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Pubblicazioni recenti - cardiac arrest
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Intra-arrest transesophageal echocardiography during cardiopulmonary resuscitation.
Clin Exp Emerg Med2022 Dec;():. doi: 10.15441/ceem.22.399.
Hwang Sung Oh, Jung Woo Jin, Roh Young-Il, Cha Kyoung-Chul,
Abstract
Determining the cause of cardiac arrest (CA) and the heart status during CA is crucial for its treatment. Transesophageal echocardiography (TEE) is an imaging method that facilitates close observation of the heart without interfering with cardiopulmonary resuscitation (CPR). Intra-arrest TEE is a point-of-care ultrasound technique that is used during CPR. Intra-arrest TEE is performed to diagnose the cause of CA, determine the presence of cardiac contraction, evaluate the quality of CPR, assist with catheter insertion, and explore the mechanism of blood flow during CPR. The common causes of CA diagnosed using intra-arrest TEE include cardiac tamponade, aortic dissection, pulmonary embolism, and intracardiac thrombus, which can be observed on a few simple image planes at the mid-esophageal and upper esophageal positions. To operate an intra-arrest TEE program, it is necessary to secure a physician who is capable of performing TEE, provide appropriate training, establish implementation protocols, and prepare a plan in collaboration with the CPR team.
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Comparing the First-Pass Success Rate of the King LTS-D and the i-gel Airway Devices in Out-of-Hospital Cardiac Arrest.
Cureus2022 Nov;14(11):e30987. doi: e30987.
Price Patrick, Laurie Anne, Plant Eric, Chandra Kavish, Pishe Tushar, Brunt Keith,
Abstract
OBJECTIVES:
Significant heterogeneity exists internationally in the airway devices used in the pre-hospital setting during cardiac arrest. This study evaluated the first-pass success (FPS) rate of two supraglottic airways (SGAs) used by paramedics during out-of-hospital cardiac arrest: the King LTS-D and the i-gel.
METHODS:
By examining 2,680 patient care records compiled by Ambulance New Brunswick between 2015 and 2020, we evaluated the FPS rate of the two SGAs using a 2x2 Pearson chi-square test for association, and a Mann-Whitney U test, to determine whether there were significant differences in FPS rates.
RESULTS:
Our study demonstrated a statistically significant association between airway devices and FPS favoring the i-gel with an FPS of 90.6% compared to a 76.6% FPS with the King LTS-D; (1) = 96.01, p
CONCLUSIONS:
Among patients in New Brunswick with out-of-hospital cardiac arrest, paramedics had a higher FPS rate with the i-gel compared to the King LTS-D. Our study also found a statistically significant difference between the King LTS-D and i-gel, favoring the i-gel in fewer attempts. Our findings suggest that the i-gel provides a more consistent FPS rate compared to the King LTS-D within our study populations; however, further research is necessary to determine the clinical implications of this. While multiple attempts at tracheal intubation are associated with negative clinical outcomes, no such evidence exists for SGAs.
Copyright © 2022, Price et al.
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In-hospital cardiac arrest: the state of the art.
Crit Care2022 Dec;26(1):376. doi: 10.1186/s13054-022-04247-y.
Penketh James, Nolan Jerry P,
Abstract
In-hospital cardiac arrest (IHCA) is associated with a high risk of death, but mortality rates are decreasing. The latest epidemiological and outcome data from several cardiac arrest registries are helping to shape our understanding of IHCA. The introduction of rapid response teams has been associated with a downward trend in hospital mortality. Technology and access to defibrillators continues to progress. The optimal method of airway management during IHCA remains uncertain, but there is a trend for decreasing use of tracheal intubation and increased use of supraglottic airway devices. The first randomised clinical trial of airway management during IHCA is ongoing in the UK. Retrospective and observational studies have shown that several pre-arrest factors are strongly associated with outcome after IHCA, but the risk of bias in such studies makes prognostication of individual cases potentially unreliable. Shared decision making and advanced care planning will increase application of appropriate DNACPR decisions and decrease rates of resuscitation attempts following IHCA.
© 2022. The Author(s).
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Organ damage evaluation in a temperature-controlled circulatory arrest rat model.
BMC Cardiovasc Disord2022 Dec;22(1):527. doi: 10.1186/s12872-022-02955-5.
Xiong Yaoyao, Zheng Quan, Wang Chunle, Yan Wei, He Wei,
Abstract
BACKGROUND:
Deep hypothermic circulatory arrest (DHCA) is commonly used in adult aortic surgery and pediatric complex congenital heart disease, and is associated with pathophysiological changes and postoperative complications. Here, a temperature-controlled circulatory arrest model in rats was established to study the suitable temperature of circulatory arrest by investigating the damage to body organs under different temperatures.
