Pubblicazioni recenti - cardiac arrest
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Postresuscitation Ventilation With a Mixture of Argon and Hydrogen Reduces Brain Injury After Cardiac Arrest in a Pig Model.
J Am Heart Assoc2024 Apr;():e033367. doi: 10.1161/JAHA.123.033367.
Motta Francesca, De Giorgio Daria, Cerrato Marianna, Salmaso Anita, Magliocca Aurora, Merigo Giulia, Olivari Davide, Perego Carlo, Fumagalli Francesca, Ristagno Giuseppe,
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Association between eGFR and neurological outcomes among patients with out-of-hospital cardiac arrest: A nationwide prospective study in Japan.
Acute Med Surg2024 ;11(1):e952. doi: 10.1002/ams2.952.
Kandori Kenji, Okada Asami, Nakajima Satoshi, Matsuyama Tasuku, Kitamura Tetsuhisa, Narumiya Hiromichi, Iizuka Ryoji, Hitosugi Masahito, Okada Yohei,
Abstract
AIM:
We aimed to investigate the association between estimated glomerular filtration rate and prognosis in out-of-hospital cardiac arrest patients and explore the heterogeneity of the association.
METHODS:
Patients experiencing out-of-hospital cardiac arrest due to medical causes and registered in the JAAM-OHCA Registry between June 2014 and December 2019 were stratified into shockable rhythm, pulseless electrical activity, and asystole groups according to the cardiac rhythm at the scene. The primary outcome was a 1-month favorable neurological status. Adjusted odds ratios with 95% confidence intervals were calculated to investigate the association between estimated glomerular filtration rate and outcomes using a logistic model.
RESULTS:
Of the 19,443 patients included, 2769 had initial shockable rhythm at the scene, 5339 had pulseless electrical activity, and 11,335 had asystole. As the estimated glomerular filtration rate decreased, the adjusted odds ratio for a 1-month favorable neurological status decreased among those with initial shockable rhythm (estimated glomerular filtration rate, adjusted odds ratio [95% CI]: 45-59?mL/min/1.73?m, 0.61 [0.47-0.79]; 30-44?mL/min/1.73?m, 0.45 [0.32-0.62]; 15-29?mL/min/1.73?m, 0.35 [0.20-0.63]; and 65?years or patients with initial pulseless electrical activity or asystole.
CONCLUSION:
The estimated glomerular filtration rate is associated with neurological prognosis in out-of-hospital cardiac arrest patients with initial shockable rhythm at the scene but not in those with initial non-shockable rhythm.
© 2024 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.
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First Experience With the Triolifter, a Novel Device for Organ Fixation Used as a Heart Positioner in Cardiac Surgery.
Cureus2024 Mar;16(3):e56461. doi: 10.7759/cureus.56461.
Umeda Yukio, Matsuno Yukihiro, Mitta Shohei, Yoshikawa Shoji,
Abstract
We describe our first experience with the Triolifter (Fuji Systems, Yokohama, Japan) in cardiac surgery. The Triolifter is a less expensive, novel organ fixation device developed as a fixation indenter mainly for traction of the lung under video-assisted surgery and is now available in Japan. An 84-year-old man diagnosed with unstable angina pectoris underwent emergency coronary artery bypass grafting (CABG) under cardiac arrest. Following the declamping of the aorta and the resumption of the beating heart, bleeding from the left anterior descending artery (LAD) anastomosis site was observed. The Triolifter was used as a heart positioner to expose the anastomosis site for hemostasis in the setting of an on-pump beating heart. Hemostasis of the posterior descending artery (PDA) anastomosis site could also be confirmed by traction of the right ventricular anterior wall using the Triolifter. It could be effectively and safely used with neither significant subepicardial hematoma nor epicardial injury. In Japan, the Triolifter might be used as one of the insurance-covered devices in off-pump CABG in the future, but globally, it could also be used in on-pump CABG without hesitation because it is so inexpensive.
