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Patients who were comatose after resuscitation from cardiac arrest with a nonshockable rhythm were randomly assigned to moderate therapeutic hypothermia (33°C) or targeted normothermia (37°C). Therapeutic hypothermia improved survival with a favorable neurologic outcome at 90 days.

In this multicenter trial, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant survival benefit in comatose children who survived in-hospital cardiac arrest. Therapeutic hypothermia for comatose adults who have had an out-of-hospital cardiac arrest was recommended on the basis of results of clinical trials reported in 2002. 1 – 3 More recent trials have shown that fever prevention with therapeutic normothermia is equally efficacious as therapeutic hypothermia in adult and pediatric populations. 4 , 5 Current guidelines recommend either hypothermia or normothermia for temperature management after out-of-hospital cardiac arrest in adults and children. 6 , 7 In-hospital cardiac arrest in children commonly results in death or in a poor long-term functional outcome in survivors; however, outcomes in the in-hospital setting are significantly better than those in the out-of-hospital . . .

A trial involving comatose survivors of cardiac arrest tested whether aggressively treating rhythmic and periodic EEG activity would improve neurologic outcomes. Despite suppression of abnormal EEG activity, the incidence of a poor neurologic outcome did not differ significantly from that with standard care, and mortality was high.

The themes of qualitative assessments that characterize the experience of family members offered the choice of observing cardiopulmonary resuscitation (CPR) of a loved one have not been formally identified. In the context of a multicenter randomized clinical trial offering family members the choice of observing CPR of a patient with sudden cardiac arrest, a qualitative analysis, with a sequential explanatory design, was conducted. The aim of the study was to understand family members' experience during CPR. All participants were interviewed by phone at home three months after cardiac arrest. Saturation was reached after analysis of 30 interviews of a randomly selected sample of 75 family members included in the trial. Four themes were identified: 1- choosing to be actively involved in the resuscitation; 2- communication between the relative and the emergency care team; 3- perception of the reality of the death, promoting acceptance of the loss; 4- experience and reactions of the relatives who did or did not witness the CPR, describing their feelings. Twelve sub-themes further defining these four themes were identified. Transferability of our findings should take into account the country-specific medical system. Family presence can help to ameliorate the pain of the death, through the feeling of having helped to support the patient during the passage from life to death and of having participated in this important moment. Our results showed the central role of communication between the family and the emergency care team in facilitating the acceptance of the reality of death.

Patients who remain unconscious after resuscitation from cardiac arrest outside the hospital have a poor prognosis. In this trial, 77 patients were assigned to treatment with moderate induced hypothermia or normothermia. Survival to hospital discharge with good neurologic recovery was more frequent in the hypothermia group than in the normothermia group. Treatment with moderate hypothermia appears to improve outcomes. Cardiac arrest outside the hospital is a major cause of unexpected death in developed countries, with survival rates ranging from less than 5 percent to 35 percent. 1 – 3 In patients who are initially resuscitated, anoxic neurologic injury is an important cause of morbidity and mortality. 4 Currently, the treatment of patients with coma after resuscitation from out-of-hospital cardiac arrest is largely supportive. Because cerebral ischemia may persist for some hours after resuscitation, 5 the use of induced hypothermia to decrease cerebral oxygen demand has been proposed as a treatment option. 6 Although this suggestion has been supported by studies in animal models, 7 – . . .

