Out-of-Hospital Cardiac Arrest.

Survival from out-of-hospital cardiac arrest (OHCA) is predicated on a community and system-wide approach that includes rapid recognition of cardiac arrest, capable bystander CPR, effective basic and advanced life support (BLS and ALS) by EMS providers, and coordinated postresuscitation care. Management of these critically ill patients continues to evolve. This article focuses on the management of OHCA by EMS providers.

Out-of-Hospital Cardiac Arrest.

Survival from out-of-hospital cardiac arrest (OHCA) is predicated on a community and system-wide approach that includes rapid recognition of cardiac arrest, capable bystander CPR, effective basic and advanced life support (BLS and ALS) by EMS providers, and coordinated postresuscitation care. Management of these critically ill patients continues to evolve. This article focuses on the management of OHCA by EMS providers.

Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis.

OBJECTIVE: Overall survival from out-of-hospital cardiac arrest (OHCA) is less than 10%. After initial bag-valve mask ventilation, 80% of patients receive an advanced airway, either by endotracheal intubation (ETI) or placement of a supraglottic airway (SGA). The objective of this meta-analysis was to compare patient outcomes for these two advanced airway methods in OHCA patients treated by Emergency Medical Services (EMS). METHODS: A dual-reviewer search was conducted in PubMed, Scopus, and the Cochrane Database to identify all relevant peer-reviewed articles for inclusion in the meta-analysis. Exclusion criteria were traumatic arrests, pediatric patients, physician/nurse intubators, rapid sequence intubation, video devices, and older airway devices. Outcomes were (1) return of spontaneous circulation (ROSC), (2) survival to hospital admission, (3) survival to hospital discharge, and (4) neurologically intact survival to hospital discharge. Results were adjusted for covariates when available and combined using the random effects model. RESULTS: From 3,454 titles, 10 observational studies fulfilled all criteria, representing 34,533 ETI patients and 41,116 SGA patients. Important covariates were similar between groups. Patients who received ETI had statistically significant higher odds of ROSC (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.05-1.55), survival to hospital admission (OR 1.34, CI 1.03-1.75), and neurologically intact survival (OR 1.33, CI 1.09-1.61) compared to SGA. Survival to hospital discharge was not statistically different (OR 1.15, CI 0.97-1.37). CONCLUSIONS: Patients with OHCA who receive ETI by EMS are more likely to obtain ROSC, survive to hospital admission, and survive neurologically intact when compared to SGA.

Water-in-water emulsions stabilized by non-amphiphilic interactions: polymer-dispersed lyotropic liquid crystals.

Emulsion systems involving surfactants are mainly driven by the separation of the hydrophobic interactions of the aliphatic chains from the hydrophilic interactions of amphiphilic molecules in water. In this study, we report an emulsion system that does not include amphiphilic molecules but molecules with functional groups that are completely solvated in water. These functional groups give rise to molecular interactions including hydrogen bonding, pi stacking, and salt bridging and are segregated into a dispersion of droplets forming a water-in-water emulsion. This water-in-water emulsion consists of dispersing droplets of a water-solvated biocompatible liquid crystal--disodium cromoglycate (DSCG)--in a continuous aqueous solution containing specific classes of water-soluble polymers. Whereas aqueous solutions of polyols support the formation of emulsions of spherical droplets consisting of lyotropic liquid crystal DSCG with long-term stability (for at least 30 days), aqueous solutions of polyamides afford droplets of DSCG in the shape of prolate ellipsoids that are stable for only 2 days. The DSCG liquid crystal in spherical droplets assumes a radial configuration in which the optical axis of the liquid crystal aligns perpendicular to the surface of the droplets but assumes a tangential configuration in prolate ellipsoids in which the optical axis of the liquid crystal aligns parallel to the surface of the droplet. Other classes of water-soluble polymers including polyethers, polycations, and polyanions do not afford a stable emulsion of DSCG droplets. Both the occurrence and the stability of this unique emulsion system can be rationalized on the basis of the functional groups of the polymer. The different configurations of the liquid crystal (DSCG) droplets were also found to correlate with the strength of the hydrogen bonding that can be formed by the functional groups on the polymer.