METHODS:
Thirty Sprague?Dawley rats were randomly divided into 5 equal groups for DHCA experiments: I (15-20 °C), II (20-25 °C), III (25-30 °C), IV (normothermic cardiopulmonary bypass), and V (sham operation group). Blood gas analysis, homodynamic parameters, and intervals of cardiac recovery were measured at different time points in all groups. Morphological changes in intestinal tissue were observed under light and electron microscopes. Oxidative stress was measured by MPO activity, MDA, and SOD content. Tissue damage was confirmed by serum detection of ALT, AST, BUN, Cr, and LDH. To examine the inflammatory response, cytokines, including IL-1, IL-4, IL-10, IFN-?, and TNF-?, were detected.
RESULTS:
The extracorporeal circulation technique caused damage to the body; the degree of the damage caused by the circulatory arrest technique may be related to circulating temperature, with the least amount of damage occurring at 20-25 °C compared to 15-20 °C and 25-30 °C. Ischemia and hypoxia can cause intestinal tissue damage, which manifests primarily as a loss of the intestinal mucosal barrier. Ischemic intestinal damage caused by DHCA was not associated with inflammation.
CONCLUSION:
The study provides new insights into the pathophysiologic mechanisms of DHCA.
© 2022. The Author(s).
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Hemoperfusion for Clinically Suspected Organophosphate and Carbamate Poisoning in Critically Ill Patients: A Randomized Trial.
Blood Purif2022 Dec;():1-9. doi: 10.1159/000525936.
Omar Shahed, Sooka Praveer Navin, Khoza Siyabonga, Van Rooyen Martin Charles, Mashamba Lushavhana, Madi S'fisosikayise, Mathivha Lufuno Rudo, George Jaya Anna,
Abstract
INTRODUCTION:
Organophosphate poisoning occurs frequently, and despite treatment, increased severity and intensive care unit (ICU) admissions have been observed. We hypothesized that early hemoperfusion/hemadsorption (HA) therapy would change the clinical course of the disease.
METHODS:
We performed a prospective, open, randomized controlled study at an academic ICU. Adult patients referred for an acute cholinergic toxidrome were screened. Patients meeting inclusion and exclusion criteria were randomized to standard of care (SoC) or HA therapy plus SoC, which included 2 6-h cycles of HA 12 h apart beginning within the first 24 h of ICU admission. The primary outcome was a comparison of ICU length of stay (LOS).
RESULTS:
There were no significant baseline differences between the groups. The median ICU LOS was 6.5 days (IQR 4.5-10) in the HA group compared to 8 days (IQR 3.5-17) for the control group, p = 0.58. Among patients with an excess ICU LOS ?7 days, the median ICU LOS was significantly shorter for the HA group, 10 days (IQR 8-12) compared to 17 days (IQR 14-22) for the control group, p = 0.001, resulting in a cost saving of EUR 7308 per patient. Duration (8 days vs. 13.5 days) and cumulative dosage (316 mg vs. 887 mg) of atropine among patients with excess ICU LOS were significantly lower in the HA group compared to the SoC group, respectively. A similar reduction in the duration of mechanical ventilation (HA = 6 days vs. SoC = 15 days, p = 0.001) was found. The combination of day 28 mortality and severe complications was lower in the HA group (10%, n = 2/20) compared to the SoC group (42%, 14/33) p = 0.01.
CONCLUSION:
HA therapy resulted in significant cost savings driven by a reduced LOS among patients with excess ICU LOS ?7 days. This therapy was also associated with a significant reduction in the combination of day 28 mortality and severe complications including cardiac arrest, organ dysfunction, reintubation, and tracheostomy.
© 2022 S. Karger AG, Basel.
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Fibrinolysis in Cardiac Arrest Patients Treated with Hypothermia.
Ther Hypothermia Temp Manag2022 Dec;():. doi: 10.1089/ther.2022.0037.
