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Combined Use of Venoarterial Extracorporeal Membrane Oxygenation and Intra-Aortic Balloon Pump after Cardiac Arrest.

Resuscitation 2021 Jul 24. Epub 2021 Jul 24.

Tokyo CCU Network, Scientific Committee, Tokyo, Japan; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.

Objectives: We investigated whether intra-aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA-ECMO) was associated with favourable neurological outcomes for patients after the return of spontaneous circulation (ROSC). Moreover, we evaluated the aetiology of cardiac arrest on the effectiveness of this therapy in a sub-study.

Background: There is insufficient research on the optimal combination of machines for patients after ROSC is not established. Read More

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General health condition of patients hospitalized after an incident of in-hospital or out-of hospital sudden cardiac arrest with return of spontaneous circulation.

Clin Cardiol 2021 Jul 27. Epub 2021 Jul 27.

Department of Histology, Cytophysiology, and Embryology, Faculty of Medicine in Zabrze, The University of Technology in Katowice, Katowice, Poland.

Background: Sudden cardiac arrest (SCA) is one of the main reasons for admission to the intensive care unit (ICU), which influences discharge in a good neurological state.

Hypothesis: To analyze patients who had recovery of spontaneous circulation (ROSC) during hospitalization in the ICU using the Glasgow Outcome Scale (GOS).

Methods: The study group comprised 78 patients after SCA (35 after out-of-hospital cardiac arrest [OHCA] and 43 after in-hospital cardiac arrest [IHCA]) with ROSC who were admitted to the ICU of Regional Hospital No. Read More

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Quantitative magnetic resonance imaging assessment of brain injury after successful cardiopulmonary resuscitation in a rat model of asphyxia cardiac arrest.

Brain Imaging Behav 2021 Jul 23. Epub 2021 Jul 23.

The Seventh Affiliated Hospital, Sun Yat-Sen University, 628 Zhenyuan Road, Xinhu Street, Guangming New District, Shenzhen, 518107, Guangdong, China.

The aim of this study was to use dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted magnetic resonance imaging (DWI) to measure changes in blood-brain barrier (BBB) permeability and cerebral edema over time in a rat model of asphyxial cardiac arrest (ACA). ACA was established by endotracheal tube clamping. Male rats were randomized into a sham group (n = 5) and three ACA groups (n = 18). Read More

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Effects of Add-On Left Ventricular Assist Device to Extracorporeal Membrane Oxygenation During Refractory Cardiac Arrest in a Porcine Model.

ASAIO J 2021 Jul 20. Epub 2021 Jul 20.

From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Department of Clinical Science, University of Bergen, Bergen, Norway Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway Centre for Violence and Traumatic Stress Studies Oslo, Oslo, Norway Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway Faculty of Medicine, University of Bergen, Bergen, Norway.

This study evaluated the effects of extracorporeal membrane oxygenation (ECMO) in combination with a percutaneous adjunctive left ventricular assist device (LVAD) in a porcine model during 60 minutes of refractory cardiac arrest (CA). Twenty-four anesthetized swine were randomly allocated into three groups given different modes of circulatory assist: group 1: ECMO 72 ml/kg/min and LVAD; group 2: ECMO 36 ml/kg/min and LVAD; and group 3: ECMO 72 ml/kg/min. During CA and extracorporeal cardiopulmonary resuscitation (ECPR), mean left ventricular pressure (mLVP) was lower in group 1 (p = 0. Read More

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Effect of Advanced Airway Management by Paramedics During Out-of-Hospital Cardiac Arrest on Chest Compression Fraction and Return of Spontaneous Circulation.

Open Access Emerg Med 2021 12;13:305-310. Epub 2021 Jul 12.

Emergency and Disaster Medicine, University of Toyama, Toyama, Japan.

Purpose: To obtain effective systemic blood flow and coronary perfusion by chest compressions during cardiopulmonary resuscitation, it is recommended that the interruption time of chest compressions be kept to a minimum, and that the chest compression fraction (CCF) should be kept high. In this study, we examined the effects of advanced airway management by paramedics in out-of-hospital cardiac arrest (OHCA) cases on CCF and on return of spontaneous circulation (ROSC) before arrival at the hospital.