Copyright © 2024, Umeda et al.
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Greater Disease Severity and Worse Clinical Outcomes in Patients Hospitalised with COVID-19 in Africa.
Glob Heart2024 ;19(1):34. doi: 10.5334/gh.1314.
Hahnle Lina, Mennen Mathilda, Gumedze Freedom, Mutithu Daniel, Adriaanse Marguerite, Egan Daniel, Mazondwa Simthandile, Walters Rochelle, Appiah Lambert Tetteh, Inofomoh Francisca, Ogah Okechukwu, Adekanmbi Olukemi, Goma Fastone, Ogola Elijah, Mwazo Kieran, Suliman Ahmed, Singh Kavita, Raspail Lana, Prabhakaran Dorairaj, Perel Pablo, Sliwa Karen, Ntusi Ntobeko A B,
Abstract
BACKGROUND:
COVID-19 cardiovascular research from Africa is limited. This study describes cardiovascular risk factors, manifestations, and outcomes of patients hospitalised with COVID-19 in the African region, with an overarching goal to investigate whether important differences exist between African and other populations, which may inform health policies.
METHODS:
A multinational prospective cohort study was conducted on adults hospitalised with confirmed COVID-19, consecutively admitted to 40 hospitals across 23 countries, 6 of which were African countries. Of the 5,313 participants enrolled globally, 948 were from African sites (n = 9). Data on demographics, pre-existing conditions, clinical outcomes in hospital (major adverse cardiovascular events (MACE), renal failure, neurological events, pulmonary outcomes, and death), 30-day vitality status and re-hospitalization were assessed, comparing African to non-African participants.
RESULTS:
Access to specialist care at African sites was significantly lower than the global average (71% vs. 95%), as were ICU admissions (19.4% vs. 34.0%) and COVID-19 vaccination rates (0.6% vs. 7.4%). The African cohort was slightly younger than the non-African cohort (55.0 vs. 57.5 years), with higher rates of hypertension (48.8% vs. 46.9%), HIV (5.9% vs. 0.3%), and Tuberculosis (3.6% vs. 0.3%). In African sites, a higher proportion of patients suffered cardiac arrest (7.5% vs. 5.1%) and acute kidney injury (12.7% vs. 7.2%), with acute kidney injury (AKI) appearing to be one of the strongest predictors of MACE and death in African populations compared to other populations. The overall mortality rate was significantly higher among African participants (18.2% vs. 14.2%).
CONCLUSIONS:
Overall, hospitalised African patients with COVID-19 had a higher mortality despite a lower mean age, contradicting literature that had previously reported a lower mortality attributed to COVID-19 in Africa. African sites had lower COVID-19 vaccination rates and higher AKI rates, which were positively associated with increased mortality. In conclusion, African patients were hospitalized with more severe COVID-19 cases and had poorer outcomes.
Copyright: © 2024 The Author(s).
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Advancing the Scientific Basis for Determining Death in Controlled Organ Donation After Circulatory Determination of Death.
Transplantation2024 Apr;():. doi: 10.1097/TP.0000000000005002.
Murphy Nicholas B, Shemie Sam D, Capron Alex, Truog Robert D, Nakagawa Thomas, Healey Andrew, Gofton Teneille, Bernat James L, Fenton Kathleen, Khush Kiran K, Schwartz Bryanna, Wall Stephen P,
Abstract
In controlled organ donation after circulatory determination of death (cDCDD), accurate and timely death determination is critical, yet knowledge gaps persist. Further research to improve the science of defining and determining death by circulatory criteria is therefore warranted. In a workshop sponsored by the National Heart, Lung, and Blood Institute, experts identified research opportunities pertaining to scientific, conceptual, and ethical understandings of DCDD and associated technologies. This article identifies a research strategy to inform the biomedical definition of death, the criteria for its determination, and circulatory death determination in cDCDD. Highlighting knowledge gaps, we propose that further research is needed to inform the observation period following cessation of circulation in pediatric and neonatal populations, the temporal relationship between the cessation of brain and circulatory function after the withdrawal of life-sustaining measures in all patient populations, and the minimal pulse pressures that sustain brain blood flow, perfusion, activity, and function. Additionally, accurate predictive tools to estimate time to asystole following the withdrawal of treatment and alternative monitoring modalities to establish the cessation of circulatory, brainstem, and brain function are needed. The physiologic and conceptual implications of postmortem interventions that resume circulation in cDCDD donors likewise demand attention to inform organ recovery practices. Finally, because jurisdictionally variable definitions of death and the criteria for its determination may impede collaborative research efforts, further work is required to achieve consensus on the physiologic and conceptual rationale for defining and determining death after circulatory arrest.
