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Aziz S, Barratt J, Wilson-Baig N, Lachowycz K, Major R, Barnard EB, Rees P. A protocol for the ERICA-ARREST feasibility study of Emergency Resuscitative Endovascular Balloon occlusion of the Aorta in Out-of-Hospital Cardiac Arrest. Resusc Plus 2024; 19:100688. [PMID: 38974930 PMCID: PMC11225899 DOI: 10.1016/j.resplu.2024.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 07/09/2024] Open
Abstract
Background Fewer than one in ten out-of-hospital cardiac arrest (OHCA) patients survive to hospital discharge in the UK. For prehospital teams to improve outcomes in patients who remain in refractory OHCA despite advanced life support (ALS); novel strategies that increase the likelihood of return of spontaneous circulation, whilst preserving cerebral circulation, should be investigated. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has been shown to improve coronary and cerebral perfusion during cardiopulmonary resuscitation. Early, prehospital initiation of REBOA may improve outcomes in patients who do not respond to standard ALS. However, there are significant clinical, technical, and logistical challenges with rapidly delivering prehospital REBOA in OHCA; and the feasibility of delivering this intervention in the UK urban-rural setting has not been evaluated. Methods The Emergency Resuscitative Endovascular Balloon Occlusion of the Aorta in Out-of-Hospital Cardiac Arrest (ERICA-ARREST) study is a prospective, single-arm, interventional feasibility study. The trial will enrol 20 adult patients with non-traumatic OHCA. The primary objective is to assess the feasibility of performing Zone I (supra-coeliac) aortic occlusion in patients who remain in OHCA despite standard ALS in the UK prehospital setting. The trial's secondary objectives are to describe the hemodynamic and physiological responses to aortic occlusion; to report key time intervals; and to document adverse events when performing REBOA in this context. Discussion Using compressed geography, and targeted dispatch, alongside a well-established femoral arterial access programme, the ERICA-ARREST study will assess the feasibility of deploying REBOA in OHCA in a mixed UK urban and rural setting.Trial registration.ClinicalTrials.gov (NCT06071910), registration date October 10, 2023, https://classic.clinicaltrials.gov/ct2/show/NCT06071910.
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Affiliation(s)
- Shadman Aziz
- Department of Research, Audit, Innovation, and Development (RAID). East Anglian Air Ambulance, Norwich, UK
| | - Jon Barratt
- Department of Research, Audit, Innovation, and Development (RAID). East Anglian Air Ambulance, Norwich, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Clinical Innovation), Birmingham, UK
- Emergency Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Noamaan Wilson-Baig
- Department of Research, Audit, Innovation, and Development (RAID). East Anglian Air Ambulance, Norwich, UK
- Departments of Anaesthesia and Critical Care, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Kate Lachowycz
- Department of Research, Audit, Innovation, and Development (RAID). East Anglian Air Ambulance, Norwich, UK
| | - Rob Major
- Department of Research, Audit, Innovation, and Development (RAID). East Anglian Air Ambulance, Norwich, UK
| | - Ed B.G. Barnard
- Department of Research, Audit, Innovation, and Development (RAID). East Anglian Air Ambulance, Norwich, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Clinical Innovation), Birmingham, UK
- Emergency and Urgent Care Research in Cambridge (EUReCa), PACE Section, Department of Medicine, Cambridge University, Cambridge, UK
| | - Paul Rees
- Department of Research, Audit, Innovation, and Development (RAID). East Anglian Air Ambulance, Norwich, UK
- Academic Department of Military Medicine, Royal Centre for Defence Medicine(Research & Clinical Innovation), Birmingham, UK
- Barts Heart Centre, Barts Health NHS Trust, London, UK
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Pareek N, Kordis P, Beckley-Hoelscher N, Pimenta D, Kocjancic ST, Jazbec A, Nevett J, Fothergill R, Kalra S, Lockie T, Shah AM, Byrne J, Noc M, MacCarthy P. A practical risk score for early prediction of neurological outcome after out-of-hospital cardiac arrest: MIRACLE2. Eur Heart J 2021; 41:4508-4517. [PMID: 32731260 DOI: 10.1093/eurheartj/ehaa570] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/25/2020] [Accepted: 07/01/2020] [Indexed: 02/02/2023] Open
Abstract