Participants And Methods: A total of 283 adult, non-traumatic OHCA cases who were in cardiopulmonary arrest at the time of EMS contact between April 2015 and March 2017 were registered for this study. Read More

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Sustained Inflation During Chest Compression: A New Technique of Pediatric Cardiopulmonary Resuscitation That Improves Recovery and Survival in a Pediatric Porcine Model.

J Am Heart Assoc 2021 Jul 21:e019136. Epub 2021 Jul 21.

Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation Royal Alexandra Hospital Edmonton Alberta Canada.

Background Chest compression (CC) during sustained inflations (CC+SI) compared with CC with asynchronized ventilation (CCaV) during cardiopulmonary resuscitation in asphyxiated pediatric piglets will reduce time to return of spontaneous circulation (ROSC). Methods and Results Piglets (20-23 days of age, weighing 6.2-10. Read More

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Prediction of Neurological Outcomes in Out-of-hospital Cardiac Arrest Survivors Immediately after Return of Spontaneous Circulation: Ensemble Technique with Four Machine Learning Models.

J Korean Med Sci 2021 Jul 19;36(28):e187. Epub 2021 Jul 19.

Department of Biomedical Engineering, College of Medicine and Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea.

Background: We performed this study to establish a prediction model for 1-year neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients who achieved return of spontaneous circulation (ROSC) immediately after ROSC using machine learning methods.

Methods: We performed a retrospective analysis of an OHCA survivor registry. Patients aged ≥ 18 years were included. Read More

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The Value of Extracellular Cold-Inducible RNA-Binding Protein (eCIRP) in Predicting the Severity and Prognosis of Patients After Cardiac Arrest: A Preliminary Observational Study.

Shock 2021 Aug;56(2):229-236

Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.

Background: Extracellular cold-inducible RNA-binding protein (eCIRP) acting as a novel damage-associated molecular pattern molecule promotes systemic inflammatory responses, including neuroinflammation in cerebral ischemia. We aimed to observe the changes of serum eCIRP and evaluate whether the increased serum eCIRP was associated with the severity and prognosis in patients with restoration of spontaneous circulation (ROSC).

Methods: A total of 73 patients after ROSC were divided into non-survivor (n = 48) and survivor (n = 25) groups based on 28-day survival. Read More

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Impact of intraosseous versus intravenous resuscitation during in-hospital cardiac arrest: A retrospective study.

Resuscitation 2021 Jul 14;166:7-13. Epub 2021 Jul 14.

University of Alabama at Birmingham Division of Pulmonary, Allergy and Critical Care Medicine, 1900 University Blvd., Tinsley Harrison Tower, Suite 422, Birmingham, AL 35294, United States. Electronic address:

Aim: To compare outcomes between Intraosseous (IO) and peripheral intravenous (PIV) injection during in-hospital cardiac arrest (IHCA) and examine its utility in individuals with obesity.

Methods: We performed a retrospective cohort analysis of adult, atraumatic IHCA at a single tertiary care center. Subjects were classified as either IO or PIV resuscitation. Read More

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Long-term survival and health-related quality of life after in-hospital cardiac arrest.

Resuscitation 2021 Jul 13. Epub 2021 Jul 13.

Department of Intensive Care Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands.

Introduction: In-hospital cardiac arrest (IHCA) is an adverse event associated with high mortality. Because of the impact of IHCA more data is needed on incidence, outcomes and associated factors that are present prior to cardiac arrest. The aim was to assess one-year survival, patient-centred outcomes after IHCA and their associated pre-arrest factors. Read More

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Out-of-hospital cardiac arrest outcomes in emergency departments.

Resuscitation 2021 Jul 13. Epub 2021 Jul 13.

Department of Epidemiology and Preventive Medicine, Monash University; Alfred Hospital; Prehospital, Resuscitation & Emergency Care Research Unit, Curtin University. Electronic address:

Background: The emergency department (ED) plays an important role in out-hospital-cardiac arrest (OHCA) management. However, ED outcomes are not widely reported. This study aimed to 1) describe OHCA ED outcomes and reasons for ED deaths, and 2) whether these differed between hospitals. Read More

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Validation of Unani concept of (drug substitution) by physicochemical standardization and hepatoprotective activity of Linn. and its substitute Rosc. in albino Wistar rats.

J Complement Integr Med 2021 Jul 15. Epub 2021 Jul 15.

Regional Research Institute of Unani Medicine (RRIUM), CCRUM, Ministry of AYUSH, Govt. of India, Chennai, India.

