319 results on '"Giuseppe Ristagno"'
Search Results
2. Postresuscitation Ventilation With a Mixture of Argon and Hydrogen Reduces Brain Injury After Cardiac Arrest in a Pig Model
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Francesca Motta, Daria De Giorgio, Marianna Cerrato, Anita Salmaso, Aurora Magliocca, Giulia Merigo, Davide Olivari, Carlo Perego, Francesca Fumagalli, and Giuseppe Ristagno
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argon ,brain injury ,cardiac arrest ,hydrogen ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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3. Treatment with inhaled Argon: a systematic review of pre-clinical and clinical studies with meta-analysis on neuroprotective effectResearch in context
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Giulia Merigo, Gaetano Florio, Fabiana Madotto, Aurora Magliocca, Ivan Silvestri, Francesca Fumagalli, Marianna Cerrato, Francesca Motta, Daria De Giorgio, Mauro Panigada, Alberto Zanella, Giacomo Grasselli, and Giuseppe Ristagno
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Argon ,Noble gas ,Neuroprotection ,Organ protection ,Meta-analysis ,Medicine ,Medicine (General) ,R5-920 - Abstract
Summary: Background: Argon (Ar) has been proposed as a potential therapeutic agent in multiple clinical conditions, specifically in organ protection. However, conflicting data on pre-clinical models, together with a great variability in Ar administration protocols and outcome assessments, have been reported. The aim of this study was to review evidence on treatment with Ar, with an extensive investigation on its neuroprotective effect, and to summarise all tested administration protocols. Methods: Using the PubMed database, all existing pre-clinical and clinical studies on the treatment with Ar were systematically reviewed (registration: https://doi.org/10.17605/OSF.IO/7983D). Study titles and abstracts were screened, extracting data from relevant studies post full-text review. Exclusion criteria included absence of full text and non-English language. Furthermore, meta-analysis was also performed to assess Ar potential as neuroprotectant agent in different clinical conditions: cardiac arrest, traumatic brain injury, ischemic stroke, perinatal hypoxic-ischemic encephalopathy, subarachnoid haemorrhage. Standardised mean differences for neurological, cognitive and locomotor, histological, and physiological measures were evaluated, through appropriate tests, clinical, and laboratory variables. In vivo studies were evaluated for risk of bias using the Systematic Review Center for Laboratory Animal Experimentation tool, while in vitro studies underwent assessment with a tool developed by the Office of Health Assessment and Translation. Findings: The systematic review detected 60 experimental studies (16 in vitro, 7 ex vivo, 31 in vivo, 6 with both in vitro and in vivo) investigating the role of Ar. Only one clinical study was found. Data from six in vitro and nineteen in vivo studies were included in the meta-analyses. In pre-clinical models, Ar administration resulted in improved neurological, cognitive and locomotor, and histological outcomes without any change in physiological parameters (i.e., absence of adverse events). Interpretation: This systematic review and meta-analysis based on experimental studies supports the neuroprotective effect of Ar, thus providing a rationale for potential translation of Ar treatment in humans. Despite adherence to established guidelines and methodologies, limitations in data availability prevented further analyses to investigate potential sources of heterogeneity due to study design. Funding: This study was funded in part by Italian Ministry of Health-Current research IRCCS and by Ministero della Salute Italiano, Ricerca Finalizzata, project no. RF 2019-12371416.
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- 2024
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4. Wolf Creek XVII Part 8: Neuroprotection
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Karen G. Hirsch, Tomoyoshi Tamura, Giuseppe Ristagno, and Mypinder S. Sekhon
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Cardiac arrest ,Neuroprotection ,Post-cardiac arrest brain injury ,Specialties of internal medicine ,RC581-951 - Abstract
Introduction: Post-cardiac arrest brain injury (PCABI) is the primary determinant of clinical outcomes for patients who achieve return of spontaneous circulation after cardiac arrest (CA). There are limited neuroprotective therapies available to mitigate the acute pathophysiology of PCABI. Methods: Neuroprotection was one of six focus topics for the Wolf Creek XVII Conference held on June 14–17, 2023 in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of CA resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation, and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised and ranked by all attendees to identify the top 5 for each category. Results: Top 5 knowledge gaps included developing therapies for neuroprotection; improving understanding of the pathophysiology, mechanisms, and natural history of PCABI; deploying precision medicine approaches; optimizing resuscitation and CPR quality; and determining optimal timing for and duration of interventions. Top 5 barriers to translation included patient heterogeneity; nihilism & lack of knowledge about cardiac arrest; challenges with the translational pipeline; absence of mechanistic biomarkers; and inaccurate neuro-triage and neuroprognostication. Top 5 research priorities focused on translational research and trial optimization; addressing patient heterogeneity and individualized interventions; improving understanding of pathophysiology and mechanisms; developing mechanistic and outcome biomarkers across post-CA time course; and improving implementation of science and technology. Conclusion: This overview can serve as a guide to transform the care and outcome of patients with PCABI. Addressing these topics has the potential to improve both research and clinical care in the field of neuroprotection for PCABI.
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- 2024
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5. Out-of-Hospital Cardiac Arrest in the Paediatric Patient: An Observational Study in the Context of National Regulations
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Roberta Pireddu, Giuseppe Ristagno, Lorenzo Gianquintieri, Rodolfo Bonora, Andrea Pagliosa, Aida Andreassi, Giuseppe Maria Sechi, Carlo Signorelli, and Giuseppe Stirparo
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epidemiology ,public health ,policy ,OHCA ,Medicine - Abstract
Introduction: Cardiac arrest results in a high death rate if cardiopulmonary resuscitation and early defibrillation are not performed. Mortality is strongly linked to regulations, in terms of prevention and emergency–urgency system organization. In Italy, training of lay rescuers and the presence of defibrillators were recently made mandatory in schools. Our analysis aims to analyze Out-of-Hospital Cardiac Arrest (OHCA) events in pediatric patients (under 18 years old), to understand the epidemiology of this phenomenon and provide helpful evidence for policy-making. Methods: A retrospective observational analysis was conducted on the emergency databases of Lombardy Region, considering all pediatric OHCAs managed between 1 January 2016, and 31 December 2019. The demographics of the patients and the logistics of the events were statistically analyzed. Results: The incidence in pediatric subjects is 4.5 (95% CI 3.6–5.6) per 100,000 of the population. School buildings and sports facilities have relatively few events (1.9% and 4.4%, respectively), while 39.4% of OHCAs are preventable, being due to violent accidents or trauma, mainly occurring on the streets (23.2%). Conclusions: Limiting violent events is necessary to reduce OHCA mortality in children. Raising awareness and giving practical training to citizens is a priority in general but specifically in schools.
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- 2024
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6. Acute Lung Injury after Cardiopulmonary Resuscitation: A Narrative Review
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Giuseppe Marchese, Elisabetta Bungaro, Aurora Magliocca, Francesca Fumagalli, Giulia Merigo, Federico Semeraro, Elisa Mereto, Giovanni Babini, Erik Roman-Pognuz, Giuseppe Stirparo, Alberto Cucino, and Giuseppe Ristagno
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cardiac arrest ,cardiopulmonary resuscitation ,lung injury ,lung edema ,Medicine - Abstract
Although cardiopulmonary resuscitation (CPR) includes lifesaving maneuvers, it might be associated with a wide spectrum of iatrogenic injuries. Among these, acute lung injury (ALI) is frequent and yields significant challenges to post-cardiac arrest recovery. Understanding the relationship between CPR and ALI is determinant for refining resuscitation techniques and improving patient outcomes. This review aims to analyze the existing literature on ALI following CPR, emphasizing prevalence, clinical implications, and contributing factors. The review seeks to elucidate the pathogenesis of ALI in the context of CPR, assess the efficacy of CPR techniques and ventilation strategies, and explore their impact on post-cardiac arrest outcomes. CPR-related injuries, ranging from skeletal fractures to severe internal organ damage, underscore the complexity of managing post-cardiac arrest patients. Chest compression, particularly when prolonged and vigorous, i.e., mechanical compression, appears to be a crucial factor contributing to ALI, with the concept of cardiopulmonary resuscitation-associated lung edema (CRALE) gaining prominence. Ventilation strategies during CPR and post-cardiac arrest syndrome also play pivotal roles in ALI development. The recognition of CPR-related lung injuries, especially CRALE and ALI, highlights the need for research on optimizing CPR techniques and tailoring ventilation strategies during and after resuscitation.
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- 2024
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7. Neuronal desertification after a direct lightning strike: a case report
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Erik Roman-Pognuz, Edoardo Moro, Elisabetta Macchini, Edoardo Di Paolo, Kenneth Pesenti, Umberto Lucangelo, Rossana Bussani, Elisa Baratella, Tommaso Pellis, and Giuseppe Ristagno
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Cardiac arrest ,Lightning strike ,Neuronal desertification ,Brain injury ,Hypoxic ischaemic brain injury ,Medicine - Abstract
Abstract Background Lightning strike is a rare but dramatic cause of injury. Patients admitted to intensive care units (ICUs) with lightning strike frequently have a high mortality and significant long-term morbidity related to a direct brain injury or induced cardiac arrest (CA). Case presentation A 50-year-old Caucasian man was admitted to our hospital after being struck by lightning resulting in immediate CA. Spontaneous circulation was initially restored, and the man was admitted to the ICU, but ultimately died while in hospital due to neurological injury. The computer tomography scan revealed a massive loss of grey-white matter differentiation at the fronto-temporal lobes bilaterally. Somatosensory-evoked potentials demonstrated bilateral absence of the cortical somatosensory N20-potential, and the electroencephalogram recorded minimal cerebral electrical activity. The patient died on day 10 and a post-mortem study revealed a widespread loss of neurons. Conclusion This case study illustrates severe brain injury caused by a direct lighting strike, with the patient presenting an extraordinary microscopic pattern of neuronal desertification.