AIMS The purpose of this study was to develop a practical risk score to predict poor neurological outcome after out-of-hospital cardiac arrest (OOHCA) for use on arrival to a Heart Attack Centre. METHODS AND RESULTS From May 2012 to December 2017, 1055 patients had OOHCA in our region, of whom 373 patients were included in the King's Out of Hospital Cardiac Arrest Registry (KOCAR). We performed prediction modelling with multivariable logistic regression to identify predictors of the primary outcome to derive a risk score. This was externally validated in two independent cohorts comprising 473 patients. The primary endpoint was poor neurological outcome at 6-month follow-up (Cerebral Performance Category 3-5). Seven independent predictors of outcome were identified: missed (unwitnessed) arrest, initial non-shockable rhythm, non-reactivity of pupils, age (60-80 years-1 point; >80 years-3 points), changing intra-arrest rhythms, low pH <7.20, and epinephrine administration (2 points). The MIRACLE2 score had an area under the curve (AUC) of 0.90 in the development and 0.84/0.91 in the validation cohorts. Three risk groups were defined-low risk (MIRACLE2 ≤2-5.6% risk of poor outcome); intermediate risk (MIRACLE2 of 3-4-55.4% of poor outcome); and high risk (MIRACLE2 ≥5-92.3% risk of poor outcome). The MIRACLE2 score had superior discrimination than the OHCA [median AUC 0.83 (0.818-0.840); P < 0.001] and Cardiac Arrest Hospital Prognosis models [median AUC 0.87 (0.860-0.870; P = 0.001] and equivalent performance with the Target Temperature Management score [median AUC 0.88 (0.876-0.887); P = 0.092]. CONCLUSIONS The MIRACLE2 is a practical risk score for early accurate prediction of poor neurological outcome after OOHCA, which has been developed for simplicity of use on admission.
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Affiliation(s)
- Nilesh Pareek
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE59RS, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Peter Kordis
- Centre for Intensive Internal Medicine, University Medical Center, Zaloska 7, Ljubljana 1000, Slovenia
| | | | - Dominic Pimenta
- Department of Cardiology, Royal Free Hospital NHS Foundation Trust, Pond St, Hampstead, London NW3 2QG, UK
| | - Spela Tadel Kocjancic
- Centre for Intensive Internal Medicine, University Medical Center, Zaloska 7, Ljubljana 1000, Slovenia
| | - Anja Jazbec
- Centre for Intensive Internal Medicine, University Medical Center, Zaloska 7, Ljubljana 1000, Slovenia
| | - Joanne Nevett
- London Ambulance Service NHS Trust, 220 Waterloo Rd, London SE1 8SD, UK
| | | | - Sundeep Kalra
- Department of Cardiology, Royal Free Hospital NHS Foundation Trust, Pond St, Hampstead, London NW3 2QG, UK
| | - Tim Lockie
- Department of Cardiology, Royal Free Hospital NHS Foundation Trust, Pond St, Hampstead, London NW3 2QG, UK
| | - Ajay M Shah
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE59RS, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE59RS, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Marko Noc
- Centre for Intensive Internal Medicine, University Medical Center, Zaloska 7, Ljubljana 1000, Slovenia
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE59RS, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK
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Myall M, Rowsell A, Lund S, Turnbull J, Arber M, Crouch R, Pocock H, Deakin C, Richardson A. Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review. BMJ Open 2020; 10:e036925. [PMID: 32948555 PMCID: PMC7511644 DOI: 10.1136/bmjopen-2020-036925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To identify the factors that shape and characterise experiences of prehospital practitioners (PHPs), families and bystanders in the context of death and dying outside of the hospital environment where PHPs respond. DESIGN A scoping review using Arksey and O'Malley's five-stage framework. Papers were analysed using thematic analysis. DATA SOURCES MEDLINE; Embase; CINAHL; Scopus; Social Sciences Citation Index (Web of Science), ProQuest Dissertations & Theses A&I (Proquest), Health Technology Assessment database; PsycINFO; Grey Literature Report and PapersFirst were searched from January 2000 to May 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative and mixed methods studies reporting the experiences of PHPs, families and bystanders of death and dying in prehospital settings as a result of natural causes, trauma, suicide and homicide, >18 years of age, in Europe, USA, Canada, Australia and New Zealand. RESULTS Searches identified 15 352 papers of which 51 met the inclusion criteria. The review found substantial evidence of PHP experiences, except call handlers, and papers reporting family and bystander experiences were limited. PHP work was varied and complex, while confident in clinical work, they felt less equipped to deal with the emotion work, especially with an increasing role in palliative and end-of-life care. Families and bystanders reported generally positive experiences but their support needs were rarely explored. CONCLUSIONS To the best of our knowledge this is the first review that explores the experiences of PHPs, families and bystanders. An important outcome is identifying current gaps in knowledge where further empirical research is needed. The paucity of evidence suggested by this review on call handlers, families and bystanders presents opportunities to investigate their experiences in greater depth. Further research to address the current knowledge gaps will be important to inform future policy and practice.
