***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective . Birth asphyxia represents a serious problem worldwide , result ing in ∼1 million deaths and an equal number of serious sequelae annually . It is therefore important to develop new and better ways to treat asphyxia . Resuscitation after birth asphyxia traditionally has been carried out with 100 % oxygen , and most guidelines and textbooks recommend this ; however , the scientific background for this has never been established . On the contrary , theoretic considerations indicate that resuscitation with high oxygen concentrations could have detrimental effects . We have performed a series of animal studies as well as one pilot study indicating that resuscitation can be performed with room air just as efficiently as with 100 % oxygen . To test this more thoroughly , we organized a multicenter study and hypothesized that room air is superior to 100 % oxygen when asphyxiated newborn infants are resuscitated . Methodology . In a prospect i ve , international , controlled multicenter study including 11 centers from six countries , asphyxiated newborn infants with birth weight > 999 g were allocated to resuscitation with either room air or 100 % oxygen . The study was not blinded , and the patients were allocated to one of the two treatment groups according to date of birth . Those born on even date s were resuscitated with room air and those born on odd date s with 100 % oxygen . Informed consent was not obtained until after the initial resuscitation , an arrangement in agreement with the new proposal of the US Food and Drug Administration 's rules governing investigational drugs and medical devices to permit clinical research on emergency care without the consent of subjects . The protocol was approved by the ethical committees at each participating center . Entry criterion was apnea or gasping with heart rate < 80 beats per minute at birth necessitating resuscitation . Exclusion criteria were birth weight < 1000 g , lethal anomalies , hydrops , cyanotic congenital heart defects , and stillbirths . Primary outcome measures were death within 1 week and /or presence of hypoxic – ischemic encephalopathy , grade II or III , according to a modification of Sarnat and Sarnat . Secondary outcome measures were Apgar score at 5 minutes , heart rate at 90 seconds , time to first breath , time to first cry , duration of resuscitation , arterial blood gases and acid base status at 10 and 30 minutes of age , and abnormal neurologic examination at 4 weeks . The existing routines for resuscitation in each participating unit were followed , and the ventilation techniques described by the American Heart Association were used as guidelines aim ing at a frequency of manual ventilation of 40 to 60 breaths per minute . Results . Forms for 703 enrolled infants from 11 centers were received by the steering committee . All 94 patients from one of the centers were excluded because of violation of the inclusion criteria in 86 of these . Therefore , the final number of infants enrolled in the study was 609 ( from 10 centers ) , with 288 in the room air group and 321 in the oxygen group . Median ( 5 to 95 percentile ) gestational ages were 38 ( 32.0 to 42.0 ) and 38 ( 31.1 to 41.5 ) weeks ( NS ) , and birth weights were 2600 ( 1320 to 4078 ) g and 2560 ( 1303 to 3900 ) g ( NS ) in the room air and oxygen groups , respectively . There were 46 % girls in the room air and 41 % in the oxygen group ( NS ) . Mortality in the first 7 days of life was 12.2 % and 15.0 % in the room air and oxygen groups , respectively ; adjusted odds ratio ( OR ) = 0.82 with 95 % confidence intervals ( CI ) = 0.50–1.35 . Neonatal mortality was 13.9 % and 19.0 % ; adjusted OR = 0.72 with 95 % CI = 0.45–1.15 . Death within 7 days of life and /or moderate or severe hypoxic – ischemic encephalopathy ( primary outcome measure ) was seen in 21.2 % in the room air group and in 23.7 % in the oxygen group ; OR = 0.94 with 95 % CI = 0.63–1.40 . Heart rates did not differ between the two groups at any time point and were ( mean ± SD ) 90 ± 31 versus 93 ± 33 beats per minute at 1 minute and 110 ± 27 versus 113 ± 30 beats per minute at 90 seconds in the room air and oxygen groups , respectively . Apgar scores at 1 minute ( median and 5 to 95 