ERC-ESICM guidelines on temperature control after cardiac arrest in adults

The aim of these guidelines is to provide evidence‑based guidance for temperature control in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless of the underlying cardiac rhythm. These guidelines replace the recommendations on temperature management after cardiac arrest included in the 2021 post-resuscitation care guidelines co-issued by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM). The guideline panel included thirteen international clinical experts who authored the 2021 ERC-ESICM guidelines and two methodologists who participated in the evidence review completed on behalf of the International Liaison Committee on Resuscitation (ILCOR) of whom ERC is a member society. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations. The panel provided suggestions on guideline implementation and identified priorities for future research. The certainty of evidence ranged from moderate to low. In patients who remain comatose after cardiac arrest, we recommend continuous monitoring of core temperature and actively preventing fever (defined as a temperature > 37.7 °C) for at least 72 h. There was insufficient evidence to recommend for or against temperature control at 32–36 °C or early cooling after cardiac arrest. We recommend not actively rewarming comatose patients with mild hypothermia after return of spontaneous circulation (ROSC) to achieve normothermia. We recommend not using prehospital cooling with rapid infusion of large volumes of cold intravenous fluids immediately after ROSC

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Middeleeuwse bewoningssporen uit de 11e tot en met 13e eeuw in de periferie van Brugge. Archeologische opgraving te Sint-Pieters, Oostendste Steenweg (Brugpap)

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Stützpunkt Flugplatz (Atlantikwall) aan de Zwinmonding, en doorsnede van de Internationale Dijk. Archeologische opgraving te Knokke-Heist \u27Het Zwin\u27

Dit rapport werd ingediend bij het agentschap samen met een aantal afzonderlijke digitale bijlagen. Een aantal van deze bijlagen zijn niet inbegrepen in dit pdf document en zijn niet online beschikbaar. Sommige bijlagen (grondplannen, fotos, spoorbeschrijvingen, enz.) kunnen van belang zijn voor een betere lezing en interpretatie van dit rapport. Indien u deze bijlagen wenst te raadplegen kan u daarvoor contact opnemen met: [email protected]

Sudden Electrocardiogram Rhythm Changes after Return of Spontaneous Circulation in Porcine Models of Out-of-Hospital Cardiac Arrest: A Phenomenological Report.

OBJECTIVE: We sought to identify, quantify, and characterize post-ROSC SERC in successfully resuscitated swine. METHODS: We reviewed all LabChart data from resuscitated approximately 4- to 6-month-old swine used for various experimental protocols from 2006 to 2019. We identified those that achieved sustained ROSC and analyzed their entire post-ROSC periods for evidence of SERC in the ECG, and arterial and venous pressure tracings. Presence or absence of SERC was confirmed independently by two reviewers (ACK, DDS). We measured the interval from ROSC to first SERC, analyzed the following metrics, and calculated the change from 60 sec pre-SERC (or from ROSC if less than 60 sec) to 60 sec post-SERC: heart rate, central arterial pressure (CAP), and central venous pressure (CVP). RESULTS: A total of 52 pigs achieved and sustained ROSC. Of these, we confirmed at least one SERC in 25 (48.1%). Two pigs (8%) each had two unique SERC events. Median interval from ROSC to first SERC was 3.8 min (inter-quartile range 1.0-6.9 min; range 16 sec to 67.5 min). We observed two distinct types of SERC: type 1) the post-SERC heart rate and arterial pressure increased (72% of cases); and type 2) the post-SERC heart rate and arterial pressure decreased (28% of cases). For type 1 cases, the mean (standard deviation [SD]) heart rate increased by 33.6 (45.7) beats per minute (bpm). The mean (SD) CAP increased by 20.6 (19.2) mmHg. For type 2 cases, the mean (SD) heart rate decreased by 39.7 (62.3) bpm. The mean (SD) CAP decreased by 21.9 (15.6) mmHg. CONCLUSIONS: SERC occurred in nearly half of all cases with sustained ROSC and can occur multiple times per case. First SERC most often occurred within the first 4 minutes following ROSC. Heart rate, CAP, and CVP changed at the moment of SERC. We are proceeding to examine whether this phenomenon occurs in humans post-cardiac arrest and ROSC