Oxygen and Carbon Dioxide Targets after Cardiac Arrest: An Updated Systematic Review

Resuscitation, Год журнала: 2025, Номер unknown, С. 110620 - 110620

Опубликована: Апрель 1, 2025

To perform a systematic review and meta-analysis of oxygen carbon dioxide targets in patients with sustained return spontaneous circulation after cardiac arrest. Searches were conducted MEDLINE, Embase, Evidence-Based Medicine Reviews from August 2019 to March 2025 for randomised trials comparing specific or post-cardiac arrest patients. Two investigators independently reviewed relevance, extracted data, assessed risk bias. Data pooled using random-effects models. The certainty evidence was evaluated GRADE methodology. Fifteen manuscripts 12 included. All limited adult patients, primarily including out-of-hospital arrests. Five the prehospital setting, while six three intensive care unit setting. Risk bias as moderate most outcomes. Meta-analyses found no differences survival favourable functional outcomes when restrictive liberal either There also difference mild hypercapnia normocapnia. rated low moderate. Among resuscitated arrest, neither nor hypercapnia, compared conventional targets, improved

Язык: Английский

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Management of non-Cardiac Organ Failure in cardiogenic shock

American Heart Journal Plus Cardiology Research and Practice, Год журнала: 2025, Номер 55, С. 100549 - 100549

Опубликована: Май 1, 2025

Cardiogenic shock (CS) is a syndrome of low cardiac output leading to systemic hypoperfusion. The mainstay management involves optimizing preload, afterload, and contractility restore central hemodynamics. However, CS frequently complicated by non-cardiac organ failure, for which there limited guidance. Herein, we review the pathophysiology, assessment, respiratory, renal, hepatic, neurological failure in context CS. This intended provide an evidence-based framework extracardiac sequelae patients medical intensive care unit.

Язык: Английский

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Carbon dioxide pathophysiology and targets following acute brain injury

Intensive Care Medicine, Год журнала: 2025, Номер unknown

Опубликована: Май 5, 2025

Язык: Английский

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Higher versus lower mean arterial blood pressure after cardiac arrest and resuscitation (MAP‐CARE): A protocol for a randomized clinical trial

Acta Anaesthesiologica Scandinavica, Год журнала: 2025, Номер 69(6)

Опубликована: Май 20, 2025

Abstract Background In patients resuscitated after cardiac arrest, a higher mean arterial pressure (MAP) may increase cerebral perfusion and attenuate hypoxic brain injury. Here we present the protocol of arrest resuscitation (MAP‐CARE) trial aiming to investigate influence MAP targets on patient outcomes. Methods ‐ CARE is one component Sedation, Temperature Pressure Cardiac Arrest Resuscitation ( STEPCARE ) 2 x factorial randomized trial. The an international, multicenter, parallel‐group, investigator‐initiated, superiority designed test hypothesis that targeting (>85 mmHg intervention versus lower (>65 comparator from reduces 6‐month mortality primary outcome ). Trial participants are adults with sustained return spontaneous circulation who comatose following out‐of‐hospital arrest. two other components evaluate sedation temperature control strategies. Apart interventions, all aspects general intensive care will be according local practices participating site. Neurological prognostication performed European Council Society Intensive Care Medicine guidelines by physician blinded allocation group. sample size 3500 provides 90% power alpha 0.05 detect 5.6 absolute risk reduction in mortality, assuming 60% Secondary outcomes poor functional 6 months randomization, patient‐reported overall health proportion predefined severe adverse events. Conclusion MAP‐CARE if compared during mortality.

