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Pubblicazioni recenti - cardiac arrest
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Effectiveness of dispatcher instructions-dependent or independent bystander cardiopulmonary resuscitation on neurological survival among patients with out-of-hospital cardiac arrest.
J Cardiol2019 Sep;():. doi: S0914-5087(19)30266-7.
Hatakeyama Toshihiro, Kiguchi Takeyuki, Kobayashi Daisuke, Nakamura Naotoshi, Nishiyama Chika, Hayashida Sumito, Kiyohara Kosuke, Kitamura Tetsuhisa, Kawamura Takashi, Iwami Taku,
Abstract
BACKGROUND:
We evaluated the association between survival and bystandercardiopulmonary resuscitation (CPR) with or without dispatcher instructions (DI) considering the time from emergency call receipt by the dispatch center to emergency medical services (EMS) personnel's contact with the patient (i.e. time to EMS arrival).
METHODS:
This prospective study conducted in Osaka City, Japan, from 2009 to 2015 included patients with medical cause-related out-of-hospital cardiac arrest who were ?18 years old. The primary outcome was one-month favorable neurological survival. Using multiple logistic regression models, the adjusted odds ratios (AOR) of independent and DI-dependent CPR for the primary outcome were compared with no CPR. Adjustments were made for patients' age, sex, activities of daily living before the cardiac arrest, year of cardiac arrest, location, presence or absence of witnesses, etiology of cardiac arrest, and the time from EMS contact with the patient to patient's arrival at the hospital. The effective estimated "time to EMS arrival" was also calculated.
RESULTS:
For analyses 10,925 individuals were eligible. Independent CPR had a significantly higher one-month favorable neurological survival than no CPR whereas there was no significant difference between DI-dependent CPR and no CPR (AOR, 1.90 [1.47-2.46] and 1.16 [0.91-1.47], respectively). The estimated "time to EMS arrival" for a one-month favorable neurological survival after independent CPR was ?13min.
CONCLUSIONS:
Bystander CPR that did not need DI was associated with significantly higher one-month favorable neurological survival than no CPR, with an effective estimated "time to EMS arrival" of ?13min.
Copyright © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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Association between somatosensory evoked potentials and EEG in comatose patients after cardiac arrest.
Clin Neurophysiol2019 Aug;130(11):2026-2031. doi: S1388-2457(19)31208-8.
Glimmerveen Astrid B, Ruijter Barry J, Keijzer Hanneke M, Tjepkema-Cloostermans Marleen C, van Putten Michel J A M, Hofmeijer Jeannette,
Abstract
OBJECTIVE:
To analyze the association between SSEP results and EEG results in comatose patients after cardiac arrest, including the added value of repeated SSEP measurements.
METHODS:
Continuous EEG was measured in 619 patients during the first 3-5?days after cardiac arrest. SSEPs were recorded daily in the first 55 patients, and on indication in later patients. EEGs were visually classified at 12, 24, 48, and 72?h after cardiac arrest, and at the time of SSEP. Outcome at 6?m was dichotomized as good (Cerebral Performance Category 1-2) or poor (CPC 3-5). SSEP and EEG results were related to outcome. Additionally, SSEP results were related to the EEG patterns at the time of SSEP.
RESULTS:
Absent SSEP responses and suppressed or synchronous EEG on suppressed background ?24?h after cardiac arrest were invariably associated with poor outcome. SSEP and EEG identified different patients with poor outcome (joint sensitivity 39% at specificity 100%). N20 responses were always preserved in continuous traces at >8?Hz. Absent SSEPs did not re-emerge during the first five days.
CONCLUSIONS:
SSEP and EEG results may diverge after cardiac arrest.
SIGNIFICANCE:
SSEP and EEG together identify more patients without chance of recovery than one of these alone.
Copyright © 2019 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.
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?7 Nicotinic Acetylcholine Receptor Mediates the Neuroprotection of Remote Ischemic Postconditioning in a Rat Model of Asphyxial Cardiac Arrest.