Objectives: To validate the concept of (drug substitution) by evaluation of physicochemical standardization and hepatoprotective activity of & its substitute, in albino Wistar rats.

Methods: Physicochemical standardization by estimation of moisture content, ash values and extractive values were carried out using standard methods. Hepatotoxicity was induced in albino Wistar rats using CCl 1 mL/kg s. Read More

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Stress hormones kinetics in ventricular fibrillation cardiac arrest and resuscitation: Translational and therapeutic implications.

Am J Emerg Med 2021 Jul 9;50:14-21. Epub 2021 Jul 9.

European University Cyprus, School of Medicine, Engomi 1516, Cyprus.

Background: Knowing the kinetics of endogenous stress hormones during cardiac arrest and cardiopulmonary resuscitation (CRP) will help to optimize personalized physiology-guided treatment. The aim of this study was to examine the dynamic changes in stress hormones in a swine model of ventricular fibrillation (VF) cardiac arrest.

Methods: Ventricular fibrillation was induced in 10 healthy Landrace/Large White piglets, which were subsequently left untreated for 8 min. Read More

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Impact of Induced Therapeutic Hypothermia by Intravenous Infusion of Ice-Cold Fluids After Hospital Arrival in Comatose Survivors of Out-of-Hospital Cardiac Arrest With Initial Shockable Rhythm.

Circ J 2021 Jul 14. Epub 2021 Jul 14.

Faculty of Health Science, Osaka Aoyama University.

Background: The effect of in-hospital rapid cooling by intravenous ice-cold fluids for comatose survivors of out-of-hospital cardiac arrest (OHCA) is unclear.Methods and Results:From the J-PULSE-HYPO study registry, data for 248 comatose survivors with return of spontaneous circulation (ROSC) who were treated with therapeutic hypothermia (34℃ for 12-72 h) after witnessed shockable OHCA were extracted. Patients were divided into 2 groups by the median collapse-to-ROSC interval (18 min), and then into 2 groups by cooling method (rapid cooling by intravenous ice-cold fluids vs. Read More

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Hypothermic treatment reduces matrix metalloproteinase-9 expression and damage in the liver following asphyxial cardiac arrest in rats.

Lab Anim Res 2021 Jul 14;37(1):16. Epub 2021 Jul 14.

Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon, 24341, Republic of Korea.

Background: Hypothermic treatment is known to protect organs against cardiac arrest (CA) and improves survival rate. However, few studies have evaluated the effects of hypothermia on CA-induced liver damages. This study was designed to analyzed the possible protective effects of hypothermia on the liver after asphyxial CA (ACA). Read More

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Automated pupillometry helps monitor the efficacy of cardiopulmonary resuscitation and predict return of spontaneous circulation.

Am J Emerg Med 2021 Jul 3;49:360-366. Epub 2021 Jul 3.

Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Institute of Emergency Medicine, Zhejiang University, Hangzhou, Zhejiang, China. Electronic address:

Background: We investigated the effectiveness of automated pupillometry on monitoring cardiopulmonary resuscitation (CPR) and predicting return of spontaneous circulation (ROSC) in a swine model of cardiac arrest (CA).

Methods: Sixteen male domestic pigs were included. Traditional indices including coronary perfusion pressure (CPP), end-tidal carbon dioxide (ETCO), regional cerebral tissue oxygen saturation (rSO) and carotid blood flow (CBF) were continuously monitored throughout the experiment. Read More

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Association between previous health condition and outcome after cardiac arrest.

Resuscitation 2021 Jul 7. Epub 2021 Jul 7.

University of Paris, Paris, France; Inserm U970, Team 4, PARCC, Paris Sudden Death Expertise Center, France; Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.

Introduction: Overall survival of patients with out-of-hospital cardiac arrest (OHCA) remains low, even in those with return of spontaneous circulation (ROSC). In addition to usual prognostic characteristics, patients' medical history may also influence their outcome. This study aimed to investigate the role of pre-arrest comorbidities on hospital survival, neurological outcome and mode of death in OHCA patients with successful ROSC. Read More

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Levosimendan increases brain tissue oxygen levels after cardiopulmonary resuscitation independent of cardiac function and cerebral perfusion.

Sci Rep 2021 Jul 9;11(1):14220. Epub 2021 Jul 9.