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- 2022
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8. Amplitude Spectrum Area of ventricular fibrillation to guide defibrillation: a small open-label, pseudo-randomized controlled multicenter trialResearch in context
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Laura Ruggeri, Francesca Fumagalli, Filippo Bernasconi, Federico Semeraro, Jennifer M.T.A. Meessen, Adriana Blanda, Maurizio Migliari, Aurora Magliocca, Giovanni Gordini, Roberto Fumagalli, Giuseppe Sechi, Antonio Pesenti, Markus B. Skrifvars, Yongqin Li, Roberto Latini, Lars Wik, and Giuseppe Ristagno
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Cardiac arrest ,Ventricular fibrillation ,Amplitude spectrum area ,Waveform analysis ,Defibrillation ,Medicine ,Medicine (General) ,R5-920 - Abstract
Summary: Background: Ventricular fibrillation (VF) waveform analysis has been proposed as a potential non-invasive guide to optimize timing of defibrillation. Methods: The AMplitude Spectrum Area (AMSA) trial is an open-label, multicenter randomized controlled study reporting the first in-human use of AMSA analysis in out-of-hospital cardiac arrest (OHCA). The primary efficacy endpoint was the termination of VF for an AMSA ≥ 15.5 mV-Hz. Adult shockable OHCAs randomly received either an AMSA-guided cardiopulmonary resuscitation (CPR) or a standard-CPR. Randomization and allocation to trial group were carried out centrally. In the AMSA-guided CPR, an initial AMSA ≥ 15.5 mV-Hz prompted for immediate defibrillation, while lower values favored chest compression (CC). After completion of the first 2-min CPR cycle, an AMSA < 6.5 mV-Hz deferred defibrillation in favor of an additional 2-min CPR cycle. AMSA was measured and displayed in real-time during CC pauses for ventilation with a modified defibrillator. Findings: The trial was early discontinued for low recruitment due to the COVID-19 pandemics. A total of 31 patients were recruited in 3 Italian cities, 19 in AMSA-CPR and 12 in standard-CPR, and included in the data analysis. No difference in primary outcome was observed between the two groups. Termination of VF occurred in 74% of patients in the AMSA-CPR compared to 75% in the standard CPR (OR 0.93 [95% CI 0.18–4.90]). No adverse events were reported. Interpretation: AMSA was used prospectively in human patients during ongoing CPR. In this small trial, an AMSA-guided defibrillation provided no evidence of an improvement in termination of VF. Trial registration: NCT03237910. Funding: European Commission - Horizon 2020; ZOLL Medical Corp., Chelmsford, USA (unrestricted grant); Italian Ministry of Health - Current research IRCCS.
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- 2023
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9. Incidence, characteristics, and outcome of out-of-hospital cardiac arrest in Italy: A systematic review and meta-analysis
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Tommaso Scquizzato, Lorenzo Gamberini, Sonia D'Arrigo, Alessandro Galazzi, Giovanni Babini, Rosario Losiggio, Guglielmo Imbriaco, Francesca Fumagalli, Alberto Cucino, Giovanni Landoni, Andrea Scapigliati, Giuseppe Ristagno, Federico Semeraro, Francesco Bertoncello, Alberto Canalini, Stefano Colelli, Giuseppe Conti, Maurizio Giacometti, Giovanni Giuliani, Alessandro Graziano, Andrea Mina, Silvia Orazio, Andrea Paoli, Alberto Peratoner, Carlo Pegani, Andrea Roncarati, Cesare Sabetta, Simone Savastano, Federica Stella, Rosanna Varutti, Francesca Verginella, and Michele Zuliani
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Specialties of internal medicine ,RC581-951 - Abstract
Introduction: Data on out-of-hospital cardiac arrest (OHCA) is limited in Italy, and there has never been a comprehensive systematic appraisal of the available evidence. Therefore, this review aims to explore the incidence, characteristics, and outcome of OHCA in Italy. Methods: We systematically searched PubMed, Embase, Google Scholar, ResearchGate, and conference proceedings up to September 23, 2022. Studies investigating OHCA in Italy and reporting at least one outcome related to cardiac arrest were considered eligible. The primary outcome was survival at the longest follow-up available. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. A random-effects model proportion meta-analysis was performed to calculate the pooled outcomes with 95% confidence interval (CI). Results: We included 42 studies (43,042 patients) from 13 of the 20 Italian regions published between 1995 and 2022. Only five studies were deemed to be at low risk of bias. The overall average incidences of OHCA attended by emergency medical services and with resuscitation attempted were 86 (range: 10–190) and 55 (range: 6–108) per 100,000 populations per year, respectively. Survival at the longest follow-up available was 9.0% (95% CI, 6.7–12%; 30 studies and 15,195 patients) in the overall population, 25% (95% CI, 21–30%; 16 studies and 2,863 patients) among patients with shockable rhythms, 28% (95% CI, 20–37%; 8 studies and 1,292 patients) among the Utstein comparator group. Favourable neurological outcome was 5.0% (95% CI, 3.6–6.6%; 16 studies and 9,675 patients). Return of spontaneous circulation was achieved in 19% (95% CI, 16–23%; 40 studies and 30,875 patients) of cases. Bystanders initiated cardiopulmonary resuscitation in 26% (95% CI, 21–32%; 33 studies and 23,491 patients) of cases but only in 3.2% (95% CI, 1.9–4.9%; 9 studies and 8,508 patients) with an automated external defibrillator. The mean response time was 10.2 (95% CI, 8.9–11.4; 25 studies and 23,997 patients) minutes. Conclusions: Survival after OHCA in Italy occurred in one of every ten patients. Bystanders initiated cardiopulmonary resuscitation in only one-third of cases, rarely with a defibrillator. Different areas of the country collected data, but an essential part of the population was not included. There was high heterogeneity and large variation in outcomes results and reporting, limiting the confidence in the estimates of incidence and outcome. Creating and maintaining a nationwide registry is a priority.
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- 2022
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10. Clinical practice recommendations on the management of perioperative cardiac arrest: A report from the PERIOPCA Consortium
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Athanasios Chalkias, Nicolas Mongardon, Vladimir Boboshko, Vladimir Cerny, Anne-Laure Constant, Quentin De Roux, Gabriele Finco, Francesca Fumagalli, Eleana Gkamprela, Stéphane Legriel, Vladimir Lomivorotov, Aurora Magliocca, Panagiotis Makaronis, Ioannis Mamais, Iliana Mani, Theodoros Mavridis, Paolo Mura, Giuseppe Ristagno, Salvatore Sardo, Nikolaos Papagiannakis, Theodoros Xanthos, and for the PERIOPCA Consortium
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Perioperative ,Cardiac arrest ,Resuscitation ,PERIOPCA ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Perioperative cardiac arrest is a rare complication with an incidence of around 1 in 1400 cases, but it carries a high burden of mortality reaching up to 70% at 30 days. Despite its specificities, guidelines for treatment of perioperative cardiac arrest are lacking. Gathering the available literature may improve quality of care and outcome of patients. Methods The PERIOPCA Task Force identified major clinical questions about the management of perioperative cardiac arrest and framed them into the therapy population [P], intervention [I], comparator [C], and outcome [O] (PICO) format. Systematic searches of PubMed, Embase, and the Cochrane Library for articles published until September 2020 were performed. Consensus-based treatment recommendations were created using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. The strength of consensus among the Task Force members about the recommendations was assessed through a modified Delphi consensus process. Results Twenty-two PICO questions were addressed, and the recommendations were validated in two Delphi rounds. A summary of evidence for each outcome is reported and accompanied by an overall assessment of the evidence to guide healthcare providers. Conclusions The main limitations of our work lie in the scarcity of good quality evidence on this topic. Still, these recommendations provide a basis for decision making, as well as a guide for future research on perioperative cardiac arrest.
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- 2021
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11. Esmolol during cardiopulmonary resuscitation reduces neurological injury in a porcine model of cardiac arrest
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Laura Ruggeri, Francesca Nespoli, Giuseppe Ristagno, Francesca Fumagalli, Antonio Boccardo, Davide Olivari, Roberta Affatato, Deborah Novelli, Daria De Giorgio, Pierpaolo Romanelli, Lucia Minoli, Alberto Cucino, Giovanni Babini, Lidia Staszewsky, Davide Zani, Davide Pravettoni, Angelo Belloli, Eugenio Scanziani, Roberto Latini, and Aurora Magliocca
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Medicine ,Science - Abstract
Abstract Primary vasopressor efficacy of epinephrine during cardiopulmonary resuscitation (CPR) is due to its α-adrenergic effects. However, epinephrine plays β1-adrenergic actions, which increasing myocardial oxygen consumption may lead to refractory ventricular fibrillation (VF) and poor outcome. Effects of a single dose of esmolol in addition to epinephrine during CPR were investigated in a porcine model of VF with an underlying acute myocardial infarction. VF was ischemically induced in 16 pigs and left untreated for 12 min. During CPR, animals were randomized to receive epinephrine (30 µg/kg) with either esmolol (0.5 mg/kg) or saline (control). Pigs were then observed up to 96 h. Coronary perfusion pressure increased during CPR in the esmolol group compared to control (47 ± 21 vs. 24 ± 10 mmHg at min 5, p
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- 2021
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12. One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials
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Alessio Penna, Aurora Magliocca, Giulia Merigo, Giuseppe Stirparo, Ivan Silvestri, Francesca Fumagalli, and Giuseppe Ristagno
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cardiac arrest ,randomized controlled trial ,cardiopulmonary resuscitation ,outcome ,Medicine - Abstract
Cardiac arrest, one of the leading causes of death, accounts for numerous clinical studies published each year. This review summarizes the findings of all the randomized controlled clinical trials (RCT) on cardiac arrest published in the year 2022. The RCTs are presented according to the following categories: out-of- and in-hospital cardiac arrest (OHCA, IHCA) and post-cardiac arrest care. Interestingly, more than 80% of the RCTs encompassed advanced life support and post-cardiac arrest care, while no studies focused on the treatment of IHCA, except for one that, however, explored the temperature control after resuscitation in this population. Surprisingly, 9 out of 11 RCTs led to neutral results demonstrating equivalency between the newly tested interventions compared to current practice. One trial was negative, showing that oxygen titration in the immediate pre-hospital post-resuscitation period decreased survival compared to a more liberal approach. One RCT was positive and introduced new defibrillation strategies for refractory cardiac arrest. Overall, data from the 2022 RCTs discussed here provide a solid basis to generate new hypotheses to be tested in future clinical studies.
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- 2023
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13. Brain Kynurenine Pathway and Functional Outcome of Rats Resuscitated From Cardiac Arrest
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Jacopo Lucchetti, Francesca Fumagalli, Davide Olivari, Roberta Affatato, Claudia Fracasso, Daria De Giorgio, Carlo Perego, Francesca Motta, Alice Passoni, Lidia Staszewsky, Deborah Novelli, Aurora Magliocca, Silvio Garattini, Roberto Latini, Giuseppe Ristagno, and Marco Gobbi
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cardiac arrest ,cardiopulmonary resuscitation ,indoleamine 2,3‐deoxygenase ,kynurenine pathway ,neurological deficit ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Brain injury and neurological deficit are consequences of cardiac arrest (CA), leading to high morbidity and mortality. Peripheral activation of the kynurenine pathway (KP), the main catabolic route of tryptophan metabolized at first into kynurenine, predicts poor neurological outcome in patients resuscitated after out‐of‐hospital CA. Here, we investigated KP activation in hippocampus and plasma of rats resuscitated from CA, evaluating the effect of KP modulation in preventing CA‐induced neurological deficit. Methods and Results Early KP activation was first demonstrated in 28 rats subjected to electrically induced CA followed by cardiopulmonary resuscitation. Hippocampal levels of the neuroactive metabolites kynurenine, 3‐hydroxy‐anthranilic acid, and kynurenic acid were higher 2 hours after CA, as in plasma. Further, 36 rats were randomized to receive the inhibitor of the first step of KP, 1‐methyl‐DL‐tryptophan, or vehicle, before CA. No differences were observed in hemodynamics and myocardial function. The CA‐induced KP activation, sustained up to 96 hours in hippocampus (and plasma) of vehicle‐treated rats, was counteracted by the inhibitor as indicated by lower hippocampal (and plasmatic) kynurenine/tryptophan ratio and kynurenine levels. 1‐Methyl‐DL‐tryptophan reduced the CA‐induced neurological deficits, with a significant correlation between the neurological score and the individual kynurenine levels, as well as the kynurenine/tryptophan ratio, in plasma and hippocampus. Conclusions These data demonstrate the CA‐induced lasting activation of the first step of the KP in hippocampus, showing that this activation was involved in the evolving neurological deficit. The degree of peripheral activation of KP may predict neurological function after CA.
