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Vaidie J, Peju E, Jandeaux LM, Lesouhaitier M, Lacherade JC, Guillon A, Wittebole X, Asfar P, Evrard B, Daix T, Vignon P, François B. Long-term immunosuppressive treatment is not associated with worse outcome in patients hospitalized in the intensive care unit for septic shock: the PACIFIC study. Crit Care 2023; 27:340. [PMID: 37660107 PMCID: PMC10475175 DOI: 10.1186/s13054-023-04626-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Except in a few retrospective studies mainly including patients under chemotherapy, information regarding the impact of immunosuppressive therapy on the prognosis of patients admitted to the intensive care unit (ICU) for septic shock is scarce. Accordingly, the PACIFIC study aimed to asses if immunosuppressive therapy is associated with an increased mortality in patients admitted to the ICU for septic shock. METHODS This was a retrospective epidemiological multicentre study. Eight high enroller centres in septic shock randomised controlled trials (RCTs) participated in the study. Patients in the "exposed" group were selected from the screen failure logs of seven recent RCTs and excluded because of immunosuppressive treatment. The "non-exposed" patients were those included in the placebo arm of the same RCTs. A multivariate logistic regression model was used to estimate the risk of death. RESULTS Among the 433 patients enrolled, 103 were included in the "exposed" group and 330 in the "non-exposed" group. Reason for immunosuppressive therapy included organ transplantation (n = 45 [44%]) or systemic disease (n = 58 [56%]). ICU mortality rate was 24% in the "exposed" group and 25% in the "non-exposed" group (p = 0.9). Neither in univariate nor in multivariate analysis immunosuppressive therapy was associated with a higher ICU mortality (OR: 0.95; [95% CI 0.56-1.58]: p = 0.86 and 1.13 [95% CI 0.61-2.05]: p = 0.69, respectively) or 3-month mortality (OR: 1.13; [95% CI 0.69-1.82]: p = 0.62 and OR: 1.36 [95% CI 0.78-2.37]: p = 0.28, respectively). CONCLUSIONS In this study, long-term immunosuppressive therapy excluding chemotherapy was not associated with significantly higher or lower ICU and 3-month mortality in patients admitted to the ICU for septic shock.
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Affiliation(s)
- Julien Vaidie
- Réanimation Polyvalente, CHU de Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | - Edwige Peju
- Service de Médecine Intensive et Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Louise-Marie Jandeaux
- Médecine Intensive et Réanimation, Nouvel Hôpital Civil, CHRU de Strasbourg, Strasbourg, France
| | - Mathieu Lesouhaitier
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
| | | | - Antoine Guillon
- Médecine Intensive - Réanimation, CHRU Bretonneau, Tours, France
- Inserm UMR 1100, UFR de Médecine, Tours, France
| | - Xavier Wittebole
- Service de Soins Intensifs, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Pierre Asfar
- Médecine Intensive - Réanimation et médecine hyperbare, CHU Angers, Angers, France
| | - Bruno Evrard
- Réanimation Polyvalente, CHU de Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
- Inserm CIC 1435, CHU Dupuytren, Limoges, France
| | - Thomas Daix
- Réanimation Polyvalente, CHU de Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
- Inserm CIC 1435, CHU Dupuytren, Limoges, France
- Inserm UMR 1092, CHU Dupuytren, Limoges, France
| | - Philippe Vignon
- Réanimation Polyvalente, CHU de Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
- Inserm CIC 1435, CHU Dupuytren, Limoges, France
- Inserm UMR 1092, CHU Dupuytren, Limoges, France
| | - Bruno François
- Réanimation Polyvalente, CHU de Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France.
- Inserm CIC 1435, CHU Dupuytren, Limoges, France.
- Inserm UMR 1092, CHU Dupuytren, Limoges, France.
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Donizeti Silva M, Augusto Barbieri R, Figueiredo Foresti Y, Augusto Cursiol J, Antônio Viana F, Fernando dos Santos E, Pereira Rodrigues K, da Silva Rodrigues G, da Silva Garcia Nascimento J, Barcellos Dalri MC. Association of Training in Basic Life Support with the Evolution of Cardiopulmonary Resuscitation Performed by Firefighters. Emerg Med Int 2023; 2023:8150697. [PMID: 37188319 PMCID: PMC10181904 DOI: 10.1155/2023/8150697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/03/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction This study aimed to compare the results of professional technical and anthropometric anamnesis data with the transmission of external chest compressions performed by military firefighters at different execution times. Objective The objective was to evaluate the performance and perceived effort of the sequence of external chest compressions performed in two minutes, as well as the evolution of the technique over time. Materials and Methods This was a descriptive, correlational study involving adult firefighters who were members of a specific firefighter group, comprising a population of 105 individuals with a voluntary sample of 44 participants. The study used a Bayesian statistical approach to provide probabilistic expressions. Results The participants had an average work experience of 17 years, an average age of 38.6 years, an average weight of 81.48 kilograms, an average height of 176 centimeters, and an average of 2.5 qualifications. The results indicated that the firefighters performed external chest compressions with excellent technique and a moderate level of perceived effort in a two-minute evaluation. The evaluation of the evolution of the technique over time showed that the participants were able to maintain high-quality compressions for an average of 6 minutes, with a maximum of 20 uninterrupted minutes. Conclusion The study underscores the critical role of professional firefighters in performing and maintaining high-quality external chest compressions, which has the potential to reduce morbidity and mortality in cases of cardiorespiratory arrest.