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Affiliation(s)
- Michelle Myall
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Alison Rowsell
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Susi Lund
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Joanne Turnbull
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Mick Arber
- York Health Economics Consortium, University of York, York, North Yorkshire, UK
| | - Robert Crouch
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Helen Pocock
- South Central Ambulance Service NHS Foundation Trust Southern Headquarters, Otterbourne, Hampshire, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Charles Deakin
- South Central Ambulance Service NHS Foundation Trust Southern Headquarters, Otterbourne, Hampshire, UK
- NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, Hampshire, UK
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Pareek N, Kordis P, Webb I, Noc M, MacCarthy P, Byrne J. Contemporary Management of Out-of-hospital Cardiac Arrest in the Cardiac Catheterisation Laboratory: Current Status and Future Directions. Interv Cardiol 2019; 14:113-123. [PMID: 31867056 PMCID: PMC6918505 DOI: 10.15420/icr.2019.3.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is an important cause of mortality and morbidity in developed countries and remains an important public health burden. A primary cardiac aetiology is common in OHCA patients, and so patients are increasingly brought to specialist cardiac centres for consideration of coronary angiography, percutaneous coronary intervention and mechanical circulatory support. This article focuses on the management of OHCA in the cardiac catheterisation laboratory. In particular, it addresses conveyance of the OHCA patient direct to a specialist centre, the role of targeted temperature management, pharmacological considerations, provision of early coronary angiography and mechanical circulatory support.
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Affiliation(s)
- Nilesh Pareek
- King’s College Hospital NHS Foundation TrustLondon, UK
- School of Cardiovascular Medicine & Sciences, BHF Centre of ExcellenceKing’s College London, UK
| | | | - Ian Webb
- King’s College Hospital NHS Foundation TrustLondon, UK
| | - Marko Noc
- University Medical CentreLjubljana, Slovenia
| | - Philip MacCarthy
- School of Cardiovascular Medicine & Sciences, BHF Centre of ExcellenceKing’s College London, UK
| | - Jonathan Byrne
- King’s College Hospital NHS Foundation TrustLondon, UK
- School of Cardiovascular Medicine & Sciences, BHF Centre of ExcellenceKing’s College London, UK
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Moya-Mitjans À, Lidón RM. Desfibrilador externo automático en la muerte súbita extrahospitalaria: en busca del tratamiento eficaz. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moya-Mitjans À, Lidón RM. Automatic External Defibrillator in Sudden Out-of-hospital Cardiac Arrest: In Search of Effective Treatment. ACTA ACUST UNITED AC 2017; 71:64-66. [PMID: 28958405 DOI: 10.1016/j.rec.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Àngel Moya-Mitjans
- Unitat d'Arítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Rosa-Maria Lidón
- Unitat de Crítics Cardiovasculars, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Jabbour RJ, Sen S, Mikhail GW, Malik IS. Out-of-hospital cardiac arrest: Concise review of strategies to improve outcome. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:450-455. [DOI: 10.1016/j.carrev.2017.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/09/2017] [Indexed: 01/01/2023]
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Shavelle DM, Bosson N, Thomas JL, Kaji AH, Sung G, French WJ, Niemann JT. Outcomes of ST Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest (from the Los Angeles County Regional System). Am J Cardiol 2017; 120:729-733. [PMID: 28728743 DOI: 10.1016/j.amjcard.2017.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/16/2017] [Accepted: 06/01/2017] [Indexed: 01/01/2023]
Abstract