J Surg Res2019 Sep;246():6-18. doi: S0022-4804(19)30582-7.
Han Ruili, Zhang Guihe, Qiao Xiaoli, Guo Yu, Sun Li, Li Jiangjing, Gao Changjun, Sun Xude,
Abstract
BACKGROUND:
Remote ischemic postconditioning (RIPost) has been shown to reduce the ischemia-reperfusion injury of the heart and brain. However, the protection mechanisms have not yet been fully elucidated. We have observed that RIPost could alleviate the brain injury after cardiac arrest (CA). The aim of this study was to explore whether ?7 nicotinic acetylcholine receptor (?7nAChR) mediates the neuroprotection of RIPost in a rat model of asphyxial CA.
MATERIALS AND METHODS:
Asphyxial CA model was induced by occlusion of the tracheal tube for 8 min and resuscitated later. RIPost produced by three cycles of 15-min occlusion and 15-min release of the right hind limb by a tourniquet was performed respectively at the moment and the third hour after restoration of spontaneous circulation. The ?7nAChR agonist PHA-543613 and the antagonist methyllycaconitine (MLA) were used to investigate the role of ?7nAChR in mediating neuroprotective effects.
RESULTS:
Results showed that ?7nAChR was decreased in hippocampus and cortex after resuscitation, whereas RIPost could attenuate the reduction. The use of PHA-543613 provided neuroprotective effects against cerebral injury after CA. Furthermore, RIPost decreased the levels of neuron-specific enolase, inflammatory mediators, the number of apoptotic cells, and phosphorylation of nuclear factor-?B while increased the phosphorylation of signal transducer and activator of transcription-3. However, the above effects of RIPost were attenuated by ?7nAChR antagonist methyllycaconitine.
CONCLUSIONS:
Neuroprotection of RIPost was related with the activation of ?7nAChR, which could suppress nuclear factor-?B and activate signal transducer and activator of transcription-3 in a rat asphyxial CA model.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Cardioplegia defibrillation of circulatory and metabolic phase ventricular fibrillation in a swine model.
Resuscitation2019 Sep;():. doi: S0300-9572(19)30610-0.
Marill Keith A, Salcido David D, Sundermann Matthew L, Koller Allison C, Menegazzi James J,
Abstract
INTRODUCTION:
We previously found potassium cardioplegia followed by rapid calcium reversal (Kplegia) can achieve defibrillation in a swine model of electrical phase of ventricular fibrillation (VF) comparable to standard care.
HYPOTHESIS:
Exploring 3 possible potassium dose and timing protocols, we hypothesize Kplegia may benefit resuscitation of longer duration untreated VF.
METHODS:
Three separate blinded randomized placebo-controlled trials were performed with electrically-induced VF untreated for durations of 6,9, and 12?minutes in a swine model. Experimental groups received infusion of 1 or 2 boluses of intravenous (IV) potassium followed by a single calcium reversal bolus. Potassium was replaced by saline in the control groups. Outcomes included: amplitude spectrum area (AMSA) during VF, resulting rhythms, number of defibrillations, return of spontaneous circulation (ROSC), and hemodynamics for 1?hour post ROSC. Binomial and interval data outcomes were compared with exact statistics. Serial interval data were assessed with mixed regression models.
RESULTS:
Twelve, 12, and 8 animals were included at 6, 9, and 12?minute VF durations for a total of 32. ROSC was achieved in: 4/6 Kplegia and 3/6 control animals in the 6?minute protocol,(p?=?1.00), 4/6 Kplegia and 2/6 control animals in the 9?minute protocol,(p?=?0.57), and 0/5 Kplegia and 1/3 control animals in the 12?minute protocol,(p?=?0.38). Two of 8 Kplegia animals achieved ROSC with chemical defibrillation alone.