In a randomized trial, adult patients with witnessed out-of-hospital cardiac arrest were assigned to receive either the thrombolytic agent tenecteplase or placebo during cardiopulmonary resuscitation. There were no significant differences between the groups in the return of spontaneous circulation, survival to hospital admission or discharge, neurologic outcome, or 30-day survival. There were more intracranial hemorrhages in the tenecteplase group. Adult patients with out-of-hospital cardiac arrest were assigned to receive either the thrombolytic agent tenecteplase or placebo during cardiopulmonary resuscitation. There were no significant differences between the groups in the return of spontaneous circulation, survival to hospital admission or discharge, neurologic outcome, or 30-day survival. Out-of-hospital cardiac arrest is a major public health concern. According to one estimate, 155,000 persons have an out-of-hospital cardiac arrest annually in the United States, of whom less than 10% survive. 1 These statistics underscore a need for improvement in cardiopulmonary-resuscitation strategies. Cardiac arrest is caused by acute myocardial infarction or pulmonary embolism in approximately 70% of out-of-hospital cases, 2 , 3 and cardiac arrest itself activates systemic coagulation. 4 Thrombolytic therapy during cardiopulmonary resuscitation can dissolve intravascular blood clots and has beneficial effects on cerebral microcirculatory reperfusion 5 ; it may therefore improve survival 6 and neurologic recovery 7 after cardiac arrest. In a previous randomized, . . .

A multicenter trial evaluated patients with previous anterior-wall myocardial infarction who were not candidates for an implantable cardioverter–defibrillator. Patients were randomly assigned either to have an automated external defibrillator (AED) at home for management of cardiac arrest or to receive standard treatment. At a median follow-up of 3 years, there was no significant difference between the two groups in mortality from any cause. Patients with previous anterior-wall myocardial infarction were randomly assigned either to have an automated external defibrillator (AED) at home for management of cardiac arrest or to receive standard treatment. At a median follow-up of 3 years, there was no significant difference between the two groups in mortality from any cause. Sudden cardiac arrest remains an unsolved public health problem, with approximately 166,200 out-of-hospital cardiac arrests occurring annually in the United States. 1 The use of automated external defibrillators (AEDs) by trained lay responders in community-based public-access defibrillation programs has been shown to increase survival after sudden cardiac arrest. However, what effect the use of the device has on overall mortality for the community at risk is unknown. 2 – 5 Particularly impressive results have been reported when sudden cardiac arrest is witnessed and an AED is immediately available, as on airplanes and in casinos and airports. 6 – 8 However, the effect of such programs . . .

Background Tracheal intubation (TI)-associated cardiac arrest (TI-CA) occurs in 1.7% of pediatric ICU TIs. Our objective was to evaluate resuscitation characteristics and outcomes between cardiac arrest patients with and without TI-CA. Methods Secondary analysis of cardiac arrest patients in both ICU-RESUS trial and ancillary CPR-NOVA study. The primary exposure was TI-CA, defined as cardiac arrest occurred during TI procedure or within 20 min after endotracheal tube placement. The primary outcome was survival to hospital discharge with favorable neurological outcome (Pediatric Cerebral Performance Category score 1–3 or unchanged). Results Among 315 children with cardiac arrests, 48 (15.2%) met criteria for TI-CA. Pre-existing medical conditions were similar between groups. Pre-arrest non-invasive mechanical ventilation was more common among TI-CA patients (18/48, 37.5%) compared to non-TI-CA patients (35/267, 13.1%). In 48% (23/48), the TI-CA occurred within 20 min after intubation (i.e., not during intubation). Duration of CPR was longer in TI-CA patients (median 11.0 min, interquartile range [IQR]: 2.5, 35.5) than non-TI-CA patients (median 5.0 min, IQR 2.0, 21.0), p  = 0.03. Return of spontaneous circulation occurred in 32/48 (66.7%) TI-CA versus 186/267 (69.7%) non-TI-CA, p  = 0.73. Survival to hospital discharge with favorable neurological outcome occurred in 29/48 (60.4%) TI-CA versus 146/267 (54.7%) non-TI-CA, p  = 0.53. Conclusions Fifteen percent of these pediatric ICU cardiac arrests were associated with TI. Half of TI-CA occurred after endotracheal tube placement. While duration of CPR was longer in TI-CA patients, there were no differences in unadjusted outcomes following TI-CA versus non-TI-CA. Trial Registration The ICU-RESUS (ClinicalTrials.gov Identifier: NCT 02837497).