The objective of this study was to evaluate the time to primary percutaneous coronary intervention (PCI) and the outcome for patients with ST elevation myocardial infarction (STEMI) complicated by out-of-hospital cardiac arrest (OHCA). In this regional system, all patients with STEMI and/or OHCA with return of spontaneous circulation were transported to STEMI Receiving Centers. The outcomes registry was queried for patients with STEMI with underwent primary PCI from April 2011 to December 2014. Patients with STEMI complicated by OHCA were compared with a reference group of STEMI without OHCA. The primary end point was the first medical contact-to-device time. Of 4,729 patients with STEMI who underwent primary PCI, 422 patients (9%) suffered OHCA. Patients with OHCA were on average 2 years (95% confidence interval 0.7 to 3.0) older and had a slightly higher male predominance. The first medical contact-to-device time was longer in STEMI with OHCA compared with STEMI alone (94 ± 37 vs. 86 ± 34 minutes, p < 0.0001). In-hospital mortality was higher after OHCA, 38% versus 6% in STEMI alone, odds ratio 6.3 (95% confidence interval 5.3 to 7.4). Among OHCA survivors, 193 (73%) were discharged with a cerebral performance category score of 1 or 2. In conclusion, despite longer treatment intervals, neurologic outcome was good in nearly half of the surviving patients with STEMI complicated by OHCA, suggesting that these patients can be effectively treated with primary PCI in a regionalized system of care.
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Affiliation(s)
- David M Shavelle
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California.
| | - Nichole Bosson
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California; Department of Emergency Medicine, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Joseph L Thomas
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of Cardiology, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Gene Sung
- Department of Neurology, University of Southern California, Los Angeles, California
| | - William J French
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of Cardiology, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California
| | - James T Niemann
- Department of Emergency Medicine, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Mathiesen WT, Bjørshol CA, Braut GS, Søreide E. Reactions and coping strategies in lay rescuers who have provided CPR to out-of-hospital cardiac arrest victims: a qualitative study. BMJ Open 2016; 6:e010671. [PMID: 27225648 PMCID: PMC4885284 DOI: 10.1136/bmjopen-2015-010671] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Cardiopulmonary resuscitation (CPR) provided by community citizens is of paramount importance for out-of-hospital cardiac arrest (OHCA) victims' survival. Fortunately, CPR rates by community citizens seem to be rising. However, the experience of providing CPR is rarely investigated. The aim of this study was to explore reactions and coping strategies in lay rescuers who have provided CPR to OHCA victims. METHODS, PARTICIPANTS This is a qualitative study of 20 lay rescuers who have provided CPR to 18 OHCA victims. We used a semistructured interview guide focusing on their experiences after providing CPR. SETTING The study was conducted in the Stavanger region of Norway, an area with very high bystander CPR rates. RESULTS Three themes emerged from the interview analysis: concern, uncertainty and coping strategies. Providing CPR had been emotionally challenging for all lay rescuers and, for some, had consequences in terms of family and work life. Several lay rescuers experienced persistent mental recurrences of the OHCA incident and had concerns about the outcome for the cardiac arrest victim. Unknown or fatal outcomes often caused feelings of guilt and were particularly difficult to handle. Several reported the need to be acknowledged for their CPR attempts. Health-educated lay rescuers seemed to be less affected than others. A common coping strategy was confiding in close relations, preferably the health educated. However, some required professional help to cope with the OHCA incident. CONCLUSIONS Lay rescuers experience emotional and social challenges, and some struggle to cope in life after providing CPR in OHCA incidents. Experiencing a positive patient outcome and being a health-educated lay rescuer seem to mitigate concerns. Common coping strategies are attempts to reduce uncertainty towards patient outcome and own CPR quality. Further studies are needed to determine whether an organised professional follow-up can mitigate the concerns and uncertainty of lay rescuers.
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Affiliation(s)
- Wenche Torunn Mathiesen
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - Conrad Arnfinn Bjørshol
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Geir Sverre Braut
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Stord/Haugesund University College, Haugesund, Norway
| | - Eldar Søreide
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, University of Stavanger, Stavanger, Norway
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