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Pubblicazioni recenti - cardiac arrest
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Pregnancy in catecholaminergic polymorphic ventricular tachycardia: therapeutic optimization and multidisciplinary care are key to success.
Herzschrittmacherther Elektrophysiol2021 Apr;():. doi: 10.1007/s00399-021-00755-6.
Roston Thomas M, Grewal Jasmine, Krahn Andrew D,
Abstract
Women of child-bearing age comprise a large proportion of the patients followed by inherited arrhythmia clinics. Despite being a rare and dangerous diagnosis, cardiac and obstetric care providers should know that catecholaminergic polymorphic ventricular tachycardia (CPVT) is not a contraindication to pregnancy. In fact, pregnancy was not associated with an increased risk of CPVT-associated arrhythmias in a recent large cohort study, and most guideline-based anti-arrhythmic drug treatments are life-saving and carry a low risk of teratogenesis. In principle, the potential for CPVT destabilization may be more likely to occur after anti-arrhythmic drugs are decreased or stopped during pregnancy, when an implantable cardioverter defibrillator (ICD) shock exacerbates catecholamine release, or if adrenaline surges are triggered by labor and delivery. Therefore, all pregnant women should be followed by a cardio-obstetrics team with extensive knowledge of CPVT diagnosis, as well as arrhythmia risk stratification fand management. This multidisciplinary care should begin preconception and involve counseling on preimplantation genetic testing, choosing safe and effective anti-arrhythmic drugs, stopping contraindicated medications, optimal programming of ICDs, and planning for the brief hyper-adrenergic period of labor and delivery. The latest data on pregnancy in CPVT is reviewed here and the optimal care for this rare and complex patient population outlined.
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Is the Use of Routine Echocardiogram Warranted in Large Pediatric Burns?
J Burn Care Res2021 Apr;():. doi: irab056.
Wilmot I, Chang P H, Fowler L, Warner P,
Abstract
INTRODUCTION:
Cardiac dysfunction can develop in large pediatric burns during the acute and recovery phase. When occurring in this population, the cardiac abnormality appears as left ventricular dysfunction or dilated cardiomyopathy. Recent studies have demonstrated perioperative and long-term cardiac dysfunction resulting in longer hospital stays for patients over 40% total body surface area. The objective of this study was to assess if early use of echocardiograms in large burns would allow for early recognition of patients at risk for cardiac dysfunction.
MATERIAL AND METHODS:
Pediatric burn patients ages 0-18 years who sustained a burn injury of 30% TBSA or more or developed cardiac dysfunction during hospital course were evaluated. Echocardiograms were obtained upon admission with monthly repeats until three normal studies were attained or the patient was discharged and when symptomatic.
RESULTS:
Of the 130 acute burn patients admitted during 7/2017-10/2018, 10 patients met criteria for enrollment in this study. The average age was 5 years (0.8 to 10 yrs), 70% were males and 90% sustained flame injuries.Total TBSA average was 45% (24-70%) with average full thickness burns of 33% (0-67%). Twenty echocardiogram studies were obtained. One patient with 25% TBSA burn, demonstrated severe left ventricular dysfunction with an EF of 25% from post arrest myocardial stunning. Repeat echocardiogram studies demonstrated full recovery with normal EF. The remaining patients, despite large TBSA injuries, did not exhibit any abnormalities on ECHO examinations. No cardiac interventions were required.
CONCLUSIONS:
Use of echocardiograms is best performed on symptomatic burn patient populations.
© The Author(s) 2021. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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[Training and knowledge on basic life support by civil guards.]
Rev Esp Salud Publica2021 Apr;95():. doi: e202104069.
Carcedo Argüelles Lucía, Pérez Regueiro Irene, García Fernández José Antonio, Lana Alberto,
Abstract
OBJECTIVE:
Civil Guards are deployed throughout Spain and susceptible to being the first responders in out-of-hospital cardiorespiratory arrest. However, their level of training to perform Basic Life Support (BLS) is unknown. The aim of this work was to evaluate the level of knowledge on BLS of Civil Guards, and to explore the association between periodicity of training and knowledge.
