16,584 results on '"Heart arrest"'
Search Results
2. Ovarian hyperstimulation syndrome: cardiac arrest with an unexpected outcome
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Julia Kopeika, Judith Hamilton, Tom Lyne, and Jonathan Gaughran
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Adult ,In vitro fertilisation ,business.industry ,medicine.medical_treatment ,Ovarian hyperstimulation syndrome ,General Medicine ,Fertilization in Vitro ,medicine.disease ,Pulmonary embolism ,Heart Arrest ,Ovarian Hyperstimulation Syndrome ,Full recovery ,Anesthesia ,medicine ,Humans ,Female ,Ultrasonography ,business ,Pulmonary Embolism ,Venous thromboembolism - Abstract
We describe the acute deterioration of a 29-year-old undergoing in vitro fertilisation. Late-onset critical ovarian hyperstimulation syndrome triggered a massive pulmonary embolism and subsequent cardiac arrest. While the prognosis was deemed to be poor, the patient made a full recovery. The potential reasons for this are explored.
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- 2023
3. Purulent pericarditis, an unusual cause of cardiac arrest
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Kevin R Green, Vandana Seeram, Stephanie Rothweiler, and Barrett Attarha
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Constrictive pericarditis ,Pericardial drainage ,medicine.medical_specialty ,business.industry ,Septic shock ,medicine.medical_treatment ,Pericarditis, Constrictive ,General Medicine ,Pericardial space ,medicine.disease ,Surgery ,Pericardial window ,Purulent pericarditis ,Heart Arrest ,Streptococcus anginosus ,medicine ,Humans ,Pericarditis ,Loculated effusion ,business ,Pericardium ,Pericardial disease - Abstract
Purulent pericarditis is a rare infection of the pericardial space defined by the presence of gross pus or microscopic purulence. Here, we present a case of Streptococcus anginosus purulent pericarditis, leading to obstructive and septic shock. After prompt pericardial drainage, the patient experienced rapid improvement in symptoms. However, due to the presence of a loculated effusion and concern for development of constrictive pericarditis, a pericardial window was performed. Although purulent pericarditis is often fatal, this case illustrates the reduced morbidity following prompt recognition and drainage.
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- 2023
4. Asystole during Onyx embolization of 64-year-old patient with dural arteriovenous fistula
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Luis E. Savastano, Muhammad H Malik, and Waleed Brinjikji
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Bradycardia ,medicine.medical_specialty ,Side effect ,medicine.medical_treatment ,Arteriovenous fistula ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,cardiovascular diseases ,Embolization ,Asystole ,Central Nervous System Vascular Malformations ,business.industry ,Onyx embolization ,General Medicine ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Heart Arrest ,Treatment Outcome ,cardiovascular system ,Polyvinyls ,Neurology (clinical) ,medicine.symptom ,business ,Hemodynamic instability - Abstract
Asystole or bradycardia is a relatively uncommon side effect seen in patients undergoing endovascular embolization using dimethylsulfoxide based liquid embolic agents. We present a case of a patient who underwent dural arteriovenous fistula embolization and experienced bradycardia during Onyx injection but was stabilized and the procedure was completed successfully.
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- 2023
5. Patent Issued for Mobile monitoring and patient management system (USPTO 11931126).
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PATIENT monitoring ,PATENTS ,CARDIAC arrest ,BLOOD pressure ,HEART beat - Abstract
A patent has been issued to ZOLL Medical Corporation for a mobile monitoring and patient management system. The system includes communications circuitry to receive physiological information from therapeutic and monitoring medical devices, as well as a computing device with a user interface to display the information. The therapeutic medical devices can include defibrillators, cardiac pacing devices, and portable ventilators, while the monitoring medical devices can include mobile cardiac monitoring devices, patient weight monitors, and blood pressure monitors. The system allows for customized patient reports based on user selection and access level, and can compile reports using physiological data such as heart rate, ECG data, and patient symptom data. [Extracted from the article]
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- 2024
6. Patent Issued for Plakophilin-2 (PKP2) gene therapy using AAV vector (USPTO 11883506).
- Abstract
Spacecraft Seven LLC has been issued a patent for a gene therapy using an adeno-associated virus (AAV) vector to treat arrhythmogenic right ventricular cardiomyopathy (ARVC), a form of adult-onset heart disease. ARVC is characterized by the breakdown of the muscular wall of the heart over time, leading to an increased risk of abnormal heartbeat and sudden death. The therapy involves administering a recombinant AAV vector containing a polynucleotide sequence encoding the Plakophilin-2 (PKP2) gene, which is associated with ARVC. The vector is administered intravenously, intracoronarily, intracardially, or through cardiac catheterization. The patent provides a potential treatment option for PKP2-related diseases and disorders, addressing an unmet need in the field. [Extracted from the article]
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- 2024
7. Documentation of neurological status in patients admitted to an intensive care unit after cardiac arrest: A 10-year cohort study
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Ross Carne, Robert J. Short-Burchell, Charles F. Corke, Neil Orford, and Matthew J Maiden
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Adult ,medicine.medical_specialty ,Neurology ,business.industry ,Glasgow Coma Scale ,Retrospective cohort study ,Documentation ,Emergency Nursing ,Critical Care Nursing ,Intensive care unit ,Heart Arrest ,law.invention ,Cohort Studies ,Intensive Care Units ,Somatosensory evoked potential ,law ,Anesthesia ,Cohort ,Humans ,Medicine ,Corneal reflex ,business ,Retrospective Studies ,Cohort study - Abstract
Objective The objective of this study was to describe the documented neurological assessment and investigations for neuroprognostication in patients after cardiac arrest. Design, setting, and participants This was a retrospective cohort study of adult patients after cardiac arrest, admitted to a tertiary intensive care unit (ICU), between January 2009 and December 2018. Main outcome measures The main outcome measures were the proportion of patients with a documented Glasgow Coma Scale (GCS) score and investigations for neuroprognostication. Results Four hundred twenty-seven patients formed the study cohort. The GCS score was documented for 267 (63%) patients at some time during their ICU stay. The proportion of patients with the GCS score documented decreased each day of ICU stay (59% at day 1, 20% at day 5). Pupil reflex to light was recorded in 352 (82%), corneal reflex in 155 (36%), and limb reflexes in 216 (51%) patients. Twenty-eight (6.6%) patients underwent brain magnetic resonance imaging, 10 (2.3%) an electroencephalogram, and two somatosensory evoked potentials. Withdrawal of life-sustaining treatments occurred in 166 (39%) patients, and 221 (52%) patients died in hospital. Conclusions In this single-centre study of patients admitted to the ICU after cardiac arrest, the GCS score was inconsistently documented, and investigations for neuroprognostication were infrequent.
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- 2022
8. Cardiac fibroma with cardiac arrest: a rare clinical presentation of Gorlin syndrome in an 8-month-old infant
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James Loker, Mohammad Baidoun, and Mohamed Elgendy
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0301 basic medicine ,medicine.medical_specialty ,Heart Ventricles ,Connective tissue ,Nevoid basal-cell carcinoma syndrome ,Case Report ,Fibroma ,030105 genetics & heredity ,Heart Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Cardiac fibroma ,Internal medicine ,medicine ,Humans ,Family history ,Child ,business.industry ,Infant ,Basal Cell Nevus Syndrome ,General Medicine ,Emergency department ,medicine.disease ,Heart Arrest ,stomatognathic diseases ,medicine.anatomical_structure ,Ventricle ,Cardiology ,Female ,Presentation (obstetrics) ,business ,030217 neurology & neurosurgery - Abstract
Paediatric cardiac tumours are rare, often benign and carry associations with genetic conditions. Cardiac fibromas are mainly composed of fibroblast and connective tissue . They can lead to symptoms due to obstruction of blood flow or arrythmias. In this case, we report an 8-month-old girl child who presented to paediatric cardiology office for cardiac evaluation given a family history of Gorlin syndrome, also known as nevoid basal cell carcinoma syndrome, found to have a large 4×4×6 cm fibroma in the apical lateral free wall of the left ventricle and later presented to the emergency department with cardiac arrest.
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- 2023
9. Functional outcomes following an in-hospital cardiac arrest: A retrospective cohort study
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Emmanuel Saka, Gemma Pound, Zakary Doherty, Jason Fletcher, Michael J. Leach, Laura Panozzo, Kim Fuzzard, Rebecca J. Kippen, and Belinda O'Sullivan
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Adult ,medicine.medical_specialty ,Resuscitation ,Adult patients ,business.industry ,Australia ,Retrospective cohort study ,Emergency Nursing ,Critical Care Nursing ,Cardiopulmonary Resuscitation ,Hospitals ,Heart Arrest ,Cohort Studies ,Modified Rankin Scale ,Emergency medicine ,Cohort ,Equivalent function ,medicine ,Hospital discharge ,Humans ,business ,Aged ,Retrospective Studies ,Cohort study - Abstract
Background/Purpose Whilst much is known about the survival outcomes of patients that suffer an in-hospital cardiac arrest (IHCA) in Australia very little is known about the functional outcomes of survivors. This study aimed to describe the functional outcomes of a cohort of patients that suffered an in-hospital cardiac arrest (IHCA) and survived to hospital discharge in a regional Australian hospital. Methods This is a single-centre retrospective observational cohort study conducted in a regional Australian hospital. All adult patients that had an IHCA in the study hospital between 1 Jan 2017 and 31 Dec 2019 and survived to hospital discharge were included in the study. Functional outcomes were reported using the Modified Rankin Scale (mRS), a six-point scale for which increasing scores represent increasing disability. Scores were assigned through a retrospective review of medical notes. Results Overall, 102 adult patients had an IHCA during the study period, of whom 50 survived to hospital discharge. The median age of survivors was 68 years, and a third had a shockable initial arrest rhythm. Of survivors, 47 were able to be assigned both mRS scores. At discharge, 81% of patients achieved a favourable functional outcome (mRS 0–3 or equivalent function at discharge equal to admission). Conclusions Most survivors to hospital discharge following an IHCA have a favourable functional outcome and are discharged home. Although these results are promising, larger studies across multiple hospitals are required to further inform what is known about functional outcomes in Australian IHCA survivors.
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- 2022
10. Gaps in the Provision of Cognitive and Psychological Resources in Cardiac Arrest Survivors with Good Neurologic Recovery
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Sachin Agarwal, Alex Presciutti, Kelly N. Sawyer, Mary M Newman, and Sarah M. Perman
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Gerontology ,business.industry ,030208 emergency & critical care medicine ,Cognition ,Survey research ,Original Articles ,Critical Care and Intensive Care Medicine ,Heart Arrest ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Hypothermia, Induced ,Survivorship curve ,Quality of Life ,Humans ,Medicine ,Survivors ,business ,030217 neurology & neurosurgery - Abstract
We aimed to elucidate gaps in the provision of cognitive and psychological resources in cardiac arrest survivors. We conducted an online survey study between October 29, 2019, and November 15, 2019 with cardiac arrest survivors and caregiver members of the Sudden Cardiac Arrest Foundation. We queried survivors as to whether they experienced cognitive or psychological symptoms since their cardiac arrest. Next, we queried both survivors and caregivers on the provision of resources through three metrics: (1) discussions with providers about potential cognitive or psychological symptoms, (2) neurologist or psychologist appointments scheduled by providers, and (3) mental health referrals by providers. We then ran Chi-square goodness-of-fit tests to compare the proportion of survivors and caregivers who reported resource provision (observed values) to the proportion of survivors who reported experiencing cognitive and psychological symptoms, respectively (expected values). We included responses from 167 survivors and 52 caregivers. A total of 73.1% (n = 122) survivors reported experiencing cognitive symptoms and 67.1% (n = 112) psychological symptoms since their cardiac arrest. When compared to these two proportions, provision of resources was significantly lower in all three metrics: (1) fewer discussions with providers about potential for developing cognitive symptoms (31%) and psychological symptoms (26.3%), (2) fewer neurologist appointments scheduled (8.4%) and psychologist appointments scheduled (4.8%), and (3) fewer referrals to mental health (6%). Informal caregivers also reported significantly lower provision of resources in all three metrics, with the exception of discussions about developing cognitive symptoms. Our results suggest that there are discrepancies in the provision of cognitive and psychological resources in cardiac arrest survivors with good neurologic recovery. Systematic referral processes may be needed to standardize resource provision to consistently meet the pervasive cognitive and psychological needs of cardiac arrest survivors.