Jeppesen Anni Nørgaard, Duez Christophe, Kirkegaard Hans, Grejs Anders Morten, Hvas Anne-Mette,
Abstract
Hypothermia affects coagulation, but the effect of hypothermia on fibrinolysis is not clarified. Imbalance in the fibrinolytic system may lead to increased risk of bleeding or thrombosis. Our aim was to investigate if resuscitated cardiac arrest patients treated with hypothermia had an unbalanced fibrinolysis. A prospective cohort study, including 82 patients were treated with hypothermia at 33°C?±?1°C after out-of-hospital cardiac arrest. Blood samples were collected at 24 hours (hypothermia) and at 72 hours (normothermia). Samples were analyzed for fibrin D-dimer, tissue plasminogen activator (tPA), plasminogen, plasminogen activator Inhibitor-1 (PAI-1), thrombin-activatable fibrinolysis inhibitor (TAFI), and an in-house dynamic fibrin clot formation and lysis assay.Compared with normothermia, hypothermia significantly increased plasminogen activity (mean difference?=?10.4%, 95% confidence interval [CI] 7.9-12.9), ?0.001), PAI-1 levels (mean difference?=?275?ng/mL, 95% CI 203-348, ?0.001), and tPA levels (mean difference?=?1.0?ng/mL, 95% CI 0.2-1.7, ?=?0.01). No differences between hypothermia and normothermia were found in TAFI activity (?=?0.59) or in the fibrin D-dimer levels (?=?0.08). The fibrin clot lysis curves showed three different patterns: normal-, flat-, or resistant clot lysis curve. At hypothermia 45 (55%) patients had a resistant clot lysis curve and 33 (44%) patients had a resistant clot lysis curve at normothermia (?=?0.047). Comatose, resuscitated, cardiac arrest patients treated with hypothermia express an inhibited fibrinolysis even after rewarming. This could potentially increase the thromboembolic risk. ClinicalTrials.gov ID: NCT02258360.
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Store-operated calcium entry via ORAI1 regulates doxorubicin-induced apoptosis and prevents cardiotoxicity in cardiac fibroblasts.
PLoS One2022 ;17(12):e0278613. doi: 10.1371/journal.pone.0278613.
Nemoto Hiroko, Umemura Masanari, Suzuki Fumina, Nagasako Akane, Nagao Kagemichi, Hidaka Yuko, Nakakaji Rina, Uchida Keiji, Suzuki Shinichi, Masuda Munetaka, Ishikawa Yoshihiro,
Abstract
Despite exhibiting cardiotoxicity, doxorubicin (DOX) is widely used for cancer treatments. Cardiac fibroblasts (CFs) are important in the pathogenesis of heart failure. This necessitates the study of the effect of DOX on CFs. The impairment of calcium (Ca2+) homeostasis is a common mechanism of heart failure. Store-operated Ca2+ entry (SOCE) is a receptor-regulated Ca2? entry pathway that maintains calcium balance by sensing reduced calcium stores in the endoplasmic reticulum. ORAI1, a calcium channel protein and the most important component of SOCE, is highly expressed in human cardiac fibroblasts (HCFs). It is upregulated in CFs from failing ventricles. However, whether ORAI1 in HCFs is increased and/or plays a role in DOX-induced cardiotoxicity remains unknown. In this study, we aimed to elucidate the relationship between ORAI1/SOCE and DOX-induced heart failure. Induction of apoptosis by DOX was characterized in HCFs. Apoptosis and cell cycle analyses were performed by fluorescence-activated cell sorting (FACS). Reactive oxygen species (ROS) production was measured using fluorescence. YM-58483 was used as an ORAI1/SOCE inhibitor. ORAI1-knockdown cells were established by RNA interference. In vivo experiments were performed by intraperitoneally injecting YM-58483 and DOX into mice. We first demonstrated that DOX significantly increased the protein expression level of p53 in HCFs by western blotting. FACS analysis revealed that DOX increased early apoptosis and induced cell cycle arrest in the G2 phase in fibroblasts. DOX also increased ROS production. DOX significantly increased the expression level of ORAI1 in CFs. Both YM-58483 and ORAI1 gene knockdown attenuated DOX-induced apoptosis. Similarly, YM-58483 attenuated cell cycle arrest in the G2 phase, and ORAI1 knockdown attenuated DOX-induced ROS production in HCFs. In the animal experiment, YM-58483 attenuated DOX-induced apoptosis. In HCFs, ORAI1/SOCE regulates p53 expression and plays an important role in DOX-induced cardiotoxicity. ORAI1 may serve as a new target for preventing DOX-induced heart failure.
Copyright: © 2022 Nemoto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Curdione Relieved Isoproterenol-Induced Myocardial Damage through Inhibiting Oxidative Stress and Apoptosis.
Am J Chin Med2022 Dec;():1-17. doi: 10.1142/S0192415X23500052.