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Affiliation(s)
- Marcelo Donizeti Silva
- School of Nursing of Ribeirao Preto, University of Sao Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirao Preto, São Paulo, Brazil
| | - Ricardo Augusto Barbieri
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirao Preto, São Paulo, Brazil
| | - Yan Figueiredo Foresti
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirao Preto, São Paulo, Brazil
| | - Jônatas Augusto Cursiol
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirao Preto, São Paulo, Brazil
| | | | | | - Karine Pereira Rodrigues
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | - Maria Celia Barcellos Dalri
- School of Nursing of Ribeirao Preto, University of Sao Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirao Preto, São Paulo, Brazil
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Shenfu Injection Protects Brain Injury in Rats with Cardiac Arrest through Nogo/NgR Pathway. Anal Cell Pathol (Amst) 2022; 2022:4588999. [PMID: 36600931 PMCID: PMC9807299 DOI: 10.1155/2022/4588999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/23/2022] [Accepted: 11/19/2022] [Indexed: 12/27/2022] Open
Abstract
The effect of Shenfu injection on brain injury after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) along with the underlying mechanism of axonal regeneration was explored. CA/CPR model in rats was established for subsequent experiments. A total of 160 rats were randomly divided into sham group, model group, conventional western medicine (CWM) group, Shenfu group, and antagonist group (n = 32 per group). After 3 hours, 24 hours, 3 days, and 7 days of drug administration, the modified Neurological Severity Score tests were performed. The ultrastructure of the brain and hippocampus was observed by electron microscopy. Real-time quantitative polymerase chain reaction (PCR), western blotting, and immunohistochemistry were used to detect Nogo receptor (NgR) expression in the hippocampus and cerebral cortex, and Nogo-NgR expression in CA/CPR model. Neurological deficits in the model group were severe at 3 hours, 24 hours, 3 days, and 7 days after the recovery of natural circulation, whereas the neurological deficits in CWM, antagonist, and Shenfu group were relatively mild. The ultrastructure of neuronal cells in Shenfu group had relatively complete cell membranes and more vesicles than those in the model group. The results of PCR and western blotting showed lower messenger ribonucleic acid and protein expression of NgR in Shenfu group than the model group and CWM group. Immunohistochemical examination indicated a reduction of Nogo-NgR expression in Shenfu group and antagonist group. Our results suggested that Shenfu injection reduced brain injury by attenuating Nogo-NgR signaling pathway and promoting axonal regeneration.
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Pre-hospital guidelines for CPR-Induced Consciousness (CPRIC): A scoping review. Resusc Plus 2022; 12:100335. [DOI: 10.1016/j.resplu.2022.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 11/29/2022] Open
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West RL, Otto Q, Drennan IR, Rudd S, Böttiger BW, Parnia S, Soar J. CPR-related cognitive activity, consciousness, awareness and recall, and its management: A scoping review. Resusc Plus 2022; 10:100241. [PMID: 35586308 PMCID: PMC9108988 DOI: 10.1016/j.resplu.2022.100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background There are increasing numbers of reports of cognitive activity, consciousness, awareness and recall related to cardiopulmonary resuscitation (CPR) and interventions such as the use of sedative and analgesic drugs during CPR. Objectives This scoping review aims to describe the available evidence concerning CPR-related cognitive activity, consciousness, awareness and recall and interventions such as the use of sedative and analgesic drugs during CPR. Methods A literature search was conducted of Medline, Embase and CINAHL from inception to 21 October 2021. We included case studies, observational studies, review studies and grey literature. Results We identified 8 observational studies including 40,317 patients and 464 rescuers, and 26 case reports including 33 patients. The reported prevalence of CPR-induced consciousness was between 0.23% to 0.9% of resuscitation attempts, with 48–59% of experienced professional rescuers surveyed estimated to have observed CPR-induced consciousness. CPR-induced consciousness is associated with professional rescuer CPR, witnessed arrest, a shockable rhythm, increased return of spontaneous circulation (ROSC), and survival to hospital discharge when compared to patients without CPR-induced consciousness. Few studies of sedation for CPR-induced consciousness were identified. Although local protocols for treating CPR-induced consciousness exist, there is no widely accepted guidance. Conclusions CPR-related cognitive activity, consciousness, awareness and recall is uncommon but increasingly reported by professional rescuers. The data available was heterogeneous in nature and not suitable for progression to a systematic review process. Although local treatment protocols exist for management of CPR-induced consciousness, there are no widely accepted treatment guidelines. More studies are required to investigate the management of CPR-induced consciousness.
