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Pubblicazioni recenti - cardiac arrest
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Machine Learning to Decode the Electroencephalography for Post Cardiac Arrest Neuroprognostication.
Crit Care Med -
Vitamin D Deficiency and Neurologic Outcome After Sudden Cardiac Arrest.
Shock2019 Feb;():. doi: 10.1097/SHK.0000000000001335.
Cha Jung-Joon, Wi Jin,
Abstract
BACKGROUND:
Vitamin D deficiency is related to various cardiovascular diseases, including sudden cardiac arrest (SCA). This study investigated the association of vitamin D level with neurologic outcome and mortality after resuscitation from SCA.
MATERIALS AND METHODS:
We enrolled patients who were successfully resuscitated from out-of-hospital cardiac arrest of presumed cardiac cause in Severance Cardiovascular Hospital as a prospective cohort registry. Baseline blood samples including pH, lactate, and vitamin D were obtained without fluid replacement just after hospital admission. Outcome was assessed by Cerebral Performance Category (CPC) score at 1 month after SCA. Favorable outcome was defined as survival with CPC score of 1 or 2, whereas unfavorable one as death or survival with CPC scores of 3 through 5. Severe vitamin D deficiency was defined as 25(OH)D <10?ng/mL.
RESULTS:
A total of 163 patients were included. Overall 96 (59%) patients had a favorable neurologic outcome, whereas 67 patients (41%) showed unfavorable outcome, including 37 (23%) mortality. Patients with unfavorable outcome were likely to be female and have initial non-shockable rhythm, longer arrest time, severe shock, diabetes, and baseline renal dysfunction. In multivariate analysis, severe vitamin D deficiency was one of the poor prognostic factors of both unfavorable neurologic outcome and mortality after SCA.
CONCLUSIONS:
Vitamin D deficiency is very prevalent and strongly associated with both unfavorable neurologic outcome and mortality in patients resuscitated from SCA.
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Medic One Pediatric (MOPed) cards: standardising paramedic paediatric resuscitation.
BMJ Open Qual2019 ;8(3):e000534. doi: 10.1136/bmjoq-2018-000534.
Woods Brandon, Lang Benjamin, Blayney Carolyn, O'Mahony Lila, Vander Tuig Amanda, Rea Tom, Carlbom David, Sayre Michael, King Mary,
Abstract
Objective:
Paediatric resuscitation is highly stressful, technically challenging and infrequently performed by paramedics. Length-based equipment selection, weight-based medication dosing and less familiar paediatric clinical scenarios create high cognitive load. Our project aimed to decrease cognitive load and increase paramedic comfort by providing standardised paediatric resuscitation cards across an entire Emergency Medical Services (EMS) system.
Methods:
After 2 years of collaboration between EMS and regional paediatric subspecialists, we created and implemented a novel set of length-based, colour-coded cards: Medic One Pediatric (MOPed) cards. MOPed cards standardise the approach to paediatric scenarios, such as rapid sequence intubation (RSI), seizure management and cardiac arrest. We standardised drug concentrations across all five EMS agencies to allow for volume-based dosing, removing medication calculations, simplifying the process of medication administration and potentially decreasing both calculation error and time to intervention. We consolidated medications on MOPed cards to the 12 most commonly used in Paediatric Advanced Life Support scenarios. We surveyed 240 EMS personnel before and after implementation to determine use and effect on paramedic comfort.
Results:
After 12 months of implementation, 97% of respondents reported using the new cards as their primary reference, and 94% reported improved speed and accuracy of medication administration. Specifically, RSI medication administration received the greatest improvement in comfort (p=0.001). Additionally, paramedics increased the use of MOPed cards when selecting endotracheal tubes: 45% of the respondents had done so by 6 months, and 60% had done so after 12 months of implementation (p=0.01).
Conclusions:
MOPed cards were well adopted across a large EMS system, with improvement in paramedic comfort in managing some paediatric resuscitation scenarios.
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Prevalence of near-death experiences in people with and without REM sleep intrusion.
PeerJ2019 ;7():e7585. doi: 10.7717/peerj.7585.
Kondziella Daniel, Dreier Jens P, Olsen Markus Harboe,
Abstract
Background:
The origin and prevalence of near-death experiences are unknown. A recent study suggested a link with REM sleep intrusion but was criticized for its selection of control participants. We therefore assessed the association of REM intrusion and near-death experiences with different methods.
Methods:
Using a crowd-sourcing platform, we recruited 1,034 lay people from 35 countries to investigate the prevalence of near-death experiences and self-reported REM sleep intrusion. Reports were validated using the Greyson Near-Death Experiences Scale (GNDES) with ?7 points as cut-off for near-death experiences.
Results:
Near-death experiences were reported by 106 of 1,034 participants (10%; 95% CI [8.5-12%]). Evidence of REM intrusion was more common in people with near-death experiences ( = 50?106; 47%) than in people with experiences with 6 points or less on the GNDES ( = 47?183; 26%) or in those without such experiences ( = 107?744; 14%; = < 0.0001). Following multivariate regression analysis to adjust for age, gender, place of residence, employment and perceived danger, this association remained highly significant; people with REM intrusion were more likely to exhibit near-death experiences than those without (OR 2.85; 95% CI [1.68-4.88]; = 0.0001).
Discussion:
Using a crowd-sourcing approach, we found a prevalence of near-death experiences of 10%. While age, gender, place of residence, employment status and perceived threat do not seem to influence the prevalence of near-death experiences, we confirmed a possible association with REM sleep intrusion.
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Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1-Adult patients.
J Heart Lung Transplant2019 Aug;():. doi: S1053-2498(19)31632-8.