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- 2022
11. Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction in Patients With Current and Historical Cancer: An 18-Year United States Cohort Study
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Gayathri Gurumurthy, Syed Tanveer Rab, Wisit Cheungpasitporn, Saraschandra Vallabhajosyula, Pranathi R Sundaragiri, and Sri Harsha Patlolla
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Adult ,medicine.medical_specialty ,Palliative care ,medicine.medical_treatment ,Myocardial Infarction ,Shock, Cardiogenic ,Cohort Studies ,Percutaneous Coronary Intervention ,Neoplasms ,Internal medicine ,Humans ,Medicine ,Hospital Mortality ,Myocardial infarction ,business.industry ,Percutaneous coronary intervention ,Cancer ,General Medicine ,Odds ratio ,medicine.disease ,Comorbidity ,United States ,Heart Arrest ,Cohort ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
BACKGROUND Data regarding cardiac arrest (CA) complicating acute myocardial infarction (AMI) in patients with cancers are limited. METHODS Using the HCUP-NIS database (2000-2017), we identified adult admissions with AMI-CA and current or historical cancers to evaluate in-hospital mortality, utilization of coronary angiography, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), mechanical circulatory support (MCS), palliative care consultation, do-not-resuscitate status use, among those with current, historical and without cancer. RESULTS Of 11,622,528 AMI admissions, CA was noted in 584,263 (5.0%). Current and historical cancers were identified in 14,790 (2.5%) and 26,939 (4.6%), respectively. Both current and historical cancer groups were on average older, of white race, had greater comorbidity, and received care at small/medium-sized hospitals compared to those without. The current cancer cohort had the lowest rates of coronary angiography (45.2% vs. 59.2% vs. 63.3%), PCI (32.4% vs. 42.3% vs. 47.0%), MCS (13.5% vs. 16.5% vs. 20.9%) and CABG (4.1% vs. 7.6% vs. 10.2%) compared to the historical cancer and no cancer cohorts (all p < 0.001). Compared to those without, the current (61.1% vs. 44.0%; adjusted odds ratio [OR] 1.25 [95% confidence interval {CI} 1.20-1.31], p < 0.001) and historical cancer cohorts (52.2% vs. 44.0%; adjusted OR 1.05 [95% CI 1.01-1.08], p = 0.003) had higher in-hospital mortality. Cancer admissions had higher rates of palliative care consultations and do-not-resuscitate status. CONCLUSION AMI-CA admissions with cancer were older, had lower utilization of cardiac procedures, and higher rates of palliative care and do-not-resuscitate status and in-hospital mortality compared to those without cancer.
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- 2022
12. The proarrhythmic conundrum of alcohol intake
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Evdoxia J Apostolopoulos, Antonis S. Manolis, Theodora A Manolis, Antonis A. Manolis, and Helen Melita
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Male ,medicine.medical_specialty ,Alcohol Drinking ,Heart disease ,Binge drinking ,Alcohol use disorder ,030204 cardiovascular system & hematology ,Alcoholic cardiomyopathy ,Ventricular tachycardia ,Holiday heart syndrome ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,Proarrhythmia ,business.industry ,medicine.disease ,Heart Arrest ,Tachycardia, Ventricular ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
The arrhythmogenic potential of alcohol consumption that leads to cardiac arrhythmia development includes the induction of both atrial and ventricular arrhythmias, with atrial fibrillation (AF) being the commonest alcohol-related arrhythmia, even with low/moderate alcohol consumption. Arrhythmias occur both with acute and chronic alcohol use. The "Holiday Heart Syndrome" relates to the occurrence of AF, most commonly following weekend or public holiday binge drinking; however, other arrhythmias may also occur, including other supraventricular arrhythmias, and occasionally even frequent ventricular premature beats and a rare occurrence of ventricular tachycardia. Arrhythmias in individuals with alcohol use disorder, in addition to AF, may comprise ventricular arrhythmias (VAs) that may be potentially fatal leading to cardiac arrest. The effects of alcohol on triggering VAs appear to be dose-dependent, observed more commonly in heavy drinkers, both in healthy individuals and patients with underlying structural heart disease, including ischemic heart disease and alcoholic cardiomyopathy. Men appear to be affected at higher dosages of alcohol, while women can suffer from arrhythmias at lower dosages. On the other hand, low to moderate consumption of alcohol may confer some protection from serious VAs and cardiac arrest (J- or U-curve phenomenon); however, abstinence is the optimal strategy. These issues as they relate to alcohol-induced proarrhythmia are herein reviewed, with the large studies and meta-analyses tabulated and the arrhythmogenic mechanisms pictorially illustrated.
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- 2022
13. A dynamic risk factor assessment for myocardial infarction and cardiac arrest in patients undergoing pancreatectomy
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Aditya A. Munshi, Gregoris Komodikis, Harish Lavu, Marilena Petrou, and Charles J. Yeo
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medicine.medical_specialty ,Hepatology ,Gastric emptying ,business.industry ,medicine.medical_treatment ,Myocardial Infarction ,Gastroenterology ,Specific risk ,Logistic regression ,medicine.disease ,Risk Assessment ,Heart Arrest ,Pancreatectomy ,Postoperative Complications ,Risk Factors ,Pancreatic fistula ,Internal medicine ,medicine ,Humans ,In patient ,Myocardial infarction ,Risk factor ,business ,Retrospective Studies - Abstract
Background To identify pancreatectomy specific risk factors for myocardial infarction and cardiac arrest (MICA) and to assess whether addition of new information obtained during the hospitalization changes these risk factors. Methods Analysis was performed on elective pancreatectomy data from the ACS-NSQIP database (2014–2019). Risk factors were grouped into pre-operative, intra-operative, and postoperative phases. Factors were selected using a bootstrap resampling procedure to determine MICA association. Independent significance was assessed by logistic regression. Results In the first 30 days post-op, 650 of 39779 patients (1.88%) developed MICA. Some of the surgery specific, intra- and post-operative factors that were identified are: delayed gastric emptying (OR: 2.61; 95% CI: 2.12–3.21), total pancreatectomy (OR: 2.16; 95% CI: 1.29–3.42), pancreatic fistula (OR: 1.54; 95% CI: 1.25–1.90), post-operative transfusion (OR: 1.28; 95% CI: 1.03–1.58), and open approach (OR: 1.36; 95% CI: 1.05–1.77). Adding new variables improved statistical model performance and the c-statistic improved from 0.69 to 0.76 in the final analysis. Conclusion Surgery specific, intra-, and post-operative factors were associated with MICA. Addition of new information during the hospital course changed risk factors and the statistical prediction of MICA risk improved.
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- 2022
14. Definity, echo contrast, induced cardiac arrest: brief review of the literature
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Alward Abdo, Eliezer Bar Meir, Kayleigh Watson, Tanveer Mir, and Mohammed Uddin
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0301 basic medicine ,Male ,medicine.medical_specialty ,Contrast Media ,Case Report ,030105 genetics & heredity ,Induced cardiac arrest ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Rare case ,medicine ,Humans ,Adverse effect ,Endocardium ,Aged ,Fluorocarbons ,business.industry ,General Medicine ,Heart Arrest ,Male patient ,Contrast echocardiography ,Cardiology ,Heart Arrest, Induced ,business ,030217 neurology & neurosurgery - Abstract
Definity is a contrast media used to enhance the endocardium during echocardiography. Cardiac arrest as an adverse reaction to Definity is still a debate. We are presenting a rare case of a 69-year-old male patient who developed cardiopulmonary arrest immediately after Definity injection during resting echocardiography.
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- 2023
15. Pickering syndrome: a rare presentation in emergency department
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Roshan Mathew, Prawal Shrimal, Abhinav Bansal, and Ankit Kumar Sahu
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medicine.medical_specialty ,Adolescent ,Acute pulmonary edema ,Pulmonary Edema ,Case Report ,030204 cardiovascular system & hematology ,Renal artery stenosis ,Renal Artery Obstruction ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Intervention (counseling) ,medicine ,Humans ,Hypertensive emergency ,business.industry ,030208 emergency & critical care medicine ,General Medicine ,Emergency department ,Syndrome ,medicine.disease ,Comorbidity ,Cardiopulmonary Resuscitation ,Heart Arrest ,Heart failure ,Emergency medicine ,Female ,Presentation (obstetrics) ,business ,Emergency Service, Hospital - Abstract
Sympathetic crash acute pulmonary edema (SCAPE) is a life-threatening injury, which requires early recognition and intervention to prevent mortality. We present a case of 18-year-old woman with no previous comorbidity, presenting with SCAPE who was successfully resuscitated and eventually diagnosed with renal artery stenosis. Pickering syndrome is a rare cause of hypertensive emergency and should be considered in a young patient presenting with SCAPE in emergency department.
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- 2023
16. Alert system-supported lay defibrillation and basic life-support for cardiac arrest at home
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Frank Riedijk, Martin Smeekes, Marieke T. Blom, Remy Stieglis, Jolande A. Zijlstra, Rudolph W. Koster, Jan G.P. Tijssen, Wim Van der Worp, Aeilko H. Zwinderman, General practice, ACS - Diabetes & metabolism, APH - Health Behaviors & Chronic Diseases, Graduate School, Cardiology, ACS - Heart failure & arrhythmias, and ACS - Amsterdam Cardiovascular Sciences
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Emergency Medical Services ,medicine.medical_specialty ,Defibrillation ,Automated external defibrillator ,medicine.medical_treatment ,Electric Countershock ,Volunteer responder ,medicine ,Humans ,Cardiopulmonary resuscitation ,Ventricular fibrillation ,Volunteer ,Alert system ,business.industry ,Dispatch ,Basic life support ,Heart arrest ,medicine.disease ,Relative risk ,Emergency medicine ,Cardiology and Cardiovascular Medicine ,business ,Out-of-Hospital Cardiac Arrest ,Defibrillators - Abstract
Aims Automated external defibrillators (AEDs) are placed in public, but the majority of out-of-hospital cardiac arrests (OHCA) occur at home. Methods and results In residential areas, 785 AEDs were placed and 5735 volunteer responders were recruited. For suspected OHCA, dispatchers activated nearby volunteer responders with text messages, directing two-thirds to an AED first and one-third directly to the patient. We analysed survival (primary outcome) and neurologically favourable survival to discharge, time to first defibrillation shock, and cardiopulmonary resuscitation (CPR) before Emergency Medical Service (EMS) arrival of patients in residences found with ventricular fibrillation (VF), before and after introduction of this text-message alert system. Survival from OHCAs in residences increased from 26% to 39% {adjusted relative risk (RR) 1.5 [95% confidence interval (CI): 1.03–2.0]}. RR for neurologically favourable survival was 1.4 (95% CI: 0.99–2.0). No CPR before ambulance arrival decreased from 22% to 9% (RR: 0.5, 95% CI: 0.3–0.7). Text-message-responders with AED administered shocks to 16% of all patients in VF in residences, while defibrillation by EMS decreased from 73% to 39% in residences (P < 0.001). Defibrillation by first responders in residences increased from 22 to 40% (P < 0.001). Use of public AEDs in residences remained unchanged (6% and 5%) (P = 0.81). Time from emergency call to defibrillation decreased from median 11.7 to 9.3 min; mean difference –2.6 (95% CI: –3.5 to –1.6). Conclusion Introducing volunteer responders directed to AEDs, dispatched by text-message was associated with significantly reduced time to first defibrillation, increased bystander CPR and increased overall survival for OHCA patients in residences found with VF. Key Question The Emergency Medical Service introduced a text-message alert system to alert volunteers close to an out-of-hospital cardiac arrest patient. In addition, 785 automated external defibrillators (AEDs) were added and made available in the community. Does adding this system result in more basic life support (BLS), earlier defibrillation, and better survival? Key Finding We found that BLS increased from 78% to 91%, the time from emergency call to the first defibrillation shock decreased by 2.6 min and survival for patients at home, and found in ventricular fibrillation, increased from 26% to 39%. Take Home Message For patients with a cardiac arrest at home, an alert system that includes nearby volunteers activated by the ambulance dispatch centre and many easily accessible AEDs really saves lives. Implementation is an effective community effort.
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- 2022
17. Causes of death among dengue patients causes of death among hospitalized adults with dengue fever in Tainan, 2015: Emphasis on cardiac events and bacterial infections
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Jen Chieh Lee, Cong Tat Cia, Wen Chien Ko, Nai Ying Ko, Nan Yao Lee, and Po Lin Chen
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Adult ,0301 basic medicine ,Microbiology (medical) ,Pediatrics ,medicine.medical_specialty ,Secondary infection ,030106 microbiology ,Dengue fever ,Dengue ,03 medical and health sciences ,0302 clinical medicine ,Cause of Death ,Case fatality rate ,medicine ,Humans ,Immunology and Allergy ,Viral rna ,Severe Dengue ,030212 general & internal medicine ,Aged ,Retrospective Studies ,General Immunology and Microbiology ,Coinfection ,business.industry ,Retrospective cohort study ,Bacterial Infections ,General Medicine ,Emergency department ,medicine.disease ,Heart Arrest ,Hospitalization ,Pneumonia ,Infectious Diseases ,Health education ,business - Abstract
Introduction The 2015 dengue outbreak in southern Taiwan caused substantial mortality. We analyzed the causes of death among these patients. Materials and methods This retrospective study was conducted at a medical center in Tainan from August 2015 to December 2015. Dengue was diagnosed based on the detection of serum dengue NS1 antigen, IgM, or viral RNA in the blood. Causes of death were retrieved from chart reviews by three clinicians. Results There were 4488 cases of dengue in the study hospital, with an in-hospital fatality rate of 1.3% (60 cases). The mean age of the 60 fatal cases was 73 years, among whom 90% were aged ≥65 years. Twenty-eight (46.7%) patients died of severe dengue, and 29 (48.3%) deaths were possibly related to dengue. Of the latter, 24 (40%) died of secondary infections. Thirteen cardiac arrest events, including out-of-hospital (5 events) and in-hospital (8) cardiac arrests in the emergency department, occurred during the dengue epidemic. Seven (53.8%) patients did not receive medical aid before the event. Of the 40 deaths that occurred within one week after hospitalization, 60% died of severe dengue. In contrast, 50% of 20 deaths that occurred one week after hospitalization were related to hospital-acquired infections, mainly pneumonia. Conclusion Of 60 fatal cases, with a predominance of elderly patients, deaths were related to severe dengue within the first week after admission and secondary infections thereafter. The absence of medical care before cardiac arrest events highlights the importance of health education for warning signs of dengue.
