with OR 1.91 (95% CI 1.18-3.06; P <0.001). Analysing subgroups divided after initial rhythm, these effects remained unchanged for patients with shockable rhythm, but not for patients with non-shockable rhythm where use of TH and female gender lost their predictive value.ConclusionsAlthough TH was used in the majority of unconscious OHCA patients admitted to the ICU, actual use varied significantly between subgroups. Increasing age predicted both a decreased utilisation of TH as well as lower survival. Further, in patients with a shockable rhythm female gender predicted both a lower use of TH and poorer survival. Our results indicate an underutilisation of TH in some subgroups. Hence, more research on factors affecting TH use and the associated outcomes in subgroups of post-resuscitation patients is needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU

et al. 2013

View full text Add to dashboard Cite

show abstract

“…The level of PEEP can be modified according to the anesthesiologist in charge if the systolic arterial pressure drops <90 mmHg for more than 3 minutes despite intravenous fluid infusion and/or start of vasopressors, if dosages of vasopressors are at the highest level tolerated, if new arrhythmias develop which are unresponsive to treatment suggested by the Advanced Cardiac Life Support Guidelines [18], if there is need of massive transfusion to maintain Ht >21% (Hb >7 mg/dl), or if there is a surgical complication determining life-threatening situations.…”

Section: Methodsmentioning

confidence: 99%

Rationale and study design of PROVHILO - a worldwide multicenter randomized controlled trial on protective ventilation during general anesthesia for open abdominal surgery

Hemmes

Severgnini

Jaber³

et al. 2011

Trials

View full text Add to dashboard Cite

BackgroundPost-operative pulmonary complications add to the morbidity and mortality of surgical patients, in particular after general anesthesia >2 hours for abdominal surgery. Whether a protective mechanical ventilation strategy with higher levels of positive end-expiratory pressure (PEEP) and repeated recruitment maneuvers; the "open lung strategy", protects against post-operative pulmonary complications is uncertain. The present study aims at comparing a protective mechanical ventilation strategy with a conventional mechanical ventilation strategy during general anesthesia for abdominal non-laparoscopic surgery.MethodsThe PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure ("PROVHILO") trial is a worldwide investigator-initiated multicenter randomized controlled two-arm study. Nine hundred patients scheduled for non-laparoscopic abdominal surgery at high or intermediate risk for post-operative pulmonary complications are randomized to mechanical ventilation with the level of PEEP at 12 cmH2O with recruitment maneuvers (the lung-protective strategy) or mechanical ventilation with the level of PEEP at maximum 2 cmH2O without recruitment maneuvers (the conventional strategy). The primary endpoint is any post-operative pulmonary complication.DiscussionThe PROVHILO trial is the first randomized controlled trial powered to investigate whether an open lung mechanical ventilation strategy in short-term mechanical ventilation prevents against postoperative pulmonary complications.Trial registrationISRCTN: ISRCTN70332574

show abstract

“…Guidelines from the American Heart Association (AHA) and the European Resuscitation Council (ERC) emphasize the importance of optimizing intra-arrest treatment, and recent guidelines also emphasize management of patients during the post-arrest period (2–4). …”

Section: Introductionmentioning

confidence: 99%

Initial Lactate and Lactate Change in Post–Cardiac Arrest

Donnino

Andersen

Giberson

et al. 2014

Critical Care Medicine

146

101

View full text Add to dashboard Cite

Introduction Rate of lactate change is associated with in-hospital mortality in post-cardiac arrest patients. This association has not been validated in a prospective multicenter study. Objective To determine the association between percent lactate change and outcomes in post-cardiac arrest patients. Methods Four-center prospective observational study conducted from June 2011 to March 2012. Inclusion criteria consisted of adult out-of-hospital non-traumatic cardiac arrest patients who were comatose after return of spontaneous circulation. The primary outcome was survival to hospital discharge, and secondary outcome was good neurological outcome. We compared the absolute lactate levels and the differences in the percent lactate change over 24-hrs between survivors and non-survivors and between subjects with good and bad neurological outcomes. Results 100 patients were analyzed. The median age was 63 years (IQR: 50 – 75) and 40% were female. 97% received therapeutic hypothermia and overall survival was 46%. Survivors and patients with good neurological outcome had lower lactate levels at 0, 12 and 24 hours (p < 0.01). In adjusted models percent lactate decrease at 12 hours was greater in survivors (OR 2.2 [95% CI 1.1 – 6.2]) and in those with good neurological outcome (OR 2.2 [95% CI 1.1 – 4.4]). Conclusion Lower lactate levels at 0, 12 and 24 hours as well as greater percent decrease in lactate over the first 12-hours post-cardiac arrest are associated with survival and good neurologic outcome.

show abstract

Part 4: Advanced life support

Cited by 119 publications

References 564 publications

Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU

Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU

Rationale and study design of PROVHILO - a worldwide multicenter randomized controlled trial on protective ventilation during general anesthesia for open abdominal surgery

Initial Lactate and Lactate Change in Post–Cardiac Arrest

Contact Info

Product

Resources

About