CONCLUSIONS:
The majority of animals achieved ROSC after up to 9?minutes of untreated VF arrest using K plegia protocols. K plegia requires further optimization for both peripheral IV and intraosseous infusion, and to assess for superiority over standard care. Institutional Animal Care and Use Committee protocol #15127224.
Copyright © 2019. Published by Elsevier B.V.
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Surgical management of large undifferentiated cardiac sarcoma involving the right ventricle to pulmonary trunk.
Gen Thorac Cardiovasc Surg2019 Sep;():. doi: 10.1007/s11748-019-01208-1.
Furukawa Hiroshi, Honda Takeshi, Yamasawa Takahiko, Kanaoka Yuji, Tanemoto Kazuo,
Abstract
A large intra-cardiac tumor from the right ventricle to pulmonary trunk was detected by contrast-enhanced computed tomography and transthoracic echocardiography in a 59-year-old woman with progressive dyspnea on effort and acute congestive right-sided heart failure. Emergent surgical management was performed with cardiopulmonary bypass under cardiac arrest, however, tumor resection was incomplete, because it originated from the interventricular septum. Concomitant tricuspid valve replacement using a bioprosthesis was required due to the involvement of the septal leaflet of the tricuspid valve. Although large pulmonary thromboembolism was initially suspected, a pathological examination confirmed undifferentiated cardiac sarcoma. The patient did not consent to additional neoadjuvant chemotherapy or radiation therapy. After palliative surgical management, she was discharged. Recurrence rapidly progressed and the patient died approximately 2 months after surgery. We herein present a successful palliative surgical case of large cardiac undifferentiated sarcoma originating from the intraventricular septum and involving the right ventricle to pulmonary trunk.
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Subphenotypes of Cardiac Arrest Patients Admitted to Intensive Care Unit: a latent profile analysis of a large critical care database.
Sci Rep2019 Sep;9(1):13644. doi: 10.1038/s41598-019-50178-0.
Zhang Zhongheng, Yao Min, Ho Kwok M, Hong Yucai,
Abstract
Cardiac arrest (CA) may occur due to a variety of causes with heterogeneity in their clinical presentation and outcomes. This study aimed to identify clinical patterns or subphenotypes of CA patients admitted to the intensive care unit (ICU). The clinical and laboratory data of CA patients in a large electronic healthcare database were analyzed by latent profile analysis (LPA) to identify whether subphenotypes existed. Multivariable Logistic regression was used to assess whether mortality outcome was different between subphenotypes. A total of 1,352 CA patients fulfilled the eligibility criteria were included. The LPA identified three distinct subphenotypes: Profile 1 (13%) was characterized by evidence of significant neurological injury (low GCS). Profile 2 (15%) was characterized by multiple organ dysfunction with evidence of coagulopathy (prolonged aPTT and INR, decreased platelet count), hepatic injury (high bilirubin), circulatory shock (low mean blood pressure and elevated serum lactate); Profile 3 was the largest proportion (72%) of all CA patients without substantial derangement in major organ function. Profile 2 was associated with a significantly higher risk of death (OR: 2.09; 95% CI: 1.30 to 3.38) whilst the mortality rates of Profiles 3 was not significantly different from Profile 1 in multivariable model. LPA using routinely collected clinical data could identify three distinct subphenotypes of CA; those with multiple organ failure were associated with a significantly higher risk of mortality than other subphenotypes. LPA profiling may help researchers to identify the most appropriate subphenotypes of CA patients for testing effectiveness of a new intervention in a clinical trial.
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Perioperative Changes of Right Ventricular Function in Cardiac Surgical Patients Assessed by Myocardial Deformation Analysis and 3-Dimensional Echocardiography.
J Cardiothorac Vasc Anesth2019 Aug;():. doi: S1053-0770(19)30893-6.