Ma Yulei, Wang Penghe, Wu Zimei, Li Mengru, Gu Yuting, Wu Hong, Liu Hongrui,
Abstract
Isoproterenol (ISO) is widely used to treat bronchial asthma, cardiogenic or septic shock, complete atrioventricular block, and cardiac arrest. However, it can also cause myocardial damage owing to infarct-like necrosis. Curdione, an extract of the Chinese herb , has a variety of pharmacological activities, including cardioprotective effects. In this study, we investigated the protective effects of curdione and its underlying mechanisms in an ISO-induced myocardial injury model. Our results showed that curdione attenuated ISO-induced H9c2 cell proliferation inhibition and lactic dehydrogenase (LDH) release. Curdione ameliorated morphological damage and reduced the ISO-induced elevation of serum creatine kinase-MB isoenzyme (CK-MB) and LDH. Furthermore, curdione inhibited ISO-induced cell apoptosis, modulated the expression of Bcl-2 and Bax proteins, repealed the accumulation of ISO-induced reactive oxygen species (ROS), prevented mitochondrial dysfunction, and activated the Nrf2/SOD1/HO-1 signaling pathway. The above results show that curdione exerts a protective effect against ISO-induced myocardial damage by inhibiting apoptosis and oxidative stress, suggesting that curdione is a potential therapeutic strategy to prevent ISO-induced myocardial damage.
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Postmortem genetic testing in young individuals: What clinical medical practitioners need to know.
S Afr Med J2022 Dec;112(12):886-889. doi: 10.7196/SAMJ.2022.v112i12.16800.
Stroh van Deventer B, Du Toit-Prinsloo L, Van Niekerk C,
Abstract
The death of a young person is most often a tragic occurrence, more so when this death was unexpected. Forensic pathologists are mandated to investigate such deaths, and there has been a strong move internationally towards genetic testing as an additional investigative tool. The aim of our article is to bring the advantage of implementing the so-called molecular autopsy in a local setting to the attention of medical practitioners. When a multidisciplinary approach is taken in cases of sudden unexpected death, the benefits to family members, and society as a whole, are irrefutable.
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REPERFUSION INJURY IN ACUTE PERIOD OF MYOCARDIAL INFARCTION - WAYS OF PREVENTION AND CORRECTION.
Wiad Lek2022 ;75(10):2514-2518. doi: 10.36740/WLek202210137.
Vytrykhovskyi Andriy I, Fedorchenko Muhaylo V,
Abstract
OBJECTIVE:
The aim: To identify pathophysiological peculiarities of myocardial reperfusion injury and ways of its reduction based on the literature data analysis.
PATIENTS AND METHODS:
Materials and methots: This literature review was made by searching the PubMed database using key words . Additional data were sought in the Google search engine by entering key words: " risk factors, ischemic heart disease, arrhythmia, sudden cardiac death, heart rhythm, heart failure." in the Polish, English, Russian and Ukrainian language versions.
CONCLUSION:
Conclusions: Considering conducted data analysis, provided data indicate the prospects of phosphocreatine usage in treatment scheme of heart rhythm disorders and heart failure on the background of myocardial ischemia and elimination of reperfusion injury and myocardial remodeling consequences.
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Decreased Heart Rate Variability in COVID-19.
Intensive Care Res2022 Dec;():1-5. doi: 10.1007/s44231-022-00024-1.
Yin Chengfen, Li Jianguo, Wang Zhiyong, Zhi Yongle, Xu Lei,
Abstract
PURPOSE:
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which primarily infects the lower airways and binds to angiotensin-converting enzyme 2 (ACE2) on alveolar epithelial cells. ACE2 is widely expressed not only in the lungs but also in the cardiovascular system. Therefore, SARS-CoV-2 can also damage the myocardium. This report aimed to highlight decreased heart rate variability (HRV) and cardiac injury caused by SARS-CoV-2.
MATERIALS AND METHODS:
We evaluated three COVID-19 patients who died. Patients' data were collected from electronic medical records. We collected patient's information, including baseline information, lab results, body temperature, heart rate (HR), clinical outcome and other related data. We calculated the HRV and the difference between the expected and actual heart rate changes as the body temperature increased.
RESULTS:
As of March 14, 2020, 3 (2.2%) of 136 patients with COVID-19 in Tianjin died in the early stage of the COVID-19 epidemic. The immediate cause of death for Case 1, Case 2, and Case 3 was cardiogenic shock, cardiac arrest and cardiac arrest, respectively. The HRV were substantially decreased in the whole course of all three cases. The actual increases in heart rate were 5 beats/min, 13 beats/min, and 4 beats/min, respectively, less than expected as their temperature increased. Troponin I and Creatine Kinase MB isoenzyme (CK-MB) were substantially increased only in Case 3, for whom the diagnosis of virus-related cardiac injury could not be made until day 7. In all three cases, decreased in HRV and HR changes occurred earlier than increases in cardiac biomarkers (e.g., troponin I and CK-MB).