METHODS:
Cross-sectional study of 839 Civil Guards in Asturias (Spain). A questionnaire with 14 multiple-choice questions assessed knowledge on cardiopulmonary resuscitation (CPR) and use of automatic defibrillator, which were transferred to 0-10 points scales (higher score indicted higher knowledge). Multiple linear regressions were used to estimate mean knowledge scores according to training on BLS (never, >2 years ago and ?2 years ago), adjusted by sociodemographic and occupational variables.
RESULTS:
Around 1 out of 10 Civil Guards performed some real CPR (11.2%). Regarding training, 42.5% had never participated in courses and 33.4% were trained >2 years ago. There was a discordance between willingness to perform BLS (65.6%) and self-perception of preparation (21.8%). A dose-response association was detected between training periodicity and knowledge: 4.26 points (95% CI: 4.07-4.45) of those never formed, 5.93 (95% CI: 5.71-6, 15) of those trained >2 years ago, 7.18 (95% CI: 6.92-7.44) of those trained ?2 years ago (p-trend <0.001).
CONCLUSIONS:
The level of training and knowledge on BLS of the Civil Guards is low. Receiving training every two years is significantly associated with greater knowledge.
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Association between age and neurological outcomes in out-of-hospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation: a nationwide multicentre observational study.
Eur Heart J Acute Cardiovasc Care2021 Apr;():. doi: zuab021.
Miyamoto Yuki, Matsuyama Tasuku, Goto Tadahiro, Ohbe Hiroyuki, Kitamura Tetsuhisa, Yasunaga Hideo, Ohta Bon,
Abstract
AIMS:
Little is known about the difference in outcomes between young and old patients who received extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA). Therefore, we aimed to investigate the differences in outcomes between those aged ?75?years and <75?years who experienced OHCA and were resuscitated with ECPR.
METHODS AND RESULTS:
We performed a secondary analysis of a nationwide prospective cohort study using the Japanese Association for Acute Medicine OHCA registry. We identified patients aged ?18?years with OHCA who received ECPR. The patients were classified into three age groups (18-59?years, 60-74?years, and ?75?years). The primary outcome was a 1-month neurological outcome. To examine the association between age and 1-month neurological outcome, we performed logistic regression analyses fitted with generalized estimating equations. From 2014 to 2017, we identified 875 OHCA patients aged ?18?years who received ECPR. The proportion of patients who survived with favourable neurological outcome in the patients aged 18-59?years, 60-74?years, and ?75?years were 15% (64/434), 8.9% (29/326), and 1.7% (2/115), respectively. In the multivariable analysis, compared with the age of 18-59?years, the proportions of favourable neurological outcomes were significantly lower in patients aged 60-74?years [adjusted odds ratio (OR), 0.44; 95% confidence interval (CI), 0.32-0.61] and those aged ?75?years (adjusted OR, 0.26; 95% CI, 0.11-0.59).
CONCLUSION:
Advanced age (age ?75?years in particular) was significantly associated with poor neurological outcomes in patients with OHCA who received ECPR.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
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Surviving a cardiac arrest: need for action now!
Rev Port Cardiol -
Which symptoms pose the highest risk in patients calling for an ambulance? A population-based cohort study from Denmark.
Scand J Trauma Resusc Emerg Med2021 Apr;29(1):59. doi: 10.1186/s13049-021-00874-6.
Ibsen Stine, Lindskou Tim Alex, Nickel Christian H, Kløjgård Torben, Christensen Erika Frischknecht, Søvsø Morten Breinholt,
Abstract
BACKGROUND:
Emergency medical service patients are a vulnerable population and the risk of mortality is considerable. In Denmark, healthcare professionals receive 112-emergency calls and assess the main reason for calling. The main aim was to investigate which of these reasons, i.e. which symptoms or mechanism of injury, contributed to short-term risk of death. Secondary aim was to study 1-30?day-mortality for each symptom/ injury.
METHODS:
Historic population-based cohort study of emergency medical service patients calling 112 in the North Denmark Region between 01.01.2016-31.12.2018. We defined 1-day mortality as death on the same or the following day. The frequency of each symptom and cumulative number of deaths on day 1 and 30 together with 1- and 30-day mortality for each symptom/mechanism of injury is presented in proportions. Poisson regression with robust variance estimation was used to estimate incident rates (IR) of mortality with 95% confidence intervals (CI), crude and age and sex adjusted, mortality rates on day 1 per 100,000 person-year in the population.