Donauer Marcell, Schneider Jens, Jander Nikolaus, Beyersdorf Friedhelm, Keyl Cornelius,
Abstract
OBJECTIVES:
To test the hypothesis that longitudinal strain of the right ventricle (RV) is significantly reduced in patients undergoing cardiac surgery with extracorporeal circulation and cardioplegic cardiac arrest at the end of surgery, whereas RV ejection fraction remains unchanged.
DESIGN:
Prospective observational cohort study.
SETTING:
Single university hospital.
PARTICIPANTS:
Thirty patients with normal myocardial function undergoing coronary artery bypass grafting with cardioplegic cardiac arrest.
INTERVENTIONS:
Right ventricular 3-dimensional echocardiography and strain analysis were performed preoperatively, intraoperatively, and postoperatively.
MEASUREMENTS AND MAIN RESULTS:
Peak longitudinal systolic strain of the RV lateral and inferior wall, RV outflow tract, and interventricular septum was reduced significantly at the end of surgery after sternal closure compared to preoperatively (lateral: -16 ± 5 v -22 ± 4, p < 0.001; inferior: -12 ± 4 v -19 ± 5, p < 0.001; outflow tract, -11 ± 5 v . -20 ± 6, p < 0.001; septum: -9 ± 3 v -14 ± 4, p < 0.001), whereas peak circumferential systolic strain of the RV lateral wall had increased significantly (-16 ± 4 v -12 ± 5, p?=?0.008). Right ventricular ejection fraction remained stable (51 ± 6% v. 50 ± 7%, p?=?0.34).
CONCLUSION:
In patients undergoing coronary artery bypass grafting with cardioplegic cardiac arrest, the longitudinal contraction of the RV lateral and inferior wall, the RV outflow tract, and the interventricular septum is impaired at the end of surgery. This impairment is compensated by an increase in circumferential contraction without changes in RV ejection fraction.
Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.
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[Isolated right ventricular acute myocardial infarction mimicking anterior infarction].
Ann Cardiol Angeiol (Paris)2019 Sep;():. doi: S0003-3928(19)30072-1.
Pham V, Midey C, Georges J L, Lefevre G, Blicq E, Charbonnel C, Legriel S, Livarek B,
Abstract
Isolated right ventricular acute myocardial infarction is rare and its presentation can sometimes mimic an anterior ST-segment elevation myocardial infarction. We reported two cases of isolated right ventricular acute myocardial infarction presenting with a ST-elevation in anterior leads. The first case was admitted for an out-of-hospital cardiac arrest due to ventricular fibrillation. The patient died from neurologic consequences of the cardiac arrest, despite a successful prehospital thrombolysis, followed by a percutaneous angioplasty of the right coronary artery. The second case occurred after a complex percutaneous angioplasty of the right coronary artery, complicated by a total occlusion of a right marginal branch. These two cases illustrate the limits of the ECG for the diagnosis of isolated right ventricular acute infarction, and the difficulties of the differential diagnosis with anterior infarction, which may determine the treatment and the prognosis.
Copyright © 2019 Elsevier Masson SAS. All rights reserved.
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Epinephrine in Out-of-Hospital Cardiac Arrest: What Is the Role of the Timing Interval?
Ann Emerg Med -
What Is the Utility of Prophylactic Antibiotics for Patients After Cardiac Arrest?
Ann Emerg Med2019 Sep;():. doi: S0196-0644(19)30584-0.
Gottlieb Michael, Landas Trevor, Purim-Shem-Tov Yanina A,
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Association between Achievement of Estimated Average Glucose Level and 6-Month Neurologic Outcome in Comatose Cardiac Arrest Survivors: A Propensity Score-Matched Analysis.
J Clin Med2019 Sep;8(9):. doi: E1480.