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- 2022
18. Laypersons’ Psychological Barriers Against Rescue Actions in Emergency Situations ― A Questionnaire Survey ―
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Tomonari Shimamoto, Taku Iwami, Satoe Okabayashi, Yosuke Yamamoto, Chika Nishiyama, Haruka Shida, Tetsuya Sakamoto, and Takashi Kawamura
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Emergency Medical Services ,Out-of-hospital cardiac arrest ,Inclusion (disability rights) ,business.industry ,medicine.medical_treatment ,Questionnaire ,General Medicine ,Odds ratio ,medicine.disease ,Psychological barriers ,Emergency situations ,Cardiopulmonary Resuscitation ,Confidence interval ,Heart Arrest ,Questionnaire survey ,Primary outcome ,Surveys and Questionnaires ,Humans ,Medicine ,Rescue actions ,Cardiopulmonary resuscitation ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND: Although bystanders' performance is important to improve outcomes of patients after cardiac arrests, few studies have investigated the barriers of bystanders, including those who could not perform cardiopulmonary resuscitation or any other rescue actions in emergency situations. This study aimed to assess the relationship between the psychological barriers of laypersons who encountered emergency situations and their rescue actions.Methods and Results:A questionnaire survey was conducted and this included laypersons who had encountered emergency situations during the last 5 years. Six questions were about the psychological barriers and 8 questions were about the laypersons' rescue actions. The primary outcome was any rescue actions performed by laypersons in an actual emergency situation. Overall, 7, 827 (92.8%) of 8, 430 laypersons responded; of them, 1, 361 (16.1%) had encountered emergency situations during the last 5 years, and 1, 220 (14.5%) were eligible for inclusion in the analyses. Of the 6 psychological barriers, "fear of approaching a collapsed person" (adjusted odds ratio [AOR] 0.50; 95% confidence interval [95% CI] 0.32-0.79) and "difficulties in judging whether to perform any rescue action" (AOR 0.63; 95% CI 0.40-0.99) were significantly associated with performing any rescue actions. CONCLUSIONS: The fear of approaching a collapsed person and difficulties in judging whether to take any actions were identified as the psychological barriers in performing any rescue actions by laypersons who encountered emergency situations.
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- 2022
19. Serum levels of the cold stress hormones FGF21 and GDF-15 after cardiac arrest in infants and children enrolled in single center therapeutic hypothermia clinical trials
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Keri Janesko-Feldman, Robert S. B. Clark, Rachel P. Berger, Jeremy R. Herrmann, Patrick M. Kochanek, Alicia K. Au, Travis C. Jackson, Ericka L. Fink, and Anthony Fabio
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medicine.medical_specialty ,Growth Differentiation Factor 15 ,FGF21 ,Emergency Nursing ,Single Center ,Gastroenterology ,Article ,Hypothermia, Induced ,Internal medicine ,Intensive care ,medicine ,Humans ,Child ,Cold stress ,Clinical Trials as Topic ,business.industry ,Cold-Shock Response ,Infant ,Hypothermia ,Serum samples ,Hormones ,Heart Arrest ,Fibroblast Growth Factors ,Clinical trial ,Emergency Medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Hormone - Abstract
OBJECTIVE: Fibroblast Growth Factor 21 (FGF21) and Growth Differentiation Factor-15 (GDF-15) are putative neuroprotective cold stress hormones (CSHs) provoked by cold exposure that may be age-dependent. We sought to characterize serum FGF21 and GDF-15 levels in pediatric cardiac arrest (CA) patients and their association with use of therapeutic hypothermia (TH). METHODS: Secondary analysis of serum samples from clinical trials. We measured FGF21 and GDF-15 levels in pediatric patients post-CA and compared levels to both pediatric intensive care (PICU) and healthy controls. Post-CA, we compared normothermia (NT) vs TH (33°C for 72h) treated cohorts at
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- 2022
20. Activation of the kynurenine pathway predicts mortality and neurological outcome in cardiac arrest patients: A validation study
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Hans Pargger, Sebastian Gross, Philipp Schuetz, Kai Tisljar, Simon A. Amacher, Peter Neyer, Alessia Vincent, Sabina Hunziker, Katharina Beck, Nina Loretz, Seraina Hochstrasser, Raoul Sutter, Stephan Marsch, Jonas Mueller, Luca Bernasconi, Christoph Becker, and Kerstin Metzger
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Oncology ,medicine.medical_specialty ,Validation study ,Future studies ,Kynurenine pathway ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Cohort Studies ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,medicine ,Hospital discharge ,Humans ,Hospital Mortality ,Kynurenine ,business.industry ,Tryptophan ,Heart Arrest ,3. Good health ,chemistry ,Cohort ,business ,030217 neurology & neurosurgery - Abstract
Activation of the kynurenine pathway (KP) has been shown to predict outcome in cardiac arrest (CA) patients. We validated these findings in a Swiss cohort.We measured admission tryptophan and kynurenine levels in 270 consecutive CA patients (38 in-hospital CA) and investigated associations with in-hospital mortality and neurological outcome at hospital discharge.120 of 270 (44%) patients died in the hospital. Compared to survivors, non-survivors showed higher median initial kynurenine levels (5.28 μmol/l [IQR 2.91 to 7.40] vs 3.58 μmol/l [IQR 2.47 to 5.46]; p 0.001) and a higher median kynurenine/tryptophan ratio (0.10 μmol/l [IQR 0.07 to 0.17] vs 0.07 μmol/l [IQR 0.05 to 0.1]; p 0.001). In a model adjusted for age, gender and comorbidities, kynurenine (OR 1.16, 95% CI 1.05 to 1.27; p = 0.001) and kynurenine/tryptophan ratio (OR 1.19, 95% CI 1.08 to 1.31; p = 0.003) were significantly associated with mortality. Results were similar for neurological outcome.Our findings validate a previous study and show associations of the activation of the KP with unfavorable outcomes after CA. Future studies should evaluate whether therapeutic modulation of the KP may impact clinical outcomes after CA.
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- 2022
21. Predicting the survivals and favorable neurologic outcomes after targeted temperature management by artificial neural networks
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Cheng-Hsueh Wu, Yu-san Chien, Hung Wen Chiu, Lung Chan, Chen-Chih Chung, Chien-Hua Huang, Chih Hsin Hsu, Wei-Ting Chiu, and Chen-Hsu Wang
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Artificial neural network ,Medicine (General) ,medicine.medical_specialty ,medicine.medical_treatment ,Targeted temperature management ,Percutaneous Coronary Intervention ,R5-920 ,Hypothermia, Induced ,Internal medicine ,medicine ,Humans ,Cardiopulmonary resuscitation ,Stroke ,Outcome ,Receiver operating characteristic ,business.industry ,Percutaneous coronary intervention ,General Medicine ,Cardiac arrest ,medicine.disease ,Cardiopulmonary Resuscitation ,Heart Arrest ,Blood pressure ,Heart failure ,Conventional PCI ,Cardiology ,Neural Networks, Computer ,Prediction ,business ,Out-of-Hospital Cardiac Arrest - Abstract
Background To identify the outcome-associated predictors and develop predictive models for patients receiving targeted temperature management (TTM) by artificial neural network (ANN). Methods The derived cohort consisted of 580 patients with cardiac arrest and ROSC treated with TTM between January 2014 and August 2019. We evaluated the predictive value of parameters associated with survival and favorable neurologic outcome. ANN were applied for developing outcome prediction models. The generalizability of the models was assessed through 5-fold cross-validation. The performance of the models was assessed according to the accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Results The parameters associated with survival were age, duration of cardiopulmonary resuscitation, history of diabetes mellitus (DM), heart failure, end-stage renal disease (ESRD), systolic blood pressure (BP), diastolic BP, body temperature, motor response after ROSC, emergent coronary angiography or percutaneous coronary intervention (PCI), and the cooling methods. The parameters associated with the favorable neurologic outcomes were age, sex, DM, chronic obstructive pulmonary disease, ESRD, stroke, pre-arrest cerebral-performance category, BP, body temperature, motor response after ROSC, emergent coronary angiography or PCI, and cooling methods. After adequate training, ANN Model 1 to predict survival achieved an AUC of 0.80. Accuracy, sensitivity, and specificity were 75.9%, 71.6%, and 79.3%, respectively. ANN Model 4 to predict the favorable neurologic outcome achieved an AUC of 0.87, with accuracy, sensitivity, and specificity of 86.7%, 77.7%, and 88.0%, respectively. Conclusions The ANN-based models achieved good performance to predict the survival and favorable neurologic outcomes after TTM. The models proposed have clinical value to assist in decision-making.
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- 2022
22. Atypical Antipsychotic Safety in the CICU
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Amrish Deshmukh, Scott W. Ketcham, Hallie C. Prescott, Sarah Adie, Michael P. Thomas, Matthew C. Konerman, Ahmad A. Abdul-Aziz, Keerthi Gondi, and Matthew P. Hanna
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Male ,Olanzapine ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Shock, Cardiogenic ,Atypical antipsychotic ,Ventricular tachycardia ,Quetiapine Fumarate ,Internal medicine ,Intensive care ,Humans ,Medicine ,cardiovascular diseases ,Antipsychotic ,Adverse effect ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Failure ,Endocarditis ,business.industry ,Coronary Care Units ,Delirium ,Arrhythmias, Cardiac ,Length of Stay ,Middle Aged ,medicine.disease ,Heart Arrest ,Long QT Syndrome ,Emergency medicine ,Tachycardia, Ventricular ,cardiovascular system ,Cardiology ,ST Elevation Myocardial Infarction ,Quetiapine ,Female ,Hypotension ,medicine.symptom ,Respiratory Insufficiency ,Cardiology and Cardiovascular Medicine ,business ,Antipsychotic Agents ,medicine.drug - Abstract
Atypical antipsychotics are used in cardiac intensive care units (CICU) to treat delirium despite limited data on safety in patients with acute cardiovascular conditions. Patients treated with these agents may be at higher risk for adverse events such as QTc prolongation and arrhythmias. We performed a retrospective cohort study of 144 adult patients who were not receiving antipsychotics before admission and received olanzapine (n = 50) or quetiapine (n = 94) in the Michigan Medicine CICU. Data on baseline characteristics, antipsychotic dose and duration, length of stay, and adverse events were collected. Adverse events included ventricular tachycardia (sustained ventricular tachycardia attributed to the medication), hypotension (systolic blood pressure90 mm Hg attributed to the medication), and QTc prolongation (QTc increase by ≥60 ms or to an interval ≥500 ms). Twenty-six patients (18%) experienced an adverse event. Of those adverse events, 20 patients (14%) experienced QTc prolongation, 3 patients (2%) had ventricular tachycardia, and 3 patients (2%) had hypotension. Patients who received quetiapine had a higher rate of adverse events (25% vs 6%, p = 0.01) including QTc prolongation (18% vs 6%, p = 0.046). Intensive care unit length of stay was shorter in patients who received olanzapine (6.5 vs 9.5 days, p = 0.047). Eighteen patients (13%) had their antipsychotic continued at discharge from the hospital. In conclusion, QTc prolongation was more common in patients treated with quetiapine versus olanzapine although the number of events was relatively low with both agents in a CICU cohort.