percentiles ) were significantly higher in the room air group ( 5 [ 1 to 6.7 ] ) than in the oxygen group ( 4 [ 1 to 7 ] ) ; however , at 5 minutes there were no significant differences , with 8 ( 4 to 9 ) versus 7 ( 3 to 9 ) . There were significantly more infants with very low 1-minute Apgar scores ( < 4 ) in the oxygen group ( 44.4 % ) than in the room air group ( 32.3 % ) . There also were significantly more infants with 5-minute Apgar score < 7 in the oxygen group ( 31.8 % ) than in the room air group ( 24.8 % ) . There were no differences in acid base status or Sao 2during the observation period between the two groups . Mean ( SD ) Pao 2 was 31 ( 17 ) versus 30 ( 22 ) mm Hg in cord blood in the room air and oxygen groups , respectively ( NS ) . At 10 minutes Pao 2 was 76 ( 32 ) versus 87 ( 49 ) mm Hg ( NS ) , and at 30 minutes , the values were 74 ( 29 ) versus 89 ( 42 ) mm Hg in the room air and oxygen groups , respectively . Median ( 95 % CI ) time to first breath was 1.1 ( 1.0–1.2 ) minutes in the room air group versus 1.5 ( 1.4 to 1.6 ) minutes in the oxygen group . Time to the first cry also was in mean 0.4 minute shorter in the room air group compared with the oxygen group . In the room air group , there were 25.7 % so-called resuscitation failures ( bradycardia and /or central cyanosis after 90 seconds ) that were switched to 100 % oxygen after 90 seconds . The percentage of resuscitation failures in the oxygen group was 29.8 % . Conclusions . This study with patients enrolled primarily from developing countries indicates that asphyxiated newborn infants can be resuscitated with room air as efficiently as with pure oxygen . In fact , time to first breath and first cry was significantly shorter in room air- versus oxygen-resuscitated infants . Resuscitation with 100 % oxygen may depress ventilation and therefore delay the first breath . More studies are needed confirming these results before resuscitation guidelines are changed ABSTRACT : To test the hypothesis that room air is superior to 100 % oxygen when asphyxiated newborns are resuscitated , 84 neonates ( birth weight > 999 g ) with heart rate < 80 and /or apnea at birth were allocated to be resuscitated with either room air ( n = 42 ) or 100 % oxygen ( n = 42 ) . Serial , unblinded observations of heart rates at 1 , 3 , 5 , and 10 min and Apgar scores at 1 min revealed no significant differences between the two groups . At 5 min , median ( 25th and 75th percentile ) Apgar scores were higher in the room air than in the oxygen group [ 8 ( 7–9 ) versus 7 ( 6–8 ) , p = 0.03 ] . After the initial resuscitation , arterial partial pressure of oxygen , pH , and base excess were comparable in the two groups . Assisted ventilation was necessary for 2.4 ( 1.5–3.4 ) min in the room air group and 3.0 ( 2.0–4.0 ) min in the oxygen group ( p = 0.14 ) . The median time to first breath was 1.5 ( 1.0–2.0 ) min in both the room air and oxygen groups ( p = 0.59 ) , and the time to first cry was 3.0 ( 2.0–4.0 ) min and 3.5 ( 2.5–5.5 ) min in the room air and oxygen groups , respectively ( p = 0.19 ) . Three neonates in the room air group and four in the oxygen group died in the neonatal period . At 28 d , 72 of the 77 surviving neonates were available for follow-up ( 36 in each group ) , and none had any neurologic sequelae . This preliminary study did not provide conclusive evidence that room air is superior to 100 % oxygen in the resuscitation of  asphyxiated newborns , although it indicated that room air is as effective as 100 % oxygen . Additional trials with increased numbers of patients are necessary before deciding whether room air or oxygen should be used in clinical practice BACKGROUND Traditional fluid resuscitation strategy in the actively hemorrhaging trauma patient emphasizes maintenance of a normal systolic blood pressure ( SBP ) . One human trial has demonstrated improved survival when fluid resuscitation is restricted , whereas numerous laboratory studies have reported improved survival when resuscitation is directed to a lower than normal pressure . We hypothesized that fluid resuscitation titrated to a lower than normal SBP during the period of active hemorrhage would improve survival in trauma patients presenting to the hospital in hemorrhagic shock . METHODS Patients