Pubblicazioni recenti - cardiopulmonary resuscitation
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Effect of intra-arrest transport, extracorporeal cardiopulmonary resuscitation and immediate invasive assessment in refractory out-of-hospital cardiac arrest: a long-term follow-up of the Prague OHCA trial.
Crit Care2024 Apr;28(1):125. doi: 10.1186/s13054-024-04901-7.
Rob Daniel, Farkasovska Klaudia, Kreckova Marketa, Smid Ondrej, Kavalkova Petra, Macoun Jaromir, Huptych Michal, Havrankova Petra, Gallo Juraj, Pudil Jan, Dusik Milan, Havranek Stepan, Linhart Ales, Belohlavek Jan,
Abstract
BACKGROUND:
Randomized data evaluating the impact of the extracorporeal cardiopulmonary resuscitation (ECPR) approach on long-term clinical outcomes in patients with refractory out-of-hospital cardiac arrest (OHCA) are lacking. The objective of this follow-up study was to assess the long-term clinical outcomes of the ECPR-based versus CCPR approach.
METHODS:
The Prague OHCA trial was a single-center, randomized, open-label trial. Patients with witnessed refractory OHCA of presumed cardiac origin, without return of spontaneous circulation, were randomized during ongoing resuscitation on scene to conventional CPR (CCPR) or an ECPR-based approach (intra-arrest transport, ECPR if ROSC is not achieved prehospital and immediate invasive assessment).
RESULTS:
From March 2013 to October 2020, 264 patients were randomized during ongoing resuscitation on scene, and 256 patients were enrolled. Long-term follow-up was performed 5.3 (interquartile range 3.8-7.2) years after initial randomization and was completed in 255 of 256 patients (99.6%). In total, 34/123 (27.6%) patients in the ECPR-based group and 26/132 (19.7%) in the CCPR group were alive (log-rank P?=?0.01). There were no significant differences between the treatment groups in the neurological outcome, survival after hospital discharge, risk of hospitalization, major cardiovascular events and quality of life. Of long-term survivors, 1/34 (2.9%) in the ECPR-based arm and 1/26 (3.8%) in the CCPR arm had poor neurological outcome (both patients had a cerebral performance category score of 3).
CONCLUSIONS:
Among patients with refractory OHCA, the ECPR-based approach significantly improved long-term survival. There were no differences in the neurological outcome, major cardiovascular events and quality of life between the groups, but the trial was possibly underpowered to detect a clinically relevant difference in these outcomes. Trial registration ClinicalTrials.gov Identifier: NCT01511666, Registered 19 January 2012.
© 2024. The Author(s).
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CT Brain Perfusion Patterns and Clinical Outcome after Successful Cardiopulmonary Resuscitation: A Pilot Study.
Resuscitation2024 Apr;():110216. doi: 10.1016/j.resuscitation.2024.110216.
Hakim Arsany, Branca Mattia, Kurmann Christoph, Wagner Benedikt, Iten Manuela, Hänggi Matthias, Wagner Franca,
Abstract
AIM:
CT perfusion is a valuable tool for evaluating cerebrovascular diseases, but its role in patients with hypoxic ischaemic encephalopathy is unclear. This study aimed to investigate 1) the patterns of cerebral perfusion changes that may occur early on after successful resuscitation, and 2) their correlation with clinical outcome to explore their value for predicting outcome.
METHODS:
We conducted a retrospective analysis of perfusion maps from patients who underwent CT brain perfusion within 12 hours following successful resuscitation. We classified the perfusion changes into distinct patterns. According to the cerebral performance category (CPC) score clinical outcome was categorised as favourable (CPC 1-2), or unfavourable (CPC 3-5).