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- 2022
23. In-depth assessment of health-related quality of life after in-hospital cardiac arrest
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Sanne E. Hoeks, B. van den Bogaard, A.H.M. Knook, Robert Jan Stolker, T. van Melsen, Evert-Jan Wils, R. J. G. Peters, M. Schluep, Chris Hukshorn, Michiel J. Blans, Koen S. Simons, Henrik Endeman, C. Kuijs, B.J.M. van der Meer, G. Spijkers, A.W.M.M. Koopman Van Gemert, J.W. Vermeijden, B.Y. Gravesteijn, Anesthesiology, and Intensive Care
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Adult ,Male ,medicine.medical_specialty ,Population ,Critical Care and Intensive Care Medicine ,Quality of life ,SDG 3 - Good Health and Well-being ,Surveys and Questionnaires ,medicine ,Humans ,Prospective Studies ,Survivors ,education ,Prospective cohort study ,Health related quality of life ,education.field_of_study ,business.industry ,Psychological distress ,humanities ,Hospitals ,Heart Arrest ,Index score ,Functional independence ,Physical therapy ,Quality of Life ,Functional status ,business - Abstract
Introduction Evidence on physical and psychological well-being of in-hospital cardiac arrest (IHCA) survivors is scarce. The aim of this study is to describe long-term health-related quality of life (HRQoL), functional independence and psychological distress 3 and 12 months post-IHCA. Methods A multicenter prospective cohort study in 25 hospitals between January 2017 – May 2018. Adult IHCA survivors were included. HRQoL (EQ-5D-5L, SF-12), psychological distress (HADS, CSI) and functional independence (mRS) were assessed at 3 and 12 months post-IHCA. Results At 3-month follow-up 136 of 212 survivors responded to the questionnaire and at 12 months 110 of 198 responded. The median (IQR) EQ-utility Index score was 0.77 (0.65–0.87) at 3 months and 0.81 (0.70–0.91) at 12 months. At 3 months, patients reported a median SF-12 (IQR) physical component scale (PCS) of 38.9 (32.8–46.5) and mental component scale (MCS) of 43.5 (34.0–39.7) and at 12 months a PCS of 43.1 (34.6–52.3) and MCS 46.9 (38.5–54.5). Discussion Using various tools most IHCA survivors report an acceptable HRQoL and a substantial part experiences lower HRQoL compared to population norms. Our data suggest that younger (male) patients and those with poor functional status prior to admission are at highest risk of impaired HRQoL.
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- 2022
24. Efficacy of Glucocorticoid Administration in Patients with Cardiac Arrest: A Systematic Review of Clinical Studies
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Arezoo Ahmadi, Amin Salehi-Abargouei, Hamidreza Sharifnia, Fatemeh Saghafi, Mojtaba Mojtahedzadeh, Atabak Najafi, Farhad Najmeddin, Shahideh Amini, and Adeleh Sahebnasagh
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Hemodynamics ,Return of spontaneous circulation ,Biochemistry ,Adrenal Cortex Hormones ,Internal medicine ,Drug Discovery ,Adrenal insufficiency ,Humans ,Medicine ,Cardiopulmonary resuscitation ,Glucocorticoids ,Pharmacology ,business.industry ,Organic Chemistry ,medicine.disease ,Cardiopulmonary Resuscitation ,Heart Arrest ,Hospitalization ,Clinical trial ,Molecular Medicine ,Observational study ,business ,Glucocorticoid ,medicine.drug ,Cohort study - Abstract
Background: The pathophysiology of cardiac arrest (CA) involves over-activation of systemic inflammatory responses, relative adrenal insufficiency, and glycocalyx damage. Corticosteroids have beneficial effects in preventing the perturbation of the endothelial glycocalyx. Objectives: The aim of this systematic review was to determine the efficacy of glucocorticoids in patients with cardiac arrest. Methods: We searched PubMed, Scopus, ISI Web of Science, Google Scholar, and Cochrane central register for relevant clinical trials and cohort studies until September 2019. Results: We retrieved 7 peer-reviewed published studies for the systematic review. Two studies were clinical trials evaluating 147 patients, while five illustrated cohort design, evaluating 196,192 patients. In total, 196,339 patients were assessed. There was limited evidence and conflicting results to establish a correlation between glucocorticoids and the survival of patients suffering from cardiac arrest. However, the links between these medications and survival-to-admission, survival-to discharge, and 1-year survival rates were strong and consistent in observational studies. Conclusion: The clinical evidence regarding the efficacy and safety of glucocorticoids in CA is limited to observational studies with inconsistent methodology and few clinical trials with a small sample size. Nevertheless, it seems that glucocorticoid supplementation during and after cardiopulmonary resuscitation (CPR) may have beneficial effects in terms of survival-to-admission, survival to discharge, 1-year survival rates, and an improved return of spontaneous circulation (ROSC) rate, especially in patients with hemodynamic instability and cardiovascular diseases (i.e., refractory hemodynamic shock). Future studies with high-quality, large-scale, long-term intervention and precise baseline characteristics are needed to evaluate the exact effective dose, duration, and efficacy of glucocorticoids in CA.
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- 2022
25. Prevalence and related factors of do-not-resuscitate orders among in-hospital cardiac arrest patients
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Chunyi Wang, Kai Cheng, Chuanbao Li, Yanyan Ma, Feng Xu, Tangxing Jiang, Yuguo Chen, and Jiaqi Zheng
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Do Not Resuscitate Order ,Critical Care and Intensive Care Medicine ,Logistic regression ,Tertiary Care Centers ,Coronary artery disease ,Internal medicine ,Prevalence ,Humans ,Medicine ,health care economics and organizations ,Resuscitation Orders ,Retrospective Studies ,Related factors ,business.industry ,DNR orders ,Medical record ,Do not resuscitate ,medicine.disease ,Comorbidity ,humanities ,Heart Arrest ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose Studies concerning do-not-resuscitate (DNR) orders in mainland China are rather scarce. We explored the prevalence and related factors of DNR orders among in-hospital cardiac arrest (IHCA) patients at a general tertiary hospital in mainland China. Materials and Methods We identified all IHCA patients hospital-wide between July 2019 and September 2020. Data regarding DNR status were collected from medical records. We investigated the frequency of DNR orders and explored the determinant factors of DNR establishment using logistic regression. Results A total of 1154 IHCA patients were included, 535 (46.4%) of whom established DNR orders. The following variables were independently associated with a higher DNR rate: female (OR 1.491; 95% CI 1.130–1.965), older age (OR 1.016; 95% CI 1.008–1.024), being a local resident (OR 1.790; 95% CI 1.344–2.383), pulmonary infection (OR 1.398; 95% CI 1052–1.859), respiratory insufficiency (OR 1.356; 95% CI 1.009–1.823), shock (OR 1.735; 95% CI 1.301–2.313), acute stroke (OR 1.821; 95% CI 1.235–2.686),neurological dysfunction (OR 1.527; 95% CI 1.149–2.028) and cancer (OR 3.316; 95% CI 2.461–4.468). Counterintuitively, patients with new-onset coronary artery disease (OR 0.592; 95% CI 0.419–0.837) were less likely to create DNR orders. Conclusion In mainland China, the DNR order signing rate is low, and the establishment of a DNR order is associated with demographics and comorbidity characteristics.
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- 2022
26. Emergency preservation and resuscitation for cardiac arrest from trauma
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Samuel A. Tisherman
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Resuscitation ,Time Factors ,General Biochemistry, Genetics and Molecular Biology ,law.invention ,History and Philosophy of Science ,Hypothermia, Induced ,law ,Hospital discharge ,Cardiopulmonary bypass ,Animals ,Humans ,Medicine ,Cardiopulmonary Bypass ,business.industry ,General Neuroscience ,Hypothermia ,medicine.disease ,Heart Arrest ,Clinical trial ,Hemostasis ,Anesthesia ,Circulatory system ,medicine.symptom ,business ,Penetrating trauma - Abstract
Patients who suffer a cardiac arrest from trauma rarely survive. Surgical control of hemorrhage cannot be obtained in time to prevent irreversible organ damage. Emergency preservation and resuscitation (EPR) was developed to utilize hypothermia to buy time to achieve hemostasis and allow delayed resuscitation. Large animal studies have demonstrated that cooling to tympanic membrane temperature 10 °C during exsanguination cardiac arrest can allow up to 2 h of circulatory arrest and repair of simulated injuries with normal neurologic recovery. The Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT) trial is testing the feasibility and safety of initiating EPR. Study subjects include patients with penetrating trauma who lose a pulse within 5 minutes of hospital arrival and remain pulseless despite standard care. EPR is initiated via an intra-aortic flush of ice-cold saline solution. Following hemostasis, delayed resuscitation and rewarming are accomplished with cardiopulmonary bypass. The primary outcome is survival to hospital discharge without significant neurologic deficits. If trained team members are available, subjects can undergo EPR. If not, subjects can be enrolled as concurrent controls. Ten EPR and 10 control subjects will be enrolled. If successful, EPR could save the lives of trauma patients who are currently dying from exsanguinating hemorrhage.
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- 2021
27. Comparison of Circadian Variation for In-Hospital Versus Out-of-Hospital Sudden Cardiac Arrest Survivors
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Aditya Bhonsale, Samir Saba, Yicheng Tang, Sandeep Jain, Nathan Anthony Mark Estes, Tarryn Tertulien, and Krishna Kancharla
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Male ,medicine.medical_specialty ,Patient demographics ,Comorbidity ,Ventricular Flutter ,Age Distribution ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,In patient ,Survivors ,Circadian rhythm ,Renal Insufficiency, Chronic ,Aged ,Out of hospital ,business.industry ,Sudden cardiac arrest ,Length of Stay ,Middle Aged ,Circadian Rhythm ,Heart Arrest ,Large cohort ,Death, Sudden, Cardiac ,Ventricular Fibrillation ,Tachycardia, Ventricular ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Out-of-Hospital Cardiac Arrest - Abstract
Several studies have reported circadian periodicity of sudden cardiac arrest (SCA). It remains unclear to what extent this circadian rhythm is influenced by variation in patients' activities. One way to elucidate this is to compare patients with out-of-hospital cardiac arrests (OHCAs) with those with in-hospital cardiac arrests (IHCAs). We therefore examined the presence of a circadian pattern of SCA in a large cohort of OHCA and IHCA survivors. A total of 1,433 consecutive survivors of SCA in the Pittsburgh area from 2002 to 2012 were included. Patient demographics, including clinical histories and details of SCA, were collected. The distribution of SCA throughout the day was tested for differences using the chi-square test. Of the 1,224 patients analyzed, 706 had IHCA and 518 OHCA. We observed a nadir of SCA in the nighttime hours between 12 a.m. and 6 a.m. in both IHCA and OHCA groups (p0.001), although this pattern was more blunted in the IHCA group. Patients who had an SCA in the nighttime window had more co-morbidities (p = 0.01). The circadian pattern was noted to be absent in patients with higher co-morbidity burden in IHCA only. In conclusion, the typical pattern of nighttime nadir in SCA is observed in patients with both OHCA and IHCA but is blunted in the hospital and especially in sicker patients. This suggests a common mechanistic pathway of SCA transcending differences in physical activities of patients and a difference in how co-morbidities interact with the timing of SCA in the inpatient setting.
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- 2021
28. Predicting neurological outcome in comatose patients after cardiac arrest with multiscale deep neural networks
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Jimeng Sun, Susan T. Herman, Wei-Long Zheng, M. Brandon Westover, Mohammad M. Ghassemi, Jong Woo Lee, Adithya Sivaraju, Jin Jing, Jeannette Hofmeijer, Barry J. Ruijter, Michel J.A.M. van Putten, Wendong Ge, Marleen C. Tjepkema-Cloostermans, Shenda Hong, Ona Wu, Nicolas Gaspard, Trudy Pang, Edilberto Amorim, Clinical Neurophysiology, and TechMed Centre
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medicine.medical_specialty ,Emergency Nursing ,Electroencephalography ,Convolutional neural network ,Article ,Internal medicine ,Machine learning ,Medicine ,Humans ,Prospective Studies ,EEG ,Coma ,Artificial neural network ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Deep learning ,Prognosis ,Cardiac arrest ,Confidence interval ,Heart Arrest ,Neurological outcome ,Recurrent neural network ,Emergency Medicine ,Cardiology ,Artificial intelligence ,Neural Networks, Computer ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective Electroencephalography (EEG) is an important tool for neurological outcome prediction after cardiac arrest. However, the complexity of continuous EEG data limits timely and accurate interpretation by clinicians. We develop a deep neural network (DNN) model to leverage complex EEG trends for early and accurate assessment of cardiac arrest coma recovery likelihood. Methods We developed a multiscale DNN combining convolutional neural networks (CNN) and recurrent neural networks (long short-term memory [LSTM]) using EEG and demographic information (age, gender, shockable rhythm) from a multicenter cohort of 1,038 cardiac arrest patients. The CNN learns EEG feature representations while the multiscale LSTM captures short-term and long-term EEG dynamics on multiple time scales. Poor outcome is defined as a Cerebral Performance Category (CPC) score of 3-5 and good outcome as CPC score 1-2 at 3-6 months after cardiac arrest. Performance is evaluated using area under the receiver operating characteristic curve (AUC) and calibration error. Results Model performance increased with EEG duration, with AUC increasing from 0.83 (95% Confidence Interval [CI] 0.79-0.87 at 12h to 0.91 (95%CI 0.88-0.93) at 66h. Sensitivity of good and poor outcome prediction was 77% and 75% at a specificity of 90%, respectively. Sensitivity of poor outcome was 50% at a specificity of 99%. Predicted probability was well matched to the observation frequency of poor outcomes, with a calibration error of 0.11 [0.09-0.14]. Conclusions These results demonstrate that incorporating EEG evolution over time improves the accuracy of neurologic outcome prediction for patients with coma after cardiac arrest.