Jung Yong Hun, Lee Byung Kook, Jeung Kyung Woon, Lee Dong Hun, Lee Hyoung Youn, Cho Yong Soo, Youn Chun Song, Park Jung Soo, Min Yong Ii,
Abstract
We investigated whether achieving estimated average glucose (EAG) levels versus achieving standard glucose levels (180 mg/dL) was associated with neurologic outcome in cardiac arrest survivors. This single-center retrospective observational study included adult comatose cardiac arrest survivors undergoing therapeutic hypothermia (TH) from September 2011 to December 2017. EAG level was calculated using HbA1c obtained after the return of spontaneous circulation (ROSC), and the mean glucose level during TH was calculated. We designated patients to the EAG or standard glucose group according to whether the mean blood glucose level was closer to the EAG level or 180 mg/dL. Patients in the EAG and standard groups were propensity score- matched. The primary outcome was the 6-month neurologic outcome. The secondary outcomes were hypoglycemia (?70 mg/dL) and serum neuron-specific enolase (NSE) at 48 h after ROSC. Of 384 included patients, 137 (35.7%) had a favorable neurologic outcome. The EAG group had a higher favorable neurologic outcome (104/248 versus 33/136), higher incidence of hypoglycemia (46/248 versus 11/136), and lower NSE level. After propensity score matching, both groups had similar favorable neurologic outcomes (24/93 versus 27/93) and NSE levels; the EAG group had a higher incidence of hypoglycemia (21/93 versus 6/93). Achieving EAG levels was associated with hypoglycemia but not neurologic outcome or serum NSE level.
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Reply to "the futility of resuscitating an out-of-hospital cardiac arrest cannot be summarized by three simple criteria."
Resuscitation2019 Sep;():. doi: S0300-9572(19)30619-7.
Glober Nancy K, Tainter Christopher R, Kim David,
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The futility of resuscitating an out-of-hospital cardiac arrest cannot be summarized by three simple criteria.
Resuscitation2019 Sep;():. doi: S0300-9572(19)30616-1.
Javaudin François, Le Bastard Quentin, Lascarrou Jean-Baptiste, Baert Valentine, Hubert Hervé, ,
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The Cardiac Arrest Survival Score: A Predictive Algorithm for In-Hospital Mortality after Out-of-Hospital Cardiac Arrest.
Resuscitation2019 Sep;():. doi: S0300-9572(19)30617-3.
Balan Prakash, Hsi Brian, Thangam Manoj, Zhao Yelin, Monlezun Dominique, Arain Salman, Charitakis Konstantinos, Dhoble Abhijeet, Johnson Nils, Anderson H Vernon, Persse David, Warner Mark, Ostermayer Daniel, Prater Samuel, Wang Henry, Doshi Pratik,
Abstract
BACKGROUND:
Out-of-hospital cardiac arrest (OHCA) is associated with high mortality. Current methods for predicting mortality post-arrest require data unavailable at the time of initial medical contact. We created and validated a risk prediction model for patients experiencing OHCA who achieved return of spontaneous circulation (ROSC) which relies only on objective information routinely obtained at first medical contact.
METHODS:
We performed a retrospective evaluation of 14,892 OHCA patients in a large metropolitan cardiac arrest registry, of which 3,952 patients had usable data. This population was divided into a derivation cohort (n?=?2,635) and a verification cohort (n?=?1,317) in a 2:1 ratio. Backward stepwise logistic regression was used to identify baseline factors independently associated with death after sustained ROSC in the derivation cohort. The Cardiac Arrest Survival Score (CASS) was created from the model and its association with in-hospital mortality was examined in both the derivation and verification cohorts.
RESULTS:
Baseline characteristics of the derivation and verification cohorts were not different. The final CASS model included age > 75 years (odds ratio [OR]?=?1.61, confidence interval [CI][1.30-1.99], p?
CONCLUSION:
CASS accurately predicts mortality in OHCA patients. The model uses only binary, objective clinical data routinely obtained at first medical contact. Early risk stratification may allow identification of more patients in whom timely and aggressive invasive management may improve outcomes.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Prehospital advanced airway management for paediatric patients with out-of-hospital cardiac arrest: A nationwide cohort study.
Resuscitation2019 Sep;():. doi: S0300-9572(19)30614-8.
