RESUMO
Stroke is the second most common cause of global death following coronary artery disease. Time is crucial in managing stroke to reduce the rapidly progressing insult of the ischemic penumbra and the serious neurologic deficits that might follow it. Strokes are mainly either hemorrhagic or ischemic, with ischemic being the most common of all types of strokes. Thrombolytic therapy with recombinant tissue plasminogen activator and endovascular thrombectomy are the main types of management of acute ischemic stroke (AIS). In addition, there is a vital need for neuroprotection in the setting of AIS. Neuroprotective agents are important to investigate as they may reduce mortality, lessen disability, and improve quality of life after AIS. In our review, we will discuss the main types of management and the different modalities of neuroprotection, their mechanisms of action, and evidence of their effectiveness after ischemic stroke.
RESUMO
Background and Aim: Cardiopulmonary resuscitation (CPR) in full-coded patients requires effective chest compressions with minimal interruptions to maintain adequate perfusion to the brain and other vital organs. Many novel approaches have been proposed to attain better organ perfusion compared to traditional CPR techniques. The purpose of this review is to investigate the safety and efficacy of heads-up CPR versus supine CPR. Methods: We searched PubMed Central, SCOPUS, Web of Science, and Cochrane databases from 1990 to February 2021. After the full-text screening of 40 eligible studies, only seven studies were eligible for our meta-analysis. We used the RevMan software (5.4) to perform the meta-analysis. Results: In survival outcome, the pooled analysis between heads-up and supine CPR was (risk ratio = 0.98, 95% confidence interval [CI] = 0.17-5.68, p = 0.98). The pooled analyses between heads-up CPR and supine CPR in cerebral flow, cerebral perfusion pressure and coronary perfusion pressure outcomes, were (mean difference [MD] = 0.10, 95% CI = 0.03-0.17, p = 0.003), (MD = 12.28, 95% CI = 5.92-18.64], p = 0.0002), and (MD = 8.43, 95% CI = 2.71-14.14, p = 0.004), respectively. After doing a subgroup analysis, cerebral perfusion was found to increase during heads-up CPR compared with supine CPR at 6 min CPR duration and 18 to 20 min CPR duration as well. Conclusion: Our study suggests that heads-up CPR is associated with better cerebral and coronary perfusion compared to the conventional supine technique in pigs' models. However, more research is warranted to investigate the safety and efficacy of the heads-up technique on human beings and to determine the best angle for optimization of the technique results.
RESUMO
Background and Aims: Some studies have suggested that earlier initiation of antibiotics has shown positive outcomes in sepsis patients. We aimed to do a systematic review and meta-analysis to evaluate the effect of prehospital administration of antibiotics on 28 days mortality and length of stay in hospital and intensive care unit for sepsis patients. Methods: We formulated a search strategy and used it on search databases PubMed, Scopus, Web of Science, and Embase. We then screened the records for eligibility and included controlled studies, either clinical trials or cohort studies reporting prehospital antibiotic administration for sepsis patients. We excluded duplicates, books, conferences' abstracts, case reports, editorials, letters, author responses, not English studies, and studies with nonavailable full text. Animal and lab studies were also excluded. Results: The total number of studies identified is 1811, 19 were eligible for systematic review and 4 for meta-analysis (three cohort and one clinical trial). The total number of sepsis patients in the four included studies in the 28 days mortality outcome was 3523 (1779 took prehospital antibiotics and 1744 did not take prehospital antibiotics). Of 1779 who took the antibiotics, 190 died, and of 1744 who did not take antibiotics, 292 died (95% confidence interval 0.68-0.97, p = 0.02). Conclusion: This meta-analysis reveals that receiving prehospital antibiotics can significantly lower mortality in sepsis patients compared to patients who do not receive prehospital antibiotics. However, more clinical trials and multicenter prospective studies with high sample sizes are needed to get strong evidence supporting our findings.