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- 2021
29. Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: an Expert Consensus Statement From the Society of Cardiovascular Anesthesiologists—Part I, Technical Aspects of Extracorporeal Membrane Oxygenation
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Jeffrey M. Dodd-o, Mabel Chung, Vidya K. Rao, Rebecca M. Bauer, Jose Mauricio Del Rio, Joseph S. Meltzer, Jacob T. Gutsche, James Ramsay, Antonio Hernandez, Amit Bardia, Michael A. Mazzeffi, Raymond Rector, and Sree Satyapriya
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Adult ,medicine.medical_specialty ,Intraoperative Care ,Consensus ,Adult patients ,business.industry ,Patient Selection ,medicine.medical_treatment ,Expert consensus ,Heart Arrest ,Anesthesiologists ,Extracorporeal Membrane Oxygenation ,surgical procedures, operative ,Anesthesiology and Pain Medicine ,Intraoperative management ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Abstract
Extracorporeal membrane oxygenation (ECMO) is used to support patients with refractory cardiopulmonary failure. Given ECMO's increased use in adults and the fact that many ECMO patients are cared for by anesthesiologists, the Society of Cardiovascular Anesthesiologists ECMO working group created an expert consensus statement that is intended to help anesthesiologists manage adult ECMO patients who are cared for in the operating room. In the first part of this 2-part series, technical aspects of ECMO are discussed, and related expert consensus statements are provided.
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- 2021
30. Hypertonic versus isotonic crystalloid infusion for cerebral perfusion pressure in a porcine experimental cardiac arrest model
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Young Sun Ro, Jeong Ho Park, Hyoukjae Lim, Hyun Jeong Kang, Ki Jeong Hong, Kyoung Jun Song, Joo Jeong, Tae Han Kim, Ki Hong Kim, and Sang Do Shin
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Mean arterial pressure ,Swine ,medicine.medical_treatment ,Hypertonic Solutions ,medicine ,Animals ,Cardiopulmonary resuscitation ,Cerebral perfusion pressure ,Intracranial pressure ,business.industry ,CEPP ,Crystalloid Solutions ,General Medicine ,medicine.disease ,Cardiopulmonary Resuscitation ,Heart Arrest ,Disease Models, Animal ,Epinephrine ,Cerebrovascular Circulation ,Anesthesia ,Ventricular fibrillation ,Emergency Medicine ,Tonicity ,Female ,Isotonic Solutions ,business ,medicine.drug - Abstract
Background The effect of intravenous (IV) fluid administration type on cerebral perfusion pressure (CePP) during cardiopulmonary resuscitation (CPR) is controversial. The purpose of this study was to evaluate the association between IV fluid type and CePP in a porcine cardiac arrest model. Methods We randomly assigned 12 pigs to the hypertonic crystalloid, isotonic crystalloid and no-fluid groups. After 4 min of untreated ventricular fibrillation (VF), chest compression was conducted for 2 cycles (CC only). Chest compression with IV fluid infusion (CC + IV) was followed for 2 cycles. Advanced life support, including defibrillation and epinephrine, was added for 8 cycles (ALS phase). Mean arterial pressure (MAP), intracranial pressure (ICP) and CePP were measured. A paired t-test was used to measure the mean difference in CePP. Results Twelve pigs underwent the experiment. The hypertonic crystalloid group showed higher CePP values than those demonstrated by the isotonic crystalloid group from ALS cycles 2 to 8. The MAP values in the hypertonic group were higher than those in the isotonic group starting at ALS cycle 2. The ICP values in the hypertonic group were lower than those in the isotonic group starting at ALS cycle 4. From ALS cycles 2 to 8, the reduction in the mean difference in the isotonic group was larger than that in the other groups. Conclusion In a VF cardiac arrest porcine study, the hypertonic crystalloid group showed higher CePP values by maintaining higher MAP values and lower ICP values than those of the isotonic crystalloid group.
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- 2021
31. Risk factors and outcomes for recurrent paediatric in-hospital cardiac arrest: Retrospective multicenter cohort study
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Kaitlin Jones, Heather Griffis, Tensing Maa, Javier J. Lasa, Vinay M. Nadkarni, Richard Hanna, Aaron Donoghue, Dana Niles, Robert M. Sutton, Sandeep Gangadharan, Tara L. Petersen, Anita Sen, Takanari Ikeyama, Elizabeth Masse, Diane Atkins, Lynda Knight, Ken Tegtmeyer, Wendy L Van Ittersum, Corinne M. P. Buysse, Kamal Abulebda, Michael R. Flaherty, Jonathan Gilleland, Matthew S. Braga, Andrea Xin Hui Yeo, Jesse Wenger, Stephanie R. Brown, Jennifer Hayes, Orsola Gawronski, Gabry de Jong, Corrado Cecchetti, Joan Roberts, Michael T. Meyer, Heather Wolfe, Stuart Friess, Helen Harvey, Lindsay Ryerson, Alexis A. Topjian, Pricilla Yu, Gene Ong, Priti Jani, Yee Hui Mok, Kelly Corbett, Tia T Raymond, Marc D. Berg, Tara Lemoine, Maria E. Frazier, Dori-Ann Martin, Dana E. Niles, Robert A. Berg, Marcy N. Singleton, Sholeen Nett, Andrea Christoff, Shilpa Balikai, Ryan W. Morgan, Maya Dewan, Kasper G Lauridsen, Denise Welsby, Betsy Hunt, Ichiro Watanabe, Ilana Harwayne-Gidansky, Felice Su, Allan DeCaen, Sophie Skellet, Prakad Rajapreyar, Hiroshi Kurosawa, Jordan Duval-Arnould, Todd Sweberg, Amanda O’Halloran, Daniel Stromberg, Sarah Haskell, Michelle Olson, Javier Urbano Villaescusa, Luz Marina Mejia, Adam Cheng, Jimena del Castillo, Monica E. Kleinman, Ivie Esangbedo, Kiran Heber, Oscar Tegg, Utpal Bhalala, and Pediatric Surgery
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Adult ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Emergency Nursing ,Cohort Studies ,Continuous variable ,Risk Factors ,Interquartile range ,Internal medicine ,Chi-square test ,Humans ,Medicine ,Cardiopulmonary resuscitation ,Child ,Retrospective Studies ,business.industry ,Retrospective cohort study ,Hospitals, Pediatric ,Cardiopulmonary Resuscitation ,Heart Arrest ,Cohort ,Propensity score matching ,Emergency Medicine ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Aim of study: Recurrent in-hospital cardiac arrest (IHCA) is associated with morbidity and mortality in adults. We aimed to describe the risk factors and outcomes for paediatric recurrent IHCA. Methods: Retrospective cohort study of patients ≤18 years old with single or recurrent IHCA. Recurrent IHCA was defined as ≥2 IHCA within the same hospitalization. Categorical variables expressed as percentages and compared via Chi square test. Continuous variables expressed as medians with interquartile ranges and compared via rank sum test. Outcomes assessed in a propensity match cohort. Results: From July 1, 2015 to January 26, 2021, 139/894 (15.5%) patients experienced recurrent IHCA. Compared to patients with a single IHCA, recurrent IHCA patients were more likely to be trauma and less likely to be surgical cardiac patients. Median duration of cardiopulmonary resuscitation (CPR) was shorter in the recurrent IHCA (5 vs. 11 min; p < 0.001) with no difference in IHCA location or immediate cause of CPR. Patients with recurrent IHCA had worse survival to intensive care unit (ICU) discharge (31% vs. 52%; p < 0.001), and worse survival to hospital discharge (30% vs. 48%; p < 0.001) in unadjusted analyses and after propensity matching, patients with recurrent IHCA still had worse survival to ICU (34% vs. 67%; p < 0.001) and hospital (31% vs. 64%; p < 0.001) discharge. Conclusion: When examining those with a single vs. a recurrent IHCA, event and patient factors including more pre-existing conditions and shorter duration of CPR were associated with risk for recurrent IHCA. Recurrent IHCA is associated with worse survival outcomes following propensity matching.
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- 2021
32. QRS duration predicts outcomes in cardiac arrest survivors undergoing therapeutic hypothermia
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Wei-Tien Chang, Hooi Nee Ong, Wei Ting Chen, Jia-Yu Chen, Min-Shan Tsai, Wen-Jone Chen, and Chien-Hua Huang
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Adult ,Male ,medicine.medical_specialty ,Return of spontaneous circulation ,Electrocardiography ,QRS complex ,Hypothermia, Induced ,Clinical Decision Rules ,Internal medicine ,Odds Ratio ,medicine ,Hospital discharge ,Humans ,Rewarming ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,social sciences ,General Medicine ,Middle Aged ,Hypothermia ,Survival Analysis ,humanities ,Heart Arrest ,Logistic Models ,Treatment Outcome ,cardiovascular system ,Emergency Medicine ,Cardiology ,Female ,Return of Spontaneous Circulation ,medicine.symptom ,business ,human activities - Abstract
Whether the electrocardiography (ECG) serial changes predict outcomes in cardiac arrest survivors undergoing therapeutic hypothermia remains unclear.This retrospective observational study enrolled 366 adult nontraumatic cardiac arrest survivors who underwent therapeutic hypothermia in a tertiary transfer center during 2006-2018. The ECG at return of spontaneous circulation (ROSC), during hypothermia and after rewarming were analyzed. 295 cardiac arrest survivors were included. Compared with the survivors, the non-survivors had longer QRS durations at the ROSC (118.33 ± 32.47 ms vs 106.88 ± 29.78 ms, p 0.001) and after rewarming (99.26 ± 25.07 ms vs 93.03 ± 19.09 ms, p = 0.008). The enrolled patients were classified into 4 groups based on QRS duration at the ROSC and after rewarming, namely (1) narrow-narrow (narrow QRS at ROSC and narrow QRS after rewarming, n = 156), (2) narrow-wide (n = 29), (3) wide-narrow (n = 87), and (4) wide-wide (n = 23) group. The wide-wide group had the worst survival rates [odds ratio (OR) = 0.141, p = 0.001], followed by the narrow-wide group (OR 0.223, p = 0.003) and the wide-narrow group (OR 0.389, p = 0.003).In cardiac arrest survivors given therapeutic hypothermia, QRS durations at the ROSC, after rewarming and their changes may predict survival to hospital discharge.
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- 2021
33. Effects of vibration-guided cardiopulmonary resuscitation with a smartwatch versus metronome guidance cardiopulmonary resuscitation during adult cardiac arrest: a randomized controlled simulation study
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Sung-Woo Choi, Young Hwan Lee, Minjung Kathy Chae, and Sangsoo Han
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,education ,Metronome ,Emergency Nursing ,Manikins ,Vibration ,law.invention ,Smartwatch ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Randomized controlled trial ,law ,Interquartile range ,Pressure ,Humans ,Medicine ,030212 general & internal medicine ,Cardiopulmonary resuscitation ,business.industry ,Basic life support ,030208 emergency & critical care medicine ,Data compression ratio ,Cardiopulmonary Resuscitation ,Heart Arrest ,business ,Guidance system - Abstract
Background Smartwatches could be used as a cardiopulmonary resuscitation (CPR) guidance system through its vibration function. This study was conducted to determine whether vibration guidance by a smartwatch application influences CPR performance compared to metronome guided CPR in a simulated noisy setting. Methods This study was randomised controlled trial. A total of 130 university students were enrolled. The experiment was conducted using a cardiac arrest model with hands-only CPR. Participants were randomly divided into two groups 1:1 ratio and performed 2-min metronome guidance or vibration guidance compression at the rate of 110/min. Basic life support quality data were compared in simulated noisy environments. Results There were significant differences between the audio and vibration guidance groups in the mean compression rate (MCR). However, there were no significant differences in correct or mean compression depth, correct hand position, and correctly released compression. The vibration guidance group resulted in 109 MCR (Interquartile range [IQR] 108–110), whereas the metronome guidance group resulted in 115 MCR (IQR 112–117) (p Conclusion In a simulated noisy environment, vibration guided CPR showed to be particularly advantageous in maintaining a desired MCR during hands-only CPR compared to metronome guided CPR.