RESULTS:
A total of 87 patients were included of whom 33 had a favourable outcome (60.6% male, mean age 60 ±16 years), whereas 54 exhibited an unfavourable outcome (59.3% male, mean age 60 ±19 years). Of the patients in the favourable outcome group, 30.3% showed no characteristic perfusion changes, in contrast to the unfavourable outcome group where all patients exhibit changes in perfusion. Eighteen perfusion patterns were identified. The most significant patterns for prediction of unfavourable outcome in terms of their high specificity and frequency were hypoperfusion of the brainstem as well as coexisting hypoperfusion of the brainstem and thalamus.
CONCLUSION:
This pilot study identified various perfusion patterns in patients after resuscitation, indicative of circulatory changes associated with post-cardiac-arrest brain injury. After validation, certain patterns could potentially be used in conjunction with other prognostic markers for stratifying patients and adjusting personalized treatment following cardiopulmonary resuscitation. Normal brain perfusion within 12 hours after resuscitation is predictive of favourable outcome with high specificity.
Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.
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Extracorporeal vs. conventional CPR for out-of-hospital cardiac arrest: A systematic review and meta-analysis.
Am J Emerg Med2024 Apr;80():185-193. doi: 10.1016/j.ajem.2024.04.002.
Wang Jing-Yi, Chen Yan, Dong Run, Li Shan, Peng Jin-Min, Hu Xiao-Yun, Jiang Wei, Wang Chun-Yao, Weng Li, Du Bin, ,
Abstract
BACKGROUND:
Out-of-hospital cardiac arrest (OHCA) remains a significant cause of mortality and morbidity worldwide. Extracorporeal cardiopulmonary resuscitation (ECPR) is a potential intervention for OHCA, but its effectiveness compared to conventional cardiopulmonary resuscitation (CCPR) needs further evaluation.
METHOD:
We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, and ClinicalTrials.gov for relevant studies from January 2010 to March 2023. Pooled meta-analysis was performed to investigate any potential association between ECPR and improved survival and neurological outcomes.
RESULTS:
This systematic review and meta-analysis included two randomized controlled trials enrolling 162 participants and 10 observational cohort studies enrolling 4507 participants. The pooled meta-analysis demonstrated that compared to CCRP, ECPR did not improve survival and neurological outcomes at 180 days following OHCA (RR: 3.39, 95% CI: 0.79 to 14.64; RR: 2.35, 95% CI: 0.97 to 5.67). While a beneficial effect of ECPR was obtained regarding 30-day survival and neurological outcomes. Furthermore, ECPR was associated with a higher risk of bleeding complications. Subgroup analysis showed that ECPR was prominently beneficial when exclusively initiated in the emergency department. Additional post-resuscitation treatments did not significantly impact the efficacy of ECPR on 180-day survival with favorable neurological outcomes.
CONCLUSIONS:
There is no high-quality evidence supporting the superiority of ECPR over CCPR in terms of survival and neurological outcomes in OHCA patients. However, due to the potential for bias, heterogeneity among studies, and inconsistency in practice, the non-significant results do not preclude the potential benefits of ECPR. Further high-quality research is warranted to optimize ECPR practice and provide more generalizable evidence. Clinical trial registration PROSPERO, https://www.crd.york.ac.uk/prospero/, registry number: CRD42023402211.
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.
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Mechanical trauma in children and adolescents in Berlin.
Forensic Sci Med Pathol2024 Apr;():. doi: 10.1007/s12024-024-00814-7.