CONCLUSIONS:
In conclusion, COVID-19 could affect HRV and counteract tachycardia in response to increases in body temperature. The decreases of HRV and HR changes happened earlier than the increases of myocardial markers (troponin I and CK-MB). It suggested the decreases of HRV and HR changes might help predict cardiac injury earlier than myocardial markers in COVID-19, thus its early identification might help improve patient prognosis.
SUPPLEMENTARY INFORMATION:
The online version contains supplementary material available at 10.1007/s44231-022-00024-1.
© The Author(s) 2022.
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Parameters associated with successful weaning of veno-arterial extracorporeal membrane oxygenation: a systematic review.
Crit Care2022 Dec;26(1):375. doi: 10.1186/s13054-022-04249-w.
Charbonneau Francis, Chahinian Karina, Bebawi Emmanuel, Lavigueur Olivier, Lévesque Émilie, Lamarche Yoan, Serri Karim, Albert Martin, Noly Pierre-Emmanuel, Cournoyer Alexis, Cavayas Yiorgos Alexandros,
Abstract
PURPOSE:
Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) can be used to restore organ perfusion in patients with cardiogenic shock until native heart recovery occurs. It may be challenging, however, to determine when patients can be weaned successfully from ECMO-surviving without requiring further mechanical support or heart transplant. We aimed to systematically review the medical literature to determine the biomarkers, hemodynamic and echocardiographic parameters associated with successful weaning of VA-ECMO in adults with cardiogenic shock and to present an evidence-based weaning algorithm incorporating key findings.
METHOD:
We systematically searched PubMed, Embase, ProQuest, Google Scholars, Web of Science and the Grey literature for pertinent original research reports. We excluded studies limited to extracorporeal cardiopulmonary resuscitation (ECPR) as the neurological prognosis may significantly alter the decision-making process surrounding the device removal in this patient population. Studies with a mixed population of VA-ECMO for cardiogenic shock or cardiac arrest were included. We excluded studies limited to patients in which ECMO was only used as a bridge to VAD or heart transplant, as such patients are, by definition, never "successfully weaned." We used the Risk of Bias Assessment tool for Non-Randomized Studies. The study was registered on the International prospective register of systematic reviews (PROSPERO CRD42020178641).
RESULTS:
We screened 14,578 records and included 47 that met our pre-specified criteria. Signs of lower initial severity of shock and myocardial injury, early recovery of systemic perfusion, left and right ventricular recovery, hemodynamic and echocardiographic stability during flow reduction trial and/or pump-controlled retrograde trial off predicted successful weaning. The most widely used parameter was the left ventricular outflow tract velocity time integral, an indicator of stroke volume. Most studies had a moderate or high risk of bias. Heterogeneity in methods, timing, and conditions of measurements precluded any meta-analysis.
CONCLUSIONS:
In adult patients on VA-ECMO for cardiogenic shock, multiple biomarkers, hemodynamic and echocardiographic parameters may be used to track resolution of systemic hypoperfusion and myocardial recovery in order to identify patients that can be successfully weaned.
© 2022. The Author(s).
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Successful management of hemodynamic instability secondary to saddle pulmonary embolism-induced cardiac arrest using VA-ECMO in advanced malignancy with brain metastases.
J Cardiothorac Surg2022 Dec;17(1):296. doi: 10.1186/s13019-022-02044-w.
Pan Jianneng, Zhou Xiaoyang, Xu Zhaojun, Chen Bixin,
Abstract
BACKGROUND:
Saddle pulmonary embolism (SPE) represents a rare type of venous thromboembolism that frequently causes circulation collapse and sudden death. While venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been well established as a salvage treatment for SPE-induced circulatory shock, it is infrequently administered in patients with advanced malignancy, especially those with brain metastases, given the potential bleeding complications and an uncertain prognosis. As far, there are rare case reports regarding the successful management of hemodynamic instability secondary to SPE-induced cardiac arrest using VA-ECMO in advanced malignancy patients with brain metastases.