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- 2021
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14. Changes to the Major Trauma Pre-Hospital Emergency Medical System Network before and during the 2019 COVID-19 Pandemic
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Giuseppe Stirparo, Giuseppe Ristagno, Lorenzo Bellini, Rodolfo Bonora, Andrea Pagliosa, Maurizio Migliari, Aida Andreassi, Carlo Signorelli, Giuseppe Maria Sechi, and Nazzareno Fagoni
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major trauma ,coronavirus disease 2019 ,emergency medical service ,Medicine - Abstract
Objectives: During the coronavirus disease 2019 pandemic, emergency medical services (EMSs) were among the most affected; in fact, there were delays in rescue and changes in time-dependent disease networks. The aim of the study is to understand the impact of COVID-19 on the time-dependent trauma network in the Lombardy region. Methods: A retrospective analysis on major trauma was performed by analysing all records saved in the EmMa database from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020. Age, gender, time to first emergency vehicle on scene and mission duration were collected. Results: In 2020, compared to 2019, there was a reduction in major trauma diagnoses in March and April, during the first lockdown, OR 0.59 (95% CI 0.49–0.70; p < 0.0001), and a reduction in road accidents and accidents at work, while injuries related to falls from height and violent events increased. There was no significant increase in the number of deaths in the prehospital setting, OR 1.09 (95% CI 0.73–1.30; p = 0.325). Conclusions: The COVID-19 pandemic has changed the epidemiology of major trauma, but in the Lombardy region there was no significant change in mortality in the out-of-hospital setting.
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- 2022
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15. The Impact of COVID-19 on Lombardy Region ST-Elevation Myocardial Infarction Emergency Medical System Network—A Three-Year Study
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Giuseppe Stirparo, Lorenzo Bellini, Giuseppe Ristagno, Rodolfo Bonora, Andrea Pagliosa, Maurizio Migliari, Aida Andreassi, Carlo Signorelli, Giuseppe M. Sechi, and Nazzareno Fagoni
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emergency care ,COVID-19 ,STEMI ,Lombardy region ,Medicine - Abstract
Objectives: The COVID-19 pandemic had a significant impact on emergency medical systems (EMS). Regarding the ST-elevation myocardial infarction (STEMI) dependent time network, however, there is little evidence linked to the post-pandemic phase regarding this issue. Such information could prove to be of pivotal importance regarding STEMI clinical management, especially pre-hospital clinical protocols such as fibrinolysis. Methods: A retrospective observational cohort study of all STEMI rescues recorded in the Lombardy EMS registry from the 1st of January 2019 to the 30th of December 2021. Results: Regarding the number of STEMI diagnoses, March 2020 (first pandemic wave in Italy) saw a reduction compared to March 2019 (OR 0.76 [0.60–0.93], p = 0.011). The average time of the entire mission increased to 63.1 min in 2021, reaching 64.7 min in 2020, compared with 57.7 min in 2019. The number of HUBs for STEMI patients saw a reduction, falling from 52 HUBs in the pre-pandemic phase to 13 HUBs during the first wave. Conclusions: During the pandemic phase, there was an increase in the transportation times of STEMI patients from home to the hospital. Such changes did not alter the clinical approach in the out-of-hospital phase. Indeed, the implementation of fibrinolysis was not required.
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- 2022
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16. A complete review of preclinical and clinical uses of the noble gas argon: Evidence of safety and protection
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Francesca Nespoli, Simone Redaelli, Laura Ruggeri, Francesca Fumagalli, Davide Olivari, and Giuseppe Ristagno
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Argon ,cardiac arrest ,ischemia-reperfusion injury ,neuroprotection ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
The noble gas argon (Ar) is a “biologically” active element and has been extensively studied preclinically for its organ protection properties. This work reviews all preclinical studies employing Ar and describes the clinical uses reported in literature, analyzing 55 pertinent articles found by means of a search on PubMed and Embase. Ventilation with Ar has been tested in different models of acute disease at concentrations ranging from 20% to 80% and for durations between a few minutes up to days. Overall, lesser cell death, smaller infarct size, and better functional recovery after ischemia have been repeatedly observed. Modulation of the molecular pathways involved in cell survival, with resulting anti-apoptotic and pro-survival effects, appeared as the determinant mechanism by which Ar fulfills its protective role. These beneficial effects have been reported regardless of onset and duration of Ar exposure, especially after cardiac arrest. In addition, ventilation with Ar was safe both in animals and humans. Thus, preclinical and clinical data support future clinical studies on the role of inhalatory Ar as an organ protector.
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- 2019
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17. Ventilation With Argon Improves Survival With Good Neurological Recovery After Prolonged Untreated Cardiac Arrest in Pigs
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Francesca Fumagalli, Davide Olivari, Antonio Boccardo, Daria De Giorgio, Roberta Affatato, Sabina Ceriani, Simone Bariselli, Giulia Sala, Alberto Cucino, Davide Zani, Deborah Novelli, Giovanni Babini, Aurora Magliocca, Ilaria Russo, Lidia Staszewsky, Monica Salio, Jacopo Lucchetti, Antonio Marco Maisano, Fabio Fiordaliso, Roberto Furlan, Marco Gobbi, Mario Vittorio Luini, Davide Pravettoni, Eugenio Scanziani, Angelo Belloli, Roberto Latini, and Giuseppe Ristagno
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argon ,cardiac arrest ,neurological outcome ,noble gas ,treatment ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Ventilation with the noble gas argon (Ar) has shown neuroprotective and cardioprotective properties in different in vitro and in vivo models. Hence, the neuroprotective effects of Ar were investigated in a severe, preclinically relevant porcine model of cardiac arrest. Methods and Results Cardiac arrest was ischemically induced in 36 pigs and left untreated for 12 minutes before starting cardiopulmonary resuscitation. Animals were randomized to 4‐hour post‐resuscitation ventilation with: 70% nitrogen–30% oxygen (control); 50% Ar–20% nitrogen–30% oxygen (Ar 50%); and 70% Ar–30% oxygen (Ar 70%). Hemodynamic parameters and myocardial function were monitored and serial blood samples taken. Pigs were observed up to 96 hours for survival and neurological recovery. Heart and brain were harvested for histopathology. Ten animals in each group were successfully resuscitated. Ninety‐six‐hour survival was 60%, 70%, and 90%, for the control, Ar 50%, and Ar 70% groups, respectively. In the Ar 50% and Ar 70% groups, 60% and 80%, respectively, achieved good neurological recovery, in contrast to only 30% in the control group (P
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- 2020
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18. Simvastatin Prevents Liver Microthrombosis and Sepsis Induced Coagulopathy in a Rat Model of Endotoxemia
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Vincenzo La Mura, Nicoletta Gagliano, Francesca Arnaboldi, Patrizia Sartori, Patrizia Procacci, Luca Denti, Eleonora Liguori, Niccolò Bitto, Giuseppe Ristagno, Roberto Latini, Daniele Dondossola, Francesco Salerno, Armando Tripodi, Massimo Colombo, and Flora Peyvandi
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sepsis ,sinusoidal endothelial cells ,thrombomodulin ,coagulation ,Cytology ,QH573-671 - Abstract
Background: Endotoxemia causes endothelial dysfunction and microthrombosis, which are pathogenic mechanisms of coagulopathy and organ failure during sepsis. Simvastatin has potential anti-thrombotic effects on liver endothelial cells. We investigated the hemostatic changes induced by lipopolysaccharide (LPS) and explored the protective effects of simvastatin against liver vascular microthrombosis. Methods and results: We compared male Wistar rats exposed to LPS (5 mg/kg one i.p. dose) or saline in two experimental protocols—placebo (vehicle) and simvastatin (25 mg/kg die, orally, for 3 days before LPS). Morphological studies were performed by light- and electron-microscopy analyses to show intravascular fibrin deposition, vascular endothelial structure and liver damage. Peripheral- and organ-hemostatic profiles were analyzed using whole blood viscoelastometry by ROTEM, liver biopsy and western-blot/immunohistochemistry of thrombomodulin (TM), as well as immunohistochemistry of the von Willebrand factor (VWF). LPS-induced fibrin deposition and liver vascular microthrombosis were combined with a loss of sinusoidal endothelial TM expression and VWF-release. These changes were associated with parenchymal eosinophilia and necrosis. ROTEM analyses displayed hypo-coagulability in the peripheral blood that correlated with the degree of intrahepatic fibrin deposition (p < 0.05). Simvastatin prevented LPS-induced fibrin deposition by preserving TM expression in sinusoidal cells and completely reverted the peripheral hypo-coagulability caused by endotoxemia. These changes were associated with a significant reduction of liver cell necrosis without any effect on eosinophilia. Conclusions: Simvastatin preserves the antithrombotic properties of sinusoidal endothelial cells disrupted by LPS, deserving pharmacological properties to contrast sepsis-associated coagulopathy and hepatic failure elicited by endotoxemia
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- 2022
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19. Resuscitation Plus: The right journal for a new dawn for experimental resuscitation science research
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Asger Granfeldt, Jerry P. Nolan, and Giuseppe Ristagno
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Animal ,Experimental ,Basic science ,Specialties of internal medicine ,RC581-951 - Published
- 2020
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20. Primary pulmonary arterial hypertension: Protocol to assess comprehensively in the rat the response to pharmacologic treatments
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Deborah Novelli, Francesca Fumagalli, Lidia Staszewsky, Giuseppe Ristagno, Davide Olivari, Serge Masson, Daria De Giorgio, Sabina Ceriani, Roberta Massafra, Francesco De Logu, Romina Nassini, Marco Milioli, Fabrizio Facchinetti, Silvia Cantoni, Marcello Trevisani, Teresa Letizia, Ilaria Russo, Monica Salio, and Roberto Latini
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Monocrotaline ,Randomization ,Sample size ,Echocardiography ,Blood pressure ,Right ventricular systolic pressure ,Science - Abstract
The identification of new treatments for primary pulmonary arterial hypertension (PAH) is a critical unmet need since there is no a definitive cure for this disease yet. Due to the complexity of PAH, a wide set of methods are necessary to assess the response to a pharmacological intervention. Thus, a rigorous protocol is crucial when experimental studies are designed. In the present experimental protocol, a stepwise approach was followed in a monocrotaline-induced PAH model in the rat, moving from the dose finding study of treatment compounds to the recognition of the onset of disease manifestation, in order to identify when to start a curative treatment. A complete multidimensional evaluation of treatment effects represented the last step. The primary study endpoint was the change in right ventricular systolic pressure after 14 days of treatment; echocardiographic and biohumoral markers together with heart and pulmonary arterial morphometric parameters were considered as secondary efficacy and/or safety endpoints and for the evaluation of the biologic coherence in the different results.
