Publications by authors named "Claudio Sandroni"
Background: Accurate prognostication following cardiac arrest (CA) is crucial for informing clinical decisions. Current guidelines do not recommend a specific time point for recording somatosensory evoked potentials (SSEPs) after CA. We evaluated the ability of ultra-early short- and middle-latency SSEPs to predict good an poor neurological outcome and compared its accuracy with that of other predictors recorded early after CA.
View Article and Find Full Text PDFPurpose: To assess the risk of self-fulfilling prophecy from withdrawal of life-sustaining therapy (WLST) in comatose cardiac arrest patients undergoing neuroprognostication.
Methods: Post-hoc multicentre study matching adults resuscitated from out-of-hospital cardiac arrests, in WLST-permitting cohorts (TTM and TTM2), and non-WLST-permitting cohorts (KORHN and ProNeCA). We matched patients in a 1:1 ratio based on a propensity score, assessing the risk of WLST due to a presumed poor neurological prognosis and criteria predictive of poor neurological outcome, as outlined in the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) guidelines.
Purpose: To explore modifications of the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) guideline algorithm for neuroprognostication after cardiac arrest to improve its prognostic accuracy.
Methods: Post-hoc analysis of four prospective multicentre studies (TTM, TTM2, KORHN and ProNeCA). We raised the Glasgow Coma Scale motor (GCS-M) inclusion threshold at 72 h after cardiac arrest from the current GCS-M < 4 to GCS-M < 6 (all unconscious patients).
Introduction: Patients who die after cardiopulmonary resuscitation (CPR) are an important source of solid organs, but ischaemia-reperfusion injury may lead to worse recipient outcomes. This systematic review and meta-analysis assessed if solid organs transplanted from donors who underwent CPR had worse outcomes compared to organs from donors who did not receive CPR.
Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched until January 1, 2025.
Importance: Understanding the relationship between patients' clinical characteristics and outcomes is fundamental to medicine. When critically ill patients die after withdrawal of life-sustaining therapy (WLST), the inability to observe the potential for recovery with continued aggressive care could bias future clinical decisions and research.
Objective: To quantify the frequency with which experts consider patients who died after WLST following resuscitated cardiac arrest to have had recovery potential if life-sustaining therapy had been continued.
Cardiac arrest (CA) is associated with high incidence and mortality rates. Among patients who survive the acute phase, brain injury stands out as a primary cause of death or disability. Effective intensive care management, including targeted temperature management, seizure treatment and maintenance of normal physiological parameters, plays a crucial role in improving survival and neurological outcomes.
View Article and Find Full Text PDFArticle Synopsis
- The eighth annual summary from the International Liaison Committee on Resuscitation (ILCOR) focuses on the latest findings in cardiopulmonary resuscitation (CPR) and emergency cardiovascular care, building on a comprehensive review from 2020.
- This summary is based on the evaluation of recent resuscitation evidence by experts from six different ILCOR task forces, who utilized specific criteria to assess the quality of evidence and reached consensus treatment recommendations.
- The document also identifies key areas where more research is needed, sharing insights into the task forces’ discussions through sections like Justification and Evidence-to-Decision Framework Highlights.
This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations.
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- Colistin, specifically colistimethate (CMS), is still used in critically ill patients, particularly those on continuous renal replacement therapy (CRRT) for infections caused by carbapenem-resistant bacteria, despite limited real-life data on its effectiveness and safety.
- A study involving 20 critically ill patients receiving a specific dosage of CMS showed high colistin levels in their blood but raised concerns about exceeding safety limits, as many patients experienced poor outcomes including a high mortality rate.
- The findings suggest that while the recommended dosing achieves effective concentrations against bacteria, it poses risks of toxicity, and close monitoring is necessary to balance efficacy and safety.
Article Synopsis
- The study aimed to evaluate the effectiveness of the 2021 ERC/ESICM algorithm in predicting neurological outcomes for cardiac arrest survivors in intensive care.
- A total of 337 patients were examined, with the algorithm successfully identifying all 175 patients predicted to have poor neurological outcomes and showing high specificity for various predictive tools like EEG and clinical examination.
- For patients with uncertain outcomes, favorable indicators could help predict positive recovery, providing valuable guidance in prognosis and treatment decisions.
Objectives: To investigate the following: (a) effects of intercostal muscle contraction on sonographic assessment of lung sliding and (b) inter-rater and intra-observer agreement on sonographic detection of lung sliding and lung pulse.
Methods: We used Valsalva and Muller maneuvers as experimental models in which closed glottis and clipped nose prevent air from entering the lungs, despite sustained intercostal muscles contraction. Twenty-one healthy volunteers underwent bilateral lung ultrasound during tidal breathing, apnea, hyperventilation, and Muller and Valsalva maneuvers.
Aim: To assess the ability of clinical examination, biomarkers, electrophysiology and brain imaging, individually or in combination to predict good neurological outcomes at 6 months after CA.
Methods: This was a retrospective analysis of the Korean Hypothermia Network Prospective Registry 1.0, which included adult out-of-hospital cardiac arrest (OHCA) patients (≥18 years).
Mastering the brain in critical conditions: an update.
Intensive Care Med Exp
January 2024
Article Synopsis
- Acute brain injuries, like traumatic brain injuries and strokes, are major causes of death and long-term disabilities around the world.
- These injuries have different starting causes but share similar problems afterward that affect healing and recovery.
- A recent course taught doctors new ways to help brain injury patients by using special monitoring and treatments to improve blood flow to the brain and understand recovery possibilities better.
Article Synopsis
- The study evaluated the effectiveness of highly malignant EEG patterns (HMEP) in predicting poor neurological outcomes after cardiac arrest, following 2021 guidelines from the ERC and ESICM.
- In a multicenter trial involving 845 patients, HMEP showed 50% sensitivity and 93% specificity for poor outcomes, with an increase in specificity to 97% when combined with an unresponsive EEG.
- The findings indicate that while the specificity of these EEG patterns is high, it's less than previously reported, suggesting a need for cautious application in clinical settings due to potential biases affecting results.
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training.
View Article and Find Full Text PDFThe International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training.
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