Any further evolution and development of the course should be based upon contemporary educational theory to ensure that it remains fit for purpose.
  Although hypoxic patients attending low-resource hospitals have a high mortality, many are not given supplemental oxygen. If oximetry is not available, then the decision to provide oxygen must be based on other factors.
 
  The variables associated with the decision to provide supplemental oxygen made by an emergency department staff, without access to oximetry, in a low resource Ugandan hospital were determined from data collected within 16h of admission to the hospital's medical and surgical wards.
 
  Of 2,599 patients, 731 (28.1%) had an oxygen saturation <95%, and 164 (6.3%) an oxygen saturation <90%. Of the 731 patients with oxygen levels below 95% 573 (83%) were not given oxygen; oxygen was only given to 63 (38%) of the 164 patients with oxygen saturation <90%. On average, a patient given oxygen was more likely to die than one not given oxygen, regardless of their oxygen saturation (odds ratio 13.4, 95%CI 9.1-19.6). After multivariate analysis weakness, dyspnoea, low oxygen saturation, high heart rate, high respiratory rate, low temperature, alertness, gait, and a medical illness were all significantly associated with the use of supplemental oxygen and in-hospital mortality. Logistic regression modelling of these variables had comparable discrimination for both oxygen use (c statistic 0.88 SE 0.02) and in-hospital mortality (c statistic 0.84 SE 0.02).
 
  The intuitive decision to provide oxygen was strongly associated with in-hospital mortality, suggesting that oxygen was given to those considered the sickest patients. In the future, oximetry may guide oxygen therapy more efficiently.
 The intuitive decision to provide oxygen was strongly associated with in-hospital mortality, suggesting that oxygen was given to those considered the sickest patients. In the future, oximetry may guide oxygen therapy more efficiently.
  Evaluate cerebral autoregulation (CAR) by intracranial pressure reactivity index (PRx) and cerebral blood flow reactivity index (CBFx) during the first four hours following return of spontaneous circulation (ROSC) in a porcine model of pediatric cardiac arrest. Determine whether impaired CAR is associated with neurologic outcome.
 
  Four-week-old swine underwent seven minutes of asphyxia followed by ventricular fibrillation induction and hemodynamic-directed CPR. Those achieving ROSC had arterial blood pressure, intracranial pressure (ICP), and microvascular cerebral blood flow (CBF) monitored for 4h. Animals were assigned an 8-h post-ROSC swine cerebral performance category score (1=normal; 2-4=abnormal neurologic function). In this secondary analytic study, we calculated PRx and CBFx using a continuous, moving correlation coefficient between mean arterial pressure (MAP) and ICP, and between MAP and CBF, respectively. Burden of impaired CAR was the area under the PRx or CBFx curve using a threshold of 0.3 and normalized as percentage of monitoring duration.
 
  Among 23 animals, median PRx was 0.14 [0.06,0.25] and CBFx was 0.36 [0.05,0.44]. Median burden of impaired CAR was 21% [18,27] with PRx and 30% [17,40] with CBFx. Neurologically abnormal animals (n=10) did not differ from normal animals (n=13) in post-ROSC MAP (63 vs. 61mmHg, p=0.74), ICP (15 vs. 14mmHg, p=0.78) or CBF (274 vs. 397 Perfusion Units, p=0.12). CBFx burden was greater among abnormal than normal animals (45% vs. 24%, p=0.001), but PRx burden was not (25% vs. 20%, p=0.38).
 
  CAR is impaired early after ROSC. A greater burden of CAR impairment measured by CBFx was associated with abnormal neurologic outcome.CHOP Institutional Animal Care and Use Committee protocol 19-001327.
 CAR is impaired early after ROSC. A greater burden of CAR impairment measured by CBFx was associated with abnormal neurologic outcome.CHOP Institutional Animal Care and Use Committee protocol 19-001327.
  Compare vasopressin to a second dose of epinephrine as rescue therapy after ineffective initial doses of epinephrine in diverse models of pediatric in-hospital cardiac arrest.
 
  67 one- to three-month old female swine (10-30kg) in six experimental cohorts from one laboratory received hemodynamic-directed CPR, a resuscitation method where high quality chest compressions are provided and vasopressor administration is titrated to coronary perfusion pressure (CoPP) ≥20mmHg. Vasopressors are given when CoPP is <20mmHg, in sequences of two doses of 0.02mg/kg epinephrine separated by minimum one-minute, then a rescue dose of 0.4 U/kg vasopressin followed by minimum two-minutes.  https://www.selleckchem.com/products/icfsp1.html  Invasive measurements were used to evaluate and compare the hemodynamic and neurologic effects of each vasopressor dose.
 
  Increases in CoPP and cerebral blood flow (CBF) were greater with vasopressin rescue than epinephrine rescue (CoPP +8.16 [4.35, 12.06] mmHg vs.+5.43 [1.56, 9.82] mmHg, p=0.02; CBF +14.58 [-0.05, 38.12] vs.+0.00 [-0.77, 18.24] perfusion units (PFU), p=0.005). Twenty animals (30%) failed to achieve CoPP ≥20mmHg after two doses of epinephrine; 9/20 (45%) non-responders achieved CoPP ≥20mmHg after vasopressin. Among all animals, the increase in CBF was greater with vasopressin (+14.58 [-0.58, 38.12] vs. 0.00 [-0.77, 18.24] PFU, p=0.005).
 
  CoPP and CBF rose significantly more after rescue vasopressin than after rescue epinephrine. Importantly, CBF increased after vasopressin rescue, but not after epinephrine rescue. In the 30% that failed to meet CoPP of 20mmHg after two doses of epinephrine, 45% achieved target CoPP with a single rescue vasopressin dose.
 CoPP and CBF rose significantly more after rescue vasopressin than after rescue epinephrine. Importantly, CBF increased after vasopressin rescue, but not after epinephrine rescue. In the 30% that failed to meet CoPP of 20 mmHg after two doses of epinephrine, 45% achieved target CoPP with a single rescue vasopressin dose.
  The present study aimed to describe the prevalence, prognosis and annual trends of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) patients, using a nationwide inpatient database in Japan.
 
  This was a nationwide retrospective cohort study, using the Japanese Diagnosis Procedure Combination inpatient database. We included OHCA patients registered in the database from July 2010 to March 2017 and analyzed the annual prevalence of OHCA patients who received ECPR. The outcomes included survival to hospital discharge and survival with favorable neurologic outcome at hospital discharge. The annual trends on the outcomes were also analyzed.
 
  We identified 217,907 eligible patients. OHCA patients were divided into patients with ECPR (n=5,612) and conventional CPR (n=212,295). The prevalence of ECPR performed in OHCA patients was 2.6%. ECPR prevalence significantly increased from 2.1% in 2010 to 3.0% in 2016 (
  <0.001). Overall survival to hospital discharge was 16.4% and 2.