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
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Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: be aware of the temporal selection bias.
Crit Care2024 Apr;28(1):126. doi: 10.1186/s13054-024-04907-1.
Jouffroy Romain, Vie Anne-Cécile, Vivien Benoît,
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Associated factors with the occurrence of in-hospital cardiac arrest in patients admitted to internal medicine wards for non-cardiovascular causes.
Med Clin (Barc)2024 Apr;():. doi: S0025-7753(24)00131-3.
Carmona-Puerta Raimundo, Choque-Laura José Luis, Chávez-González Elibet, Peñaló-Batista Joel, Martínez-Sánchez Marielys Del Carmen, Lorenzo-Martínez Elizabeth,
Abstract
BACKGROUND AND OBJECTIVE:
In-hospital cardiac arrest (IHCA) has a low survival rate, so it is essential to recognize the cases with the highest probability of developing it. The aim of this study is to identify factors associated with the occurrence of IHCA.
MATERIAL AND METHODS:
A single-center case-control study was conducted including 65 patients admitted to internal medicine wards for non-cardiovascular causes who experienced IHCA, matched with 210 admitted controls who did not present with IHCA.
RESULTS:
The main reason for admission was pneumonia. The most prevalent comorbidity was arterial hypertension. Four characteristics were strongly and independently associated with IHCA presentation, these are electrical left ventricular hypertrophy (LVH) (OR: 13.8; 95% IC: 4.7-40.7), atrial fibrillation (OR: 9.4: 95% CI: 4.3-20.6), the use of drugs with known risk of torsades de pointes (OR: 2.7; 95% CI: 1.3-5.5) and the combination of the categories known risk plus conditional risk (OR: 17.1; 95% CI: 6.7-50.1). The first two detected in the electrocardiogram taken at the time of admission.
CONCLUSION:
In admitted patients for non-cardiovascular causes, the use of drugs with a known risk of torsades de pointes, as well as the detection of electrical LVH and atrial fibrillation in the initial electrocardiogram, is independently associated with a higher probability of suffering a IHCA.
Copyright © 2024 Elsevier España, S.L.U. All rights reserved.
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Duration of cardiopulmonary resuscitation and outcomes for adults with in-hospital cardiac arrest: retrospective cohort study.
BMJ -
Cerebral Edema Following Cardiac Arrest: Are All Shades of Gray Equal?
Resuscitation2024 Apr;():110213. doi: 10.1016/j.resuscitation.2024.110213.
Beekman Rachel, Gilmore Emily J,
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Fluid balance during acute phase extracorporeal cardiopulmonary resuscitation and outcomes in OHCA patients: a retrospective multicenter cohort study.
Clin Res Cardiol2024 Apr;():. doi: 10.1007/s00392-024-02444-z.
Taira Takuya, Inoue Akihiko, Okamoto Hiroshi, Maekawa Kunihiko, Hifumi Toru, Sakamoto Tetsuya, Kuroda Yasuhiro, Suga Masafumi, Nishimura Takeshi, Ijuin Shinichi, Ishihara Satoshi, ,
Abstract
OBJECTIVE:
The association between fluid balance and outcomes in patients who underwent out-of-hospital cardiac arrest (OHCA) and received extracorporeal cardiopulmonary resuscitation (ECPR) remains unknown. We aimed to examine the above relationship during the first 24 h following intensive care unit (ICU) admission.
