Early mechanical cardiopulmonary resuscitation can improve outcomes in patients with non-traumatic cardiac arrest in the emergency department.

OBJECTIVE: To compare the outcomes of patients with non-traumatic cardiac arrest (CA) who received early versus late mechanical cardiopulmonary resuscitation (CPR) with the Lund University Cardiac Assist System (LUCAS) device in the emergency department (ED). METHODS: This was a retrospective observational study in the ED of a single medical center performed from May 2018 to December 2019; 68 patients with CA were eligible. We grouped the patients according to the time to initiating LUCAS use after CA into an early group (≤4 minutes) and late group (>4 minutes). RESULTS: The rate of return of spontaneous circulation (ROSC) was higher in the early group vs the late group (69.2% vs 52.4%, respectively). The 4-hour survival rate was significantly higher in the early group vs the late group (83.3% vs 45.5%, respectively), and CPR duration was significantly shorter in the early group (23.3 ± 12.5 vs 31.1 ± 14.8 minutes, respectively). CONCLUSION: Early mechanical CPR can improve the success of achieving ROSC and the 4-hour survival rate in patients with non-traumatic CA in the ED, considering that more benefits were observed in patients who received early vs late LUCAS device therapy.

Prolonged treatment with macrolides in adult patients with non-cystic fibrosis bronchiectasis: meta-analysis of randomized controlled trials.

BACKGROUND: Infection, resulting in chronic airway inflammation, forms the basis of bronchiectasis pathogenesis. Macrolides possess antibacterial, anti-inflammatory and immunomodulatory properties, and are used to treat patients with non-cystic fibrosis bronchiectasis (NCFB). However, the efficacy and safety of long-term treatment with macrolides in patients with bronchiectasis have been controversial. We performed a meta-analysis to assess the efficacy and safety of macrolides in adults with NCFB. METHODS: We performed electronic search of several databases, including: Pubmed, EMBASE, EBSCO, SCI, and CENTRAL, and also searched references from identified articles for further consideration. Only randomized controlled trials (RCTs) comparing prolonged macrolide treatment with placebo for adult bronchiectasis were included. Data were extracted independently by two reviewers and combined using a fixed-effects model or random-effects with effect size expressed as OR or MD or SMD and 95% CIs for different situations. RESULTS: 834 studies were identified. Four RCTs met the inclusion criteria. Macrolide treatment significantly reduced pulmonary exacerbation (OR = 0.39, 95% CI 0.25-0.63) and improved lung function (SMD = 0.37, 95% CI 0.16-0.58) as compared to the placebo group. However, macrolide treatment did not significantly improve quality of life (MD = -1.90, 95% CI -7.01 to 3.20). With respect to the total numbers of participants who developed adverse events, there was no significant difference between the macrolides and placebo groups (OR = 0.83, 95% CI 0.50-1.39). Macrolides therapy could have increased the rate of macrolide resistance in adults with NCFB. CONCLUSIONS: Macrolide maintenance therapy was effective in reducing pulmonary exacerbations, and improving lung function in adults with NCFB. However, it did not improve quality of life, and could have led to macrolide resistance.