Department of Anesthesiology, Medical Center, Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany.

Prompt reperfusion is important to rescue ischemic tissue; however, the process itself presents a key pathomechanism that contributes to a poor outcome following cardiac arrest. Experimental data have suggested the use of levosimendan to limit ischemia-reperfusion injury by improving cerebral microcirculation. However, recent studies have questioned this effect. Read More

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Outcomes of Targeted Temperature Management for In-Hospital and Out-Of-Hospital Cardiac Arrest: A Matched Case-Control Study Using the National Database of Taiwan Network of Targeted Temperature Management for Cardiac Arrest (TIMECARD) Registry.

Med Sci Monit 2021 Jul 10;27:e931203. Epub 2021 Jul 10.

Department of Critical Care, Mackay Memorial Hospital, Taipei, Taiwan.

BACKGROUND This study aimed to compare outcomes of targeted temperature management (TTM) for patients with in-hospital and out-of-hospital cardiac arrest using the national database of TaIwan network of targeted temperature ManagEment for CARDiac arrest (TIMECARD) registry. MATERIAL AND METHODS A retrospective, matched, case-control study was conducted. Patients with in-hospital cardiac arrest (IHCA) treated with TTM after the return of spontaneous circulation (ROSC) were selected as the case group and controls were defined as the same number of patients with out-of-hospital cardiac arrest (OHCA), matched for sex, age, Charlson comorbidity index, and cerebral performance category. Read More

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In-Hospital Cardiac Arrest (IHCA) and Outcomes in Patients Admitted With COVID-19 Infection.

Cureus 2021 Jun 1;13(6):e15365. Epub 2021 Jun 1.

Pulmonary and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, USA.

During the COVID-19 pandemic, many patients are hospitalized, and those suffering from in-hospital cardiac arrest (IHCA) have been previously reported to have poor outcomes. This is a single-center, retrospective, observational study conducted at the Veterans Affairs Medical Center, Washington, DC, USA. The inclusion criteria were: patients admitted to the hospital with a diagnosis of COVID-19 who underwent cardiopulmonary resuscitation (CPR) for IHCA. Read More

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Prehospital Tibial Intraosseous Drug Administration is Associated with Reduced Survival Following Out of Hospital Cardiac Arrest: A study for the CARES Surveillance Group.

Resuscitation 2021 Jul 5. Epub 2021 Jul 5.

Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA.

Background: Recent reports have questioned the efficacy of intraosseous (IO) drug administration for out-of-hospital cardiac arrest (OHCA) resuscitation. Our aim was to determine whether prehospital administration of resuscitative medications via the IO route was associated with lower rates of return of spontaneous circulation (ROSC) and survival to hospital discharge than peripheral intravenous (IV) infusion in the setting of OHCA.

Methods: We obtained data on all OHCA patients receiving prehospital IV or IO drug administration from the three most populous counties in Michigan over three years. Read More

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Multimodal monitoring including early EEG improves stratification of brain injury severity after pediatric cardiac arrest.

Resuscitation 2021 Jul 5. Epub 2021 Jul 5.

Division of Neurology, Children's Hospital of Philadelphia, United States; Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, United States.

Aims: Assessment of brain injury severity early after cardiac arrest (CA) may guide therapeutic interventions and help clinicians counsel families regarding neurologic prognosis. We aimed to determine whether adding EEG features to predictive models including clinical variables and examination signs increased the accuracy of short-term neurobehavioral outcome prediction.

Methods: This was a prospective, observational, single-center study of consecutive infants and children resuscitated from CA. Read More

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First Report of Nigrospora oryzae Causing Leaf Spot on Ginger in China.

Plant Dis 2021 Jul 8. Epub 2021 Jul 8.

Nanning, China;

Ginger (Zingiber officinale Rosc.) is an herbal crop widely grown in China for its medicinal and savory qualities of rhizomes. In August 2018, leaf spot symptoms were observed on ginger plants grown in a field in Nanning, Guangxi Province (E108°3'54", N23°14'48"). Read More

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Incidence of in-hospital cardiac arrest at general wards before and after implementation of an early warning score.

BMC Emerg Med 2021 Jul 7;21(1):79. Epub 2021 Jul 7.

Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet - University of Copenhagen, Inge Lehmanns Vej 6, section 6011, DK-2100, Copenhagen, Denmark.