Okubo Masashi, Komukai Sho, Izawa Junichi, Gibo Koichiro, Kiyohara Kosuke, Matsuyama Tasuku, Kiguchi Takeyuki, Iwami Taku, Callaway Clifton W, Kitamura Tetsuhisa,
Abstract
BACKGROUND:
Although prehospital advanced airway management (AAM) (i.e., endotracheal intubation [ETI] and insertion of supraglottic airways [SGA]) has been performed for paediatric out-of-hospital cardiac arrest (OHCA), the effect of AAM has not been fully studied. We evaluated the association between prehospital AAM for paediatric OHCA and patient outcomes.
METHODS:
We conducted an observational cohort study, using the All-Japan Utstein Registry between 2014 and 2016. We included paediatric patients (age <18 years) with OHCA. We calculated time-dependent propensity score at each minute after initiation of cardiopulmonary resuscitation by EMS providers, using a Fine-Gray regression model. We sequentially matched patients who received AAM during cardiac arrest to patients at risk of receiving AAM within the same minute (risk-set matching). The primary outcome was 1-month survival. Secondary outcome was 1-month survival with favourable functional status, defined as Cerebral Performance Category score of 1 or 2.
RESULTS:
We analysed 3,801 paediatric patients with OHCA. 481 patients (12.7%) received AAM and 3,320 (87.3%) did not. Among the 3,801 analysed patients, 912 patients underwent risk-set matching. In the matched cohort, AAM was not associated with 1-month survival (AAM: 52/456 [11.4%] vs. no AAM: 44/456 [9.6%]; risk ratio [RR], 1.15 [95% CI, 0.76-1.73]; risk difference [RD], 1.5% [-3.0 to 6.1%]) or favourable functional status (AAM: 9/456 [2.0%] vs. no AAM: 10/456 [2.2%]; RR, 0.69 [95% CI, 0.26-1.79]; RD, -0.8% [-2.9 to 1.3%]).
CONCLUSION:
Among paediatric patients with OHCA, we found that prehospital AAM was not associated with 1-month survival or favourable functional status.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Factors associated with return to work among survivors of out-of-hospital cardiac arrest.
Resuscitation2019 Sep;():. doi: S0300-9572(19)30613-6.
Kearney Jason, Dyson Kylie, Andrew Emily, Bernard Stephen, Smith Karen,
Abstract
BACKGROUND:
Although out-of-hospital cardiac arrest (OHCA) is a major cause of global mortality, survival rates have increased over the last decade. As such, there is an increasing need to explore long-term functional outcomes of survivors, such as return to work (RTW).
METHODOLOGY:
We analysed baseline and 12-month follow-up data from the Victorian Ambulance Cardiac Arrest Registry for patients that arrested between 2010 and 2016 who were working prior to their arrest. We also conducted more detailed RTW interviews in a subset of OHCA survivors who arrested between July and September 2017. Factors associated with RTW were assessed using multivariable logistic regression analysis.
RESULTS:
A total of 884 previously working survivors were included in the analysis, 650 (73%) of whom RTW. Male sex (AOR 1.80; 95%CI: 1.10-2.94), arrests witnessed by emergency medical services (AOR 2.72; 95%CI: 1.50-9.25), discharge directly home from hospital (AOR 4.13; 95%CI: 2.38-7.18) and favourable 12-month health-related quality of life according to the EQ-5D were associated with RTW. Increasing age (AOR 0.97; 95%CI: 0.95-0.98), traumatic arrest aetiology (AOR 0.18; 95%CI: 0.04-0.77), and labour-intensive occupations (AOR 0.44; 95%CI: 0.29-0.66) were associated with decreased odds of RTW. Of the 23 OHCA survivors that participated in the more detailed RTW telephone-interview, 87% RTW. Flexible work hours or modified duties were offered to 74% of participants. Fatigue was the most frequently reported barrier to RTW.