RESULTS:
The five most frequent reasons for calling 112 were "chest pain" (15.9%), "unclear problem" (11.9%), "accidents" (11.2%), "possible stroke" (10.9%), and "breathing difficulties" (8.3%). Four of these contributed to the highest numbers of deaths: "breathing difficulties" (17.2%), "unclear problem" (13.2%), "possible stroke" (8.7%), and "chest pain" (4.7%), all exceeded by "unconscious adult - possible cardiac arrest" (25.3%). Age and sex adjusted IR of mortality per 100,000 person-year was 3.65 (CI 3.01-4.44) for "unconscious adult - possible cardiac arrest" followed by "breathing difficulties" (0.45, CI 0.37-0.54), "unclear problem"(0.30, CI 0.11-0.17), "possible stroke"(0.13, CI 0.11-0.17) and "chest pain"(0.07, CI 0.05-0.09).
CONCLUSION:
In terms of risk of death on the same day and the day after the 112-call, "unconscious adult/possible cardiac arrest" was the most deadly symptom, about eight times more deadly than "breathing difficulties", 12 times more deadly than "unclear problem", 28 times more deadly than "possible stroke", and 52 times more deadly than "chest pain". "Breathing difficulties" and "unclear problem" as presented when calling 112 are among the top three contributing to short term deaths when calling 112, exceeding both stroke symptoms and chest pain.
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Assessment of the knowledge level and experience of healthcare personnel concerning CPR and early defibrillation: an internal survey.
BMC Cardiovasc Disord2021 Apr;21(1):195. doi: 10.1186/s12872-021-02009-2.
Spinelli G, Brogi E, Sidoti A, Pagnucci N, Forfori F,
Abstract
BACKGROUND:
In-hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. Rapid cardiopulmonary resuscitation and early defibrillation is extremely connected to patient outcome. In this study, we aimed to assess the effects of a basic life support and defibrillation course in improving knowledge in IHCA management.
METHODS:
We performed a prospective observational study recruiting healthcare personnel working at Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. Study consisted in the administration of two questionnaires before and after BLS-D course. The course was structured as an informative meeting and it was held according to European Resuscitation Council guidelines.
RESULTS:
78 participants completed pre- and post-course questionnaires. Only 31.9% of the participants had taken part in a BLS-D before our study. After the course, we found a significative increase in the percentage of participants that evaluated their skills adequate in IHCA management (17.9% vs 42.3%; p?
CONCLUSIONS:
The training course resulted in significant increase in the level of knowledge about the general management of IHCA in hospital staff. Therefore, a simple intervention such as an informative meetings improved significantly the knowledge about IHCA and, consequently, can lead to a reduction of morbidity and mortality.
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A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest.
BMC Emerg Med2021 Apr;21(1):51. doi: 10.1186/s12873-021-00444-0.
Lønvik Maja Pålsdatter, Elden Odd Eirik, Lunde Mats Joakimsen, Nordseth Trond, Bakkelund Karin Elvenes, Uleberg Oddvar,
Abstract
BACKGROUND:
Airway management in patients with out of hospital cardiac arrest (OHCA) is important and several methods are used. The establishment of a supraglottic airway device (SAD) is a common technique used during OHCA. Two types of SAD are routinely used in Norway; the Kings LTS-D? and the I-gel®. The aim of this study was to compare the clinical performance of these two devices in terms of difficulty, number of attempts before successful insertion and overall success rate of insertion.
METHODS:
All adult patients with OHCA, in whom ambulance personnel used a SAD over a one-year period in the ambulance services of Central Norway, were included. After the event, a questionnaire was completed and the personnel responsible for the airway management were interviewed. Primary outcomes were number of attempts until successful insertion, by either same or different ambulance personnel, and the difficulty of insertion graded by easy, medium or hard. Secondary outcomes were reported complications with inserting the SAD's.
RESULTS:
Two hundred and fifty patients were included, of whom 191 received I-gel and 59 received LTS-D. Overall success rate was significantly higher in I-gel (86%) compared to LTS-D (75%, p?=?0.043). The rates of successful placements were higher when using I-gel compared to LTS-D, and there was a significant increased risk that the insertion of the LTS-D was unsuccessful compared to the I-gel (risk ratio 1.8, p?=?0.04). I-gel was assessed to be easy to insert in 80% of the patients, as opposed to LTS-D which was easy to insert in 51% of the patients.