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- 2020
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21. Incidence and cost of perioperative red blood cell transfusion for elective spine fusion in a high-volume center for spine surgery
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Giuseppe Ristagno, Simonetta Beluffi, Guido Menasce, Dario Tanzi, Juan C. Pastore, Giuseppe D’Aviri, Federica Belloli, and Giorgio Savoia
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Spine fusion ,Transfusion ,Blood ,Costs ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background Spine fusion is a surgical procedure characterized by a significant perioperative bleeding, which often requires red blood cell (RBC) transfusion. Methods The incidence and the cost of RBC transfusion were evaluated in all patients undergoing elective surgery for spine fusion in our Institution, a high-volume center for spine surgery, over a period of 3 years. The analysis specifically addressed the RBC transfusion need in all the different spine fusion procedures (atlanto-axial, cervical, dorsal, lumbar, revisions) with the different surgical approaches (anterior, posterior). Results During the 3 years of observation, a total of 1.882 elective spine fusions were performed. More than half of the procedures (n = 964) were posterior lumbar fusions. Overall, 5% of the patients (n = 103) required RBC transfusion. The cervical fusions were the procedures with the lowest percentage of RBC need (0–5%), while the dorsal and the lumbar ones, with the anterior approach, represented the procedures with the highest rate of transfusion (29% and 25% respectively). More than 60 % of the RBC units were employed in the instance of posterior lumbar fusion, while a variable 1–10% of the units was used in each of the other procedures. The overall transfusion cost was of 46.000 euros, with a distribution of costs that paralleled the amount of units transfused for each procedure. Conclusions Several surgical and patient factors may contribute to the perioperative blood loss. An accurate patient blood management, may efficiently decrease transfusion requirements and ultimately healthcare costs.
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- 2018
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22. Community Initiatives to Promote Basic Life Support Implementation—A Scoping Review
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Andrea Scapigliati, Drieda Zace, Tasuku Matsuyama, Luca Pisapia, Michela Saviani, Federico Semeraro, Giuseppe Ristagno, Patrizia Laurenti, Janet E. Bray, Robert Greif, and on behalf of the International Liaison Committee on Resuscitation Education, Implementation and Teams Task Force
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basic life support ,community initiatives ,outcome ,out-of-hospital cardiac arrest ,scoping review ,cardiopulmonary resuscitation ,Medicine - Abstract
Introduction: Early intervention of bystanders (the first links of the chain of survival) have been shown to improve survival and good neurological outcomes of patients suffering out-of-hospital cardiac arrest (OHCA). Many initiatives have been implemented to increase the engagement of communities in early basic life support (BLS) and cardiopulmonary resuscitation (CPR), especially of lay people with no duty to respond. A better knowledge of the most effective initiatives might help improve survival and health system organization. Aim of the scoping review: To assess the impact of specific interventions involving lay communities on bystander BLS rates and other consistent clinical outcomes, and to identify relevant knowledge gaps. Methods: This scoping review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We performed a literature search using the PubMed, EMBASE, and Cochrane databases until 1 February 2021. The screening process was conducted based on predefined inclusion/exclusion criteria, and for each included study, we performed data extraction focusing on the type of intervention implemented, and the impact of these interventions on the specific OHCAs outcomes. Results: Our search strategy identified 19 eligible studies, originating mainly from the USA (47.4%) and Denmark (21%). The type of intervention included in 57.9% of cases was a community CPR training program, in 36.8% bundled interventions, and in 5.3% mass-media campaigns. The most commonly reported outcome for OHCAs was bystander CPR rate (94.7%), followed by survival to hospital discharge (36.8%), proportion of people trained (31.6%), survival to hospital discharge with good neurological outcome (21%), and Return of Spontaneous Circulation (10.5%). Community training programs and bundled interventions improved bystander CPR in most of the included studies. Conclusion: Based on the results of our scoping review, we identified the potential benefit of community initiatives, such as community training in BLS, even as part of bundled intervention, in order to improve bystander CPR rates and patient outcomes.
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- 2021
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23. The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study
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Enrico Baldi, Niccolò B. Grieco, Giuseppe Ristagno, Hajriz Alihodžić, Valentine Canon, Alexei Birkun, Ruggero Cresta, Diana Cimpoesu, Carlo Clarens, Julian Ganter, Andrej Markota, Pierre Mols, Olympia Nikolaidou, Martin Quinn, Violetta Raffay, Fernando Rosell Ortiz, Ari Salo, Remy Stieglis, Anneli Strömsöe, Ingvild Tjelmeland, Stefan Trenkler, Jan Wnent, Jan-Thorsten Grasner, Bernd W. Böttiger, and Simone Savastano
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out-of-hospital cardiac arrest (OHCA) ,automated external defibrillator (AED) system ,legislation ,first responders ,Medicine - Abstract
Introduction: The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of an AED use. We aimed to verify the situation regarding AED legislation, the AED mapping system and first responders (FRs) equipped with an AED across European countries. Methods: We performed a survey across Europe entitled “European Study about AED Use by Lay Rescuers” (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it. Results: Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12–59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0–7.9%), reflecting the difference in OHCA survival. Conclusions: Our survey highlighted a heterogeneity in AED legislation, AED mapping systems and AED use in Europe, which was reflected in different AED use and survival.
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- 2021
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24. Targeted Temperature Management after Cardiac Arrest: A Systematic Review and Meta-Analysis with Trial Sequential Analysis
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Filippo Sanfilippo, Luigi La Via, Bruno Lanzafame, Veronica Dezio, Diana Busalacchi, Antonio Messina, Giuseppe Ristagno, Paolo Pelosi, and Marinella Astuto
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cardiac arrest ,hospital discharge ,neurological outcome ,cerebral performance category ,mortality ,Medicine - Abstract
Target temperature management (TTM) in cardiac arrest (CA) survivors is recommended after hospital admission for its possible beneficial effects on survival and neurological outcome. Whether a lower target temperature (i.e., 32–34 °C) improves outcomes is unclear. We conducted a systematic review and meta-analysis on Pubmed and EMBASE to evaluate the effects on mortality and neurologic outcome of TTM at 32–34 °C as compared to controls (patients cared with “actively controlled” or “uncontrolled” normothermia). Results were analyzed via risk ratios (RR) and 95% confidence intervals (CI). Eight randomized controlled trials (RCTs) were included. TTM at 32–34 °C was compared to “actively controlled” normothermia in three RCTs and to “uncontrolled” normothermia in five RCTs. TTM at 32–34 °C does not improve survival as compared to normothermia (RR:1.06 (95%CI 0.94, 1.20), p = 0.36; I2 = 39%). In the subgroup analyses, TTM at 32–34 °C is associated with better survival when compared to “uncontrolled” normothermia (RR: 1.31 (95%CI 1.07, 1.59), p = 0.008) but shows no beneficial effects when compared to “actively controlled” normothermia (RR: 0.97 (95%CI 0.90, 1.04), p = 0.41). TTM at 32–34 °C does not improve neurological outcome as compared to normothermia (RR: 1.17 (95%CI 0.97, 1.41), p = 0.10; I2 = 60%). TTM at 32–34 °C increases the risk of arrhythmias (RR: 1.35 (95%CI 1.16, 1.57), p = 0.0001, I2 = 0%). TTM at 32–34 °C does not improve survival nor neurological outcome after CA and increases the risk of arrhythmias.
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- 2021
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25. New Early Warning Score: EMS Off-Label Use in Out-of-Hospital Patients
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Federico Semeraro, Giovanni Corona, Tommaso Scquizzato, Lorenzo Gamberini, Anna Valentini, Marco Tartaglione, Andrea Scapigliati, Giuseppe Ristagno, Carmela Martella, Carlo Descovich, Cosimo Picoco, and Giovanni Gordini
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cardiac arrest ,EMS ,National Early Warning Score ,NEWS ,ambulance ,apps ,Medicine - Abstract
Background: The National Early Warning Score (NEWS) is an assessment scale of in-hospital patients’ conditions. The purpose of this study was to assess the appropriateness of a potential off-label use of NEWS by the emergency medical system (EMS) to facilitate the identification of critical patients and to trigger appropriate care in the pre-hospital setting. Methods: A single centre, longitudinal, prospective study was carried out between July and August 2020 in the EMS service of Bologna. Home patients with age ≥ 18 years old were included in the study. The exclusion criterion was the impossibility to collect all the parameters needed to measure NEWS. Results: A total of 654 patients were enrolled in the study. The recorded NEWS values increased along with the severity of dispatch priority code, the EMS return code, the emergency department triage code, and with patients’ age (r = 0.135; p = 0.001). The aggregated value of NEWS was associated with an increased risk of hospitalization (OR = 1.30 (1.17; 1.34); p < 0.0001). Conclusion: This study showed that the use of NEWS in the urgent and emergency care services can help patient assessment while not affecting EMS crew operation and might assist decision making in terms of severity-code assignment and resources utilization.
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- 2021
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26. Pentraxin 3 in Cardiovascular Disease
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Giuseppe Ristagno, Francesca Fumagalli, Barbara Bottazzi, Alberto Mantovani, Davide Olivari, Deborah Novelli, and Roberto Latini
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PTX 3 ,pentraxin ,cardiovascular disease ,cardiac arrest (CA) ,heart failure ,biomarker ,Immunologic diseases. Allergy ,RC581-607 - Abstract
The long pentraxin PTX3 is a member of the pentraxin family produced locally by stromal and myeloid cells in response to proinflammatory signals and microbial moieties. The prototype of the pentraxin family is C reactive protein (CRP), a widely-used biomarker in human pathologies with an inflammatory or infectious origin. Data so far describe PTX3 as a multifunctional protein acting as a functional ancestor of antibodies and playing a regulatory role in inflammation. Cardiovascular disease (CVD) is a leading cause of mortality worldwide, and inflammation is crucial in promoting it. Data from animal models indicate that PTX3 can have cardioprotective and atheroprotective roles regulating inflammation. PTX3 has been investigated in several clinical settings as possible biomarker of CVD. Data collected so far indicate that PTX3 plasma levels rise rapidly in acute myocardial infarction, heart failure and cardiac arrest, reflecting the extent of tissue damage and predicting the risk of mortality.