presenting in hemorrhagic shock were r and omized to one of two fluid resuscitation protocol s : target SBP > 100 mm Hg ( conventional ) or target SBP of 70 mm Hg ( low ) . Fluid therapy was titrated to this endpoint until definitive hemostasis was achieved . In-hospital mortality , injury severity , and probability of survival were determined for each patient . RESULTS One hundred ten patients were enrolled over 20 months , 55 in each group . The study cohort had a mean age of 31 years , and consisted of 79 % male patients and 51 % penetrating trauma victims . There was a significant difference in SBP observed during the study period ( 114 mm Hg vs. 100 mm Hg , p < 0.001 ) . Injury Severity Score ( 19.65 + /- 11.8 vs. 23.64 + /- 13.8 , p = 0.11 ) and the duration of active hemorrhage ( 2.97 + /- 1.75 hours vs. 2.57 + /- 1.46 hours , p = 0.20 ) were not different between groups . Overall survival was 92.7 % , with four deaths in each group . CONCLUSION Titration of initial fluid therapy to a lower than normal SBP during active hemorrhage did not affect mortality in this study . Reasons for the decreased overall mortality and the lack of differentiation between groups likely include improvements in diagnostic and therapeutic technology , the heterogeneous nature of human traumatic injuries , and the imprecision of SBP as a marker for tissue oxygen delivery BACKGROUND Cardiac arrest with widespread cerebral ischemia frequently leads to severe neurologic impairment . We studied whether mild systemic hypothermia increases the rate of neurologic recovery after resuscitation from cardiac arrest due to ventricular fibrillation . METHODS In this multicenter trial with blinded assessment of the outcome , patients who had been resuscitated after cardiac arrest due to ventricular fibrillation were r and omly assigned to undergo  therapeutic hypothermia ( target temperature , 32 degrees C to 34 degrees C , measured in the bladder ) over a period of 24 hours or to receive st and ard treatment with normothermia . The primary end point was a favorable neurologic outcome within six months after cardiac arrest ; secondary end points were mortality within six months and the rate of complications within seven days . RESULTS Seventy-five of the 136 patients in the hypothermia group for whom data were available ( 55 percent ) had a favorable neurologic outcome ( cerebral-performance category , 1 [ good recovery ] or 2 [ moderate disability ] ) , as compared with 54 of 137 ( 39 percent ) in the normothermia group ( risk ratio , 1.40 ; 95 percent confidence interval , 1.08 to 1.81 ) . Mortality at six months was 41 percent in the hypothermia group ( 56 of 137 patients died ) , as compared with 55 percent in the normothermia group ( 76 of 138 patients ; risk ratio , 0.74 ; 95 percent confidence interval , 0.58 to 0.95 ) . The complication rate did not differ significantly between the two groups . CONCLUSIONS In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation , therapeutic mild hypothermia increased the rate of a favorable neurologic outcome and reduced mortality BACKGROUND Fluid resuscitation may be detrimental when given before bleeding is controlled in patients with trauma . The purpose of this study was to determine the effects of delaying fluid resuscitation until the time of operative intervention in hypotensive patients with penetrating injuries to the torso . METHODS We conducted a prospect i ve trial comparing immediate and delayed fluid resuscitation in 598 adults with penetrating torso injuries who presented with a pre-hospital systolic blood pressure of < or = 90 mm Hg . The study setting was a city with a single 
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We did not find strong or consistent evidence that quasi-r and omization is associated with selection bias more often than true r and omization .
High risk of bias judgements for quasi-r and omized emergency studies should therefore not be assumed in systematic review s. Clinical heterogeneity across trials within review s , coupled with limited availability of relevant trial accrual data , meant it was not possible to adequately explore the possibility that true r and omization might result in slower trial recruitment rates , or the recruitment of less representative population