Eimer Christine, Buschmann Claas, Deeken Jonas, Kerner Thoralf,
Abstract
Management of severe pediatric trauma remains challenging. Injury patterns vary according to patient age and trauma mechanism. This study analyzes trauma mechanisms in deceased pediatric patients. Fatal pediatric trauma cases aged 0-18 years who underwent forensic autopsy in the Federal State of Berlin, Germany, between 2008 until 2018 were enrolled in this retrospective study. Autopsy protocols were analyzed regarding demographic characteristics, trauma mechanisms, injury patterns, resuscitation measures, survival times as well as place, and cause of death. 71 patients (73% male) were included. Traffic accidents (40%) were the leading cause of trauma, followed by falls from height?>?3 m (32%), railway accidents (13%), third party violence (11%) and other causes (4%). While children under 14 years of age died mostly due to traumatic brain injury (59%), polytrauma was the leading cause of death in patients?>?14 years (55%). Other causes of death were hemorrhage (9%), thoracic trauma (1%) or other (10%). A suicidal background was proven in 24%. In the age group of >?14 years, 40% of all mortalities were suicides. Cardiopulmonary resuscitation was carried out in 39% of all patients. 42% of the patients died at the scene. Children between 0 and 14 years of age died most frequently from traumatic brain injury. In adolescents between 14 and 18 years of age, polytrauma was mostly the cause of death with a high coincidence of suicidal deaths. The frequency of fatal traffic accidents and suicides shows the need to improve accident and suicide prevention for children and adolescents.
© 2024. The Author(s).
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The ACE2/Ang-(1-7)/MasR axis alleviates brain injury after cardiopulmonary resuscitation in rabbits by activating PI3K/Akt signaling.
Transl Neurosci2024 Jan;15(1):20220334. doi: 10.1515/tnsci-2022-0334.
Cheng Jing, Yang Hong, Chen Fang, Qiu Li, Chen Fang, Du Yanhua, Meng Xiangping,
Abstract
BACKGROUND:
Death among resuscitated patients is mainly caused by brain injury after cardiac arrest/cardiopulmonary resuscitation (CA/CPR). The angiotensin converting enzyme 2 (ACE2)/angiotensin (Ang)-(1-7)/Mas receptor (MasR) axis has beneficial effects on brain injury. Therefore, we examined the roles of the ACE2/Ang-(1-7)/MasR axis in brain injury after CA/CPR.
METHOD:
We used a total of 76 male New Zealand rabbits, among which 10 rabbits underwent sham operation and 66 rabbits received CA/CPR. Neurological functions were determined by assessing serum levels of neuron-specific enolase and S100 calcium-binding protein B and neurological deficit scores. Brain water content was estimated. Neuronal apoptosis in the hippocampus was assessed by terminal deoxynucleotidyl transferase dUTP nick end labeling assays. The expression levels of various genes were measured by enzyme-linked immunosorbent assay and western blotting.
RESULTS:
Ang-(1-7) (MasR activator) alleviated CA/CPR-induced neurological deficits, brain edema, and neuronal damage, and A779 (MasR antagonist) had the opposite functions. The stimulation of ACE2/Ang-(1-7)/MasR inactivated the ACE/Ang II/AT1R axis and activated PI3K/Akt signaling. Inhibiting PI3K/Akt signaling inhibited Ang-(1-7)-mediated protection against brain damage after CA/CPR.
CONCLUSION:
Collectively, the ACE2/Ang-(1-7)/MasR axis alleviates CA/CPR-induced brain injury through attenuating hippocampal neuronal apoptosis by activating PI3K/Akt signaling.
© 2024 the author(s), published by De Gruyter.
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Correction to: 2023 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.
Circulation -
Cardiopulmonary Resuscitation for Organ Preservation After Death by Neurologic Criteria: Let Patients' Interests Guide Us.
Crit Care Med2024 May;52(5):e255-e256. doi: 10.1097/CCM.0000000000006202.
Michetti Christopher P,
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The Protective Effect and Mechanism of Mild Hypothermia on Lung Injury after Cardiopulmonary Resuscitation in Pigs.
Crit Rev Immunol2024 ;44(5):51-58. doi: 10.1615/CritRevImmunol.2024052420.