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- 2019
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27. LUCAS Versus Manual Chest Compression During Ambulance Transport: A Hemodynamic Study in a Porcine Model of Cardiac Arrest
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Aurora Magliocca, Davide Olivari, Daria De Giorgio, Davide Zani, Martina Manfredi, Antonio Boccardo, Alberto Cucino, Giulia Sala, Giovanni Babini, Laura Ruggeri, Deborah Novelli, Markus B Skrifvars, Bjarne Madsen Hardig, Davide Pravettoni, Lidia Staszewsky, Roberto Latini, Angelo Belloli, and Giuseppe Ristagno
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ambulance transport ,cardiac arrest ,cardiopulmonary resuscitation ,chest compression resuscitation ,manual cardiopulmonary resuscitation ,mechanical cardiopulmonary resuscitation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Mechanical chest compression (CC) is currently suggested to deliver sustained high‐quality CC in a moving ambulance. This study compared the hemodynamic support provided by a mechanical piston device or manual CC during ambulance transport in a porcine model of cardiopulmonary resuscitation. Methods and Results In a simulated urban ambulance transport, 16 pigs in cardiac arrest were randomized to 18 minutes of mechanical CC with the LUCAS (n=8) or manual CC (n=8). ECG, arterial and right atrial pressure, together with end‐tidal CO2 and transthoracic impedance curve were continuously recorded. Arterial lactate was assessed during cardiopulmonary resuscitation and after resuscitation. During the initial 3 minutes of cardiopulmonary resuscitation, the ambulance was stationary, while then proceeded along a predefined itinerary. When the ambulance was stationary, CC‐generated hemodynamics were equivalent in the 2 groups. However, during ambulance transport, arterial and coronary perfusion pressure, and end‐tidal CO2 were significantly higher with mechanical CC compared with manual CC (coronary perfusion pressure: 43±4 versus 18±4 mmHg; end‐tidal CO2: 31±2 versus 19±2 mmHg, P
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- 2019
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28. High-Resolution Mass Spectrometry-Based Approaches for the Detection and Quantification of Peptidase Activity in Plasma
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Elisa Maffioli, Zhenze Jiang, Simona Nonnis, Armando Negri, Valentina Romeo, Christopher B. Lietz, Vivian Hook, Giuseppe Ristagno, Giuseppe Baselli, Erik B. Kistler, Federico Aletti, Anthony J. O’Donoghue, and Gabriella Tedeschi
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peptidomics ,mass spectrometry ,plasma ,aminopeptidase ,carboxypeptidase ,endoprotease ,Organic chemistry ,QD241-441 - Abstract
Proteomic technologies have identified 234 peptidases in plasma but little quantitative information about the proteolytic activity has been uncovered. In this study, the substrate profile of plasma proteases was evaluated using two nano-LC-ESI-MS/MS methods. Multiplex substrate profiling by mass spectrometry (MSP-MS) quantifies plasma protease activity in vitro using a global and unbiased library of synthetic peptide reporter substrates, and shotgun peptidomics quantifies protein degradation products that have been generated in vivo by proteases. The two approaches gave complementary results since they both highlight key peptidase activities in plasma including amino- and carboxypeptidases with different substrate specificity profiles. These assays provide a significant advantage over traditional approaches, such as fluorogenic peptide reporter substrates, because they can detect active plasma proteases in a global and unbiased manner, in comparison to detecting select proteases using specific reporter substrates. We discovered that plasma proteins are cleaved by endoproteases and these peptide products are subsequently degraded by amino- and carboxypeptidases. The exopeptidases are more active and stable in plasma and therefore were found to be the most active proteases in the in vitro assay. The protocols presented here set the groundwork for studies to evaluate changes in plasma proteolytic activity in shock.
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- 2020
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29. New burns and trauma journal celebrating translational research
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Antonino Gullo, Giovanni Li Volti, and Giuseppe Ristagno
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Burns ,epistemology ,ontology ,science communication ,trauma ,translational research ,translational medicine ,Medicine - Abstract
Welcome to the journal of Burns & Trauma launched in 2013 and published by the prestigious Wolters Kluwer Health. We are grateful to promote a cultural challenge toward a new horizon in the field of translational research (TR). We enjoy to work together with the common objective to perform continuous medical education programs, exploring the methods in research, designing study, and to improve multidisciplinary and multiprofessional collaboration in the basic sciences and in the clinical trials. Defined narrowly, epistemology is the study of knowledge and justified belief. Epistemology is concerned with the following questions: What are the necessary and sufficient conditions of knowledge? What are its sources? What is its structure and what are its limits? More broadly, epistemology is about issues having to do with the creation and dissemination of knowledge in particular areas of inquiry as defined and revisiting at the beginning of the last decades. Translational medicine (TM) should meet the demands to maintain or expanding the biomedical workforce and education programs that attract and retain young people in the translational and biomedical sciences. With this present contributes, we invite the members of the editorial board of Burns & Trauma to encourage submitting, in a special section, their personal experience about the philosophy of "Translation research." If this has a chance, welcome to the researchers, clinicians, and the allied people for their decisive contributions to strengthen the importance of a common way about the principles and methods of basic and clinical research. TR and TM represent a dynamic entity making a link, a sort of bridge, "from bench to bedside", or from laboratory experiments through clinical trials to point-of-care patient applications. Epistemological pluralism is a critical point for conducting innovative, collaborative research which can lead to more successful integrated and successfully study, particularly important in the field of burns and trauma.
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- 2013
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30. Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery
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Giuseppe Ristagno, Simonetta Beluffi, Dario Tanzi, Federica Belloli, Paola Carmagnini, Massimo Croci, Giuseppe D’Aviri, Guido Menasce, Juan C. Pastore, Armando Pellanda, Alberto Pollini, and Giorgio Savoia
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blood ,blood loss ,spine surgery ,spine fusion ,lumbar ,transfusion ,red blood cell ,hemoglobin ,predictors ,operative time ,Medicine - Abstract
(1) Background: This study evaluated the perioperative red blood cell (RBC) transfusion need and determined predictors for transfusion in patients undergoing elective primary lumbar posterior spine fusion in a high-volume center for spine surgery. (2) Methods: Data from all patients undergoing spine surgery between 1 January 2014 and 31 December 2016 were reviewed. Patients’ demographics and comorbidities, perioperative laboratory results, and operative time were analyzed in relation to RBC transfusion. Multivariate logistic regression analysis was performed to identify the predictors of transfusion. (3) Results: A total of 874 elective surgeries for primary spine fusion were performed over the three years. Only 54 cases (6%) required RBC transfusion. Compared to the non-transfused patients, transfused patients were mainly female (p = 0.0008), significantly older, with a higher ASA grade (p = 0.0002), and with lower pre-surgery hemoglobin (HB) level and hematocrit (p < 0.0001). In the multivariate logistic regression, a lower pre-surgery HB (OR (95% CI) 2.84 (2.11–3.82)), a higher ASA class (1.77 (1.03–3.05)) and a longer operative time (1.02 (1.01–1.02)) were independently associated with RBC transfusion. (4) Conclusions: In the instance of elective surgery for primary posterior lumbar fusion in a high-volume center for spine surgery, the need for RBC transfusion is low. Factors anticipating transfusion should be taken into consideration in the patient’s pre-surgery preparation.
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- 2018
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31. Recurrent Neural Networks to Predict the Outcome of Subsequent Defibrillation Shocks in Cardiac Arrest.
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Xabier Jaureguibeitia, Gorka Zubia, Unai Irusta, Elisabete Aramendi, and Giuseppe Ristagno
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- 2021
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32. Quality indicators for post-resuscitation care after out-of-hospital cardiac arrest: a joint statement from the Association for Acute Cardiovascular Care of the European Society of Cardiology, the European Resuscitation Council, the European Society of Intensive Care Medicine, and the European Society for Emergency Medicine
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Johannes Grand, Francois Schiele, Christian Hassager, Jerry P Nolan, Abdo Khoury, Alessandro Sionis, Nikolaos Nikolaou, Katia Donadello, Wilhelm Behringer, Bernd W Böttiger, Alain Combes, Tom Quinn, Susanna Price, Pablo Jorge-Perez, Guido Tavazzi, Giuseppe Ristagno, Alain Cariou, and Eric Bonnefoy Cudraz
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post-resuscitation care ,acute cardiovascular care ,resuscitation ,Quality of care ,cardiac arrest ,quality indicators ,General Medicine ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,intensive care - Abstract
Aims Quality of care (QoC) is a fundamental tenet of modern healthcare and has become an important assessment tool for healthcare authorities, stakeholders and the public. However, QoC is difficult to measure and quantify because it is a multifactorial and multidimensional concept. Comparison of clinical institutions can be challenging when QoC is estimated solely based on clinical outcomes. Thus, measuring quality through quality indicators (QIs) can provide a foundation for quality assessment and has become widely used in this context. QIs for the evaluation of QoC in acute myocardial infarction are now well-established, but no such indicators exist for the process from resuscitation of cardiac arrest and post-resuscitation care in Europe. Methods and results The Association of Acute Cardiovascular Care of the European Society Cardiology, the European Resuscitation Council, European Society of Intensive Care Medicine and the European Society for Emergency Medicine, have reflected on the measurement of QoC in cardiac arrest. A set of QIs have been proposed, with the scope to unify and evolve QoC for the management of cardiac arrest across Europe. Conclusion We present here the list of QIs (6 primary QIs and 12 secondary Qis), with descriptions of the methodology used, scientific justification and motives for the choice for each measure with the aim that this set of QIs will enable assessment of the quality of postout-of-hospital cardiac arrest management across Europe.
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- 2023
33. Amplitude Spectrum Area of ventricular fibrillation to guide defibrillation: a small open-label, pseudo-randomized controlled multicenter trial
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Laura Ruggeri, Francesca Fumagalli, Filippo Bernasconi, Federico Semeraro, Jennifer M.T.A. Meessen, Adriana Blanda, Maurizio Migliari, Aurora Magliocca, Giovanni Gordini, Roberto Fumagalli, Giuseppe Sechi, Antonio Pesenti, Markus B. Skrifvars, Yongqin Li, Roberto Latini, Lars Wik, and Giuseppe Ristagno
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General Medicine ,Articles ,General Biochemistry, Genetics and Molecular Biology - Abstract
BACKGROUND: Ventricular fibrillation (VF) waveform analysis has been proposed as a potential non-invasive guide to optimize timing of defibrillation. METHODS: The AMplitude Spectrum Area (AMSA) trial is an open-label, multicenter randomized controlled study reporting the first in-human use of AMSA analysis in out-of-hospital cardiac arrest (OHCA). The primary efficacy endpoint was the termination of VF for an AMSA ≥ 15.5 mV-Hz. Adult shockable OHCAs randomly received either an AMSA-guided cardiopulmonary resuscitation (CPR) or a standard-CPR. Randomization and allocation to trial group were carried out centrally. In the AMSA-guided CPR, an initial AMSA ≥ 15.5 mV-Hz prompted for immediate defibrillation, while lower values favored chest compression (CC). After completion of the first 2-min CPR cycle, an AMSA < 6.5 mV-Hz deferred defibrillation in favor of an additional 2-min CPR cycle. AMSA was measured and displayed in real-time during CC pauses for ventilation with a modified defibrillator. FINDINGS: The trial was early discontinued for low recruitment due to the COVID-19 pandemics. A total of 31 patients were recruited in 3 Italian cities, 19 in AMSA-CPR and 12 in standard-CPR, and included in the data analysis. No difference in primary outcome was observed between the two groups. Termination of VF occurred in 74% of patients in the AMSA-CPR compared to 75% in the standard CPR (OR 0.93 [95% CI 0.18–4.90]). No adverse events were reported. INTERPRETATION: AMSA was used prospectively in human patients during ongoing CPR. In this small trial, an AMSA-guided defibrillation provided no evidence of an improvement in termination of VF. TRIAL REGISTRATION: NCT03237910. FUNDING: European Commission - Horizon 2020; ZOLL Medical Corp., Chelmsford, USA (unrestricted grant); Italian Ministry of Health - Current research IRCCS.