METHODS:
We performed a secondary analysis of the SAVE-J II study, a retrospective multicenter study involving OHCA patients aged???18 years treated with ECPR between 2013 and 2018 and who received fluid therapy following ICU admission. Fluid balance was calculated based on intravenous fluid administration, blood transfusion, and urine output. The primary outcome was in-hospital mortality. The secondary outcomes included unfavorable outcome (cerebral performance category scores of 3-5 at discharge), acute kidney injury (AKI), and need for renal replacement therapy (RRT).
RESULTS:
Overall, 959 patients met our inclusion criteria. In-hospital mortality was 63.6%, and the proportion of unfavorable outcome at discharge was 82.0%. The median fluid balance in the first 24 h following ICU admission was 3673 mL. Multivariable analysis revealed that fluid balance was significantly associated with in-hospital mortality (odds ratio (OR), 1.04; 95% confidence interval (CI), 1.02-1.06; p?0.001), unfavorable outcome (OR, 1.03; 95% CI, 1.01-1.06; p?=?0.005), AKI (OR, 1.04; 95% CI, 1.02-1.05; p?0.001), and RRT (OR, 1.05; 95% CI, 1.03-1.07; p?0.001).
CONCLUSIONS:
Excessive positive fluid balance in the first day following ICU admission was associated with in-hospital mortality, unfavorable outcome, AKI, and RRT in ECPR patients. Further investigation is warranted.
© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.
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Re: "Factors associated with favorable outcomes in cardiac arrest and target temperature management" by Kimura et al.
Ther Hypothermia Temp Manag2024 Apr;():. doi: 10.1089/ther.2024.0013.
Çoner Ali, Köseo?lu Cemal, Öncel Can Ramazan, Da?a?an Göksel,
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Cardiac MRI after Sudden Cardiac Arrest: A Systematic Review.
Radiol Cardiothorac Imaging2024 Apr;6(2):e230216. doi: 10.1148/ryct.230216.
Scharinger Bernhard, Boxhammer Elke, Rezar Richard, Hecht Stefan, Wernly Sarah, Widhalm Tobias, Lichtenauer Michael, Hoppe Uta C, Hergan Klaus, Wernly Bernhard, Strohmer Bernhard, Kaufmann Reinhard,
Abstract
Purpose To perform a systematic review to assess the diagnostic and prognostic value of cardiac MRI after sudden cardiac arrest (SCA). Materials and Methods PubMed and Cochrane Library databases were systematically searched for studies investigating cardiac MRI after SCA in adult patients (?18 years of age). The time frame of the encompassed studies spans from January 2012 to January 2023. The study protocol was preregistered in OSF Registries , and the systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the included studies was evaluated using the Newcastle-Ottawa quality assessment scale. Results Fourteen studies involving 1367 individuals, 1257 (91.9%) of whom underwent cardiac MRI, were included. Inconsistent findings were reported on the diagnostic value of cardiac MRI-specific findings. The included studies demonstrated the following main findings: cardiac MRI led to a new or alternative diagnosis in patients with SCA; cardiac MRI identified pathologic or arrhythmogenic substrates; cardiac MRI helped detect myocardial edema (potentially reversible); cardiac MRI provided evidence for the occurrence of adverse events; and functional markers or ventricular dimensions were considered prognostically relevant in a few studies. Relevant challenges in this systematic review were the lack of comparators and reference standards relative to cardiac MRI as the index test and patient selection bias. Conclusion Cardiac MRI following SCA can contribute to the diagnostic process and offer supplementary information essential for treatment planning. Limitations of the review include studies with insufficient comparators and potential bias in patient selection. Systematic review registration link: osf.io/nxaev Cardiac MRI, Cardiovascular Disease, Cardiomyopathy, Ischemia, Myocardial Edema, Sudden Cardiac Arrest © RSNA, 2024.