CONCLUSIONS:
Overall success rate was significantly higher and the difficulty in insertion was significantly lower in the I-gel group compared to the LTS-D in patients with OHCA.
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Identifying prognostic factors and developing accurate outcome predictions for in-hospital cardiac arrest by using artificial neural networks.
J Neurol Sci2021 Apr;425():117445. doi: S0022-510X(21)00139-8.
Chung Chen-Chih, Chiu Wei-Ting, Huang Yao-Hsien, Chan Lung, Hong Chien-Tai, Chiu Hung-Wen,
Abstract
BACKGROUND:
Accurate estimation of neurological outcomes after in-hospital cardiac arrest (IHCA) provides crucial information for clinical management. This study used artificial neural networks (ANNs) to determine the prognostic factors and develop prediction models for IHCA based on immediate preresuscitation parameters.
METHODS:
The derived cohort comprised 796 patients with IHCA between 2006 and 2014. We applied ANNs to develop prediction models and evaluated the significance of each parameter associated with favorable neurological outcomes. An independent dataset of 108 IHCA patients receiving targeted temperature management was used to validate the identified parameters. The generalizability of the models was assessed through fivefold cross-validation. The performance of the models was assessed using the area under the curve (AUC).
RESULTS:
ANN model 1, based on 19 baseline parameters, and model 2, based on 11 prearrest parameters, achieved validation AUCs of 0.978 and 0.947, respectively. ANN model 3 based on 30 baseline and prearrest parameters achieved an AUC of 0.997. The key factors associated with favorable outcomes were the duration of cardiopulmonary resuscitation; initial cardiac arrest rhythm; arrest location; and whether the patient had a malignant disease, pneumonia, and respiratory insufficiency. On the basis of these parameters, the validation performance of the ANN models achieved an AUC of 0.906 for IHCA patients who received targeted temperature management.
CONCLUSION:
The ANN models achieved highly accurate and reliable performance for predicting the neurological outcomes of successfully resuscitated patients with IHCA. These models can be of significant clinical value in assisting with decision-making, especially regarding optimal postresuscitation strategies.
Copyright © 2021. Published by Elsevier B.V.
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Clinical performance of early warning scoring systems for identifying sepsis among anti-hypertensive agent users.
Am J Emerg Med2021 Apr;48():120-127. doi: S0735-6757(21)00286-2.
Osawa Itsuki, Sonoo Tomohiro, Soeno Shoko, Hara Konan, Nakamura Kensuke, Goto Tadahiro,
Abstract
BACKGROUND:
Little is known about the accuracy of the quick Sequential Organ Failure Assessment (qSOFA) and the National Early Warning Score (NEWS) in identifying sepsis patients with a history of hypertension on anti-hypertensive agents, which affect vital signs as components of the scoring systems. We aimed to examine the ability of qSOFA and NEWS to predict sepsis among anti-hypertensive agent users by comparing them with non-users.
METHODS:
We retrospectively identified adult patients (aged ?18years) with suspected infection who presented to an emergency department (ED) of a large tertiary medical center in Japan between April 2018 and March 2020. Suspected infection was defined based on the chief complaint of fever, high body temperature, or the clinical context on arrival at the ED. We excluded patients who had trauma or cardiac arrest, those who were transported to other hospitals after arrival at the ED, and those whose vital signs data were mostly missing. The predictive performances of qSOFA and NEWS based on initial vital signs were examined separately for sepsis, ICU admission, and in-hospital mortality and compared between anti-hypertensive agent users and non-users.
RESULTS:
Among 2900 patients with suspected infection presenting to the ED, 291 (10%) had sepsis, 1023 (35%) were admitted to the ICU, and 188 (6.5%) died. The prediction performances of qSOFA and NEWS for each outcome among anti-hypertensive agent users were lower than that among non-users (e.g., c-statistics of qSOFA for sepsis, 0.66 vs. 0.71, p = 0.07; and for ICU admission, 0.70 vs. 0.75, p = 0.01). For identifying sepsis, the sensitivity and specificity of qSOFA ?2 were 0.43 and 0.77 in anti-hypertensive agent users and 0.51 and 0.82 in non-users. Similar associations were observed for identifying ICU admission and in-hospital mortality. Regardless of the use of anti-hypertensive agents, NEWS had better prediction abilities for each outcome than qSOFA.