CASE PRESENTATION:
A 65-year-old woman presenting with cough and waist discomfort who had a history of lung cancer with brain metastases was admitted to the hospital to receive chemoradiotherapy. She suffered sudden cardiac arrest during hospitalization and returned to spontaneous circulation after receiving a 10-min high-quality cardiopulmonary resuscitation. Pulmonary embolism was suspected due to the collapsed hemodynamics and a distended right ventricle identified by echocardiography. Subsequent computed tomographic pulmonary angiography revealed a massive saddle thrombus straddling the bifurcation of the pulmonary trunk. VA-ECMO with adjusted-dose systemic heparinization was initiated to rescue the unstable hemodynamics despite receiving thrombolytic therapy with alteplase. Immediately afterward, the hemodynamic status of the patient stabilized rapidly. VA-ECMO was successfully discontinued within 72 h of initiation without any clotting or bleeding complications. She was weaned off invasive mechanical ventilation on the 6th day of intensive care unit (ICU) admission and discharged from the ICU 3 days later with good neurological function.
CONCLUSION:
VA-ECMO may be a 'bridging' therapy to circulation recovery during reperfusion therapy for SPE-induced hemodynamic collapse in malignancy patients with brain metastases.
© 2022. The Author(s).
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Targeting endogenous kidney regeneration using anti-IL11 therapy in acute and chronic models of kidney disease.
Nat Commun2022 Dec;13(1):7497. doi: 10.1038/s41467-022-35306-1.
Widjaja Anissa A, Viswanathan Sivakumar, Shekeran Shamini G, Adami Eleonora, Lim Wei-Wen, Chothani Sonia, Tan Jessie, Goh Joyce Wei Ting, Chen Hui Mei, Lim Sze Yun, Boustany-Kari Carine M, Hawkins Julie, Petretto Enrico, Hübner Norbert, Schafer Sebastian, Coffman Thomas M, Cook Stuart A,
Abstract
The kidney has large regenerative capacity, but this is compromised when kidney damage is excessive and renal tubular epithelial cells (TECs) undergo SNAI1-driven growth arrest. Here we investigate the role of IL11 in TECs, kidney injury and renal repair. IL11 stimulation of TECs induces ERK- and p90RSK-mediated GSK3? inactivation, SNAI1 upregulation and pro-inflammatory gene expression. Mice with acute kidney injury upregulate IL11 in TECs leading to SNAI1 expression and kidney dysfunction, which is not seen in Il11 deleted mice or in mice administered a neutralizing IL11 antibody in either preemptive or treatment modes. In acute kidney injury, anti-TGF? reduces renal fibrosis but exacerbates inflammation and tubule damage whereas anti-IL11 reduces all pathologies. Mice with TEC-specific deletion of Il11ra1 have reduced pathogenic signaling and are protected from renal injury-induced inflammation, fibrosis, and failure. In a model of chronic kidney disease, anti-IL11 therapy promotes TEC proliferation and parenchymal regeneration, reverses fibroinflammation and restores renal mass and function. These data highlight IL11-induced mesenchymal transition of injured TECs as an important renal pathology and suggest IL11 as a therapeutic target for restoring stalled endogenous regeneration in the diseased kidney.
© 2022. The Author(s).
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TIMECARD score: An easily operated prediction model of unfavorable neurological outcomes in out-of-hospital cardiac arrest patients with targeted temperaturemanagement.
J Formos Med Assoc2022 Dec;():. doi: S0929-6646(22)00433-8.
Lin Jr-Jiun, Huang Chien-Hua, Chien Yu-San, Hsu Chih-Hsin, Chiu Wei-Ting, Wu Cheng-Hsueh, Wang Chen-Hsu, Tsai Min-Shan,
Abstract
BACKGROUND:
Targeted temperature management (TTM) is recommended for comatose out-of-hospital cardiac arrest (OHCA) survivors. Several prediction models have been proposed; however, most of these tools require data conversion and complex calculations. Early and easy predictive model of neurological prognosis in OHCA survivors with TTM warrant investigation.
MATERIALS AND METHODS:
This multicenter retrospective cohort study enrolled 408 non-traumatic adult OHCA survivors with TTM from the TaIwan network of targeted temperature ManagEment for CARDiac arrest (TIMECARD) registry during January 2014 to June 2019. The primary outcome was unfavorable neurological outcome at discharge. The clinical variables associated with unfavorable neurological outcomes were identified and a risk prediction score-TIMECARD score was developed. The model was validated with data from National Taiwan University Hospital.
RESULTS:
There were 319 (78.2%) patients presented unfavorable neurological outcomes at hospital discharge. Eight independent variables, including malignancy, no bystander cardiopulmonary resuscitation (CPR), non-shockable rhythm, call-to-start CPR duration >5 min, CPR duration >20 min, sodium bicarbonate use during resuscitation, Glasgow Coma Scale motor score of 1 at return of spontaneous circulation, and no emergent coronary angiography, revealed a significant correlation with unfavorable neurological prognosis in TTM-treated OHCA survivors. The TIMECARD score was established and demonstrated good discriminatory performance in the development cohort (area under the receiver operating characteristic curve [AUC] = 0.855) and validation cohorts (AUC = 0.918 and 0.877, respectively).
