“Background: Survival after out-of-hospital cardiac arrest

“Background: Survival after out-of-hospital cardiac arrest (OHCA) has increased in recent years, and new data are therefore needed to avoid unsubstantiated statements when debating futility of resuscitation attempts following OHCA in nursing

home (NH)-residents. We aimed to investigate the outcome and prognosis after OHCA in NH.

Methods: Consecutive Emergency Medical Service (EMS) attended OHCA-patients in Copenhagen during 2007-2011 were included. Utstein-criteria for pre-hospital data and review of individual patient charts for in-hospital post-resuscitation care were collected.

Results: A total of 2541 consecutive OHCA-patients were recorded, 245 (10%) of who JQ-EZ-05 order were current NH-residents. NH-patients were older, more frequently female, had more witnessed arrests, fewer shockable primary rhythm and assumed cardiac aetiology, but shorter time to the return of spontaneous circulation (ROSC) compared to OHCA in non-nursing homes (non-NH). Overall 30-day survival

rate was 9% in NH and 18% in non-NH, p<0.001. Of the 245 NH-arrests 79 (32%) patients were admitted to hospital compared to 937 (41%) from non-NH (p<0.001). Thirty-day survival rate in patients admitted to hospital were 27% for NH- and 42% for non-NH-patients, p<0.001. OHCA in NH was, however, not associated with a significantly worse prognosis (HR = 0.88 (0.64-1.21), p=0.4) after adjustment for known prognostic factors including co-morbidity.

Conclusions: Nursing home residents ARN-509 manufacturer resuscitated from CUDC-907 OHCA and admitted to hospital have similar survival rates as non-NH-patients when adjusting for known prognostic factors and pre-existing comorbidity. A policy of not attempting resuscitation in nursing homes at all may therefore not be justified. (C) 2013 Elsevier Ireland Ltd. All rights reserved.”
“Background and Purpose: Mini-PCNL was developed to reduce the morbidity of PCNL

by using smaller tract sizes. Most mini-techniques, however, require specialized instruments and use ureteroscopes as surrogates for nephroscopes, resulting in decreased visualization, poor irrigation, and difficult fragment extraction. We describe our modified technique (mPCNL) that allows for the use of standard PCNL equipment through a tract that is smaller than standard PCNL (sPCNL) but larger than previously reported for mini-PCNL.

Technique: After ureteral access with a coaxial anti-retropulsion device, the patient is placed in the prone position. After percutaneous access under fluoroscopic guidance, a 24F balloon dilating catheter is used to place a 24F Amplatz sheath. A standard 26F rigid nephroscope is used to complete the entire procedure, with the modification of selectively removing the outer sheath to allow the scope to fit in the smaller tract. Standard lithotripters and graspers are used, as necessary.

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