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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 . . .

Purpose Few outcome data are available about temperature management after intraoperative cardiac arrest (IOCA). We describe targeted temperature management (TTM) (32–34 °C) modalities, adverse events, and association with 1-year functional outcome in patients with IOCA. Methods Patients admitted to 11 ICUs after IOCA in 2008–2013 were studied retrospectively. The main outcome measure was 1-year functional outcome. Results Of the 101 patients [35 women and 66 men; median age, 62 years (interquartile range, 42–72)], 68 (67.3%) were ASA PS I to III and 57 (56.4%) had emergent surgery. First recorded rhythms were asystole in 44 (43.6%) patients, pulseless electrical activity in 36 (35.6%), and ventricular fibrillation/tachycardia in 20 (19.8%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation (ROSC) were 0 min (0–0) and 10 min (4–20), respectively. The 30 (29.7%) patients who received TTM had an increased risk of infection ( P  = 0.005) but not of arrhythmia, bleeding, or metabolic/electrolyte disorders. By multivariate analysis, one or more defibrillation before ROSC was positively associated with a favorable functional outcome at 1-year (OR 3.06, 95% CI 1.05–8.95, P  = 0.04) and emergency surgery was negatively associated with 1-year favorable functional outcome (OR 0.36; 95% CI 0.14–0.95, P  = 0.038). TTM use was not independently associated with 1-year favorable outcome (OR 0.82; 95% CI 0.27–2.46, P  = 0.72). Conclusions TTM was used in less than one-third of patients after IOCA. TTM was associated with infection but not with bleeding or coronary events in this setting. TTM did not independently predict 1-year favorable functional outcome after IOCA in this study.

PurposePatients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) frequently develop arterial hyperoxaemia, which may be harmful. However, lower oxygen saturation targets may also lead to harmful episodes of hypoxaemia.MethodsIn this registry-embedded, multicentre trial, we randomly assigned adult patients receiving VA-ECMO in an intensive care unit (ICU) to either a conservative (target SaO2 92–96%) or to a liberal oxygen strategy (target SaO2 97–100%) through controlled oxygen administration via the ventilator and ECMO gas blender. The primary outcome was the number of ICU-free days to day 28. Secondary outcomes included ICU-free days to day 60, mortality, ECMO and ventilation duration, ICU and hospital lengths of stay, and functional outcomes at 6 months.ResultsFrom September 2019 through June 2023, 934 patients who received VA-ECMO were reported to the EXCEL registry, of whom 300 (192 cardiogenic shock, 108 refractory cardiac arrest) were recruited. We randomised 149 to a conservative and 151 to a liberal oxygen strategy. The median number of ICU-free days to day 28 was similar in both groups (conservative: 0 days [interquartile range (IQR) 0–13.7] versus liberal: 0 days [IQR 0–13.3], median treatment effect: 0 days [95% confidence interval (CI) – 3.1 to 3.1]). Mortality at day 28 (59/149 [39.6%] vs 59/151 [39.1%]) and at day 60 (64/149 [43%] vs 62/151 [41.1%] were similar in conservative and liberal groups, as were all other secondary outcomes and adverse events. The conservative group experienced 44 (29.5%) major protocol deviations compared to 2 (1.3%) in the liberal oxygen group (P < 0.001).ConclusionsIn adults receiving VA-ECMO in ICU, a conservative compared to a liberal oxygen strategy, did not affect the number of ICU-free days to day 28.

In this clinical trial of dispatcher-assisted bystander cardiopulmonary resuscitation (CPR), results were similar with chest compressions alone and with chest compressions plus rescue breathing. However, patients with a cardiac cause of the arrest and those with shockable rhythms fared better with chest-compression-only CPR. These results are likely to influence clinical practice guidelines. Out-of-hospital cardiac arrest claims hundreds of thousands of lives each year worldwide. 1 , 2 Successful resuscitation is challenging but achievable, requiring an interdependent set of actions that consist of early arrest recognition, early cardiopulmonary resuscitation (CPR), early defibrillation, expert advanced life support, and timely postresuscitation care. 3 Early initiation of CPR by a layperson can increase the patient's chances of surviving and having a favorable long-term neurologic recovery. 4 , 5 CPR performed by a layperson has traditionally consisted of chest compressions interspersed with rescue breathing, which allows some measure of both circulation and oxygenation. 6 Interest in CPR that focuses on chest compressions and . . .