CONCLUSION:
The clinical performance of qSOFA and NEWS for identifying sepsis among anti-hypertensive agent users was likely lower than that among non-users.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Identification of a novel presumed cardiac sarcoidosis category for patients at high risk of disease.
Int J Cardiol2021 Apr;():. doi: S0167-5273(21)00658-6.
Rosenbaum Andrew N, Kolluri Nikhil, Elwazir Mohamed Y, Kapa Suraj, Abou Ezzeddine Omar F, Bois John P, Chareonthaitawee Panithaya, Schmidt Tyler J, Cooper Leslie T,
Abstract
BACKGROUND:
Histologic evidence is required for a definitive diagnosis of cardiac sarcoidosis (CS) by published guidelines; however, the sporadic nature of the disease may produce false negative biopsy results, causing CS to be underdiagnosed. We sought to establish a clinical category of CS absent histologic findings.
METHODS:
Patients evaluated for CS were stratified into 3 groups: probable CS and definite CS based on Heart Rhythm Society (HRS) criteria and presumed CS, ie, patients without any histologic evidence of sarcoidosis, but with unexplained high-grade atrioventricular block or ventricular arrhythmia and findings suggestive of CS on either cardiac magnetic resonance imaging or positron emission tomography. The primary end point was hospitalization-free and overall survival at 10?years.
RESULTS:
A total of 383 patients were included in the study: 59, definite CS; 223, probable CS; and 101, presumed CS (62, isolated CS and 39, systemic CS). Compared with patients meeting HRS criteria for CS, patients with presumed CS had lower odds of New York Heart Association class III or IV symptoms (odds ratio [OR], 0.44 [95% CI, 0.23-0.83]; P?=?.01) but greater odds of previous ventricular tachycardia (OR, 2.4 [95% CI, 1.4-4.0]; P?=?.001) or history of resuscitated sudden cardiac arrest (OR, 2.9 [95% CI, 1.0-8.6]; P?=?.05). Hospitalization-free and overall survival were similar among groups (P?=?.51 and P?=?.71, respectively).
CONCLUSIONS:
Clinical categorization of patients with presumed CS identified a high-risk cohort comparable to patients with histologic evidence of disease, although caution should be exercised in reaching this diagnosis without paying due diligence to the differential diagnosis.
Copyright © 2021. Published by Elsevier B.V.
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[Influence of therapeutic temperature management on the clinical course in patients after in-hospital cardiac arrest : A retrospective analysis].
Med Klin Intensivmed Notfmed2021 Apr;():. doi: 10.1007/s00063-021-00814-3.
Wanek Felix, Meißner Stefanie, Nuding Sebastian, Hoberück Sebastian, Werdan Karl, Noutsias Michel, Ebelt Henning,
Abstract
METHODS:
Retrospective analysis of all patients with in-hospital cardiac arrest and return of spontaneous circulation (ROSC) in the ICU of the cardiologic department of the University Hospital of Halle (Saale) between 1999 and 2009.
RESULTS:
During the observation period, 169 patients with in-hospital cardiac arrest and information regarding temperature measurements were treated. Invasive therapeutic temperature management (TTM+) was applied in 64 patients (37.9%), while 105 patients (62.1%) underwent no therapeutic temperature management (TTM-). TTM+ and TTM- showed no relevant differences regarding patient age (TTM+: 67.6?±?12.6 years; TTM-: 69.8?±?12.6 years; p?=?0.257), comorbidities and the initial rhythm; however, there were more men in the TTM+ group (76.6% vs. 58.1%; p?=?0.015). All patients had been intubated. Time until ROSC in TTM+ was significantly longer (25.9?±?25.8?min vs. 15.0?±?12.4?min; p?
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Definity, echo contrast, induced cardiac arrest: brief review of the literature.
BMJ Case Rep2021 Apr;14(4):. doi: e240492.