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Affiliation(s)
- Rebecca L. West
- Anaesthetics Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Quentin Otto
- Anaesthetics Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Ian R. Drennan
- Sunnybrook Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Rudd
- Anaesthetics Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Sam Parnia
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Medical Center, New York City, USA
| | - Jasmeet Soar
- Anaesthetics Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- Corresponding author.
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Mirza M, Zafar M, Siddiqui M, Abbas A, Nahas J, Mirza M, Tauseef A. Role of steroids in critically-ill sepsis patients: a review article and literature to review. J Community Hosp Intern Med Perspect 2021; 11:825-829. [PMID: 34804399 PMCID: PMC8604467 DOI: 10.1080/20009666.2021.1964164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sepsis, a life-threatening condition, commonly affecting critically ill patients, is a major cause of death worldwide. It is thus of great importance to determine the optimum management to cure this condition. This review article summarizes the role and effects of corticosteroids in the treatment of sepsis and septic shock, and to determine its mortality benefits. We used PubMed, Google scholar, Scopus, and Embase databases for literature review, and terminologies commonly searched were 'sepsis', 'septic shock', 'therapeutic use' and 'corticosteroids'. In this review article, we reviewed a total of eight different articles being done in last 10 years, relevant to the clinical outcome and effects of corticosteroids. Among those, two demonstrated improved clinical outcomes, two showed both improved clinical outcomes and decreased mortality, three showed increased adverse effects, and the remaining one showed unequivocal results.
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Affiliation(s)
- Mohsin Mirza
- Internal Medicine Department, Creighton University School of Medicine, Omaha, NE, USA
| | - Maryam Zafar
- Internal Medicine, Dow University of Health Sciences, DUHS, Karachi, Pakistan
| | - Mariam Siddiqui
- Internal Medicine, Dow University of Health Sciences, DUHS, Karachi, Pakistan
| | - Anum Abbas
- Internal Medicine Department, University of Nebraska Medical Center, Omaha, NE, USA
| | - Joseph Nahas
- Internal Medicine Department, Creighton University School of Medicine, Omaha, NE, USA
| | - Muazzam Mirza
- Internal Medicine Department, Creighton University School of Medicine, Omaha, NE, USA
| | - Abubakar Tauseef
- Internal Medicine Department, Creighton University School of Medicine, Omaha, NE, USA
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Lewandowski K, Kretschmer B, Schmidt KW. [175 years of anesthesia and narcosis-Towards a "human right to unconsciousness"]. Anaesthesist 2021; 70:811-831. [PMID: 34529093 PMCID: PMC8444521 DOI: 10.1007/s00101-021-01043-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 01/01/2023]
Abstract
The Ether Day, a key moment in the history of mankind, commemorates its 175th anniversary on 16 October 2021. On that day the dentist William T. G. Morton successfully gave the first public ether anesthesia in Boston. From then on it was possible to save people from pain with justifiable risk and at the same time to protect them from psychological damage by inducing unconsciousness. The German philosopher Peter Sloterdijk, one of the most renowned and effective philosophers of our times, deduced that from then on humans, to some extent, had a right to unconsciousness when in psychophysical distress. This postulate unfolded from his concept of "anthropotechnics" developed around 1997, meaning the idea of treating human nature as an object of possible improvements. According to Sloterdijk, in favorable cases a synthesis of man and technology can result in a significant improvement of human capabilities in the sense of "enhancement", i.e. an increase, an improvement or even an expansion of intellectual, physical or psychological possibilities, as it were in a transgression of the human (so-called transhumanism). Man should go into vertical tension, i.e. strive for higher aims and exploit his inherent potential, he should not dwell in the horizontal. This is not meant as an appeal but as an imperative: "You must change your life!". In this context modern anesthesia may prove helpful: be operated on by others in order to undergo an enhancement. Or, in its most extreme form, the operation in the "auto-operational curved space", a person can even operate on himself as has been dramatically demonstrated by Rogozov, a young Russian physician and trainee surgeon who successfully performed a self-appendectomy under local anesthesia at the Novolazarevskaya Antarctic Station in 1961; however, the implementation of this idea is a long way off. On the one hand, many countries lack qualified personnel in sufficiently large numbers to perform even vital operations with patients under anesthesia. On the other hand, over the decades it has become clear that anesthesia is obviously beneficial for mankind in that it offers relief from pain and psychological stress but that it can also often show its dark side: substance abuse, use of anesthetics in torture and in executions. In addition, the role of anesthetics in resuscitation, palliative care, and allaying executions is unclear or controversial. Finally, the necessary formal legal steps to acknowledge a "human right to unconsciousness" have not yet been implemented.