The 'chain of survival'-including early call for help, early cardiopulmonary resuscitation (CPR) and early defibrillation-represents the most beneficial approach for favourable patient outcome after out-of-hospital cardiac arrest (OHCA). Despite increasing numbers of publicly accessible automated external defibrillators (AED) and interventions to increase public awareness for basic life support (BLS), the number of their use in real-life emergency situations remains low. In this prospective population-based cross-sectional study, a total of 501 registered inhabitants of Vienna (Austria) were randomly approached via telephone calls between 08/2014 and 09/2014 and invited to answer a standardized questionnaire in order to identify public knowledge and awareness of BLS and AED-use. We found that more than 52 percent of participants would presume OHCA correctly and would properly initiate BLS attempts. Of alarming importance, only 33 percent reported that they would be willing to perform CPR and 50 percent would use an AED device. There was a significantly lower willingness to initiate BLS attempts (male: 40% vs. female: 25%; OR: 2.03 [95%CI: 1.39-2.98]; p<0.001) and to use an AED device (male: 58% vs. female: 44%; OR: 1.76 [95%CI: 1.26-2.53]; p = 0.002) in questioned female individuals compared to their male counterparts. Interestingly, we observed a strongly decreasing level of knowledge and willingness for BLS attempts (-14%; OR: 0.72 [95%CI: 0.57-0.92]; p = 0.027) and AED-use (-19%; OR: 0.68 [95%CI: 0.54-0.85]; p = 0.001) with increasing age. We found an overall poor knowledge and awareness concerning BLS and the use of AEDs among the Viennese population. Both female and elderly participants reported the lowest willingness to perform BLS and use an AED in case of OHCA. Specially tailored programs to increase awareness and willingness among both the female and elderly community need to be considered for future educational interventions.

Introduction Though early hypotension after pediatric in-hospital cardiac arrest (IHCA) is associated with inferior outcomes, ideal post-arrest blood pressure (BP) targets have not been established. We aimed to leverage prospectively collected BP data to explore the association of post-arrest BP thresholds with outcomes. We hypothesized that post-arrest systolic and diastolic BP thresholds would be higher than the currently recommended post-cardiopulmonary resuscitation BP targets and would be associated with higher rates of survival to hospital discharge. Methods We performed a secondary analysis of prospectively collected BP data from the first 24 h following return of circulation from index IHCA events enrolled in the ICU-RESUScitation trial (NCT02837497). The lowest documented systolic BP (SBP) and diastolic BP (DBP) were percentile-adjusted for age, height and sex. Receiver operator characteristic curves and cubic spline analyses controlling for illness category and presence of pre-arrest hypotension were generated exploring the association of lowest post-arrest SBP and DBP with survival to hospital discharge and survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category of 1–3 or no change from baseline). Optimal cutoffs for post-arrest BP thresholds were based on analysis of receiver operator characteristic curves and spline curves. Logistic regression models accounting for illness category and pre-arrest hypotension examined the associations of these thresholds with outcomes. Results Among 693 index events with 0–6 h post-arrest BP data, identified thresholds were: SBP > 10th percentile and DBP > 50th percentile for age, sex and height. Fifty-one percent ( n  = 352) of subjects had lowest SBP above threshold and 50% ( n  = 346) had lowest DBP above threshold. SBP and DBP above thresholds were each associated with survival to hospital discharge (SBP: aRR 1.21 [95% CI 1.10, 1.33]; DBP: aRR 1.23 [1.12, 1.34]) and survival to hospital discharge with favorable neurologic outcome (SBP: aRR 1.22 [1.10, 1.35]; DBP: aRR 1.27 [1.15, 1.40]) (all p  < 0.001). Conclusions Following pediatric IHCA, subjects had higher rates of survival to hospital discharge and survival to hospital discharge with favorable neurologic outcome when BP targets above a threshold of SBP > 10th percentile for age and DBP > 50th percentile for age during the first 6 h post-arrest.