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- 2021
34. Post-cardiac arrest physiology and management in the neonatal intensive care unit
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Heidi M. Herrick, Mary Haggerty, and Sarah A. Coggins
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Adult ,medicine.medical_specialty ,Resuscitation ,Neonatal intensive care unit ,Physiology ,Emergency Nursing ,Article ,Intensive Care Units, Neonatal ,medicine ,Humans ,Post cardiac arrest ,Neonatology ,Child ,Vital sign monitoring ,Retrospective Studies ,business.industry ,Medical record ,Infant, Newborn ,Hypothermia ,Cardiopulmonary Resuscitation ,Heart Arrest ,Blood pressure ,Emergency Medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
AIM: The importance of high-quality post-cardiac arrest care is well-described in adult and paediatric populations, but data are lacking to inform post-cardiac arrest care in the neonatal intensive care unit (NICU). The objective of this study was to describe post-cardiac arrest physiology and management in a quaternary NICU. METHODS: Retrospective descriptive study of post-cardiac arrest physiology and management. Data were abstracted from electronic medical records and an institutional resuscitation database. A cardiac arrest was defined as ≥1 minute of chest compressions. Only index arrests were analysed. Descriptive statistics were used to report patient, intra-arrest, and post-arrest characteristics. RESULTS: There were 110 index cardiac arrests during the 5-year study period from 1/2017–2/2021. The majority (69%) were acute respiratory compromise leading to cardiopulmonary arrest (ARC-CPA) and 26% were primary cardiopulmonary arrests (CPA). Vital sign monitoring within 24 hours post-arrest was variable, especially non-invasive blood pressure frequency (median 5, range 1–44 measurements). There was a high prevalence of hypothermia (73% of arrest survivors). There was substantial variability in laboratory frequency within 24 hours post-arrest. Patients with primary CPA received significantly more lab testing and had a higher prevalence of acidosis (pH
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- 2021
35. Racial differences in outcomes and utilization after cardiac arrest in the USA: A longitudinal study comparing different geographical regions in the USA from 2006–2018
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John P. Gaughan, Elizabeth Cerceo, Jean-Sebastien Rachoin, and Phillip Olsen
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Out of hospital ,African american ,Longitudinal study ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Emergency Nursing ,Lower risk ,United States ,Heart Arrest ,Race Factors ,Black or African American ,Internal medicine ,Emergency Medicine ,medicine ,Humans ,Racial differences ,Longitudinal Studies ,Quality of care ,Cardiology and Cardiovascular Medicine ,business ,Retrospective Studies ,Cardiac catheterization - Abstract
AIM Healthcare disparities can affect access and quality of care among many in the United States (US). In addition to race, we sought to assess if geography affected rates of cardiac arrest, and the subsequent outcomes. METHODS Using the National Inpatient Sample database from 2006-2018, we assessed rates of cardiac arrest (out of hospital that survived to admission and in-hospital) and cardiac catheterization, and length of stay (LOS) in four regions: Northeast (NE), South (SO) West (W) and Midwest (MW). RESULTS Cardiac arrest increased from 27,611 (2006) to 43,333 (2018). The proportion of African American (AA) patients experiencing cardiac arrest significantly increased from 11.9% to 18.8%. The mortality decreased from 65.4% to 60.8% in all patients and 70.2% to 61.4% in AA. Mortality in AA remained higher than non-AA (OR, 1.09 [1.08-1.11], p
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- 2021
36. Single versus continuous sustained inflations during chest compressions and physiological-based cord clamping in asystolic lambs
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Georg M. Schmölzer, Vanesa Stojanovska, Robert Galinsky, Shiraz Badurdeen, Martin Kluckow, Stuart B. Hooper, Graeme R. Polglase, Andrew W. Gill, Suzanne L. Miller, Calum T. Roberts, Kelly J. Crossley, and Douglas A Blank
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Resuscitation ,Hemodynamics ,Return of spontaneous circulation ,Umbilical cord ,Asphyxia ,Animals ,Medicine ,Asystole ,Sheep ,business.industry ,Obstetrics and Gynecology ,Insufflation ,General Medicine ,Oxygenation ,medicine.disease ,Constriction ,Cardiopulmonary Resuscitation ,Heart Arrest ,medicine.anatomical_structure ,Blood pressure ,Animals, Newborn ,Anesthesia ,Pediatrics, Perinatology and Child Health ,medicine.symptom ,business - Abstract
BackgroundThe feasibility and benefits of continuous sustained inflations (SIs) during chest compressions (CCs) during delayed cord clamping (physiological-based cord clamping; PBCC) are not known. We aimed to determine whether continuous SIs during CCs would reduce the time to return of spontaneous circulation (ROSC) and improve post-asphyxial blood pressures and flows in asystolic newborn lambs.MethodsFetal sheep were surgically instrumented immediately prior to delivery at ~139 days’ gestation and asphyxia induced until lambs reached asystole. Lambs were randomised to either immediate cord clamping (ICC) or PBCC. Lambs then received a single SI (SIsing; 30 s at 30 cmH2O) followed by intermittent positive pressure ventilation, or continuous SIs (SIcont: 30 s duration with 1 s break). We thus examined 4 groups: ICC +SIsing, ICC +SIcont, PBCC +SIsing, and PBCC +SIcont. Chest compressions and epinephrine administration followed international guidelines. PBCC lambs underwent cord clamping 10 min after ROSC. Physiological and oxygenation variables were measured throughout.ResultsThe time taken to achieve ROSC was not different between groups (mean (SD) 4.3±2.9 min). Mean and diastolic blood pressure was higher during chest compressions in PBCC lambs compared with ICC lambs, but no effect of SIs was observed. SIcontsignificantly reduced pulmonary blood flow, diastolic blood pressure and oxygenation after ROSC compared with SIsing.ConclusionWe found no significant benefit of SIcontover SIsingduring CPR on the time to ROSC or on post-ROSC haemodynamics, but did demonstrate the feasibility of continuous SIs during advanced CPR on an intact umbilical cord. Longer-term studies are recommended before this technique is used routinely in clinical practice.
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- 2021
37. Feasibility, utility, and safety of fully incorporating transesophageal echocardiography into emergency medicine practice
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Chris Kaczmarczyk, Teresa Dunphy, James R. Miner, Emily Thompson, Johanna C. Moore, Michael A. Puskarich, Barrett Wagner, Craig Tschautscher, Will Smoot, Daniel Lee, Joseph Novik, Thomas Pahl, Andie Rowland Fisher, Elliott Chinn, Robert F. Reardon, Dave Plummer, and Andrew Laudenbach
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medicine.medical_specialty ,Critically ill ,business.industry ,Critical Illness ,Ultrasound ,General Medicine ,Credentialing ,Heart Arrest ,Standard procedure ,Emergency medicine ,Emergency Medicine ,Feasibility Studies ,Humans ,Medicine ,In patient ,Complication ,business ,Quality assurance ,Echocardiography, Transesophageal ,Endotracheal tube - Abstract
Transthoracic echocardiography (TTE) is a standard procedure for emergency physicians (EPs). Transesophageal echocardiography (TEE) is known to have great utility in patients who are critically ill or in cardiac arrest and has been used by some EPs with specialized ultrasound (US) training, but it is generally considered outside the reach of the majority of EPs. We surmised that all of our EPs could learn to perform focused TEE (F-TEE), so we trained and credentialed all of the physicians in our group.We trained 52 EPs to perform and interpret F-TEEs using a 4-h simulator-based course. We kept a database of all F-TEE examinations for quality assurance and continuous quality feedback. Data are reported using descriptive statistics.Emergency physicians attempted 557 total F-TEE examinations (median = 10, interquartile range = 5-15) during the 42-month period following training. Clinically relevant images were obtained in 99% of patients. EPs without fellowship or other advanced US training performed the majority of F-TEEs (417, 74.9%) and 94.3% (95% confidence interval [CI] = 91.4%-96.3%) had interpretable images recorded. When TTE and TEE were both performed (n = 410), image quality of TEE was superior in 378 (93.3%, 95% CI = 89.7%-95%). Indications for F-TEE included periarrest states (55.7%), cardiac arrest (32.1%), and shock (12.2%). There was one case of endotracheal tube dislodgement during TEE placement, but this was immediately identified and replaced without complication.After initiating a mandatory group F-TEE training and credentialing program, we report the largest series to date of EP-performed resuscitative F-TEE. The majority of F-TEE examinations (75%) were performed by EPs without advanced US training beyond residency.
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- 2021
38. Changes of Key Rate-Limiting Enzyme Activity in Glucose Metabolism After Cardiopulmonary Resuscitation
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Zitong Huang, Liangliang Wu, Yue Fu, Liwen Wang, Xiangshao Fang, Longyuan Jiang, and Zhengfei Yang
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Male ,medicine.medical_specialty ,Resuscitation ,medicine.medical_treatment ,Carbohydrate metabolism ,Critical Care and Intensive Care Medicine ,Phosphocreatine ,Rats, Sprague-Dawley ,Asphyxia ,chemistry.chemical_compound ,Internal medicine ,medicine ,Animals ,Citrate synthase ,Cardiopulmonary resuscitation ,biology ,business.industry ,Pyruvate dehydrogenase complex ,Cardiopulmonary Resuscitation ,Phosphofructokinase activity ,Heart Arrest ,Rats ,Glucose ,Endocrinology ,chemistry ,Emergency Medicine ,biology.protein ,business ,Pyruvate kinase - Abstract
OBJECTIVES To investigate the activity of key rate-limiting enzymes of glucose metabolism after restoration of spontaneous circulation (ROSC), to explore the potential pathophysiological mechanism of impaired myocardial energy metabolism after cardiopulmonary resuscitation (CPR). METHODS Twenty-one male Sprague-Dawley rats were randomized into three experimental groups assigned in accordance with different observation times after ROSC: 1) Sham, instrumented rats without induced cardiac arrest or resuscitation; 2) Post-resuscitation (PR2 h); 3) PR24 h. In these groups, CPR, including precordial compressions and synchronized mechanical ventilation, was initiated 6 min after asphyxia-induced cardiac arrest. Hearts were harvested after ROSC and samples were used to detect high-energy phosphate and glucose metabolic enzyme activity. RESULTS Compared with sham, the contents of phosphocreatine and adenosine triphosphate reduced in the PR2 h group, while remained unchanged in the PR24 h group. Activities of hexokinase and pyruvate kinase did not change after ROSC. Phosphofructokinase activity decreased only in the PR24 h group. Activities of pyruvate dehydrogenase and citrate synthase fell in PR2 h group and recovered in the PR24 h group. However, isocitrate dehydrogenase and α-ketoglutarate dehydrogenase activities fell in the PR2 h group, but did not recover in the PR24 h group. CONCLUSIONS Lowered key rate-limiting enzymes activity in glucose metabolism resulted in impairment of energy production in the early stage of ROSC, but partially recovered in 24 h. This process has a role in the mechanism of impaired myocardial energy metabolism after CPR. This investigation might shed light on new strategies to treat post resuscitation myocardial dysfunction.
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- 2021
39. Hydrogen gas with extracorporeal cardiopulmonary resuscitation improves survival after prolonged cardiac arrest in rats
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Ernesto P. Molmenti, Santiago J. Miyara, Junichi Sasaki, Koichiro Shinozaki, Tai Yin, Muhammad Shoaib, Shuhei Eguchi, Kentaro Oka, Kei Hayashida, Daniel M Rolston, Mitsuaki Nishikimi, Motomichi Takahashi, Koichiro Homma, Tomoaki Aoki, Rishabh C. Choudhary, Ryosuke Takegawa, Lance B Becker, Tadashi Ariyoshi, Asami Matsumoto, Yusuke Endo, and Junhwan Kim
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Vascular Endothelial Growth Factor A ,medicine.medical_treatment ,Placebo ,General Biochemistry, Genetics and Molecular Biology ,medicine ,Extracorporeal membrane oxygenation ,Coagulopathy ,Animals ,Humans ,Extracorporeal cardiopulmonary resuscitation ,Survival rate ,Mechanical ventilation ,business.industry ,Research ,Central venous pressure ,General Medicine ,Oxygenation ,Heart arrest ,medicine.disease ,Cardiopulmonary Resuscitation ,Rats ,Anesthesia ,Medicine ,business ,Ischemia reperfusion injury ,Hydrogen - Abstract
Background Despite the benefits of extracorporeal cardiopulmonary resuscitation (ECPR) in cohorts of selected patients with cardiac arrest (CA), extracorporeal membrane oxygenation (ECMO) includes an artificial oxygenation membrane and circuits that contact the circulating blood and induce excessive oxidative stress and inflammatory responses, resulting in coagulopathy and endothelial cell damage. There is currently no pharmacological treatment that has been proven to improve outcomes after CA/ECPR. We aimed to test the hypothesis that administration of hydrogen gas (H2) combined with ECPR could improve outcomes after CA/ECPR in rats. Methods Rats were subjected to 20 min of asphyxial CA and were resuscitated by ECPR. Mechanical ventilation (MV) was initiated at the beginning of ECPR. Animals were randomly assigned to the placebo or H2 gas treatment groups. The supplement gas was administered with O2 through the ECMO membrane and MV. Survival time, electroencephalography (EEG), brain functional status, and brain tissue oxygenation were measured. Changes in the plasma levels of syndecan-1 (a marker of endothelial damage), multiple cytokines, chemokines, and metabolites were also evaluated. Results The survival rate at 4 h was 77.8% (7 out of 9) in the H2 group and 22.2% (2 out of 9) in the placebo group. The Kaplan–Meier analysis showed that H2 significantly improved the 4 h-survival endpoint (log-rank P = 0.025 vs. placebo). All animals treated with H2 regained EEG activity, whereas no recovery was observed in animals treated with placebo. H2 therapy markedly improved intra-resuscitation brain tissue oxygenation and prevented an increase in central venous pressure after ECPR. H2 attenuated an increase in syndecan-1 levels and enhanced an increase in interleukin-10, vascular endothelial growth factor, and leptin levels after ECPR. Metabolomics analysis identified significant changes at 2 h after CA/ECPR between the two groups, particularly in d-glutamine and d-glutamate metabolism. Conclusions H2 therapy improved mortality in highly lethal CA rats rescued by ECPR and helped recover brain electrical activity. The underlying mechanism might be linked to protective effects against endothelial damage. Further studies are warranted to elucidate the mechanisms responsible for the beneficial effects of H2 on ischemia–reperfusion injury in critically ill patients who require ECMO support.