CONCLUSION:
This is the largest study to collectively examine factors associated with RTW among survivors of OHCA. Although larger qualitative studies are needed, our findings highlight which patients are at risk of not RTW and who may benefit from targeted rehabilitation strategies.
Copyright © 2019 Elsevier B.V. All rights reserved.
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ARONIA JUICE CONSUMPTION PRIOR TO HALF-MARATHON RACE CAN ACUTELY AFFECT PLATELET ACTIVATION IN RECREATIONAL RUNNERS.
Appl Physiol Nutr Metab2019 Sep;():. doi: 10.1139/apnm-2019-0267.
Stevanovi? Vuk, Pantovi? Ana, Krga Irena, Zekovi? Milica, ?arac Ivana, Glibeti? Marija, Vidovi? Nevena,
Abstract
Long-distance running, especially in non-professional runners, can increase cardiac arrest risk by enhancing platelet activation and aggregation. Polyphenols can exert cardioprotective effects by positively influencing platelet function. This study aimed to examine the acute effects of polyphenol-rich aronia juice consumption, before simulation of a half-marathon race, on platelet activation and aggregation with leukocytes in recreational runners. In this acute cross-over study, 10 healthy male runners (age 30.8 ± 2.3years) consumed breakfast with 200ml of aronia juice or 200ml of placebo. They warmed-up and ran a simulated half-marathon race (21.1km). Blood was collected at baseline, 15min, 1h and 24h after the run. All variables were analysed with 4(Time)x2(Group) analysis of variance with repeated measures on both factors. Results revealed a significant effect of Group on platelet activation parameters: P-selectin and GPIIb-IIIa expressions significantly decreased in aronia compared with the placebo arm (F(1,9)=10.282, p=0.011 and F(1,9)=7.860, p=0.021, respectively). The effect of Time was significant on both platelet aggregation markers: platelet-monocyte and platelet-neutrophil aggregates were significantly lower after the race (F(3,7)=4.227, p=0.014 and F(3,7)=70.065, p=0.000, respectively), with changes more pronounced in the later. All effects remained when platelets were exposed to an agonist. These results suggest that aronia consumption could counteract the half-marathon race-induced changes in platelet function. ?Aronia juice consumption significantly decreased the expression of platelet activation markers, but didn't affect platelet aggregation. ?The race itself did significantly reduced platelet-neutrophil aggregation. ?Aronia juice may serve as a supplement beverage for recreational runners, to alleviate enhanced platelet reactivity caused by prolonged running.
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The complement lectin pathway protein MAp19 and out-of-hospital cardiac arrest: Insights from two randomized clinical trials.
Eur Heart J Acute Cardiovasc Care2019 Sep;():2048872619870031. doi: 10.1177/2048872619870031.
Bro-Jeppesen John, Jeppesen Anni Nørgaard, Haugaard Simon, Troldborg Anne, Hassager Christian, Kjaergaard Jesper, Kirkegaard Hans, Wanscher Michael, Hvas Anne-Mette, Thiel Steffen,
Abstract
AIM:
Activation of the complement system is known to be a potent inducer of systemic inflammation, which is an important component of post-cardiac arrest syndrome. Mannan-binding-lectin associated protein of 19 kDa (MAp19) is suggested to be a regulatory component of the lectin pathway of complement activation. The aims of this study were to describe serial levels of MAp19 protein in comatose survivors of out-of-hospital cardiac arrest (OHCA), to evaluate the effect of two different regimes of targeted temperature management and to investigate the possible association between levels of MAp19 and mortality.
METHODS:
In this post-hoc study, we analysed data from two large randomized controlled studies: 'Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest' (TTM) and 'Targeted temperature management for 48 versus 24 h and neurological outcome after out-of-hospital cardiac arrest' (TTH). We measured serial levels of MAp19 in 240 patients within 72 h after OHCA and in 82 healthy controls. The effect of targeted temperature management on MAp19 levels was analysed according to temperature allocation in main trials.
