Early Neurological ASsessment with pupillometrY during Cardiac Arrest REsuscitation (EASY-CARE): protocol for an observational multicentre prospective study

INTRODUCTION: Out-of-hospital cardiac arrest is burdened with a high rate of ineffective resuscitation and poor neurological outcome among survivors. To date, there are few perfusion assessment tools during cardiopulmonary resuscitation and none of them provide reliable data. Despite the lack of information, physicians must decide whether to extend or terminate resuscitation efforts. METHOD AND ANALYSIS: This is a multicentre prospective, observational cohort study, involving adult patients, victims of unexpected out-of-hospital cardiac arrest. Early Neurological ASsessment with pupillometrY during Cardiac Arrest Resuscitation aims to primarily describe the reliability of quantitative pupillometry through use of the Neurological Pupillary Index (NPi) during the manoeuvre of cardiopulmonary resuscitation, as a predictor of the return of spontaneous circulation. The second objective is to seek and describe the association between the NPi and neurological outcome in the surviving cohort. Patients will be excluded if they are less than 18 years of age, have sustained traumatic brain injury, cerebrovascular emergencies, direct injury to the eyes or have pupil anomalies. Neurological outcome will be collected at intensive care unit discharge, at 30 days, 6 months and at 1 year. The Glasgow Coma Scale (GCS) will be used in the emergency department; modified Rankin Score will be adopted for neurological assessment; biomarkers and neurophysiology exams will be collected as well. ETHICS AND DISSEMINATION: The study has been approved by Ethics Committee of Milano. Local committee acceptance is required for each of the centres involved in the clinical and follow-up data collection. Data will be disseminated to the scientific community through original articles submitted to peer-reviewed journals and abstracts to conferences. TRIAL REGISTRATION NUMBER: NCT05192772

ERC-ESICM guidelines for prognostication after cardiac arrest: time for an update

About two-thirds of patients who are comatose after resuscitation from cardiac arrest die before hospital discharge, of whom two-thirds die from neurological injury. In these patients, prognostication is crucial in informing clinicians and patient’s relatives. Recently, three studies from different groups of investigators have retrospectively assessed the accuracy of the 2015 ERC-ESICM prognostication algorithm. All these studies consistently confirmed the accuracy of the ERC-ESICM multimodal prognostication strategy in avoiding a falsely pessimistic prediction. Interestingly, this high specificity was confirmed when the 2014 criteria for malignant EEG were replaced with a more recent classification of EEG pattern. Besides improving sensitivity of prediction, this classification also enables a good interrater reliability, favouring guidelines’ implementation

Evaluation of mussel shells powder as reinforcement for pla-based biocomposites

The use of biopolyesters, as polymeric matrices, and natural fillers derived from wastes or by-products of food production to achieve biocomposites is nowadays a reality. The present paper aims to valorize mussel shells, 95% made of calcium carbonate (CaCO3 ), converting them into high-value added products. The objective of this work was to verify if CaCO3, obtained from Mediterranean Sea mussel shells, can be used as filler for a compostable matrix made of Polylactic acid (PLA) and Poly(butylene adipate-co-terephthalate) (PBAT). Thermal, mechanical, morphological and physical properties of these biocomposites were evaluated, and the micromechanical mechanism controlling stiffness and strength was investigated by analytical predictive models. The performances of these biocomposites were comparable with those of biocomposites produced with standard calcium carbonate. Thus, the present study has proved that the utilization of a waste, such as mussel shell, can become a resource for biocomposites production, and can be an effective option for further industrial scale-up

Increasing survival after admission to UK critical care units following cardiopulmonary resuscitation

© 2016 The Author(s). Background: In recent years there have been many developments in post-resuscitation care. We have investigated trends in patient characteristics and outcome following admission to UK critical care units following cardiopulmonary resuscitation (CPR) for the period 2004-2014. Our hypothesis is that there has been a reduction in risk-adjusted mortality during this period. Methods: We undertook a prospectively defined, retrospective analysis of the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Database (CMPD) for the period 1 January 2004 to 31 December 2014. Admissions, mechanically ventilated in the first 24 hours in the critical care unit and admitted following CPR, defined as the delivery of chest compressions in the 24 hours before admission, were identified. Case mix, withdrawal, outcome and activity were described annually for all admissions identified as post-cardiac arrest admissions, and separately for out-of-hospital cardiac arrest and in-hospital cardiac arrest. To assess whether in-hospital mortality had improved over time, hierarchical multivariate logistic regression models were constructed, with in-hospital mortality as the dependent variable, year of admission as the main exposure variable and intensive care unit (ICU) as a random effect. All analyses were repeated using only the data from those ICUs contributing data throughout the study period. Results: During the period 2004-2014 survivors of cardiac arrest accounted for an increasing proportion of mechanically ventilated admissions to ICUs in the ICNARC CMPD (9.0 % in 2004 increasing to 12.2 % in 2014). Risk-adjusted hospital mortality following admission to ICU after cardiac arrest has decreased significantly during this period (OR 0.96 per year). Over this time, the ICU length of stay and time to treatment withdrawal has increased significantly. Re-analysis including only those 116 ICUs contributing data throughout the study period confirmed all the results of the primary analysis. Conclusions: Risk-adjusted hospital mortality following admission to ICU after cardiac arrest has decreased significantly during the period 2004-2014. Over the same period the ICU length of stay and time to treatment withdrawal has increased significantly