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- 2023
34. Markers of neutrophil mediated inflammation associate with disturbed continuous electroencephalogram after out of hospital cardiac arrest
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Pirkka T. Pekkarinen, Federico Carbone, Silvia Minetti, Davide Ramoni, Giuseppe Ristagno, Roberto Latini, Lauri Wihersaari, Kaj Blennow, Henrik Zetterberg, Jussi Toppila, Pekka Jakkula, Matti Reinikainen, Fabrizio Montecucco, Markus B. Skrifvars, Research Programs Unit, Anestesiologian yksikkö, University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine, HUS Medical Imaging Center, Kliinisen neurofysiologian yksikkö, Helsinki University Hospital Area, Department of Diagnostics and Therapeutics, and HUS Emergency Medicine and Services
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HYPOTHERMIA ,Inflammation ,hypoxia ,EUROPEAN-RESUSCITATION-COUNCIL ,Settore MED/41 - Anestesiologia ,General Medicine ,cardiac arrest ,ischemia ,Prognostication ,reperfusion injury ,GUIDELINES ,3126 Surgery, anesthesiology, intensive care, radiology ,Neutrophilic granulocyte ,Anesthesiology and Pain Medicine ,Seizures ,continuous electroencephalogram ,postcardiac arrest syndrome ,REPERFUSION ,inflammation ,neutrophilic granulocyte ,prognostication ,seizures - Abstract
Background Achieving an acceptable neurological outcome in cardiac arrest survivors remains challenging. Ischemia-reperfusion injury induces inflammation, which may cause secondary neurological damage. We studied the association of ICU admission levels of inflammatory biomarkers with disturbed 48-hour continuous electroencephalogram (cEEG), and the association of the daily levels of these markers up to 72 h with poor 6-month neurological outcome. Methods This is an observational, post hoc sub-study of the COMACARE trial. We measured serum concentrations of procalcitonin (PCT), high-sensitivity C-reactive protein (hsCRP), osteopontin (OPN), myeloperoxidase (MPO), resistin, and proprotein convertase subtilisin/kexin type 9 (PCSK9) in 112 unconscious, mechanically ventilated ICU-treated adult OHCA survivors with initial shockable rhythm. We used grading of 48-hour cEEG monitoring as a measure for the severity of the early neurological disturbance. We defined 6-month cerebral performance category (CPC) 1-2 as good and CPC 3-5 as poor long-term neurological outcome. We compared the prognostic value of biomarkers for 6-month neurological outcome to neurofilament light (NFL) measured at 48 h. Results Higher OPN (p = .03), MPO (p < .01), and resistin (p = .01) concentrations at ICU admission were associated with poor grade 48-hour cEEG. Higher levels of ICU admission OPN (OR 3.18; 95% CI 1.25-8.11 per ln[ng/ml]) and MPO (OR 2.34; 95% CI 1.30-4.21) were independently associated with poor 48-hour cEEG in a multivariable logistic regression model. Poor 6-month neurological outcome was more common in the poor cEEG group (63% vs. 19% p < .001, respectively). We found a significant fixed effect of poor 6-month neurological outcome on concentrations of PCT (F = 7.7, p < .01), hsCRP (F = 4.0, p < .05), and OPN (F = 5.6, p < .05) measured daily from ICU admission to 72 h. However, the biomarkers did not have independent predictive value for poor 6-month outcome in a multivariable logistic regression model with 48-hour NFL. Conclusion Elevated ICU admission levels of OPN and MPO predicted disturbances in cEEG during the subsequent 48 h after cardiac arrest. Thus, they may provide early information about the risk of secondary neurological damage. However, the studied inflammatory markers had little value for long-term prognostication compared to 48-hour NFL.
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- 2023
35. A Nanoscale Shape-Discovery Framework Supporting Systematic Investigations of Shape-Dependent Biological Effects and Immunomodulation
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Wei Zhang, Hender Lopez, Luca Boselli, Paolo Bigini, André Perez-Potti, Zengchun Xie, Valentina Castagnola, Qi Cai, Camila P. Silveira, Joao M. de Araujo, Laura Talamini, Nicolò Panini, Giuseppe Ristagno, Martina B. Violatto, Stéphanie Devineau, Marco P. Monopoli, Mario Salmona, Valeria A. Giannone, Sandra Lara, Kenneth A. Dawson, Yan Yan, and Science Foundation Ireland, Guangdong Provincial Education Department Key Laboratory of Nano-Immunoregulation Tumor Microenvironment, Irish Research Council, Chinese Scholarship Council
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Biological and Chemical Physics ,shape identification ,biological effects ,Microfluidics ,microfluidic ,General Engineering ,Reproducibility of Results ,General Physics and Astronomy ,tunable synthesis ,02 engineering and technology ,immunomodulation ,010402 general chemistry ,021001 nanoscience & nanotechnology ,Physical Chemistry ,01 natural sciences ,Article ,Nanostructures ,0104 chemical sciences ,Machine Learning ,Immunomodulation ,Statistical, Nonlinear, and Soft Matter Physics ,nanoscale shape ,General Materials Science ,0210 nano-technology - Abstract
Since it is now possible to make, in a controlled fashion, an almost unlimited variety of nanostructure shapes, it is of increasing interest to understand the forms of biological control that nanoscale shape allows. However, a priori rational investigation of such a vast universe of shapes appears to present intractable fundamental and practical challenges. This has limited the useful systematic investigation of their biological interactions and the development of innovative nanoscale shape-dependent therapies. Here, we introduce a concept of biologically relevant inductive nanoscale shape discovery and evaluation that is ideally suited to, and will ultimately become, a vehicle for machine learning discovery. Combining the reproducibility and tunability of microfluidic flow nanochemistry syntheses, quantitative computational shape analysis, and iterative feedback from biological responses in vitro and in vivo, we show that these challenges can be mastered, allowing shape biology to be explored within accepted scientific and biomedical research paradigms. Early applications identify significant forms of shape-induced biological and adjuvant-like immunological control.
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- 2021
36. Emergency calls as an early indicator of intensive care unit demand for coronavirus disease 2019
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Tommaso Scquizzato, Giovanni Landoni, Giuseppe Ristagno, Alessandro Pruna, and Alberto Zangrillo
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Emergency Medicine - Published
- 2022
37. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces
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Myra H. Wyckoff, Robert Greif, Peter T. Morley, Kee-Chong Ng, Theresa M. Olasveengen, Eunice M. Singletary, Jasmeet Soar, Adam Cheng, Ian R. Drennan, Helen G. Liley, Barnaby R. Scholefield, Michael A. Smyth, Michelle Welsford, David A. Zideman, Jason Acworth, Richard Aickin, Lars W. Andersen, Diane Atkins, David C. Berry, Farhan Bhanji, Joost Bierens, Vere Borra, Bernd W. Böttiger, Richard N. Bradley, Janet E. Bray, Jan Breckwoldt, Clifton W. Callaway, Jestin N. Carlson, Pascal Cassan, Maaret Castrén, Wei-Tien Chang, Nathan P. Charlton, Sung Phil Chung, Julie Considine, Daniela T. Costa-Nobre, Keith Couper, Thomaz Bittencourt Couto, Katie N. Dainty, Peter G. Davis, Maria Fernanda de Almeida, Allan R. de Caen, Charles D. Deakin, Therese Djärv, Michael W. Donnino, Matthew J. Douma, Jonathan P. Duff, Cody L. Dunne, Kathryn Eastwood, Walid El-Naggar, Jorge G. Fabres, Joe Fawke, Judith Finn, Elizabeth E. Foglia, Fredrik Folke, Elaine Gilfoyle, Craig A. Goolsby, Asger Granfeldt, Anne-Marie Guerguerian, Ruth Guinsburg, Karen G. Hirsch, Mathias J. Holmberg, Shigeharu Hosono, Ming-Ju Hsieh, Cindy H. Hsu, Takanari Ikeyama, Tetsuya Isayama, Nicholas J. Johnson, Vishal S. Kapadia, Mandira Daripa Kawakami, Han-Suk Kim, Monica Kleinman, David A. Kloeck, Peter J. Kudenchuk, Anthony T. Lagina, Kasper G. Lauridsen, Eric J. Lavonas, Henry C. Lee, Yiqun (Jeffrey) Lin, Andrew S. Lockey, Ian K. Maconochie, R. John Madar, Carolina Malta Hansen, Siobhan Masterson, Tasuku Matsuyama, Christopher J.D. McKinlay, Daniel Meyran, Patrick Morgan, Laurie J. Morrison, Vinay Nadkarni, Firdose L. Nakwa, Kevin J. Nation, Ziad Nehme, Michael Nemeth, Robert W. Neumar, Tonia Nicholson, Nikolaos Nikolaou, Chika Nishiyama, Tatsuya Norii, Gabrielle A. Nuthall, Brian J. O’Neill, Yong-Kwang Gene Ong, Aaron M. Orkin, Edison F. Paiva, Michael J. Parr, Catherine Patocka, Jeffrey L. Pellegrino, Gavin D. Perkins, Jeffrey M. Perlman, Yacov Rabi, Amelia G. Reis, Joshua C. Reynolds, Giuseppe Ristagno, Antonio Rodriguez-Nunez, Charles C. Roehr, Mario Rüdiger, Tetsuya Sakamoto, Claudio Sandroni, Taylor L. Sawyer, Steve M. Schexnayder, Georg M. Schmölzer, Sebastian Schnaubelt, Federico Semeraro, Markus B. Skrifvars, Christopher M. Smith, Takahiro Sugiura, Janice A. Tijssen, Daniele Trevisanuto, Patrick Van de Voorde, Tzong-Luen Wang, Gary M. Weiner, Jonathan P. Wyllie, Chih-Wei Yang, Joyce Yeung, Jerry P. Nolan, Katherine M. Berg, Madeline C. Burdick, Susie Cartledge, Jennifer A. Dawson, Moustafa M. Elgohary, Hege L. Ersdal, Emer Finan, Hilde I. Flaatten, Gustavo E. Flores, Janene Fuerch, Rakesh Garg, Callum Gately, Mark Goh, Louis P. Halamek, Anthony J. Handley, Tetsuo Hatanaka, Amber Hoover, Mohmoud Issa, Samantha Johnson, C. Omar Kamlin, Ying-Chih Ko, Amy Kule, Tina A. Leone, Ella MacKenzie, Finlay Macneil, William Montgomery, Domhnall O’Dochartaigh, Shinichiro Ohshimo, Francesco Stefano Palazzo, Christopher Picard, Bin Huey Quek, James Raitt, Viraraghavan V. Ramaswamy, Andrea Scapigliati, Birju A. Shah, Craig Stewart, Marya L. Strand, Edgardo Szyld, Marta Thio, Alexis A. Topjian, Enrique Udaeta, Christian Vaillancourt, Wolfgang A. Wetsch, Jane Wigginton, Nicole K. Yamada, Sarah Yao, Drieda Zace, and Carolyn M. Zelop
- Subjects
Emergency Medical Services ,Consensus ,pediatrics ,resuscitation ,cardiac arrest ,first aid ,Emergency Nursing ,infant ,Cardiopulmonary Resuscitation ,Out-of-Hospital Cardiac Arrest/therapy ,AHA Scientific Statements ,infant, newborn ,basic life support ,newborn ,Physiology (medical) ,Pediatrics, Perinatology and Child Health ,Settore MED/41 - ANESTESIOLOGIA ,Emergency Medicine ,advanced life support ,Humans ,Child ,Cardiology and Cardiovascular Medicine ,Emergency Treatment - Abstract
his is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed. This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
- Published
- 2022
38. Specific theorical and practical education on mechanical chest compression during advanced life support training courses - Results from a local experience
- Author
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Fausto D'Agostino, Felice Eugenio Agrò, Pierfrancesco Fusco, Claudio Ferri, and Giuseppe Ristagno
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Emergency Medicine ,Emergency Nursing ,Cardiology and Cardiovascular Medicine - Abstract
Specific training modules focusing on mechanical chest compression and device use might be considered in a structured manner during the standard advanced life support (ALS) courses. The aim of this study was to evaluate the impact of a specific brief 15 min training on the use of a specific mechanical CPR device during Advanced Cardiac Life Support courses on its correct use and on attendees' satisfaction.