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- 2021
40. The effect of fluid bolus administration on cerebral tissue oxygenation in post-cardiac arrest patients
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P.J. Palmers, Matthias Dupont, Dominique V M Verhaert, Bert Ferdinande, J. Dens, Stefan Janssens, Alexander Wilmer, C. De Deyne, Wilfried Mullens, Petra Nijst, Eline Bogaerts, Koen Ameloot, N. Van Regenmortel, Manu L N G Malbrain, and Robin Lemmens
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Male ,Cardiac output ,Resuscitation ,Mean arterial pressure ,Central Venous Pressure ,Emergency Nursing ,Humans ,Medicine ,Arterial Pressure ,Cardiac Output ,Fluid bolus ,Aged ,business.industry ,Hemodynamics ,Central venous pressure ,Oxygenation ,Stroke volume ,Middle Aged ,Heart Arrest ,Passive leg raising test ,Anesthesia ,Emergency Medicine ,Fluid Therapy ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose Fluid boluses (FB) are often used in post-cardiac arrest (CA) patients with haemodynamic instability. Although FB may improve cardiac output (CO) and mean arterial pressure (MAP), FB may also increase central venous pressure (CVP), reduce arterial PaO2, dilute haemoglobin and cause interstitial oedema. The aim of the present study was to investigate the net effect of FB administration on cerebral tissue oxygenation saturation (SctO2) in post-CA patients. Methods Pre-planned sub-study of the Neuroprotect post-CA trial (NCT02541591). Patients with anticipated fluid responsiveness based on stroke volume variation (SVV) or passive leg raising test were administered a FB of 500 ml plasma-lyte A (Baxter Healthcare) and underwent pre- and post-FB assessments of stroke volume, CO, MAP, CVP, haemoglobin, PaO2 and SctO2. Results 52 patients (mean age 64 ± 12 years, 75% male) received a total of 115 FB. Although administration of a FB resulted in a significant increase of stroke volume (63 ± 22 vs 67 ± 23 mL, p = 0.001), CO (4,2 ± 1,6 vs 4,4 ± 1,7 L/min, p = 0.001) and MAP (74,8 ± 13,2 vs 79,2 ± 12,9 mmHg, p = 0.004), it did not improve SctO2 (68.54 ± 6.99 vs 68.70 ± 6.80%, p = 0.49). Fluid bolus administration also resulted in a significant increase of CVP (10,0 ± 4,5 vs 10,7 ± 4,9 mmHg, p = 0.02), but did not affect PaO2 (99 ± 31 vs 94 ± 31 mmHg, p = 0.15) or haemoglobin concentrations (12,9 ± 2,1 vs 12,8 ± 2,2 g/dL, p = 0.10). In a multivariate model, FB-induced changes in CO (beta 0,77; p = 0.004) and in CVP (beta −0,23; p = 0.02) but not in MAP (beta 0,02; p = 0.18) predicted post-FB ΔSctO2. Conclusions Despite improvements in CO and MAP, FB administration did not improve SctO2 in post-cardiac arrest patients.
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- 2021
41. Structural and functional connectivity of the ascending arousal network for prediction of outcome in patients with acute disorders of consciousness
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Carol J. Zarate-Ardila, Diana Andrea Vera Rivera, Mayra A. Hurtado, Cesar O Enciso-Olivera, Cristian Pulido, Francisco Gómez, Jorge H. Marín-Muñoz, José L. Hernández, Natalia Guerrero, Edgar G. Ordóñez-Rubiano, Jorge Rudas, Rosangela Casanova-Libreros, Darwin Martínez, Clara P. Hernández-Torres, and Natalia Aguilera-Bustos
- Subjects
Adult ,Male ,medicine.medical_specialty ,Consciousness ,Traumatic brain injury ,Science ,Functional magnetic resonance imaging ,Article ,Arousal ,White matter ,Magnetic resonance imaging ,Internal medicine ,Brain Injuries, Traumatic ,Neural Pathways ,Image Processing, Computer-Assisted ,Medicine ,Humans ,Coma ,Stroke ,Aged ,Univariate analysis ,Multidisciplinary ,business.industry ,Minimally conscious state ,Brain ,Middle Aged ,medicine.disease ,Prognosis ,Heart Arrest ,medicine.anatomical_structure ,Diffusion Tensor Imaging ,nervous system ,Oxygen Saturation ,Brain Injuries ,Cardiology ,Consciousness Disorders ,Wakefulness ,Female ,business ,Neurological disorders ,Biomarkers ,Diffusion MRI - Abstract
Object: To determine the role of early acquisition of blood oxygen level-dependent (BOLD) signals and diffusion tensor imaging (DTI) for analysis of the connectivity of the ascending arousal network (AAN) in predicting neurological outcomes after acute traumatic brain injury (TBI), cardiopulmonary arrest (CPA), or stroke.Methods: A prospective analysis of 50 comatose patients was performed during their ICU stay. Image processing was conducted to assess structural and functional connectivity of the AAN. Outcomes were evaluated after 3 and 6 months.Results: Nineteen patients (38%) had stroke, 18 (36%) CPA, and 13 (26%) TBI. Twenty-three patients were comatose (44%), 11 were in a minimally conscious state (20%), and 16 had unresponsive wakefulness syndrome (32%). Univariate analysis demonstrated that measurements of diffusivity, functional connectivity, and numbers of fibers in the gray matter, white matter, whole brain, midbrain reticular formation, and pontis oralis nucleus may serve as predictive biomarkers of outcome depending on the diagnosis. Multivariate analysis demonstrated a correlation of the predicted value and the real outcome for each separate diagnosis and for all the etiologies together.Conclusion: Findings suggest that the above imaging biomarkers may have a predictive role for the outcome of comatose patients after acute TBI, CPA, or stroke.
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- 2021
42. Adrenaline improves regional cerebral blood flow, cerebral oxygenation and cerebral metabolism during CPR in a porcine cardiac arrest model using low-flow extracorporeal support
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Gabriel Putzer, Patrick Spraider, Bernhard Glodny, Daniel Pinggera, Tobias Hell, Peter Mair, Marlies Bauer, Julia Abram, Christoph Krapf, Raimund Helbok, Christine Schmidt, Judith Martini, and Rouven Hornung
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Mean arterial pressure ,medicine.medical_specialty ,Epinephrine ,Swine ,medicine.medical_treatment ,Emergency Nursing ,Cerebral circulation ,Internal medicine ,medicine ,Animals ,Cardiopulmonary resuscitation ,Cerebral perfusion pressure ,Intracranial pressure ,business.industry ,Cardiopulmonary Resuscitation ,Heart Arrest ,Oxygen tension ,Blood pressure ,Cerebral blood flow ,Regional Blood Flow ,Cerebrovascular Circulation ,Emergency Medicine ,Cardiology ,Blood Gas Analysis ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND The effects of adrenaline on cerebral blood vessels during cardiopulmonary resuscitation (CPR) are not well understood. We developed an extracorporeal CPR model that maintains constant low systemic blood flow while allowing adrenaline-associated effects on cerebral vasculature to be assessed at different mean arterial pressure (MAP) levels independently of the effects on systemic blood flow. METHODS After eight minutes of cardiac arrest, low-flow extracorporeal life support (ECLS) (30 ml/kg/min) was started in fourteen pigs. After ten minutes, continuous adrenaline administration was started to achieve MAP values of 40 (n = 7) or 60 mmHg (n = 7). Measurements included intracranial pressure (ICP), cerebral perfusion pressure (CePP), laser-Doppler-derived regional cerebral blood flow (CBF), cerebral regional oxygen saturation (rSO2), brain tissue oxygen tension (PbtO2) and extracellular cerebral metabolites assessed by cerebral microdialysis. RESULTS During ECLS without adrenaline, regional CBF increased by only 5% (25th to 75th percentile: -3 to 14; p = 0.2642) and PbtO2 by 6% (0-15; p = 0.0073) despite a significant increase in MAP to 28 mmHg (25-30; p
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- 2021
43. Perioperative Emergencies: Who, What, When, Where, Why?
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Parita A. Chowatia, Anusha Priya, Ariel Mueller, Christopher M. Aiudi, Jevon J. Oliver, and Adam A. Dalia
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Adult ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Coronary artery disease ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,030202 anesthesiology ,medicine ,Humans ,Anesthesia ,Retrospective Studies ,business.industry ,Incidence ,Mortality rate ,Retrospective cohort study ,Perioperative ,Vascular surgery ,medicine.disease ,Heart Arrest ,Obstructive sleep apnea ,Anesthesiology and Pain Medicine ,Emergency medicine ,Etiology ,Emergencies ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease - Abstract
Objective(s) Throughout the last several decades, the perioperative mortality rate from anesthesia care has declined, shifting focus to perioperative emergencies. Data on these emergencies, often referred to as “Anesthesia STAT” calls (STATs), are lacking at adult hospitals. The goal of this study was to determine the etiology of STATs at a major academic medical center and to determine surgical cases and patient comorbid conditions that increase the risk for STATs. Design This was a retrospective observational study. Setting This study took place at a large academic medical center. Participants Patients who underwent anesthesia care were included in this study. Interventions No interventions were performed during this study. Measurements and Main Results Data collected included the etiologies of STATs, patient demographic information, patient comorbid conditions, and surgeries during which STATs occurred. Between February 1, 2019, and January 31, 2020, 92 STATs occurred during 58,547 anesthetic cases, with an incidence rate of 0.16%. The most common etiology for a STAT was cardiac arrest, followed by respiratory compromise. Surgical services associated with a significant increase of STATs included general, thoracic, oral/maxillofacial, and vascular surgery. Comorbid conditions that significantly increased the risk of STATs included hypertension, coronary artery disease, congestive heart failure, obstructive sleep apnea, diabetes, and chronic kidney disease. Conclusions Cardiac arrest is the most common etiology of STATs. Specific surgical services and comorbid conditions are associated with an increased risk of STATs.
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- 2021
44. Outcomes for patients with anterior myocardial infarction and prior cardiac arrest in the home automated external defibrillator trial (HAT)
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Daniel B. Mark, Graham Nichol, Sana M. Al-Khatib, Monique A Starks, Kevin L. Thomas, Larry R. Jackson, George Johnson, Jeanne E. Poole, Kerry L. Lee, Gust H. Bardy, Linda Davidson-Ray, Anne S. Hellkamp, and Jill Anderson
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medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Emergency Nursing ,Revascularization ,Sudden cardiac death ,Percutaneous Coronary Intervention ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Myocardial infarction ,reproductive and urinary physiology ,business.industry ,Proportional hazards model ,Hazard ratio ,hemic and immune systems ,Sudden cardiac arrest ,Implantable cardioverter-defibrillator ,medicine.disease ,Defibrillators, Implantable ,Heart Arrest ,Death, Sudden, Cardiac ,Conventional PCI ,Emergency Medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Patients with sudden cardiac arrest occurring in the acute phase of myocardial infarction (MI-SCA) are believed to be at similar risk of death after revascularization compared with MI patients without SCA (MI-no SCA). Among patients with anterior MI, we examined whether those with MI-SCA were at greater risk of all-cause mortality or sudden cardiac death (SCD) than MI-no SCA patients. Methods The Home Automated External Defibrillator Trial enrolled patients with anterior MI who had not received or were candidates for an implantable cardioverter defibrillator (ICD). Our cohort included patients with a reported SCA event, in the acute phase of an MI, prior to HAT trial enrollment. Cox proportional hazards models examined the adjusted association between MI-SCA versus MI-no SCA patients and all-cause mortality and sudden cardiac death (SCD). We also determined whether the relationship between prior SCA and outcomes changed with subsequent events (syncope, revascularization, and recurrent MI) during follow-up. Results Of 6849 patients, 650 (9.5%) had MI-SCA before trial enrollment. Approximately 48% of patients had the MI-SCA event ≤ 1 year prior to enrollment; 71% of SCA events were in-hospital. MI-SCA patients were younger, more frequently white, and had higher rates of prior PCI versus MI-no SCA patients. There were no differences in adjusted all-cause mortality (hazard ratio [HR 0.95; 95% CI 0.65-1.38]) or SCD (HR 1.12; 95% CI 0.68-1.83) for MI-SCA vs. MI-no SCA. After ICD implantation, MI-SCA patients experienced higher all-cause mortality risk (HR 5.01, 95% CI 1.05-23.79) versus MI-no SCA patients; there was no mortality difference between MI-SCA and MI-no SCA patients without ICD implantation (HR 0.89, 95% CI 0.60- 1.31), [interaction p=0.035]. Conclusions Patients with MI-SCA had similar adjusted risk of all-cause mortality and SCD compared with MI-no SCA. After ICD implantation, MI-SCA patients had higher mortality compared with MI-no SCA patients.