Ren Jinlin, Zhu Fangfang, Sang Dongdong, Cong Mulin, Jiang Shujuan,
Abstract
To explore the protective effect and mechanism of mild hypothermia on lung tissue damage after cardiopulmonary resuscitation in pigs. In this experiment, we electrically stimulated 16 pigs (30 ± 2 kg) for 10 min to cause ventricular fibrillation. The successfully resuscitated animals were randomly divided into two groups, a mild hypothermia group and a control group. We took arterial blood 0.5, 1, 3, and 6 h after ROSC recovery in the two groups of animals for blood gas analysis. We observed the structural changes of lung tissue under an electron microscope and calculate the wet weight/dry weight (W/D) ratio. We quantitatively analyzed the expression differences of representative inflammatory factors [interleukin-6 (IL-6) and tumor necrosis factor-alpha TNF-?)] through the ELISA test. We detected the expression levels of Bax, Bcl-2, and Caspase-3 proteins in lung tissues by Western blot. After 3 h and 6 h of spontaneous circulation was restored, compared with the control group, PaO2/FiO2 decreased significantly (P
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A single institution anesthetic experience with catheterization of pediatric pulmonary hypertension patients.
Pulm Circ2024 Apr;14(2):e12360. doi: e12360.
Morell Emily, Colglazier Elizabeth, Becerra Jasmine, Stevens Leah, Steurer Martina A, Sharma Anshuman, Nguyen Hung, Kathiriya Irfan S, Weston Stephen, Teitel David, Keller Roberta, Amin Elena K, Nawaytou Hythem, Fineman Jeffrey R,
Abstract
Cardiac catheterization remains the gold standard for the diagnosis and management of pediatric pulmonary hypertension (PH). There is lack of consensus regarding optimal anesthetic and airway regimen. This retrospective study describes the anesthetic/airway experience of our single center cohort of pediatric PH patients undergoing catheterization, in which obtaining hemodynamic data during spontaneous breathing is preferential. A total of 448 catheterizations were performed in 232 patients. Of the 379 cases that began with a natural airway, 274 (72%) completed the procedure without an invasive airway, 90 (24%) received a planned invasive airway, and 15 (4%) required an unplanned invasive airway. Median age was 3.4 years (interquartile range [IQR] 0.7-9.7); the majority were either Nice Classification Group 1 (48%) or Group 3 (42%). Vasoactive medications and cardiopulmonary resuscitation were required in 14 (3.7%) and eight (2.1%) cases, respectively; there was one death. Characteristics associated with use of an invasive airway included age
© 2024 The Authors. Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.
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Thoracic Vertebra Chance Fracture Resulting from Mechanical CPR.
J Belg Soc Radiol2024 ;108(1):37. doi: 37.
Saliba Thomas, Pather Sanjiva, Cappeliez Olivier,
Abstract
Chest compressions, used in cardiopulmonary resuscitation (CPR), cause rib and sternum fractures in around 79% and 54% of patients, respectively. Spinal fractures resulting from CPR are far rarer. We present the case of a 70-year-old man who underwent mechanical CPR after choking whilst eating. The patient received a cerebral and thoracic CT scan upon arrival to the hospital. The cerebral scan was normal, but the chest CT scan revealed signs of ankylosing spondylitis and an unstable Chance fracture of the 12th thoracic vertebra. The patient was hospitalised but passed away. This case highlights the need for awareness of uncommon spine fractures due to the high associated morbidity. In patients who have undergone thoracic compressions, one should not only search for rib fractures but also for spine fractures, which, though uncommon, have a far greater impact on the patient's morbidity, especially in patients with predisposing spine conditions.
Copyright: © 2024 The Author(s).
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The 5-factor modified frailty index (mFI-5) predicts adverse outcomes after elective anterior cervical discectomy and fusion (ACDF).
N Am Spine Soc J2024 Jun;18():100318. doi: 100318.