Mir Tanveer, Uddin Mohammed M, Watson Kayleigh, Meir Eliezer Bar, Abdo Alward,
Abstract
Definity is a contrast media used to enhance the endocardium during echocardiography. Cardiac arrest as an adverse reaction to Definity is still a debate. We are presenting a rare case of a 69-year-old male patient who developed cardiopulmonary arrest immediately after Definity injection during resting echocardiography.
© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.
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Code Blue in the Operating Room- pharmacy is on the way!
J Am Pharm Assoc (2003)2021 Apr;():. doi: S1544-3191(21)00154-0.
Aiudi Christopher M, Oliver Jevon J, Chowatia Parita A, Dalia Adam A,
Abstract
BACKGROUND:
Pharmacists have become an integrated part of the cardiac arrest (Code Blue) response team in the emergency department and inpatient settings. However, the attendance of pharmacists at intraoperative codes is less established.
OBJECTIVE:
The purpose of this paper was to describe the creation of the Perioperative Pharmacy Attendance for Intraoperative Codes Safety Initiative, report the impact it had on the intraoperative emergency code team, and discuss the limitations and difficulties experienced by the pharmacy department so that other institutions may have a foundation on which to build similar programs.
PRACTICE DESCRIPTION:
A large academic medical center successfully incorporated pharmacists into the intraoperative emergency code team.
PRACTICE INNOVATION:
We began by obtaining collaborative leadership support by using a quality assurance and improvement focus. In an organized manner, we methodically developed workflow protocols, educational programming, and promotional material to ensure that our initiative was able to be effectively used by the institution.
EVALUATION METHODS:
A year after the implementation, clinicians evaluated the program and reported its impact on team performance. An evaluation regarding the difficulties experienced with the initiation of the program was also performed.
RESULTS:
Most clinicians stated that having pharmacists at intraoperative emergencies improved patient care as well as the code team's performance. The difficulties experienced during the development of this program included workflow disruptions and the need for a continued effort to effectively advertise it to clinicians.
CONCLUSION:
Our institution was able to create the successful Perioperative Pharmacy Attendance for Intraoperative Codes Safety Initiative. This paper describes the steps taken to create and implement this successful program as well as the integration of pharmacists into the intraoperative emergency setting.
Copyright © 2021 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
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Hyperoxia After Return of Spontaneous Circulation in Cardiac Arrest Patients.
J Cardiothorac Vasc Anesth2021 Mar;():. doi: S1053-0770(21)00209-3.
Latif Rana K, Clifford Sean P, Byrne Keith R, Maggard Brittany, Chowhan Yaruk, Saleem Jawad, Huang Jiapeng,
Abstract
Current guidelines emphasize the use of 100% oxygen during cardiopulmonary resuscitation after cardiac arrest. When patients are ventilated for variable periods after return of spontaneous circulation (ROSC), hyperoxia causes increased morbidity and mortality by overproduction of reactive oxygen species. Various patient, volunteer, and animal studies have shown the harmful effects of hyperoxia. This mini-review article aims to expand the potential clinical spectrum of hyperoxia on individual organ systems leading to organ dysfunction. A framework to achieve and maintain normoxia after ROSC is proposed. Despite the harmful considerations of hyperoxia in critically ill patients, additional safety studies including dose-effect, level and onset of the reactive oxygen species effect, and safe hyperoxia applicability period after ROSC, need to be performed in various animal and human models to further elucidate the role of oxygen therapy after cardiac arrest.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Extracorporeal membrane oxygenation combined with sequential blood purification in the treatment of myocardial damage and cardiac arrest caused by mushroom poisoning.
Toxicon2021 Apr;():. doi: S0041-0101(21)00115-X.
Li Yang, Qiu Zhiqiang, Huang Liang, Cao Chunshui,
Abstract
Mushroom poisoning is a common clinical problem. Severe mushroom poisoning often causes liver and kidney failure. Although severe myocardial damage is rare, the fatality rate is extremely high. This case report describes a 56-year-old male suffered severe myocardial damage, multiple organ dysfunction, circulatory failure, recurrent malignant arrhythmia, and cardiac arrest after the ingestion of wild mushrooms. He was administered venoarterial extracorporeal membrane oxygenation (VA-ECMO) combined with hemoperfusion, plasma exchange and continuous renal replacement therapy. The heart rhythm gradually stabilized 3 hours after ECMO surgery. On the 6th day after ECMO, heart function recovered. The patient was then weaned from ECMO, and he ultimately recovered and was discharged. In patients with fatal mushroom poisoning leading to refractory arrhythmia and cardiac arrest, early implementation of VA-ECMO combined with sequential blood purification treatment can improve the prognosis and increase the survival rate.