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- 2021
45. Deviations from NIRS-derived optimal blood pressure are associated with worse outcomes after pediatric cardiac arrest
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Ryan Burnett, Kristen Lourie, Ryan W. Morgan, Matthew P. Kirschen, Mohammed Ali Shaik, Robert M. Sutton, Alexis A. Topjian, Robert A. Berg, Todd J. Kilbaugh, Forrest Beaulieu, Wesley B. Baker, Ramani Balu, Tiffany Ko, Tanmay Majmudar, Ramon Diaz-Arrastia, and Kenya Agarwal
- Subjects
medicine.medical_specialty ,Mean arterial pressure ,Blood Pressure ,Emergency Nursing ,Logistic regression ,Cerebral autoregulation ,Article ,Internal medicine ,Hospital discharge ,medicine ,Humans ,Arterial Pressure ,Oximetry ,Favorable outcome ,Child ,Cerebral oximetry ,business.industry ,Heart Arrest ,Blood pressure ,Cerebrovascular autoregulation ,Cerebrovascular Circulation ,Child, Preschool ,Emergency Medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aim Evaluate cerebrovascular autoregulation (CAR) using near-infrared spectroscopy (NIRS) after pediatric cardiac arrest and determine if deviations from CAR-derived optimal mean arterial pressure (MAPopt) are associated with outcomes. Methods CAR was quantified by a moving, linear correlation between time-synchronized mean arterial pressure (MAP) and regional cerebral oxygenation, called cerebral oximetry index (COx). MAPopt was calculated using a multi-window weighted algorithm. We calculated burden (magnitude and duration) of MAP less than 5 mmHg below MAPopt (MAPopt - 5), as the area between MAP and MAPopt - 5 curves using numerical integration and normalized as percentage of monitoring duration. Unfavorable outcome was defined as death or pediatric cerebral performance category (PCPC) at hospital discharge ≥3 with ≥1 change from baseline. Univariate logistic regression tested association between burden of MAP less than MAPopt - 5 and outcome. Results Thirty-four children (median age 2.9 [IQR 1.5,13.4] years) were evaluated. Median COx in the first 24 h post-cardiac arrest was 0.06 [0,0.20]; patients spent 27% [19,43] of monitored time with COx ≥ 0.3. Patients with an unfavorable outcome (n = 24) had a greater difference between MAP and MAPopt - 5 (13 [11,19] vs. 9 [8,10] mmHg, p = 0.01) and spent more time with MAP below MAPopt - 5 (38% [26,61] vs. 24% [14,28], p = 0.03). Patients with unfavorable outcome had a higher burden of MAP less than MAPopt - 5 than patients with favorable outcome in the first 24 h post-arrest (187 [107,316] vs. 62 [43,102] mmHg × Min/Hr; OR 4.93 [95% CI 1.16–51.78]). Conclusions Greater burden of MAP below NIRS-derived MAPopt - 5 during the first 24 h after cardiac arrest was associated with unfavorable outcomes.
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- 2021
46. Teaching NeuroImages: Medically intractable epilepsy and ictal asystole treated with cardiac pacing
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Nicholas M. Gregg, David B. Burkholder, Terrence D. Lagerlund, and Kate W. Hocquard
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Adult ,Male ,Drug Resistant Epilepsy ,medicine.medical_specialty ,Cardiac pacing ,Medically intractable epilepsy ,Electroencephalography ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Periventricular Nodular Heterotopia ,Internal medicine ,medicine ,Humans ,Ictal ,Epilepsy surgery ,030212 general & internal medicine ,Asystole ,medicine.diagnostic_test ,business.industry ,Cardiac Pacing, Artificial ,medicine.disease ,Heart Arrest ,nervous system diseases ,nervous system ,Cardiology ,Accidental Falls ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
A 43-year-old man with bihemispheric periventricular nodular heterotopia had medically intractable multifocal epilepsy and seizure-related falls. Video-EEG recorded a seizure with ictal asystole, EEG attenuation, and loss of postural tone, reflective of cerebral hypoperfusion (figure 1). After pacemaker implantation, EEG recorded a seizure with ictal cardiac pacing, without EEG attenuation (figure 2). His falls resolved. Antiseizure medications and epilepsy surgery can control seizures and ictal asystole.1 For individuals with intractable epilepsy and ictal asystole who are poor surgical candidates, pacemaker implantation is indicated to prevent injury and any potential contribution of ictal asystole in sudden unexpected death in epilepsy.1,2
- Published
- 2023
47. Survival to intensive care unit discharge among in‐hospital cardiac arrest patients by applying audiovisual feedback device
- Author
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Reza Goharani, Giuseppe M.C. Rosano, Amirhossein Sahebkar, Amir Vahedian-Azimi, Farzaneh Amanpour, and Mohamad Amin Pourhoseingholi
- Subjects
In‐hospital cardiac arrest ,medicine.medical_specialty ,Survival ,ICU length of stay ,medicine.medical_treatment ,Improved survival ,Feedback ,law.invention ,law ,Secondary analysis ,Mean Survival Time ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Medicine ,Prospective Studies ,Cardiopulmonary resuscitation ,Survival rate ,Cardio First Angel™ ,business.industry ,Patient survival ,Original Articles ,medicine.disease ,Intensive care unit ,Hospitals ,Patient Discharge ,Heart Arrest ,Intensive Care Units ,RC666-701 ,Heart failure ,Emergency medicine ,Female ,Original Article ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Survival rates after in‐hospital cardiac arrest remain very low. Although there is evidence that the use of audiovisual feedback devices can improve compression components, there are no data on patient survival. Therefore, we conducted this study to analyse the survival rate of patients with in‐hospital cardiac arrest after discharge from the intensive care unit. Methods and results This study was a secondary analysis of a prospective, randomized, controlled, parallel study of patients who received either standard manual chest compression or a real‐time feedback device. Parametric and semi‐parametric models were fitted to the data. Different survival time of length of stay was investigated by univariate and multiple analyses. Pearson's correlation between length of stay and hospital length of stay was obtained. A total of 900 patients with a mean survival time of 35 days were included. Intervention was associated with a higher length of stay. Relative time was significant in adjusted fitted log‐normal regression for intervention group, female gender, and cardiopulmonary resuscitation in the night shift. A positive correlation between length of stay and hospital length of stay was found. Conclusions Implementation of feedback device improved survival and length of stay. Cardiopulmonary resuscitation performance during the night shift decreased the survival time, which could be due to the inexperienced staff available outside working hours.
- Published
- 2021
48. Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis
- Author
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Tobias Cronberg, Mypinder S. Sekhon, and Claudio Sandroni
- Subjects
Resuscitation ,medicine.medical_specialty ,Pain medicine ,Ischemia ,Prognostication ,Electroencephalography ,Critical Care and Intensive Care Medicine ,law.invention ,law ,Anesthesiology ,Hypoxia-Ischemia ,Settore MED/41 - ANESTESIOLOGIA ,Humans ,Medicine ,EEG ,Coma ,Intensive care medicine ,medicine.diagnostic_test ,business.industry ,Brain ,Cardiac arrest ,Prognosis ,medicine.disease ,Intensive care unit ,Cardiopulmonary Resuscitation ,Pathophysiology ,Heart Arrest ,Brain Injuries ,Narrative Review ,medicine.symptom ,business - Abstract
Post-cardiac arrest brain injury (PCABI) is caused by initial ischaemia and subsequent reperfusion of the brain following resuscitation. In those who are admitted to intensive care unit after cardiac arrest, PCABI manifests as coma, and is the main cause of mortality and long-term disability. This review describes the mechanisms of PCABI, its treatment options, its outcomes, and the suggested strategies for outcome prediction.
- Published
- 2021
49. High platelet-lymphocyte ratio is a risk factor for 30-day mortality in in-hospital cardiac arrest patients: a case-control study
- Author
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Jingjing Peng, Xuefeng Wang, Lihong Huang, and Feng Li
- Subjects
medicine.medical_specialty ,Multivariate analysis ,Neutrophils ,Immunology ,Risk Factors ,White blood cell ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Lymphocyte Count ,Lymphocytes ,Risk factor ,Retrospective Studies ,Platelet lymphocyte ratio ,APACHE II ,business.industry ,Case-control study ,Prognosis ,Hospitals ,Heart Arrest ,medicine.anatomical_structure ,30 day mortality ,Health evaluation ,Case-Control Studies ,Cardiology ,business - Abstract
Background: Early identification of risk factors for short-term mortality in patients with in-hospital cardiac arrest (IHCA) is crucial for early prognostication. This study aimed to explore the association of early dynamic changes in inflammatory markers with 30-day mortality in IHCA patients.Methods: This study retrospectively collected demographic and clinical characteristics and relevant laboratory indicators within 72 h after recovery of spontaneous circulation (ROSC) of IHCA patients from December 2015 to December 2020 at the First Affiliated Hospital of Chongqing Medical University. The outcome was 30-day mortality. A linear mixed model was used to analyze the dynamic changes in laboratory indicators within 72 h after ROSC, and Cox regression was used to identify the independent risk factors for 30-day mortality.Results: Overall, 85 IHCA patients were included. The 0-72h and 0-30day cumulative mortality rates were 25.88% and 57.65%, respectively, and the median survival time was 13.79 days. There was no association of inflammatory markers before IHCA with mortality. Within 72 h after ROSC, inflammatory markers showed various changes: the absolute monocyte count (AMC) showed no significant change trend, and the absolute lymphocyte count (ALC) showed an overall upward trend, while the absolute neutral count (ANC), white blood cell (WBC) count, platelet (PLT) count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) showed an overall downward trend. Cox multivariate analysis showed that Charlson comorbidity index (CCI) (HR = 2.366, 95%CI (1.084, 5.168)), APACHE II score (HR = 2.550, 95% CI (1.001, 6.498)), abnormal Cr before IHCA (HR = 3.417, 95% CI (1.441, 8.104)) and PLR within 72 h after ROSC (HR = 2.993, 95% CI (1.442, 6.214)) were independent risk factors for 30-day mortality. When PLR ≥ 180, the risk of 30-day mortality increased by 199.3%.Conclusions: This study clarified the dynamic change trends of inflammatory markers within 72 h after ROSC. The PLR was an independent risk factor for 30-day mortality in IHCA patients; it can be used as a predictor of short-term mortality and provide a reference for early prognostication.Trial registration: ChiCTR1800014324
- Published
- 2021
50. Serum Neuron-Specific Enolase Thresholds for Predicting Postcardiac Arrest Outcome
- Author
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Merin John, Gary S. Gronseth, Kartavya Sharma, and Song Zhang
- Subjects
Coma ,medicine.medical_specialty ,Resuscitation ,Adolescent ,Receiver operating characteristic ,business.industry ,medicine.medical_treatment ,Prediction interval ,Targeted temperature management ,Prognosis ,Heart Arrest ,Hypothermia, Induced ,Phosphopyruvate Hydratase ,Meta-analysis ,Life support ,Internal medicine ,Humans ,Medicine ,Neurology (clinical) ,medicine.symptom ,business ,Biomarkers ,Out-of-Hospital Cardiac Arrest ,Cohort study - Abstract
Background and ObjectivesTo determine thresholds of serum neuron-specific enolase (NSE) for prediction of poor outcome after cardiac arrest with >95% specificity using a unique method of multiple thresholds meta-analysis.MethodsData from a systematic review by the European Resuscitation Council (ERC 2014) were updated with literature searches from PubMed, Cochrane, and Scopus until August 2020. Search terms included the MeSH terms “heart arrest” and “biomarkers” and the text words “cardiac arrest,” “neuron specific enolase,” “coma” and “prognosis.” Cohort studies with comatose cardiac arrest survivors aged >16 years undergoing targeted temperature management (TTM) and NSE levels within 96 hours of resuscitation were included. Poor outcome was defined as cerebral performance category 3–5 at hospital discharge or later. Studies without extractable contingency tables were excluded. A multiple thresholds meta-analysis model was used to generate summary receiver operating characteristic curves for various time points. NSE thresholds (and 95% prediction intervals) for >95% specificity were calculated. Evidence appraisal was performed using a method adapted from the American Academy of Neurology grading criteria.ResultsData from 11 studies (n = 1,982) at 0–24 hours, 21 studies (n = 2,815) at 24–48 hours, and 13 studies (n = 2,557) at 48–72 hours was analyzed. Areas under the curve for prediction of poor outcomes were significantly larger at 24–48 hours and 48–72 hours compared to 0–24 hours (0.82 and 0.83 vs 0.64). Quality of evidence was very low for most studies because of the risk of incorporation bias—knowledge of NSE levels potentially influenced life support withdrawal decisions. To minimize falsely pessimistic predictions, NSE thresholds at the upper 95% limit of prediction intervals are reported. For prediction of poor outcome with specificity >95%, upper limits of the prediction interval for NSE were 70.4 ng/mL at 24–48 hours and 58.6 ng/mL at 48–72 hours. Sensitivity analyses excluding studies with inconsistent TTM use or different outcome criteria did not substantially alter the results.ConclusionsNSE thresholds for highly specific prediction of poor outcome are much higher than generally used. Future studies must minimize bias by masking treatment teams to the results of potential predictors and by prespecifying criteria for withdrawal of life support.
- Published
- 2021
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