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Impact of Humidification Modality on Incidence of Endotracheal Tube Occlusion in COVID-19 Patients.
J Intensive Care Med2024 Apr;():8850666241246969. doi: 10.1177/08850666241246969.
Mattson James Richard, Gada Kunal Dhiren, Jawa Randeep, Zhang Xiaoyue, Ahmad Sahar,
Abstract
Endotracheal tube (ETT) occlusion is reported at a higher frequency among coronavirus disease-2019 (COVID-19) patients. Prior to the COVID-19 pandemic, literature examining patient and ventilator characteristics, including humidification, as etiologies of ETT occlusion yielded mixed results. Our study examines the relationship of humidification modality with ETT occlusion in COVID-19 patients undergoing invasive mechanical ventilation (IMV). We conducted a retrospective chart review of COVID-19 patients requiring IMV at a tertiary care center in New York from April 2020 to April 2021. Teleflex Neptune heated wire heated humidification (HH) and hygroscopic Intersurgical FiltaTherm and Sunmed Ballard 1500 heat and moisture exchangers (HME) were used. Episodes of ETT occlusion were recorded. Univariate and multivariable logistic regression models were used to investigate the relationship between humidification modality and the occurrence of ETT occlusion. A total of 201 eligible patients were identified. Teleflex HH was utilized in 50.2% of the population and the others Intersurgical and Sunmed HME devices. Median age was 62 years and 78.6% of patients had at least one medical comorbidity. Precisely, 24% of patients experienced an ETT occlusion after a median of 12 days. The HME group was younger (58.5 vs 64 years), predominantly male (75% vs 59.4%), and experienced more total ventilator days than the HH group (24 vs 12). Those using the studied HME devices had significantly higher odds of ETT occlusion (OR 4.4, 95% CI 1.8-10.6, ?=?.0011). Three patients (6.1%) experienced cardiac arrest as a consequence of their occlusion. There were no deaths directly attributed to ETT occlusion. The studied HME devices were significantly associated with higher odds of ETT occlusion in COVID-19 patients requiring invasive mechanical ventilation. These events are not without significant clinical consequences. Prolonged use of under-performing HME devices remains suspect in the occurrence of ETT occlusions.
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The Impact of Congestive Heart Failure on Outcomes in Patients Hospitalized With Preeclampsia.
Cureus2024 Mar;16(3):e56387. doi: e56387.
Elkattawy Omar, Patel Saahil, Montoya Javier, Sarfaraz Kanzah, Alabed Sedra, Gobji Omar, Elkattawy Sherif, Romero Jesus, Shamoon Fayez,
Abstract
INTRODUCTION:
The purpose of this study was to determine the prevalence of congestive heart failure (CHF) among patients admitted with preeclampsia as well as to analyze the independent association of CHF with in-hospital outcomes among women with preeclampsia.
METHODS:
Data were obtained from the National (Nationwide) Inpatient Sample (NIS) from January 2016 to December 2019. We assessed the independent association of CHF with outcomes in patients admitted with preeclampsia. Predictors of mortality in patients admitted with preeclampsia were also analyzed.
RESULTS:
Women with preeclampsia in the United States between 2016 and 2019 were included in our analysis. A total of 256,010 cases were isolated, comprising 1150 patients with preeclampsia and CHF (0.45%). Multivariate analysis demonstrated that CHF in patients with preeclampsia was independently associated with several outcomes, among them cardiac arrest (adjusted OR (aOR) 4.635, p=0.004), ventricular tachycardia (aOR 17.487, p
Copyright © 2024, Elkattawy et al.
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Atypical Presentation of a Type A Aortic Dissection in a Patient With an Undiagnosed Genetic Predisposition.
Cureus2024 Mar;16(3):e56394. doi: e56394.