Chung Matthew S, Patel Neil, Abdelmalek George, Coban Daniel, Changoor Stuart, Elali Faisal, Sinha Kumar, Hwang Ki, Emami Arash,
Abstract
BACKGROUND:
Anterior cervical discectomy and fusion (ACDF) is a reliable procedure commonly performed in older patients with degenerative diseases of the cervical spine. Over 130,000 procedures are performed every year with an annual increase of 5%, and overall morbidity rates can reach as high as 19.3%, indicating a need for surgeons to gauge their patients' risk for adverse outcomes. Frailty is an age-associated decline in functioning of multiple organ systems and has been shown to predict adverse outcomes following various spine procedures. There have been several proposed frailty indices of various factors including the 11-factor modified frailty index (mFI-11), which has been shown to be an effective tool for predicting complications in patients undergoing ACDF. However, there is a paucity of literature assessing the utility of the 5-factor modified frailty index (mFI-5) as a risk stratification tool for patients undergoing ACDF. The purpose of this study was to analyze the predictive capability of the mFI-5 score for 30-day postoperative adverse events following elective ACDF.
METHODS:
A retrospective review was performed using the National Surgical Quality Improvement Program (NSQIP) database from 2010 through 2019. Patients older than 50 years of age who underwent elective ACDF were identified using Current Procedural Terminology ([CPT] codes 22554, 22551, 22552, and 63075). Exclusion criteria removed patients under the age of 51, as well as those with fractures, sepsis, disseminated cancer, a prior operation in the last 30 days, ascites, wound infection, or an emergency surgery. Patients were grouped using mFI scores of 1, 2, and 3+. Univariate analysis, using chi-squared and one-way analysis of variance (ANOVA) tests, was conducted to compare demographics, comorbidities, and postoperative complications across the varying cohorts based on mFI-5 scores. Multivariate logistic regression, including patient demographics and preoperative comorbidities as covariates, was performed to evaluate if mFI-5 scores were independent predictors of 30-day postoperative adverse events. Covariates including race, BMI, sex, ASA, and comorbidities were included in regression models.
RESULTS:
The 45,991 patients were identified and allocated in cohorts based on mFI-5 score. Rates for superficial surgical site infection (SSI), organ/deep space SSI, pneumonia, progressive renal insufficiency, acute renal failure (ARF), urinary tract infection (UTI), stroke/cardiovascular accident (CVA), cardiac arrest requiring cardiopulmonary resuscitation (CPR), myocardial infarction, bleeding requiring transfusions, deep vein thrombosis/thrombophlebitis, sepsis, septic shock, readmissions, reoperation, and mortality incrementally increased with mFI-5 scores from 0 to 3+. Multivariate regression analysis revealed that mFI-5 scores 1 to 3+ increased the odds, in a stepwise manner, of total complications, cardiac arrest requiring CPR, pneumonia and mortality. MFI-5 scores of 2 and 3+ were independent predictors of readmission (2: OR=1.5, p<.001 or="2.0," p and myocardial infarction a score of increased the odds arf septic shock uti bleeding requiring transfusions reoperations>
CONCLUSION:
mFI-5 score is a quick and viable option for surgeons to use as an assessment tool to stratify high risk patients undergoing elective ACDF, as increasing mFI-5 scores showed significantly higher rates of all adverse outcomes accounted for in this study, except for deep incisional SSI, wound disruption, and PE. Additionally, moderate to severe mFI-5 scores of 2 or 3+ were independent predictors for 30-day postoperative ARF, UTI, MI, bleeding requiring transfusions, septic shock, reoperation, and readmissions following elective ACDF surgery in adults over 50 years old.
© 2024 The Author(s).
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Continuous chest compression during sustained inflation versus continuous compression with asynchronized ventilation in an infantile porcine model of severe bradycardia.
Resusc Plus2024 Jun;18():100629. doi: 100629.
Morin Chelsea, Lee Tze-Fun, O'Reilly Megan, Cheung Po-Yin, Schmölzer Georg M,
Abstract
BACKGROUND:
Recently, the American Heart Association released a statement calling for research examining the appropriate age to transition from the neonatal to pediatric cardiopulmonary resuscitation approach to resuscitation.