CONCLUSION:
In emergency settings, the TIMECARD score is a practical and simple-to-calculate tool for predicting neurological prognosis in OHCA survivors, and may help determine whether to initiate TTM in indicated patients.
Copyright © 2022 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.
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The use of 100% compared to 50% oxygen during ineffective experimental cardiopulmonary resuscitation improves brain oxygenation.
Resuscitation2022 Dec;():. doi: S0300-9572(22)00729-8.
Nelskylä Annika, Humaloja Jaana, Litonius Erik, Pekkarinen Pirkka, Babini Giovanni, Mäki-Aho Tomi P, Heinonen Juho A, Skrifvars Markus B,
Abstract
INTRODUCTION:
Perfusion pressure and chest compression quality are generally considered key determinants of brain oxygenation during cardiopulmonary resuscitation (CPR) and the impact of oxygen administration is less clear. We compared ventilation with 100% and 50% oxygen during ineffective manual chest compressions and hypothesized that 100% oxygen would improve brain oxygenation.
METHODS:
Ventricular fibrillation (VF) was induced electrically in anaesthetized pigs and left untreated for 5 minutes, followed by randomization to ineffective manual CPR with ventilation of 50% or 100% oxygen. The first defibrillation was performed 10 minutes after induction of VF, and CPR continued with mechanical chest compressions (LUCAS2?) and defibrillation every 2 minutes until 36 minutes or return of spontaneous circulation (ROSC). Brain oxygenation was measured with near-infrared spectroscopy (rSO) and invasive brain tissue oxygen (PbtO) with a probe (NEUROVENT-PTO, RAUMEDIC) inserted into frontal brain tissue. Cerebral oxygenation was compared between groups with Mann-Whitney U tests and linear mixed models.
RESULTS:
Twenty-eight pigs were included in the study: 14 subjects in each group. During ineffective chest compressions relative PbtO was higher in the group ventilated with 100% compared to 50% oxygen (5.2mmHg [1.4-20.5] vs 2.2 [0.8-6.8], p=0.001), but there was no difference in rSO (22% [16-28] vs 18 [15-25], p=0.090). The use of 50% or 100% oxygen showed no difference in relative PbtO (p=1.00) and rSO (p=0.206) during mechanical CPR.
CONCLUSIONS:
The use of 100% compared to 50% oxygen during ineffective manual CPR improved brain oxygenation measured invasively in brain tissue, but there was no difference in rSO
Copyright © 2022. Published by Elsevier B.V.
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Yield of Cardiac Magnetic Resonance Imaging in a Preparticipation Cohort of Young Asian Males With T Wave Inversion.
Circulation2022 Dec;146(23):1802-1804. doi: 10.1161/CIRCULATIONAHA.122.061271.
Thiagarajan Nishanth, Ho Wilbert H H, Lim Daniel Y Z, Loo Wesley T W, Shen Goy, Sundar Vahul, Lim Huai Yang, Lim Lian Kiat, Chua Terrance S J, Lim Paul C Y, Tang Hak Chiaw, Koh Choong Hou, Yeo Tee Joo, Chong Daniel T T,
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Percutaneous Pulmonary Artery Cannulation to Treat Acute Secondary Right Heart Failure While on Veno-venous Extracorporeal Membrane Oxygenation.
ASAIO J2022 Dec;68(12):1483-1489. doi: 10.1097/MAT.0000000000001692.
Ivins-O'Keefe Kelly M, Cahill Michael S, Mielke Arthur R, Sobieszczyk Michal J, Sams Valerie G, Mason Phillip E, Read Matthew D,
Abstract
Right heart failure (RHF) is a common, yet difficult to manage, complication of severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation (ECMO) that is associated with increased mortality. Reports of the use of percutaneous mechanical circulatory support devices for concurrent right heart and respiratory failure are limited. This series describes the percutaneous cannulation of the pulmonary artery for conversion from veno-venous to veno-pulmonary artery return ECMO in 21 patients who developed secondary RHF. All patients cannulated between May 2019 and September 2021 were included. Either a 19 or 21 French venous cannula was placed percutaneously into the pulmonary artery via the internal jugular or subclavian vein, providing a total of 821 days of support (median 23 [4-71] days per patient) with flows up to 6?L/min. Five patients underwent cannulation at the bedside, with the remainder performed in the cardiac catheterization laboratory. Pulmonary artery cannulation occurred after 12 [8.5-23.5] days of ECMO support. Vasoactive infusion requirements decreased significantly within 24 hours of pulmonary artery cannula placement (p = 0.0004). Nonetheless, 75% of these patients expired after a median of 12 [4-63] days of support, with three patients found to have had significant pericardial effusions peri-arrest. This cannulation technique may be an effective alternative to veno-arterial ECMO cannulation or the placement of a dual-lumen cannula for the treatment of RHF.