Patel Nishal N, Kurnick Adam, Bukharovich Inna,
Abstract
A 60-year-old female with a past medical history of hypertension presents to the ED with one day of throbbing left knee pain with associated numbness that worsened with ambulation. EKG shows lateral T-wave inversions with no prior for comparison. The patient had bloodwork drawn and a chest x-ray ordered. Her pain was improving with acetaminophen, and during further workup, she went into cardiac arrest. The advanced cardiac life support protocol was initiated, the patient was intubated, and point-of-care ultrasound revealed pericardial effusion. Despite all her efforts, she couldn't regain consciousness and was pronounced dead. An autopsy confirmed that the patient suffered a type A aortic dissection (AD), with findings indicating a predisposing genetic component. This case confirms that type A AD can present with different clinical symptoms and that a high index of suspicion is crucial in providing lifesaving measures.
Copyright © 2024, Patel et al.
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High-Risk Anomalous Aortic Origin of the Left Coronary Artery: Consecutive Admissions Presenting With Sudden Cardiac Arrest.
World J Pediatr Congenit Heart Surg2024 Apr;():21501351241237945. doi: 10.1177/21501351241237945.
Burns Joseph, Emeruwa Ezinne, Connell Patrick, Borges Nirica, Reaves-O'Neal Dana, Molossi Silvana,
Abstract
Anomalous aortic origin of the left coronary artery (AAOLCA) confers high risk for sudden cardiac arrest (SCA). This series aims to describe consecutive admissions with interarterial AAOLCA presenting with SCA and distinct clinical trajectories. An eight-year-old boy collapsed at school and received 10-min of cardiopulmonary resuscitation (CPR) and defibrillation prior to return of spontaneous circulation. He had no end-organ dysfunction and underwent uneventful coronary unroofing. In contrast, a 14-year-old boy presented with collapse while jogging. He received 40-min of CPR prior to extracorporeal membranous oxygenation cannulation with multisystem dysfunction and persistent severely depressed left ventricular function. He is now rehabilitating following uneventful orthotropic heart transplantation. These cases illustrate the diverse outcomes of AAOLCA with SCA following exertional syncope.
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A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study.
Scand J Trauma Resusc Emerg Med2024 Apr;32(1):31. doi: 10.1186/s13049-024-01198-x.
Ali Samir, Moors Xavier, van Schuppen Hans, Mommers Lars, Weelink Ellen, Meuwese Christiaan L, Kant Merijn, van den Brule Judith, Kraemer Carlos Elzo, Vlaar Alexander P J, Akin Sakir, Lansink-Hartgring Annemiek Oude, Scholten Erik, Otterspoor Luuk, de Metz Jesse, Delnoij Thijs, van Lieshout Esther M M, Houmes Robert-Jan, Hartog Dennis den, Gommers Diederik, Dos Reis Miranda Dinis,
Abstract
BACKGROUND:
The likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60 min. We hypothesize that the initiation of Extracorporeal Cardiopulmonary Resuscitation (ECPR) by a Helicopter Emergency Medical Services System (HEMS) will reduce the low flow time and improve outcomes in refractory Out of Hospital Cardiac Arrest (OHCA) patients.
METHODS:
The ON-SCENE study will use a non-randomised stepped wedge design to implement ECPR in patients with witnessed OHCA between the ages of 18-50 years old, with an initial presentation of shockable rhythm or pulseless electrical activity with a high suspicion of pulmonary embolism, lasting more than 20, but less than 45 min. Patients will be treated by the ambulance crew and HEMS with prehospital ECPR capabilities and will be compared with treatment by ambulance crew and HEMS without prehospital ECPR capabilities. The primary outcome measure will be survival at hospital discharge. The secondary outcome measure will be good neurological outcome defined as a cerebral performance categories scale score of 1 or 2 at 6 and 12 months.