Background: In order to reduce the incidence of in-hospital cardiac arrest (IHCA) at general wards, medical emergency teams (MET) were implemented in the Capital Region of Denmark in 2012 as the efferent part of a track and trigger system. The National Early Warning Score (NEWS) system became the afferent part. This study aims at investigating the incidence of IHCA at general wards before and after the implementation of the NEWS system. Read More

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Inhaled nitric oxide in adults with in-hospital cardiac arrest: A feasibility study.

Nitric Oxide 2021 Jul 3;115:30-33. Epub 2021 Jul 3.

Resuscitation Research Group, Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA.

Background: While inhaled nitric oxide (iNO) has revealed benefit in cardiac arrest in an animal model, no published data has yet demonstrated the impact of iNO in humans with cardiac arrest.

Methods: In this pilot study, we administered iNO, along with standard post-resuscitative care, in adults with in-hospital cardiac arrest (IHCA) following achievement of return of spontaneous circulation (ROSC) at an academic tertiary medical center. Patients receiving iNO were compared to age-matched controls with IHCA receiving standard care from an institutional registry. Read More

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Massive Pulmonary Embolism Causing Cardiac Arrest Managed with Systemic Thrombolytic Therapy: A Case Report.

Am J Case Rep 2021 Jul 6;22:e931215. Epub 2021 Jul 6.

Department of Intensive Care (Critical Care), Mayo Clinic Health System, Mankato, MN, USA.

BACKGROUND Approximately 290 000 cases of in-hospital cardiac arrest occur annually, the majority of which are due to cardiac or respiratory causes. Cardiac arrest due to acute pulmonary embolism (PE) is associated with a 90% incidence of mortality and, if identified, it can be treated with systemic thrombolytics. Here, we describe a case in which the outcome for such an event was favorable. Read More

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Focused echocardiography, end-tidal carbon dioxide, arterial blood pressure or near-infrared spectroscopy monitoring during paediatric cardiopulmonary resuscitation: A scoping review.

Resusc Plus 2021 Jun 30;6:100109. Epub 2021 Mar 30.

Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.

Aim: To evaluate the individual use and predictive value of focused echocardiography, end-tidal carbon dioxide (EtCO), invasive arterial blood pressure (BP) and near-infrared spectroscopy (NIRS) during cardiopulmonary resuscitation (CPR) in children.

Methods: This scoping review was undertaken as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR) and based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews. PubMed, MEDLINE, CINAHL and EMBASE were searched from the last ILCOR reviews until September 2020. Read More

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Intramuscular adrenaline for out-of-hospital cardiac arrest is associated with faster drug delivery: A feasibility study.

Resusc Plus 2021 Sep 31;7:100142. Epub 2021 May 31.

Division of Emergency Medicine, Division of Surgery, University of Utah School of Medicine, 30 North 1900 East, Room 1C26 SOM, Salt Lake City, UT 84132, USA.

Background: Early adrenaline administration is associated with return of spontaneous circulation (ROSC) and survival in out-of-hospital cardiac arrest (OHCA). Animal data demonstrate a similar rate of ROSC when early intramuscular (IM) adrenaline is given compared to early intravenous (IV) adrenaline.

Aim: To evaluate the feasibility of protocolized first-dose IM adrenaline in OHCA and it's effect on time from Public Safety Access Point (PSAP) call receipt to adrenaline administration when compared to IO and IV administration. Read More

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September 2021

Ultra-early serum concentrations of neuronal and astroglial biomarkers predict poor neurological outcome after out-of-hospital cardiac arrest-a pilot neuroprognostic study.

Resusc Plus 2021 Sep 8;7:100133. Epub 2021 Jun 8.

Department of Emergency Medicine, University of Florida, 1329 SW 16 Street, Gainesville, FL 32608, USA.

Objectives: To assess ultra-early neuroprognostic significance of GFAP, NF-L, UCH-L1, tau, and S100B concentrations, change trajectory, and combination profile after Out-of-Hospital Cardiac Arrest (OHCA).

Methods: Prospective enrollment of 22 OHCA and 10 control patients at an academic tertiary care center between May 1, 2017 and January 28, 2020. Blood was collected within one hour of return of spontaneous circulation (ROSC) (H0), at hours 6 (H6), 12, 18, 24, and daily or until discharge or death. Read More

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September 2021