Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a nationwide multicentre study

Background Extracorporeal cardiopulmonary resuscitation (ECPR) has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). Despite growing interest in and a growing body of literature on ECPR for refractory OHCA, robust evidence on patient eligibility is still lacking. Purpose To describe the survival, neurological outcome, and adherence to the national consensus with respect to use of ECPR for OHCA, and to identify factors associated with outcome. Methods Retrospective, observational cohort study of patients who underwent ECPR for OHCA at four cardiac arrest centres. Binary logistic regression and Kaplan-Meier survival curves were performed to assess association with 30-day mortality. Results A total of 259 patients receiving ECPR for OHCA between July 2011 and December 2020 were included in the study. Thirty-day survival was 26% and a good neurological outcome Cerebral Performance Category (CPC) 1–2 was observed in 94% of patients at discharge. Strict adherence to the national consensus showed a 30-day survival rate of 30%. Adding one or more of the following criteria to the national consensus: signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow <100 minutes, pH >6.8 and lactate <15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified initial presenting rhythm with asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (PEA) (RR 1.20, 95% CI 1.03–1.41), initial pH <6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels >15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had threefold higher survival rate than patients without signs of life (45% versus 13%, p<0.001) Conclusion A high survival rate with a good neurological outcome was observed in this population of patients treated with ECPR for OHCA. Signs of life during CPR may aid the decision-making in the selection of appropriate candidates. Stringent patient selection for ECPR may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors, why optimization of the selection criteria is still necessary. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This work was supported by the Danish Heart Foundation [20-R142-A9498-22178]; and Health Research Foundation of Central Denmark Region [R64-A3178-B1349] Survival and adherence to consensus Signs of life during CPR

Norecopa: A database of global 3R resources for better Science

Norecopa is Norway's National Consensus Platform for the 3Rs (Replacement, Reduction and Refinement of animal experiments). Founded in 2007, it has a comprehensive website of global 3R resources: https://norecopa.no

Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study

Background Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. Results A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.

Leftists possess more national consensus in Europe in one of two datasets

A regularity in US American politics is that liberals have more policy consensus than do conservatives, and both ideological groups have more consensus than moderates (Ondish &amp; Stern, 2018). The idea is that conservatives’ local conformity paradoxically results in less consensus than liberals at the national level. If this is the case, then the liberal consensus effect should also be observed in other countries. We test this using data from Europe. In the European Social Survey (Country N = 38, N = 376,129) we find that on average leftists have more consensus than do rightists; however, we do not find this using the Eurobarometer (Country N = 18, N = 375,830). In both data sources we also observe variation in ideological differences between countries. These results suggest that there is a liberal/leftist consensus effect that can be found in Europe and the United States, but there are also exceptions.

Korelasi Baldah Thayyibah Dengan Rumusan Maksud Dan Tujuan Muhammadiyah

This research is intended to understand the relationship between the term baldah thayyibah and the Islamic community which is the ultimate goal of the Muhammadiyah movement. Its main focus includes Muhammadiyah's views on Baldah Thayyibah, the depth of the meaning of the Islamic community, and understanding the country that Muhammadiyah means by Baldah Thayyibah.The research method used is descriptive correlational method, namely raising the problems, bringnig up research questions, collecting relevant data, analyzing data and answering research questions. The analysis was carried out in a correlational manner to answer the relationship between the term baldah thayyibah and the Islamic community. Muhammadiyah views that the Indonesian state is a final national consensus and binds all components of the nation. Therefore, Muhammadiyah focuses on building an Islamic community. Baldah Thayyibah referred to by Muhammadiyah is Indonesia.