RESULTS:
MAp19 levels were significantly lower in OHCA patients within 48 h after OHCA (-values <0.001) compared with healthy controls. A target temperature at 33°C compared with 36°C for 24 h was associated with significantly lower levels of MAp19 (-57 ng/mL (95% confidence interval (CI): -97 to -16 mg/mL), =0.006). Target temperature at 33°C for 48 h compared with 24 h was not associated with a difference in MAp19 levels (-31 ng/mL (95% CI: -120 to 60 mg/mL), =0.57). Low MAp19 levels at admission were associated with higher 30-day mortality (12% . 38%, =0.0008), also in adjusted analysis (two-fold higher, hazard ratio =0.48 (95% CI: 0.31 to 0.75), =0.001). Analysis of MAp19 levels at 24-72 h showed they were not associated with 30-day mortality.
CONCLUSION:
Survivors after OHCA have lower levels of MAp19 protein compared with healthy controls. A targeted temperature management at 33°C compared with 36°C was associated with significantly lower MAp19 levels, whereas target temperature at 33°C for 48 h compared with 24 h did not influence MAp19 protein levels. Low MAp19 levels at admission were independently associated with increased mortality.
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Commotio Cordis Caused During Hurling Game
Ir Med J2019 Jun;112(6):956.
Connellan C, Kelleher S, Islam M, Kenny D, James A, Prendiville T, Walsh K,
Abstract
A teenage boy had a cardiac arrest following a blow to the chest from a hurling ball (sliotar). Prompt resuscitation and automated external defibrillation enabled a full recovery. This is the first reported case of commotio cordis caused by a sliotar although it is described in other sports. Primary prevention of commotio cordis (CC) and secondary prevention of cardiac death are discussed.
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Sudden cardiac death in dialysis patients: different causes and management strategies.
Nephrol Dial Transplant2019 Sep;():. doi: gfz182.
Genovesi Simonetta, Boriani Giuseppe, Covic Adrian, Vernooij Robin W M, Combe Christian, Burlacu Alexandru, Davenport Andrew, Kanbay Mehmet, Kirmizis Dimitrios, Schneditz Daniel, van der Sande Frank, Basile Carlo,
Abstract
Sudden cardiac death (SCD) represents a major cause of death in end-stage kidney disease (ESKD). The precise estimate of its incidence is difficult to establish because studies on the incidence of SCD in ESKD are often combined with those related to sudden cardiac arrest (SCA) occurring during a haemodialysis (HD) session. The aim of the European Dialysis Working Group of ERA-EDTA was to critically review the current literature examining the causes of extradialysis SCD and intradialysis SCA in ESKD patients and potential management strategies to reduce the incidence of such events. Extradialysis SCD and intradialysis SCA represent different clinical situations and should be kept distinct. Regarding the problem, numerically less relevant, of patients affected by intradialysis SCA, some modifiable risk factors have been identified, such as a low concentration of potassium and calcium in the dialysate, and some advantages linked to the presence of automated external defibrillators in dialysis units have been documented. The problem of extra-dialysis SCD is more complex. A reduced left ventricular ejection fraction associated with SCD is present only in a minority of cases occurring in HD patients. This is the proof that SCD occurring in ESKD has different characteristics compared with SCD occurring in patients with ischaemic heart disease and/or heart failure and not affected by ESKD. Recent evidence suggests that the fatal arrhythmia in this population may be due more frequently to bradyarrhythmias than to tachyarrhythmias. This fact may partly explain why several studies could not demonstrate an advantage of implantable cardioverter defibrillators in preventing SCD in ESKD patients. Electrolyte imbalances, frequently present in HD patients, could explain part of the arrhythmic phenomena, as suggested by the relationship between SCD and timing of the HD session. However, the high incidence of SCD in patients on peritoneal dialysis suggests that other risk factors due to cardiac comorbidities and uraemia per se may contribute to sudden mortality in ESKD patients.
© The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
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