AIM:
To compare neonatal and pediatric resuscitation approach by using either continuous chest compression with asynchronized ventilation (CCaV) or continuous chest compression superimposed with sustained inflation (CC + SI) during infant cardiopulmonary resuscitation. We hypothesized that CC + SI compared to CCaV would reduce time to return of spontaneous circulation (ROSC) in infantile piglets with asphyxia-induced bradycardic cardiac arrest.
METHODS:
Twenty infantile piglets (5-10 days old) were anesthetized and asphyxiated by clamping the endotracheal tube. Piglets were randomized to CC + SI or CCaV for resuscitation (n = 10/group). Heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, intrathoracic pressure and respiratory parameters were continuously recorded throughout the experiment.
MAIN RESULTS:
The median (IQR) time to ROSC with CC + SI compared to CCaV was 179 (104-447) vs 660 (189-660), p = 0.05. The number of piglets achieving ROSC with CC + SI and CCaV were 8/10 and 6/10, p = 0.628. Piglets resuscitated with CC + SI required less epinephrine compared to CCaV (p = 0.039). CC + SI increased the intrathoracic pressure throughout resuscitation (p = 0.025) and increased minute ventilation (p
CONCLUSIONS:
CC + SI improves resuscitative efforts of infantile piglets by increasing the intrathoracic pressure and minute ventilation, and thus reducing the duration of resuscitation, compared to CCaV.
© 2024 The Author(s).
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Surviving cardiac arrest after carbon monoxide poisoning treated with hyperbaric oxygen therapy.
Undersea Hyperb Med2024 ;51(1):37-40.
Bronshteyn Vladimir, Hendriksen Stephen M, Lee Samantha J, Logue Christopher,
Abstract
Carbon monoxide (CO) and cyanide poisoning are frequent causes of morbidity and mortality in cases of house and industrial fires. The 14th edition of guidelines from the Undersea and Hyperbaric Medical Society does not recommend hyperbaric oxygen (HBO) treatment in those patients who have suffered a cardiac arrest and had to receive cardiopulmonary resuscitation. In this paper, we describe the case of a 31-year-old patient who received HBO treatment in the setting of cardiac arrest and survived.
Copyright© Undersea and Hyperbaric Medical Society.
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Pneumothorax during manned chamber operations: A summary of reported cases.
Undersea Hyperb Med2024 ;51(1):29-35.
Clarke Richard E, Van Meter Keith,
Abstract
In-chamber pneumothorax has complicated medically remote professional diving operations, submarine escape training, management of decompression illness, and hospital-based provision of hyperbaric oxygen therapy. Attempts to avoid thoracotomy by combination of high oxygen partial pressure breathing (the concept of inherent unsaturation) and greatly slowed rates of chamber decompression proved successful on several occasions. When this delicate balance designed to prevent the intrapleural gas volume from expanding faster than it contracts proved futile, chest drains were inserted. The presence of pneumothorax was misdiagnosed or missed altogether with disturbing frequency, resulting in wide-ranging clinical consequences. One patient succumbed before the chamber had been fully decompressed. Another was able to ambulate unaided from the chamber before being diagnosed and managed conventionally. In between these two extremes, patients experienced varying degrees of clinical compromise, from respiratory distress to cardiopulmonary arrest, with successful resuscitation. Pneumothorax associated with manned chamber operations is commonly considered to develop while the patient is under pressure and manifests during ascent. However, published reports suggest that many were pre-existing prior to chamber entry. Risk factors included pulmonary barotrauma-induced cerebral arterial gas embolism, cardiopulmonary resuscitation, and medical or surgical procedures usually involving the lung. This latter category is of heightened importance to hyperbaric operations as an iatrogenically induced pneumothorax may take as long as 24 hours to be detected, perhaps long after a patient has been cleared for chamber exposure.
Copyright© Undersea and Hyperbaric Medical Society.
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Formyl peptide receptor 1 mitigates colon inflammation and maintains mucosal homeostasis through the inhibition of CREB-C/EBP?-S100a8 signaling.