Язык: Английский

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Plasma phosphorylated tau (p-tau231) and total tau (t-tau) as prognostic markers of neurological outcome after cardiac arrest - a multicentre study

Resuscitation, Год журнала: 2024, Номер 206, С. 110450 - 110450

Опубликована: Дек. 3, 2024

Язык: Английский

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Validation of the CREST model and comparison with SCAI shock classification for the prediction of circulatory death in resuscitated out-of-hospital cardiac arrest

European Heart Journal Acute Cardiovascular Care, Год журнала: 2024, Номер 13(8), С. 605 - 614

Опубликована: Май 28, 2024

We validated the CREST model, a 5 variable score for stratifying risk of circulatory aetiology death (CED) following out-of-hospital cardiac arrest (OHCA) and compared its discrimination with SCAI shock classification. Circulatory occurs in approximately third patients admitted after resuscitated OHCA. There is an urgent need improved stratification patient OHCA on arrival to centre improve selection invasive interventions.

Язык: Английский

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Using machine learning to predict neurologic injury in venovenous extracorporeal membrane oxygenation recipients: An ELSO Registry analysis

JTCVS Open, Год журнала: 2024, Номер 21, С. 140 - 167

Опубликована: Июль 2, 2024

BackgroundVenovenous extracorporeal membrane oxygenation (VV-ECMO) is associated with acute brain injury (ABI), including central nervous system (CNS) ischemia (defined as ischemic stroke or hypoxic-ischemic [HIBI]) and intracranial hemorrhage (ICH). Data on prediction models for neurologic outcomes in VV-ECMO are limited.MethodsWe analyzed adult (age ≥18 years) patients the Extracorporeal Life Support Organization (ELSO) Registry (2009-2021) from 676 centers. ABI was defined CNS ischemia, ICH, death, seizures. 67 variables were extracted, clinical characteristics pre-ECMO/on-ECMO variables. Random forest, CatBoost, LightGBM, XGBoost machine learning (ML) algorithms (10-fold leave-one-out cross-validation) used to predict ABI. Feature importance scores pinpoint most important predicting ABI.ResultsOf 37,473 (median age, 48.1 years; 63% male), 2644 (7.1%) experienced ABI, 610 (2%) 1591 (4%) ICH. The areas under receiver operating characteristic curve ICH 0.70, 0.68, respectively. accuracy, positive predictive value, negative value 85%, 19%, 95%, ML identified higher center volume, pre-ECMO cardiac arrest, ECMO pump flow, elevated on-ECMO serum lactate level risk factors its subtypes.ConclusionsThis largest study of use reported date. Performance suboptimal, likely due lack standardization neuromonitoring/imaging protocols data granularity ELSO Registry. Standardized monitoring imaging needed across centers detect true prevalence

Язык: Английский

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Extracerebral multiple organ dysfunction and interactions with brain injury after cardiac arrest

Resuscitation Plus, Год журнала: 2024, Номер 19, С. 100719 - 100719

Опубликована: Июль 19, 2024

Cardiac arrest and successful resuscitation cause whole-body ischemia reperfusion, leading to brain injury extracerebral multiple organ dysfunction. Brain is the of death long-term disability in resuscitated survivors, was conceptualized treated as an isolated injury, which has neglected brain-visceral crosstalk. Extracerebral dysfunction common significantly associated with mortality poor neurological prognosis after resuscitation. However, detailed description characteristics post-resuscitation lacking, bidirectional interactions between visceral organs need be elucidated explore new treatment for neuroprotection. This review aims describe current concepts post-cardiac specific cardiovascular, respiratory, renal, hepatic, adrenal, gastrointestinal, neurohumoral systems. Additionally, we discuss crosstalk organs, especially focusing on how other factors affect progression. We think that clarifying these profound significance treat patients neural/systemic protection improve outcome.

Язык: Английский

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Prolonged Monitoring of Brain Electrical Activity in the Intensive Care Unit

Neurologic Clinics, Год журнала: 2024, Номер 43(1), С. 31 - 50

Опубликована: Окт. 16, 2024

Язык: Английский

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Paramedicine Literature Search

International Journal of Paramedicine, Год журнала: 2024, Номер 6, С. 194 - 249

Опубликована: Апрель 3, 2024

search strategy yielded a total of 1,209 citations and are listed below.

Язык: Английский

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