DISCUSSION:
The ON-SCENE study focuses on initiating ECPR at the scene of OHCA using HEMS. The current in-hospital ECPR for OHCA obstacles encompassing low survival rates in refractory arrests, extended low-flow durations during transportation, and the critical time sensitivity of initiating ECPR, which could potentially be addressed through the implementation of the HEMS system. When successful, implementing on-scene ECPR could significantly enhance survival rates and minimize neurological impairment.
TRIAL REGISTRATION:
Clinicaltyrials.gov under NCT04620070, registration date 3 November 2020.
© 2024. The Author(s).
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Bleeding sites and treatment strategies for cardiac tamponade by catheter ablation requiring thoracotomy: risks of catheter ablation in patients with left atrial diverticulum.
J Cardiothorac Surg2024 Apr;19(1):238. doi: 10.1186/s13019-024-02710-1.
Mitsuishi Atsuyuki, Miura Yujiro, Nomura Yoshinori, Hirota Takayoshi, Arima Naoki, Kitaoka Hiroaki, Tateiwa Hiroki, Katsumata Yoshifumi,
Abstract
BACKGROUND:
There is insufficient information regarding the bleeding sites and surgical strategies of cardiac tamponade during catheter ablation for atrial fibrillation (AF).
CASE PRESENTATION:
Of the five patients with cardiac tamponade, three required surgical intervention and two required pericardiocentesis. In the first case of three cardiac tamponades requiring surgical intervention, considering that the peripheral route was used, the catecholamines did not reach the heart, and due to unstable vital signs, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was inserted. No bleeding point was identified, but a thrombus had spread around the left atrium (LA) with diverticulum. Hemostasis was achieved with adhesives placed around the LA under on-pump beating. In the second case, pericardiocentesis was performed, but the patient showed heavy bleeding and unstable vital signs. Thus, VA-ECMO was inserted. Heavy bleeding was expected, and safety was enhanced by attaching a reservoir to the VA-ECMO. The bleeding point was found between the left upper pulmonary artery and LA under cardiac arrest to obtain a good surgical view for suturing repair. In the third case, the LA diverticulum was damaged. Pericardiocentesis resulted in stable vitals, but sustained bleeding was present. A bleeding point was found at the LA diverticulum, and suture repair under on-pump beating was performed.
CONCLUSIONS:
When cardiac tamponade occured in any patient with LA diverticulum, treatment could not be completed with pericardiocentesis alone, and thoracotomy was likely to be necessary. If the bleeding point could be confirmed, suturing technique is a more reliable surgical strategy than adhesive alone that leads to pseudoaneurysm. If the bleeding point is unclear, it is important to confirm the occurrence of LA diverticulum using a preoperative CT, and if confirmed, cover it with adhesive due to a high possibility of diverticulum bleeding. The necessity of CPB should be determined based on whether these operations can be completed while maintaining vital stability.
© 2024. The Author(s).
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What factors are effective on the CPR duration of patients under extracorporeal cardiopulmonary resuscitation: a single-center retrospective study.
Int J Emerg Med2024 Apr;17(1):56. doi: 10.1186/s12245-024-00608-2.
Vahedian-Azimi Amir, Hassan Ibrahim Fawzy, Rahimi-Bashar Farshid, Elmelliti Hussam, Akbar Anzila, Shehata Ahmed Labib, Ibrahim Abdulsalam Saif, Ait Hssain Ali,
Abstract
BACKGROUND:
Extracorporeal cardiopulmonary resuscitation (ECPR) is an alternative method for patients with reversible causes of cardiac arrest (CA) after conventional cardiopulmonary resuscitation (CCPR). However, cardiopulmonary resuscitation (CPR) duration during ECPR can vary due to multiple factors. Healthcare providers need to understand these factors to optimize the resuscitation process and improve outcomes. The aim of this study was to examine the different variables impacting the duration of CPR in patients undergoing ECPR.