Copyright © ASAIO 2022.
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Pediatric cardiopulmonary resuscitation in infant and children with chronic diseases: A simple approach?
Front Pediatr2022 ;10():1065585. doi: 1065585.
Uzun Davut D, Lang Kristin, Saur Patrick, Weigand Markus A, Schmitt Felix C F,
Abstract
Infants and children with complex chronic diseases have lifelong, life-threatening conditions and for many, early death is an unavoidable outcome of their disease process. But not all chronic diseases in children are fatal when treated well. Cardiopulmonary resuscitation is more common in children with chronic diseases than in healthy children. Resuscitation of infants and children presents significant challenges to physicians and healthcare providers. Primarily, these situations occur only rarely and are therefore not only medically demanding but also associated with emotional stress. In case of resuscitation in infants and children with chronic diseases these challenges become much more complex. The worldwide valid Pediatric Advanced Life Support Guidelines do not give clear recommendations how to deal with periarrest situations in chronically ill infants and children. For relevant life-limiting illnesses, a "do not resuscitate" order should be discussed early, taking into account medical, ethical, and emotional considerations. The decision to terminate resuscitative efforts in cardiopulmonary arrest in infants and children with chronic illnesses such as severe lung disease, heart disease, or even incurable cancer is complex and controversial among physicians and parents. Judging the "outcome" of resuscitation as a "good" outcome becomes complex because for some, life extension itself and for others, quality of life is a goal. Physicians often decide that a healthy child is more likely to have a reversible condition and thereby have a better outcome than a child with multiple comorbidities and chronic health care needs. Major challenges in resuscitation infants and children are that clinicians need to individualize resuscitation strategies in light of each chronic disease, anatomy and physiology. This review aims to highlight terms of resuscitation infants and children with complex chronic diseases, considering resuscitation-related factors, parent-related factors, patient-related factors, and physician-related factors.
© 2022 Uzun, Lang, Saur, Weigand and Schmitt.
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An unusual presentation of acute diaphragmatic hernia complicated by tension gastrothorax an under-recognized cause of cardiac arrest due to a fall from a height: A case report and literature review.
SAGE Open Med Case Rep2022 ;10():2050313X221140241. doi: 2050313X221140241.
Paramasivam Selvakumar Jegannathan, Purushothaman Senthil, Al Bshabshe Ali, Eltaher Osman Mohammed Jameel, Alwadai Nasser Mohammed, Sulaiman Naif, Palanivel Omprakash,
Abstract
A diaphragmatic hernia is a protrusion of the abdominal contents into the negative pressure thoracic cavity through a congenital or acquired diaphragmatic defect. Generally, acquired diaphragmatic hernia is a rare, life-threatening condition that usually follows blunt/penetrating trauma or an iatrogenic cause, resulting in the diaphragmatic rupture, accompanied by the herniation of abdominal visceral organs. We report a 47-year-old male construction worker who sustained a fall from a height of about 30?feet height. He presented with hypoxia initially and, after a primary survey, was found to have a traumatic rupture of the diaphragm with herniation of the stomach and abdominal contents, causing signs of obstructive shock. After adequate resuscitation in the Emergency Department, he was rushed to operating room. There, he suffered two very short pulseless electrical activity cardiac arrests. Therefore, an emergency anterolateral thoracotomy was done, and it was extended into laparotomy to reduce the abdominal contents through the diaphragmatic tear of 12?cm, which restored the spontaneous circulation. He recovered eventually, despite chest infections and pulmonary atelectasis, and was discharged on the 28th day and remained in good condition during the outpatient visit. Tension gastrothorax or viscerothorax is rare, but an under-recognized cause of cardiac arrest in the trauma setting necessitates a vigilant evaluation and early suspicion to prevent a catastrophic outcome. This case report emphasizes the inclusion of tension viscero or abdominal thorax as one of the recognizable causes of a pulseless electrical activity cardiac arrest.
© The Author(s) 2022.
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