- Published
- 2022
39. The effects of exposure to severe hyperoxemia on neurological outcome and mortality after cardiac arrest
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Luigi LA VIA, Marinella ASTUTO, Elena G. BIGNAMI, Diana BUSALACCHI, Veronica DEZIO, Massimo GIRARDIS, Bruno LANZAFAME, Giuseppe RISTAGNO, Paolo PELOSI, and Filippo SANFILIPPO
- Subjects
Oxygen ,Return of spontaneous circulation ,Intensive care units ,Anesthesiology and Pain Medicine ,Resuscitation ,Humans ,Blood Gas Analysis ,Brain injuries ,Mortality ,Respiration Disorders ,Hypoxia ,Heart Arrest ,Retrospective Studies - Abstract
Hyperoxemia during cardiac arrest (CA) may increase chances of successful resuscitation. However, episodes of severe hyperoxemia after intensive care unit admission occurs frequently (up to 60%), and these have been associated with higher mortality in CA patients. The impact of severe hyperoxemia on neurological outcome is more unclear.We conducted a systematic review and meta-analysis on Pubmed and EMBASE to evaluate the effects of severe hyperoxemia according to arterial blood gas analysis on neurological outcome and mortality in patients resuscitated from CA and admitted to intensive care unit.Thirteen observational studies were included, eight of them reporting data on neurological outcome and ten on mortality. Most studies reported odds ratio adjusted for confounders. Severe hyperoxemia was associated with worse neurological outcome (OR 1.37 [95%CI 1.01,1.86], P=0.04) and higher mortality at longest follow-up (OR 1.32 [95%CI 1.11,1.57], P=0.002). Subgroup analyses according to timing of hyperoxemia showed that any hyperoxemia during the first 36 hours was associated with worse neurological outcome (OR 1.52 [95%CI 1.12,2.08], P=0.008) and higher mortality (OR 1.40 [95%CI 1.18,1.66], P=0.0001), whilst early hyperoxemia was not (neurological: P=0.29; mortality: P=0.19). Sensitivity analyses mostly confirmed the results of the primary analyses.Severe hyperoxemia is associated with worse neurological outcome and lower survival in CA survivors admitted to intensive care unit. Clinical efforts should be made to avoid severe hyperoxemia during at least the first 36 hours after cardiac arrest.
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- 2022
40. OR07 Conventional and Speckle-Tracking Echocardiography (STE) and Cardiac Circulating Biomarkers in a rat model of Cardiac Arrest
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Daria De Giorgio, Davide Olivari, Francesca Fumagalli, Francesca Motta, Carlo Perego, Lidia Irene Staszewsky, and Giuseppe Ristagno
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Emergency Medicine ,Emergency Nursing ,Cardiology and Cardiovascular Medicine - Published
- 2022
41. Transthoracic Echocardiography to Assess Post-Resuscitation Left Ventricular Dysfunction After Acute Myocardial Infarction and Cardiac Arrest in Pigs
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Giuseppe Ristagno, Lidia Staszewsky, Francesca Fumagalli, Davide Olivari, and Daria De Giorgio
- Subjects
Echocardiography, Doppler, Pulsed ,Ventricular Dysfunction, Left ,General Immunology and Microbiology ,Diastole ,Echocardiography ,Swine ,General Chemical Engineering ,General Neuroscience ,Myocardial Infarction ,Animals ,Ventricular Function, Left ,General Biochemistry, Genetics and Molecular Biology ,Heart Arrest - Abstract
One of the main causes of out-of-hospital cardiac arrest is acute myocardial infarction (AMI). After successful resuscitation from cardiac arrest, approximately 70% of patients die before hospital discharge due to post-resuscitation myocardial and cerebral dysfunction. In experimental models, myocardial dysfunction after cardiac arrest, characterized by an impairment in both left ventricular (LV) systolic and diastolic function, has been described as reversible but very little data are available in cardiac arrest models associated with AMI in pigs. Transthoracic echocardiography is the first-line diagnostic test for the assessment of myocardial dysfunction, structural changes and/or AMI extension. In this pig model of ischemic cardiac arrest, echocardiography was done at baseline and 2-4 and 96 hours after resuscitation. In the acute phase, the examinations are done in anesthetized, mechanically ventilated pigs (weight 39.8 ± 0.6 kg) and ECG is recorded continuously. Mono- and bi-dimensional, Doppler and tissue Doppler recordings are acquired. Aortic and left atrium diameter, end-systolic and end-diastolic left ventricular wall thicknesses, end-diastolic and end-systolic diameters and shortening fraction (SF) are measured. Apical 2-, 3-, 4-, and 5-chamber views are acquired, LV volumes and ejection fraction are calculated. Segmental wall motion analysis is done to detect the localization and estimate the extent of myocardial infarction. Pulsed Wave Doppler echocardiography is used to record trans-mitral flow velocities from a 4-apical chamber view and trans-aortic flow from a 5-chamber view to calculate LV cardiac output (CO) and stroke volume (SV). Tissue Doppler Imaging (TDI) of LV lateral and septal mitral anulus is recorded (TDI septal and lateral s', e', a' velocities). All the recordings and measurements are done according to the recommendations of the American and European Societies of Echocardiography Guidelines.
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- 2022
42. 'De trop' meta-analyses and systematic reviews in cardiopulmonary resuscitation – A way to rapidly improve authors’ citation index at a price of real science
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Giulia Merigo, Ivan Silvestri, Aurora Magliocca, Francesca Fumagalli, and Giuseppe Ristagno
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Emergency Medicine ,Emergency Nursing ,Cardiology and Cardiovascular Medicine - Published
- 2023
43. Kurzfassung
- Author
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Silvija Hunyadi Anticevic, Dominique Hendrickx, Pierre Carli, Christian Hassager, Leo Bossaert, Spyridon Mentzelopoulos, Martijn Maas, Anatolij Truhlar, Artem Kuzovlev, Annick De Roovere, Luis Sanchez Santos, Adriana Boccuzzi, Carlo Clarens, Jasmeet Soar, Gamal Eldin, Sule Akin, David Zideman, Robert Greif, Saloua Safri, Primoz Gradisek, Jon-Kenneth Heltne, Jonathan Wyllie, Ian Maconochie, Jozef Koppl, Theodoros Christophides, Pascal Cassan, Diana Cimpoesu, Simon Attard Montalto, Nikolaos Nikolaou, Gabbas Khalifa, Roman Burkart, Wilhem Behringer, Theresa M. Olasveengen, Walter Renier, Mahmoud Tageldin Mustafa, Koen Monsieurs, John Madar, Michael Baubin, Federico Semeraro, Bernd W. Böttiger, Jacques Delchef, Heleen Van Grootven, Nicolas Mpotos, B. Dirks, U. Kreimeier, Jukka Vaahersalo, Suzanne Schilder, Carsten Lott, Patrick Van de Voorde, Els Goemans, Georg Trummer, Kathleen Pitches, Giuseppe Ristagno, Gavin D. Perkins, Janusz Andres, Jan-Thorsten Gräsner, Hildigunnur Svavarsdóttir, Hans Friberg, Jerry P. Nolan, and Violetta Raffay
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business.industry ,Emergency Medicine ,Medicine ,business - Published
- 2021
44. Basismaßnahmen zur Wiederbelebung Erwachsener (Basic Life Support)
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Giuseppe Ristagno, Gavin D. Perkins, Violetta Raffay, Hildigunnur Svavarsdóttir, Artem Kuzovlev, Anthony J. Handley, Federico Semeraro, Koenraad G. Monsieurs, Maaret Castrén, Jasmeet Soar, Michael Smyth, and Theresa M. Olasveengen
- Subjects
Resuscitation ,business.industry ,Defibrillation ,medicine.medical_treatment ,education ,Basic life support ,030208 emergency & critical care medicine ,030204 cardiovascular system & hematology ,Airway obstruction ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Emergency Medicine ,Emergency medical services ,medicine ,Emergency medical dispatch ,Cardiopulmonary resuscitation ,Medical emergency ,business ,Automated external defibrillator - Abstract
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), cardiopulmonary resuscitation (CPR) quality measurement, new technologies, safety, and foreign body airway obstruction.