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Affiliation(s)
- K Lewandowski
- Anästhesiologie und operative Intensivmedizin, Charité (extern), Berlin, Deutschland.
| | | | - K W Schmidt
- Zentrum für Ethik in der Medizin, Agaplesion Markus Krankenhaus, Frankfurt a. M., Deutschland
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Czerwonka H, Sroka M. Eine nicht „ganz normale“ Reanimation bei Kammerflimmern – Wachheit während der Wiederbelebung. DER NOTARZT 2020. [DOI: 10.1055/a-1224-4073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungWährend einer Reanimation bei Kammerflimmern wurde „Wachheit unter CPR“ beobachtet. Dies führte in der Folge zu einer kritischen Auseinandersetzung und der ethischen Fragestellung, ob eine Sedierung während der Reanimation zum ärztlichen Selbstverständnis gehören müsste, um traumatische Erinnerungen auszuschließen. Im vorliegenden Fall konnte ein junger Reisender am Frankfurter Flughafen erfolgreich wiederbelebt werden und ohne Residuen und Erinnerungen an „seine Reanimation“ nach 11 Tagen die Heimreise antreten.
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Affiliation(s)
- Holger Czerwonka
- Notfallambulanz im Medical Center („Flughafenklinik“), Medizinische Dienste Fraport AG, Frankfurt am Main
| | - Michael Sroka
- Notfallambulanz im Medical Center („Flughafenklinik“), Medizinische Dienste Fraport AG, Frankfurt am Main
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Chin KC, Yang SC, Chiang WC. Video of cardiopulmonary resuscitation induced consciousness during ventricular fibrillation. Resuscitation 2020; 155:22-23. [PMID: 32682850 DOI: 10.1016/j.resuscitation.2020.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/18/2020] [Accepted: 07/02/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Kuan-Chen Chin
- Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, Taiwan No.127, Su-Yuan Road, Hsin-Chuang District, New Taipei City, 24213, Taiwan.
| | | | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliu City, Taiwan
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Application of termination of resuscitation rules during the COVID-19 pandemic by emergency medical service. Am J Emerg Med 2020; 42:254-255. [PMID: 32591307 PMCID: PMC7301051 DOI: 10.1016/j.ajem.2020.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/21/2022] Open
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Doan TN, Adams L, Schultz BV, Bunting D, Parker L, Rashford S, Bosley E. Insights into the epidemiology of cardiopulmonary resuscitation‐induced consciousness in out‐of‐hospital cardiac arrest. Emerg Med Australas 2020; 32:769-776. [DOI: 10.1111/1742-6723.13505] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Tan N Doan
- Queensland Ambulance Service Queensland Government Department of Health Brisbane Queensland Australia
- Department of Medicine, The Royal Melbourne Hospital The University of Melbourne Melbourne Victoria Australia
- Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia
| | - Luke Adams
- Queensland Ambulance Service Queensland Government Department of Health Brisbane Queensland Australia
| | - Brendan V Schultz
- Queensland Ambulance Service Queensland Government Department of Health Brisbane Queensland Australia
| | - Denise Bunting
- Queensland Ambulance Service Queensland Government Department of Health Brisbane Queensland Australia
| | - Lachlan Parker
- Queensland Ambulance Service Queensland Government Department of Health Brisbane Queensland Australia
| | - Stephen Rashford
- Queensland Ambulance Service Queensland Government Department of Health Brisbane Queensland Australia
- School of Public Health and Social Work Queensland University of Technology Brisbane Queensland Australia
| | - Emma Bosley
- Queensland Ambulance Service Queensland Government Department of Health Brisbane Queensland Australia
- School of Clinical Sciences Queensland University of Technology Brisbane Queensland Australia
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12
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Varon J. Awareness during resuscitation: Where is the data? Am J Emerg Med 2019; 37:952-953. [DOI: 10.1016/j.ajem.2019.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022] Open
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