Copyright © 2021. Published by Elsevier Ltd.
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Outcomes of Acute Myocardial Infarction in Patients with Familial Hypercholesteremia.
Am J Med2021 Apr;():. doi: S0002-9343(21)00226-6.
Elbadawi Ayman, Elgendy Islam Y, Omer Mohamed, Abdelazeem Mohamed, Nambi Vijay, Krittawong Chayakri, Hira Ravi S, Tamis-Holland Jacqueline, Ballantyne Christie, Jneid Hani,
Abstract
BACKGROUND:
There is a paucity of contemporary data regarding the outcomes of acute myocardial infarction among patients with familial hypercholesteremia.
METHODS:
We queried the Nationwide Readmissions Database (2016-2018) for hospitalizations with acute myocardial infarction. Multivariable regression analysis was used to compare in-hospital outcomes and 30-day readmissions among patients with and without familial hypercholesteremia.
RESULTS:
The analysis included 1,363,488 hospitalizations with acute myocardial infarction. The prevalence of familial hypercholesteremia was 0.07% among acute myocardial infarction admissions. Compared to those without familial hypercholesteremia, admissions with familial hypercholesteremia were younger and had less comorbidities, but were more likely to have had prior infarct and revascularization. Admissions with familial hypercholesteremia were more likely to present with ST-elevation myocardial infarction and undergo revascularization. After multivariable adjustment, there was no difference in in-hospital case fatality among patients with versus without familial hypercholesteremia (adjusted-OR 0.76; 95% CI 0.41-1.39). Admissions with acute myocardial infarction and familial hypercholesteremia had higher adjusted rates of cardiac arrest and utilization of mechanical support. There were no group differences in overall 30-day readmission (adjusted-OR 0.75; 95% CI 0.51-1.10) or 30-day readmission for AMI. However, a non-significant trend towards higher readmission for PCI was observed among patients with familial hypercholesteremia (adjusted-OR 1.89; 95% CI 0.98-3.64).
CONCLUSION:
In this contemporary nationwide observational analysis, patients with familial hypercholesteremia represent a small proportion of the overall population with acute myocardial infarction and have a distinctive clinical profile, but do not appear to have worse in-hospital case fatality compared to those without familial hypercholesteremia.
Copyright © 2021. Published by Elsevier Inc.
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Prognostic value of 'late' electroencephalography recordings in patients with cardiopulmonal resuscitation after cardiac arrest.
J Neurol2021 Apr;():. doi: 10.1007/s00415-021-10549-y.
Doerrfuss Jakob I, Kowski Alexander B, Holtkamp Martin, Thinius Moritz, Leithner Christoph, Storm Christian,
Abstract
BACKGROUND:
Electroencephalography (EEG) significantly contributes to the neuroprognostication after resuscitation from cardiac arrest. Recent studies suggest that the prognostic value of EEG is highest for continuous recording within the first days after cardiac arrest. Early continuous EEG, however, is not available in all hospitals. In this observational study, we sought to evaluate the predictive value of a 'late' EEG recording 5-14 days after cardiac arrest without sedatives.
METHODS:
We retrospectively analyzed EEG data in consecutive adult patients treated at the medical intensive care units (ICU) of the Charité-Universitätsmedizin Berlin. Outcome was assessed as cerebral performance category (CPC) at discharge from ICU, with an unfavorable outcome being defined as CPC 4 and 5.
RESULTS:
In 187 patients, a 'late' EEG recording was performed. Of these patients, 127 were without continuous administration of sedative agents for at least 24 h before the EEG recording. In this patient group, a continuously suppressed background activity?
CONCLUSIONS:
A 'late' EEG performed 5 to 14 days after resuscitation from cardiac arrest can aide in prognosticating functional outcome. A suppressed EEG background activity in this time period indicates poor outcome.
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Variability in reporting of key outcome predictors in acute myocardial infarction cardiogenic shock trials.