- Published
- 2021
45. Lebensrettende Systeme
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Robert Greif, Sebastian Schnaubelt, Joyce Yeung, Joachim Schlieber, Giuseppe Ristagno, Theresa M. Olasveengen, Marios Georgiou, Freddy Lippert, Andrew Lockey, Diana Cimpoesu, Federico Semeraro, Bernd W. Böttiger, Andrea Scapigliati, Roman Burkart, and Koenraad G. Monsieurs
- Subjects
business.industry ,Emergency Medicine ,Medicine ,Chain of survival ,Medical emergency ,business ,medicine.disease - Published
- 2021
46. European Resuscitation Council Guidelines 2021: Executive summary
- Author
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J. Schlieber, P. Druwe, Fernando Rosell-Ortiz, D. Meyran, N. De Lucas, A.B. te Pas, Robert Greif, J. Madar, A. Boccuzzi, Kirstie L. Haywood, Jana Djakow, E. Goemans, Jonathan Wyllie, W. Renier, Patrick Van de Voorde, Carsten Lott, Tobias Cronberg, Koenraad G. Monsieurs, A. Cariou, Pierre Carli, Therese Djärv, V. Borra, Siobhán Masterson, L. Sanchez Santos, I. Lulic, E. Oliver, Theresa M. Olasveengen, David Zideman, G. Eldin, Giuseppe Ristagno, S. Akin, C. D. Cimpoesu, E. M. Singletary, Spyridon Mentzelopoulos, Joyce Yeung, A. Barelli, D. Hendrickx, G. D. Perkins, Berndt Urlesberger, Lucas Pflanzl-Knizacek, J. K. Heltne, Leo Bossaert, Andrea Scapigliati, L. Bossaert, H. van Grootven, Gavin D. Perkins, Sean Ainsworth, Ferenc Sari, Tomasz Szczapa, K. Pitches, Gamal Eldin Abbas Khalifa, B. Dirks, Dominic Wilkinson, P. Cassan, Jan Wnent, Charles Christoph Roehr, Johan Herlitz, A. de Roovere, Abel Martinez-Mejias, J. Delchef, Florian Hoffmann, M. Blom, J. Koppl, J. Soar, Keith Couper, Artem Kuzovlev, Marios Georgiou, A. Truhlar, Federico Semeraro, G. Trummer, R. Burkart, Mario Rüdiger, V. R. M. Moulaert, John Madar, Jan-Thorsen Gräsner, W. Behringer, R. Greif, C. Clarens, Spyros D. Mentzelopoulos, Torsten Lauritsen, A. Alfonzo, Freddy Lippert, Hildigunnur Svavarsdóttir, Markus B. Skrifvars, Koen Monsieurs, B. Bein, Tommaso Pellis, Maaret Castren, H. Friberg, Jan Breckwoldt, U. Kreimeier, Charles D. Deakin, Christiane Skåre, Nikolaos I. Nikolaou, S. Hunyadi Anticevic, J. P. Nolan, Anthony J. Handley, F. Taccone, S. Schilder, Jerry P. Nolan, Janusz Andres, A. Safri, O. Brissaud, Hege Langli Ersdal, Peter Paal, B. Klaassen, Karl-Christian Thies, Dominique Biarent, D. A. Zideman, Gisela Lilja, J.T. Graesner, Sebastian Schnaubelt, P. Van de Voorde, Ian Maconochie, Violetta Raffay, Michael Smyth, P. Gradisek, C. Lott, C. Genbrugge, Salma Shammet, Daniele Trevisanuto, Violeta González-Salvado, H. Svavarsdottir, N. M. Turner, M. Tageldin Mustafa, Ingvild Tjelmeland, Patricia Conaghan, T. Christophides, Colin J Morley, J. Vaahersalo, M. Baubin, Kurtis Poole, Claudio Sandroni, N. Mpotos, Jasmeet Soar, Bernd W. Böttiger, S. Attard Montalto, Jochen Hinkelbein, M. Maas, Robert Bingham, C. Hassager, T. M. Olasveengen, Francesc Carmona, Groa Bjork Johannesdottir, Andy Lockey, E. De Buck, and European Resuscitation Council Gui
- Subjects
Adult ,Resuscitation ,medicine.medical_treatment ,education ,030204 cardiovascular system & hematology ,Emergency Nursing ,03 medical and health sciences ,0302 clinical medicine ,resuscitation ,guidelines ,summary ,Nursing ,First Aid ,Humans ,Medicine ,Cardiopulmonary resuscitation ,610 Medicine & health ,Child ,Executive summary ,business.industry ,Infant, Newborn ,Basic life support ,030208 emergency & critical care medicine ,Cardiopulmonary Resuscitation ,Heart Arrest ,Advanced life support ,Europe ,Systematic review ,Life support ,Emergency Medicine ,Human medicine ,Cardiology and Cardiovascular Medicine ,business ,Systematic Reviews as Topic ,First aid - Abstract
Informed by a series of systematic reviews, scoping reviews and evidence updates from the International Liaison Committee on Resuscitation, the 2021 European Resuscitation Council Guidelines present the most up to date evidence-based guidelines for the practice of resuscitation across Europe. The guidelines cover the epidemiology of cardiac arrest; the role that systems play in saving lives, adult basic life support, adult advanced life support, resuscitation in special circumstances, post resuscitation care, first aid, neonatal life support, paediatric life support, ethics and education.
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- 2021
47. COVID‐19 and reduced bystander cardiopulmonary resuscitation: A thanatophobic attitude leading to increased deaths from cardiac arrest?
- Author
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Giovanni Babini and Giuseppe Ristagno
- Subjects
Anesthesiology and Pain Medicine ,bystander CPR ,COVID-19 ,Settore MED/41 - Anestesiologia ,cardiac arrest ,General Medicine - Published
- 2022
48. Resuscitation guideline highlights
- Author
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Theresa M. Olasveengen, Giuseppe Ristagno, and Michael A. Smyth
- Subjects
Humans ,Critical Care and Intensive Care Medicine ,Cardiopulmonary Resuscitation ,Defibrillators ,Heart Arrest - Abstract
The purpose of this review was to give an overview of the most significant updates in resuscitation guidelines and provide some insights into the new topics being considered in upcoming reviews.Recent updates to resuscitation guidelines have highlighted the importance of the earlier links in the chain-of-survival aimed to improve early recognition, early cardiopulmonary resuscitation (CPR) and defibrillation. Empowering lay rescuers with the support of emergency medical dispatchers or telecommunicators and engaging the community through dispatching volunteers and Automated External Defibrillators, are considered key in improving cardiac arrest outcomes. Novel CPR strategies such as passive insufflation and head-up CPR are being explored, but lack high-certainty evidence. Increased focus on survivorship also highlights the need for more evidence based guidance on how to facilitate the necessary follow-up and rehabilitation after cardiac arrest. Many of the systematic and scoping reviews performed within cardiac arrest resuscitation domains identifies significant knowledge gaps on key elements of our resuscitation practices. There is an urgent need to address these gaps to further improve survival from cardiac arrest in all settings.A continuous evidence evaluation process for resuscitation after cardiac arrest is triggered by new evidence or request by the resuscitation community, and provides more current and relevant guidance for clinicians.
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- 2022
49. Optimizing defibrillation during cardiac arrest
- Author
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Giovanni Babini, Giuseppe Ristagno, and Laura Ruggeri
- Subjects
medicine.medical_specialty ,Defibrillation ,medicine.medical_treatment ,Electric Countershock ,Return of spontaneous circulation ,Critical Care and Intensive Care Medicine ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,ECG analysis ,Prospective Studies ,Cardiopulmonary resuscitation ,business.industry ,030208 emergency & critical care medicine ,medicine.disease ,Cardiopulmonary Resuscitation ,Shock delivery ,Heart Arrest ,Observational Studies as Topic ,030228 respiratory system ,Waveform analysis ,Shock (circulatory) ,Ventricular Fibrillation ,Ventricular fibrillation ,Cardiology ,medicine.symptom ,business - Abstract
Purpose of review Current cardiac arrest guidelines are based on a fixed, time-based defibrillation strategy. Rhythm analysis and shock delivery (if indicated) are repeated every 2 min requiring cyclical interruptions of chest compressions. This approach has several downsides, such as the need to temporarily stop cardiopulmonary resuscitation (CPR) for a variable amount of time, thus reducing myocardial perfusion and decreasing the chance of successful defibrillation. A tailored defibrillation strategy should identify treatment priority for each patient, that is chest compressions (CCS) or defibrillation, minimize CCs interruptions, speed up the delivery of early effective defibrillation and reduce the number of ineffective shocks. Recent findings Real-time ECG analysis (using adaptive filters, new algorithms robust to chest compressions artifacts and shock-advisory algorithms) is an effective strategy to correctly identify heart rhythm during CPR and reduce the hands-off time preceding a shock. Similarly, ventricular fibrillation waveform analysis, that is amplitude spectrum area (AMSA) represents a well established approach to reserve defibrillation in patients with high chance of shock success and postpone it when ventricular fibrillation termination is unlikely. Both approaches demonstrated valuable results in improving cardiac arrest outcomes in experimental and observational study. Summary Real-time ECG analysis and AMSA have the potential to predict ventricular fibrillation termination, return of spontaneous circulation and even survival, with discretely high confidence. Prospective studies are now necessary to validate these new approaches in the clinical scenario.
- Published
- 2021
50. Cardiopulmonary Resuscitation–associated Lung Edema (CRALE). A Translational Study
- Author
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Leonello Avalli, Giacomo Grasselli, Giacomo Bellani, Davide Olivari, Emanuele Rezoagli, D. De Zani, Antonio Pesenti, Giuseppe Ristagno, Martina Manfredi, Thomas Langer, Aurora Magliocca, Francesca Fumagalli, Daria De Giorgio, Roberto Latini, Magliocca, A, Rezoagli, E, Zani, D, Manfredi, M, De Giorgio, D, Olivari, D, Fumagalli, F, Langer, T, Avalli, L, Grasselli, G, Latini, R, Pesenti, A, Bellani, G, and Ristagno, G
- Subjects
Pulmonary and Respiratory Medicine ,Cardiopulmonary resuscitation ,Lung ,business.industry ,medicine.medical_treatment ,Intrathoracic pressure ,Cardiac arrest ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,Anesthesia ,Acute lung injury ,Medicine ,Chest compression ,030212 general & internal medicine ,LUNG EDEMA ,business - Abstract
Rationale: Cardiopulmonary resuscitation is the cornerstone of cardiac arrest (CA) treatment. However, lung injuries associated with it have been reported. Objectives: To assess 1) the presence and characteristics of lung abnormalities induced by cardiopulmonary resuscitation and 2) the role of mechanical and manual chest compression (CC) in its development. Methods: This translational study included 1) a porcine model of CA and cardiopulmonary resuscitation (n = 12) and 2) a multicenter cohort of patients with out-of-hospital CA undergoing mechanical or manual CC (n = 52). Lung computed tomography performed after resuscitation was assessed qualitatively and quantitatively along with respiratory mechanics and gas exchanges. Measurements and Main Results: The lung weight in the mechanical CC group was higher compared with the manual CC group in the experimental (431 6 127 vs. 273 6 66, P = 0.022) and clinical study (1,208 6 630 vs. 837 6 306, P = 0.006). The mechanical CC group showed significantly lower oxygenation (P = 0.043) and respiratory system compliance (P, 0.001) compared with the manual CC group in the experimental study. The variation of right atrial pressure was significantly higher in the mechanical compared with the manual CC group (54 6 11 vs. 31 6 6 mm Hg, P = 0.001) and significantly correlated with lung weight (r = 0.686, P = 0.026) and respiratory system compliance (r = 20.634, P = 0.027). Incidence of abnormal lung density was higher in patients treated with mechanical compared with manual CC (37% vs. 8%, P = 0.018). Conclusions: This study demonstrated the presence of cardiopulmonary resuscitation–associated lung edema in animals and in patients with out-of-hospital CA, which is more pronounced after mechanical as opposed to manual CC and correlates with higher swings of right atrial pressure during CC.
- Published
- 2021
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