After cardiac arrest and resuscitation, part of the patients will be in a coma and treated at an intensive care unit. Their prospects are uncertain. What is needed to get an outcome prediction that is reliable? Researchers of the University of Twente and the ‘Medisch Spectrum Twente’ hospital, both in Enschede, The Netherlands, developed a learning network that is capable of interpreting EEG-patterns. It can make a reliable outcome prediction, and thus forms a valuable extra source of information.
In The Netherlands, about one third of the people that had a cardiac arrest followed by resuscitation, will have to be treated at the ICU. These patients, about 7000 each year, are in a coma. More than half of them will not regain consciousness. The family will want to know what the prospects are and, if their relative regains consciousness, what will be the quality of life. The question ‘does further treatment make sense?’ can only be answered after careful analysis of the situation. One of the options, now, is the SEPP-t
The electrical signals of the brain, the EEG pattern measured via electrodes on the head, give a lot of information as well. Analysis of EEG using artificial intelligence gives a very accurate outcome prediction, as the researchers show in their latest paper. Twelve hours after resuscitation, the learning network is capable of predicting a good outcome with 58 percent accuracy and a bad outcome with 48 percent. This is a better performance than the trained eye of a neurologist. Both computer and human, however, still have a category ‘I don’t know’, in situations the EEG data are not specific enough.
The first author, Marleen Tjepkema, already made a plea for using EEG in the outcome prediction, in her PhD thesis in 2014 as a UT Technical Medicine graduate. She and her colleagues now take this an important step further by introducing automated interpretation of the EEG scan. The learning network has been trained using 600 EEG patterns, it did not get any hints on what to look at. After that, it was fed with 300 EEG patterns to see how it performed in giving a prediction. Neurologists have to look at hundreds of EEG’s as well, as part of their training. An experienced neurologist will point out specific characteristics. Still, the EEG-patterns are so information-rich that the computer outperforms the human eye.
Once trained, the network will be capable of judging the EEG very fast, well within a second. The researchers expect that this adds valuable information to human judgment. One of the other advantages is flexibility, a prediction can be made any time of the day. Using the new technology at ICU’s will show if the ‘intensivist’ also sees as a valuable tool.
University Twentehttps://tinyurl.com/y6amneh9

The 43rd World Hospital Congress of the International Hospital Federation has invited thought leaders, experts and top-level professionals to explore how health services can be better provided during peace and crisis. Topics have been lined up to explore how health services can be more responsive through better resilience, supportive through appropriate health investments and prospective through health impactful innovations.
The World Hospital Congress is a unique global forum where leaders of national and international hospital and healthcare organizations convene to share knowledge, expertise, experiences and best practices in leadership in hospital and healthcare management and service delivery.
Hosted by the Ministry of Health of the Sultanate of Oman on 6 to 9 November in Muscat, the Congress will feature more than 100 presenters in 40 sessions, poster displays, pre-conference session, hospital site visits, healthcare exhibition, special events and networking opportunities in three transformative days which will give delegates opportunities to learn, exchange, and engage with peers.
Keynote speakers include the following thought leaders and experts:

1.    Hon. Yuthar Mohammed Al Rawahy, Founder & Honorary Life President of the Oman Cancer Association will share her perspectives on the role of patients in time of peace and crisis from self-empowerment to social mobilization;

2.    Sir Andrew Dillon CBE, Chief Executive of the National Institute for Health and Care Excellence will share how to align the ambition of health systems and the life sciences industry for successful adoption of new health technologies;

3.    Dr. Melinda Estes, President and CEO of Saint Luke’s Health System and Chair-elect of the American Hospital Association will provide insights on how hospitals and health systems are driving community health and prosperity;

4.    Dr. Agnés Soucat, Director for Health Systems Governance and Financing at the World Health Organization will discuss the role of hospitals and health services in support to population well-being.

Besides keynote presentations, panel discussions with leading industry professionals and patient representatives will examine a range of topics including:

·         The role of hospitals in time of crisis;

·         Patient and community voice in time of peace and crisis;

·         Health service providers contributing to health and prosperity;

·         Health services in support to better well-being;

·         Taking the innovation to the service.

Early bird registration to the Congress closes on 15 August 2019. https://worldhospitalcongress.org/2019-registration/ congress@ihf-fih.org

Reversibly paralysing and heavily sedating hospitalized patients with severe breathing problems do not improve outcomes in most cases, according to a National Institutes of Health-funded clinical trial conducted at dozens of North American hospitals and led by clinician-scientists at the University of Pittsburgh and University of Colorado schools of medicine.
The trial—which was stopped early due to futility—settles a long-standing debate in the critical care medicine community about whether it is better to paralyse and sedate patients in acute respiratory distress to aid mechanical ventilation or avoid heavy sedation to improve recovery.
“It’s been a conundrum—on the one hand, really well-done studies have shown that temporarily paralysing the patient to improve mechanical breathing saves lives. But you can’t paralyse without heavy sedation, and studies also show heavy sedation results in worse recovery. You can’t have both—so what’s a clinician to do?” said senior author Derek Angus, M.D., M.P.H., who holds the Mitchell P. Fink Endowed Chair of the Pitt School of Medicine’s Department of Critical Care Medicine. “Our trial finally settles it—light sedation with intermittent, short-term paralysis if necessary is as good as deep sedation with continuous paralysis.”
The Re-evaluation Of Systemic Early neuromuscular blockade (ROSE) trial is the first of the new National Heart, Lung, and Blood Institute’s (NHLBI) Prevention & Early Treatment of Acute Lung Injury (PETAL) Network. PETAL develops and conducts randomized controlled clinical trials to prevent or treat patients who have, or who are at risk for, acute lung injury or acute respiratory distress syndrome. The trial network places particular emphasis on early detection by requiring every network member institute include both critical care and emergency medicine, acute care or trauma principal investigators to ensure that critical health issues are recognized and triaged as fast as possible to improve patients’ odds of recovery before they are even transferred to the intensive care unit.
Angus, who also directs Pitt’s Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, said the trial results make him confident when he says that avoiding paralysis and deep sedation is the best practice for most patients hospitalized with breathing problems. However, he notes that future trials will be needed to tease out whether there is a subpopulation of patients with acute respiratory distress syndrome who still benefit from neuromuscular blockade.
UPMChttps://tinyurl.com/yxc95rrl