Mucosal Immunol2024 Apr;():. doi: S1933-0219(24)00038-2.
Li Tingting, Zhou Xiaojun, Zhang Qian, Miao Qi, Woodman Owen L, Chen Yuguo, Qin Chengxue,
Abstract
Excessive inflammatory responses are the main characteristic of ulcerative colitis (UC). Activation of formyl peptide receptor 1 (FPR1) has been found to promote the proliferation and migration of epithelial cells, but its role and therapeutic potential in UC remain unclear. This study observed an increased expression of FPR1 in a mouse model of colitis. Interestingly, FPR1 deficiency exacerbated UC and increased the secretion of the pro-inflammatory mediator from immune cells (e.g., macrophages), S100a8, a member of the damage-associated molecular patterns (DAMPs). Notably, the administration of the FPR agonist Cmpd43 ameliorated colon injury in a preclinical mice model of UC, likely via inhibiting phosphorylation of CREB and expression of C/EBP?, which in turn suppressed the secretion of S100a8. In conclusion, these findings discovered a novel role of FPR1 in the development of colitis and will facilitate the development of FPR1-based pharmacotherapy to treat UC.
Copyright © 2024. Published by Elsevier Inc.
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A new method of pulse control in cardiopulmonary resuscitation; Continuous femoral pulse check.
Am J Emerg Med2024 Mar;80():168-173. doi: 10.1016/j.ajem.2024.03.026.
Sonmez E, Taslidere B, Ozkan A,
Abstract
OBJECTIVES:
The reliability of manual pulse checks has been questioned but is still recommended in cardiopulmonary resuscitation (CPR) guidelines. The aim is to compare the 10-s carotid pulse check (CPC) between heart massage cycles with the continuous femoral pulse check (CoFe PuC) in CPR, and to propose a better location to shorten the interruption times for pulse check.
METHODS:
A prospective study was conducted on 117 Non-traumatic CPR patients between January 2020 and January 2022. A total of 702 dependent pulse measurements were executed, where carotid and femoral pulses were simultaneously assessed. Cardiac ultrasound, end-tidal CO2, saturation, respiration, and blood pressure were employed for pulse validation.
RESULTS:
The decision time for determining the presence of a pulse in the last cycle of CPR was 3.03 ± 1.26 s for CoFe PuC, significantly shorter than the 10.31 ± 5.24 s for CPC. CoFe PuC predicted the absence of pulse with 74% sensitivity and 88% specificity, while CPC predicted the absence of pulse with 91% sensitivity and 61% specificity.
CONCLUSION:
CoFe PuC provides much earlier and more effective information about the pulse than CPC. This shortens the interruption times in CPR. CoFe PuC should be recommended as a new and useful method in CPR guidelines.
Copyright © 2024 Elsevier Inc. All rights reserved.
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Detection and Evaluation for High-Quality Cardiopulmonary Resuscitation Based on a Three-Dimensional Motion Capture System: A Feasibility Study.
Sensors (Basel)2024 Mar;24(7):. doi: 2154.
Tang Xingyi, Wang Yan, Ma Haoming, Wang Aoqi, Zhou You, Li Sijia, Pei Runyuan, Cui Hongzhen, Peng Yunfeng, Piao Meihua,
Abstract
High-quality cardiopulmonary resuscitation (CPR) and training are important for successful revival during out-of-hospital cardiac arrest (OHCA). However, existing training faces challenges in quantifying each aspect. This study aimed to explore the possibility of using a three-dimensional motion capture system to accurately and effectively assess CPR operations, particularly about the non-quantified arm postures, and analyze the relationship among them to guide students to improve their performance. We used a motion capture system (Mars series, Nokov, China) to collect compression data about five cycles, recording dynamic data of each marker point in three-dimensional space following time and calculating depth and arm angles. Most unstably deviated to some extent from the standard, especially for the untrained students. Five data sets for each parameter per individual all revealed statistically significant differences (
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Implementation of advanced vascular access, physiological monitoring and goal-directed resuscitation during OHCA in a helicopter emergency medical service.