Microtiming patterns and interactions with musical properties in Samba music

In this study, we focus on the interaction between microtiming patterns and several musical properties: intensity, meter and spectral characteristics. The data-set of 106 musical audio excerpts is processed by means of an auditory model and then divided into several spectral regions and metric levels. The resulting segments are described in terms of their musical properties, over which patterns of peak positions and their intensities are sought. A clustering algorithm is used to systematize the process of pattern detection. The results confirm previously reported anticipations of the third and fourth semiquavers in a beat. We also argue that these patterns of microtiming deviations interact with different profiles of intensities that change according to the metrical structure and spectral characteristics. In particular, we suggest two new findings: (i) a small delay of microtiming positions at the lower end of the spectrum on the first semiquaver of each beat and (ii) systematic forms of accelerando and ritardando at a microtiming level covering two-beat and four-beat phrases. The results demonstrate the importance of multidimensional interactions with timing aspects of music. However, more research is needed in order to find proper representations for rhythm and microtiming aspects in such contexts

Adult advanced life support: Section 3 of the European Resuscitation Council Guidelines for Resuscitation 2015

Erweiterte lebensrettende Maßnahmen für Erwachsene („advanced life support“, ALS) kommen zum Einsatz, nachdem Basismaßnahmen zur Wiederbelebung („basic life support“, BLS) begonnen und, wenn sinnvoll, ein automatisierter externer Defibrillator (AED) verwendet wurde. Die Basismaßnahmen zur Wiederbelebung eines Erwachsenen und der Einsatz von AEDs wird in Kap. 2 ausgeführt. Basis- und erweiterte Maßnahmen sollen nahtlos ineinander übergehen, da erstere fortgeführt werden und sich mit den erweiterten überschneiden. Dieses Kapitel über die erweiterten Maßnahmen beinhaltet die Vermeidung des Kreislaufstillstands, spezielle Aspekte des außerklinischen ALS, den Start der innerklinischen Reanimation, den ALS-Algorithmus, die manuelle Defibrillation, das Atemwegsmanagement während der Reanimaton, Medikamente und ihre Anwendung während der Reanimation sowie die Behandlung von Periarrest-Arrhythmien. Es gibt zwei Änderungen in der äußeren Form dieser Leitlinien des Europäischen Rats für Wiederbelebung seit den Leitlinien von 2010: [1] Das Kapitel „Elektrotherapie“ [2] ist nicht mehr eigenständig, sondern Teil dieses Kapitels; und die Leitlinien zur Behandlung nach Reanimation sind in ein neues Kapitel ausgegliedert, welches die Bedeutung dieses letzten Glieds der Überlebenskette unterstreicht [3]. Diese Leitlinien basieren auf den International Liaison Committee on Resuscitation (ILCOR) Consensus on Science and Treatment Recommendations (CoSTR) für ALS von 2015 [4]. Die Überprüfung der ILCOR-Empfehlungen von 2015 konzentrierte sich auf 42 Themen, entsprechend der zeitlichen Abfolge der erweiterten Maßnahmen: Defibrillation, Atemwege, Oxygenierung und Ventilation, Kreislaufunterstützung und Überwachung und Einsatz von Medikamenten während der Reanimation. Für diese Leitlinien wurden die ILCOR-Empfehlungen durch ein gezieltes Literatur-Review ergänzt, welches von der ERC-ALS-Leitlinien Autorengruppe zu den Themen die nicht in den ILCOR-CoSTR-Empfehlungen von 2015 überarbeitet wurden erstellt wurde. Die Leitlinien wurden ausgearbeitet, von den ALS-Verfassern geprüft und abschließend von der ERC-Vollversammlung und dem ERC-Vorstand abgesegnet