Knowledge about neonatal resuscitation, frequent performance of skills, and comfort level with skill performance are dimensions of quality implementation of neonatal resuscitation.
A major advance in the general management of sepsis was the implementation of aggressive resuscitation strategies, primarily inspired from the pivotal study by Rivers and colleagues, which promoted a protocol-guided hemodynamic resuscitation based on circulatory and tissue oxygenation objectives, the so-called early goal-directed therapy (EGDT) [5].
Their prognosis is related with the severity of clinical presentation, the implementation of early resuscitation bundles and adequate empirical antibiotic therapy.
Subsequently, the Surviving Sepsis Campaign was launched, the SSC Clinical Practice Guidelines [ 18] were published, and the implementation of the resuscitation and management bundles were promoted by the SSC and the Institute for Healthcare Improvement IHIInstitute for Healthcare Improvement IHI
However, it is also possible that patients resuscitated because of the extra benefit of vasopressors are potentially salvageable with the improvement or better implementation of post-resuscitation care.
Although other investigators have evaluated prehospital implementation of post-resuscitation hypothermia [ 12, 13], the current study represents the first implementation of this novel therapeutic approach in humans during the intra-arrest period.
In an univariate analysis, presentation as septic shock (64.2 % vs 40.7%, p = 0.03), implementation of SSC early resuscitation bundles (3h) (36.3% vs 42.4%; p = 0.05) and AEAT 32.4% vs 85.7%; p = 0.02) had any impact on prognosis.
Another external factor of note was the implementation of the 2010 resuscitation guidelines during phase 1 of the study (14).
Despite the implementation of damage control resuscitation principles, exsanguination remains a frequent cause of death in hospital [ 1, 2].