J Vasc Access2024 Apr;():11297298241242157. doi: 10.1177/11297298241242157.
Aziz Shadman, Lachowycz Kate, Major Rob, Rees Paul, Barratt Jon,
Abstract
Outcomes after out-of-hospital cardiac arrest (OHCA) remain poor in the UK. In order to increase the chances of successful resuscitation, international society guidelines on cardiopulmonary resuscitation quality have recommended titration of chest compression parameters and vasopressor administration to arterial diastolic blood pressure if invasive catheters are in situ at the time of cardiac arrest. However, prehospital initiation of arterial and central venous catheterisation is seldom undertaken due to the risks and significant technical challenges in the context of ongoing resuscitation in this environment. In 2019, a dedicated programme was started at East Anglian Air Ambulance (EAAA) to enable the safe introduction of contemporary emergency vascular access devices, in order to improve physiological monitoring intra-arrest and deliver nuanced, goal-directed resuscitation in OHCA patients. This programme was entitled Specialist Percutaneous Emergency Aortic Resuscitation (SPEAR). This article details the EAAA SPEAR technique; and the development, implementation and governance of this novel endovascular strategy in our UK physician-paramedic staffed helicopter emergency medical service.
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Alternative defibrillation strategies: more answers and more questions.
Resuscitation2024 Apr;():110211. doi: 10.1016/j.resuscitation.2024.110211.
Scquizzato Tommaso, Skrifvars Markus B,
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Organ donation after extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest in a metropolitan cardiac arrest centre in Milan, Italy.
Resuscitation2024 Apr;():110214. doi: 10.1016/j.resuscitation.2024.110214.
Aldo Bonizzoni Matteo, Scquizzato Tommaso, Pieri Marina, Delrio Silvia, Nardelli Pasquale, Ortalda Alessandro, Dell'Acqua Antonio, Mara Scandroglio Anna, ,
Abstract
INTRODUCTION:
Extracorporeal cardiopulmonary resuscitation (ECPR) may improve survival in refractory out-of-hospital cardiac arrest (OHCA) but also expand the donor pool as these patients often become eligible for organ donation. Our aim is to describe the impact of organ donation in OHCA patients treated with ECPR in a high-volume cardiac arrest centre.
METHODS:
Rate of organ donation (primary outcome), organs harvested, a composite of patient survival with favourable neurological outcome or donation of ? 1 solid organ (ECPR benefit), and the potential total number of individuals benefiting from ECPR (survivors with favourable neurological outcome and potential recipients of one solid organ) were analysed among all-rhythms refractory OHCA patients treated with ECPR between January 2013-November 2022 at San Raffaele Hospital in Milan, Italy.
RESULTS:
Among 307 adults with refractory OHCA treated with ECPR (95% witnessed, 66% shockable, low-flow 70 [IQR 58-81] minutes), 256 (83%) died during hospital stay, 33% from brain death. Donation of at least one solid organ occurred in 58 (19%) patients, 53 (17%) after determination of brain death and 5 (1.6%) after determination of circulatory death, contributing a total of 167 solid organs (3.0 [IQR 2.5-4.0] organs/donor). Overall, 196 individuals (29 survivors with favourable neurological outcome and 167 potential recipients of 1 solid organ) possibly benefited from ECPR. ECPR benefit composite outcome was achieved in 87 (28%) patients. Solid organ donation decreased from 19% to 16% in patients with low-flow
CONCLUSIONS:
When ECPR fails in patients with refractory OHCA, organ donation after brain or circulatory death can help a significant number of patients awaiting transplantation, enhancing the overall benefit of ECPR. ECPR selection criteria may affect the number of potential organ donors.
Copyright © 2024 Elsevier B.V. All rights reserved.
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