METHODS:
This retrospective, single-center, observational study was conducted on adult patients who underwent ECPR due to in-hospital CA (IHCA) or out-of-hospital CA (OHCA) at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. Univariate and multivariate binary logistic regression analyses were performed to identify the prognostic factors associated with CPR duration, including demographic and clinical variables, as well as laboratory tests.
RESULTS:
The mean?±?standard division age of the 48 participants who underwent ECPR was 41.50?±?13.15 years, and 75% being male. OHCA and IHCA were reported in 77.1% and 22.9% of the cases, respectively. The multivariate analysis revealed that several factors were significantly associated with an increased CPR duration: higher age (OR: 1.981, 95%CI: 1.021-3.364, P?=?0.025), SOFA score (OR: 3.389, 95%CI: 1.289-4.911, P?=?0.013), presence of comorbidities (OR: 3.715, 95%CI: 1.907-5.219, P?=?0.026), OHCA (OR: 3.715, 95%CI: 1.907-5.219, P?=?0.026), and prolonged collapse-to-CPR time (OR: 1.446, 95%CI:1.092-3.014, P?=?0.001). Additionally, the study found that the initial shockable rhythm was inversely associated with the duration of CPR (OR: 0.271, 95%CI: 0.161-0.922, P?=?0.045). However, no significant associations were found between laboratory tests and CPR duration.
CONCLUSION:
These findings suggest that age, SOFA score, comorbidities, OHCA, collapse-to-CPR time, and initial shockable rhythm are important factors influencing the duration of CPR in patients undergoing ECPR. Understanding these factors can help healthcare providers better predict and manage CPR duration, potentially improving patient outcomes. Further research is warranted to validate these findings and explore additional factors that may impact CPR duration in this population.
© 2024. The Author(s).
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Competencies for proficiency in basic point-of-care ultrasound in anesthesiology: national expert recommendations using Delphi methodology.
Can J Anaesth2024 Apr;():. doi: 10.1007/s12630-024-02746-w.
Mizubuti Glenio B, Maxwell Sarah, Shatenko Sergiy, Braund Heather, Phelan Rachel, Ho Anthony M-H, Dalgarno Nancy, Hobbs Hailey, Szulewski Adam, Haji Faizal, Arellano Ramiro, ,
Abstract
PURPOSE:
Point-of-care ultrasound (POCUS) allows for rapid bedside assessment and guidance of patient care. Recently, POCUS was included as a mandatory component of Canadian anesthesiology training; however, there is no national consensus regarding the competencies to guide curriculum development. We therefore aimed to define national residency competencies for basic perioperative POCUS proficiency.
METHODS:
We adopted a Delphi process to delineate relevant POCUS competencies whereby we circulated an online survey to academic anesthesiologists identified as POCUS leads/experts (n?=?25) at all 17 Canadian anesthesiology residency programs. After reviewing a list of competencies derived from the Royal College of Physicians and Surgeons of Canada's National Curriculum, we asked participants to accept, refine, delete, or add competencies. Three rounds were completed between 2022 and 2023. We discarded items with?50% agreement, revised those with 50-79% agreement based upon feedback provided, and maintained unrevised those items with???80% agreement.
RESULTS:
We initially identified and circulated (Round 1) 74 competencies across 19 clinical domains (e.g., basics of ultrasound [equipment, nomenclature, clinical governance, physics]; cardiac [left ventricle, right ventricle, valve assessment, pericardial effusion, intravascular volume status] and lung ultrasound anatomy, image acquisition, and image interpretation; and clinical applications [monitoring and serial assessments, persistent hypotension, respiratory distress, cardiac arrest]). After three Delphi rounds (and 100% response rate maintained), panellists ultimately agreed upon 75 competencies.
CONCLUSION:
Through national expert consensus, this study identified POCUS competencies suitable for curriculum development and assessment in perioperative anesthesiology. Next steps include designing and piloting a POCUS curriculum and assessment tool(s) based upon these nationally defined competencies.
© 2024. Canadian Anesthesiologists' Society.
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