In a randomized clinical trial involving patients with out-of-hospital cardiac arrest, 30-day survival rates were similar when compression-only CPR was used and when standard CPR (compression and ventilation) was used. The results provide further support for a compression-only strategy. Emergency medical dispatch centers are crucial in supporting and giving instructions to witnesses or bystanders who call for help for patients with cardiac arrest before the arrival of emergency medical services (EMS) personnel. 1 Telephone instructions given for cardiopulmonary resuscitation (CPR) seem to be given predominantly for CPR involving chest compression. 2 Using an animal model, Berg and colleagues 3 found that compression-only CPR and standard CPR (i.e., CPR involving both compression and ventilation) have similar efficacy. In a clinical study in which dispatchers gave randomly assigned instructions to callers for aid to patients with cardiac arrest — to attempt resuscitation with the . . .

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, . . .

Implantable cardioverter-defibrillators (ICDs) are widely used to prevent fatal outcomes associated with life-threatening arrhythmic episodes in a variety of cardiac diseases. These ICDs rely on transvenous leads for cardiac sensing and defibrillation. A new entirely subcutaneous ICD overcomes problems associated with transvenous leads. However, the role of the subcutaneous ICD as an adjunctive or primary therapy in patients at risk for sudden cardiac death is unclear. The PRAETORIAN trial is an investigator-initiated, randomized, controlled, multicenter, prospective 2-arm trial that outlines the advantages and disadvantages of the subcutaneous ICD. Patients with a class I or IIa indication for ICD therapy without an indication for bradypacing or tachypacing are included. A total of 700 patients are randomized to either the subcutaneous or transvenous ICD (1:1). The study is powered to claim noninferiority of the subcutaneous ICD with respect to the composite primary endpoint of inappropriate shocks and ICD-related complications. After noninferiority is established, statistical analysis is done for potential superiority. Secondary endpoint comparisons of shock efficacy and patient mortality are also made. The PRAETORIAN trial is a randomized trial that aims to gain scientific evidence for the use of the subcutaneous ICD compared with the transvenous ICD in a population of patients with conventional ICD with respect to major ICD-related adverse events. This trial is registered at ClinicalTrials.gov with trial ID NCT01296022.

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 The purpose of this study was to determine whether the provision of corticosteroids improves time to shock reversal and outcomes in patients with post-cardiac arrest shock. Methods We conducted a randomized, double-blind trial of post-cardiac arrest patients in shock, defined as vasopressor support for a minimum of 1 hour. Patients were randomized to intravenous hydrocortisone 100 mg or placebo every 8 hours for 7 days or until shock reversal. The primary endpoint was time to shock reversal. Results Fifty patients were included with 25 in each group. There was no difference in time to shock reversal between groups (hazard ratio: 0.83 [95 % CI: 0.40–1.75], p  = 0.63). We found no difference in secondary outcomes including shock reversal (52 % vs. 60 %, p  = 0.57), good neurological outcome (24 % vs. 32 %, p  = 0.53) or survival to discharge (28 % vs. 36 %, p  = 0.54) between the hydrocortisone and placebo groups. Of the patients with a baseline cortisol < 15 ug/dL, 100 % (6/6) in the hydrocortisone group achieved shock reversal compared to 33 % (1/3) in the placebo group ( p  = 0.08). All patients in the placebo group died (100 %; 3/3) whereas 50 % (3/6) died in the hydrocortisone group ( p  = 0.43). Conclusions In a population of cardiac arrest patients with vasopressor-dependent shock, treatment with hydrocortisone did not improve time to shock reversal, rate of shock reversal, or clinical outcomes when compared to placebo. Clinical trial registration Clinicaltrials.gov: NCT00676585 , registration date: May 9, 2008.