Catheter Cardiovasc Interv2021 Apr;():. doi: 10.1002/ccd.29710.
Tyler Jeffrey M, Brown Christopher, Jentzer Jacob Colin, Baran David A, van Diepen Sean, Kapur Navin K, Garberich Ross F, Garcia Santiago, Sharkey Scott W, Henry Timothy D,
Abstract
BACKGROUND:
Among acute myocardial infarction patients with cardiogenic shock (AMICS), a number of key variables predict mortality, including cardiac arrest (CA) and shock classification as proposed by Society for Cardiovascular Angiography and Intervention (SCAI). Given this prognostic importance, we examined the frequency of reporting of high risk variables in published randomized controlled trials (RCTs) of AMICS patients.
METHODS:
We identified 15 RCTs enrolling 2,500 AMICS patients and then reviewed rates of CA, baseline neurologic status, right heart catheterization data, lactate levels, inotrope and vasopressor requirement, hypothermia, mechanical ventilation, left ventricular ejection fraction (LVEF), mechanical circulatory support, and specific cause of death based on the primary manuscript and Data in S1.
RESULTS:
A total of 2,500 AMICS patients have been enrolled in 15 clinical trials over 21?years with only four trials enrolling >80 patients. The reporting frequency and range for key prognostic factors was: neurologic status (0% reported), hypothermia (28% reported, prevalence 33-75%), specific cause of death (33% reported), cardiac index and wedge pressure (47% reported, range 1.6-2.3 L?min m and 15-24?mmHg), lactate (60% reported, range 4-7.7?mmol/L), LVEF (73% reported, range 25-45%), CA (80% reported, prevalence 0-92%), MCS (80% reported, prevalence 13-100%), and mechanical ventilation (93% reported, prevalence 35-100%). This variability was reflected in the 30-day mortality which ranged from 20-73%.
CONCLUSIONS:
In a comprehensive review of seminal RCTs in AMICS, important predictors of outcome were frequently not reported. Future efforts to standardize CS trial data collection and reporting may allow for better assessment of novel therapies for AMICS.
© 2021 Wiley Periodicals LLC.
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Association of Carotid Intima-Media Thickness and Other Carotid Ultrasound Features With Incident Dementia in the ARIC-NCS.
J Am Heart Assoc2021 Apr;():e020489. doi: 10.1161/JAHA.120.020489.
Wang Wendy, Norby Faye L, George Kristen M, Alonso Alvaro, Mosley Thomas H, Gottesman Rebecca F, Meyer Michelle L, Lutsey Pamela L,
Abstract
Background Increased carotid intima-media thickness, interadventitial diameter, presence of carotid plaque, and lower distensibility are predictors for cardiovascular disease. These indices likely relate to cerebrovascular disease, and thus may constitute a form of vascular contributions to dementia and Alzheimer disease-related dementia. Therefore, we assessed the relationship of carotid measurements and arterial stiffness with incident dementia in the ARIC (Atherosclerosis Risk in Communities) study. Methods and Results A total of 12 459 ARIC participants with carotid arterial ultrasounds in 1990 to 1992 were followed through 2017 for dementia. Dementia cases were identified using in-person and phone cognitive status assessments, hospitalization discharge codes, and death certificate codes. Cox proportional hazards models were used to estimate the hazard ratios (HRs) for incident dementia. Participants were aged 57±6 at baseline, 57% were women, and 23% were Black individuals. Over a median follow-up time of 24 years, 2224 dementia events were ascertained. After multivariable adjustments, the highest quintile of carotid intima-media thickness and interadventitial diameter in midlife was associated with increased risk of dementia (HR [95% CIs], 1.25 [1.08-1.45]; and 1.22 [1.04-1.43], respectively) compared with its respective lowest quintile. Presence of carotid plaque did not have a significant association with dementia (HR [95% CI], 1.06 [0.97-1.15]). Higher distensibility was associated with lower risk of dementia (HR [95% CI] highest versus lowest quintile, 0.76 [0.63-0.91]). Conclusions Greater carotid intima-media thickness, interadventitial diameter, and lower carotid distensibility are associated with an increased risk of incident dementia. These findings suggest that both atherosclerosis and carotid stiffness may be implicated in dementia risk.
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