Lorusso Roberto, Raffa Giuseppe Maria, Alenizy Khalid, Sluijpers Niels, Makhoul Maged, Brodie Daniel, McMullan Mike, Wang I-Wen, Meani Paolo, MacLaren Graeme, Kowalewski Mariusz, Dalton Heidi, Barbaro Ryan, Hou Xiaotong, Cavarocchi Nicholas, Chen Yih-Sharng, Thiagarajan Ravi, Alexander Peta, Alsoufi Bahaaldin, Bermudez Christian A, Shah Ashish S, Haft Jonathan, D'Alessandro David A, Boeken Udo, Whitman Glenn J R,
Abstract
Cardiogenic shock, cardiac arrest, acute respiratory failure, or a combination of such events, are all potential complications after cardiac surgery which lead to high mortality. Use of extracorporeal temporary cardio-circulatory and respiratory support for progressive clinical deterioration can facilitate bridging the patient to recovery or to more durable support. Over the last decade, extracorporeal membrane oxygenation (ECMO) has emerged as the preferred temporary artificial support system in such circumstances. Many factors have contributed to widespread ECMO use, including the relative ease of implantation, effectiveness, versatility, low cost relative to alternative devices, and potential for full, not just partial circulatory support. While there have been numerous publications detailing the short and midterm outcomes of ECMO support, specific reports about post-cardiotomy ECMO (PC-ECMO), are limited, single-center experiences. Etiology of cardiorespiratory failure leading to ECMO implantation, associated ECMO complications, and overall patient outcomes may be unique to the PC-ECMO population. Despite the rise in PC-ECMO use over the past decade, short-term survival has not improved. This report, therefore, aims to present a comprehensive overview of the literature with respect to the prevalence of ECMO use, patient characteristics, ECMO management, and in-hospital and early post-discharge patient outcomes for those treated for post-cardiotomy heart, lung, or heart-lung failure.
Copyright © 2019 International Society for Heart and Lung Transplantation. All rights reserved.
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Mechanical Circulatory Support in Transcatheter Aortic Valve Implantation in the United States (from the National Inpatient Sample).
Am J Cardiol2019 Aug;():. doi: S0002-9149(19)30953-1.
Alkhalil Ahmad, Hajjar Richard, Ibrahim Homam, Ruiz Carlos E,
Abstract
Acute circulatory collapse may rarely occur during transcatheter aortic valve implantation (TAVI). In such cases, immediate mechanical circulatory support (MCS) as a bridge to remedial interventions may be required. To define the rate of MCS utilization in TAVI patients and identify the predictors of MCS utilization in a cohort of TAVI patients. TAVI patients between January 2012 and September 2015 were identified in the National Inpatient Sample (NIS) by using the International Classification of Diseases, 9th Revision. Trend weights were used to generate the national estimates of MCS rate in TAVI. Multivariate regression analysis was done to identify predictors of MCS use. A total 60,985 patients underwent TAVI with 1,695 patients receiving MCS (2.8%) during index hospitalization. The most common type of MCS was intra-aortic balloon pump in 52%, followed by extra corporeal membrane oxygenator in 34%, then percutaneous ventricular assist device in 7.4%. Rate of MCS use declined over the study period from 3% in 2012 (Q1) to 1.8% in 2015 (Q3). The use of MCS during TAVI was associated with 10-fold increase in-hospital mortality (27.1% vs 2.8%, p <0.001). Predictors of MCS were congestive heart failure (OR?=?2.58, p <0.001), transapical access (OR?=?1.92, p <0.001), respiratory complication (OR?=?5.19, p <0.001), acute myocardial infarction (OR?=?4.21, p <0.001), cardiac arrest (OR?=?10.65, p <0.001), and cardiogenic shock (OR?=?19.09, p <0.001). In conclusion, the rate of MCS during TAVI hospitalization in the United States declined between 2012 and 2015. MCS during TAVI was associated with a 10-fold increase in in-hospital mortality.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest: A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia).
Circulation2019 Sep;():CIR0000000000000710. doi: 10.1161/CIR.0000000000000710.
Nolan Jerry P, Berg Robert A, Andersen Lars W, Bhanji Farhan, Chan Paul S, Donnino Michael W, Lim Swee Han, Ma Matthew Huei-Ming, Nadkarni Vinay M, Starks Monique A, Perkins Gavin D, Morley Peter T, Soar Jasmeet, ,
Abstract
Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research.
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Prognostication via early computed tomography head in patients treated with targeted temperature management after cardiac arrest.
J Neurol Sci2019 Aug;406():116437. doi: S0022-510X(19)30369-7.
Chang Jason J, Tsivgoulis Georgios, Goyal Nitin, Alsherbini Khalid, Schuring Craig, Shrestha Rabin, Yankovich Andrei, Metter Jeffrey E, Sareen Srishti, Elijovich Lucas, Malkoff Marc D, Murillo Luis, Kadaria Dipen, Alexandrov Andrei V, Sodhi Amik,
Abstract
BACKGROUND:
We evaluated computed tomography head (CTH) imaging obtained prior to targeted temperature management (TTM) in patients after cardiac arrest, and its role in prognostication.
METHODS:
In this retrospective cohort study in a tertiary-care hospital, 341 adults presenting with out-of-hospital cardiac arrest received a CTH prior to TTM. Associations between outcomes and neuroimaging variables were evaluated with Chi-square analysis for significant associations that yielded a composite neuroimaging score-Tennessee Early Neuroimaging Score (TENS). Univariable and multivariable logistic regression analysis including TENS as an independent variable and the four outcome dependent variables were analyzed.
RESULTS:
Four of the neuroimaging variables-sulcal effacement, partial gray-white matter effacement, total gray-white matter effacement, deep nuclei effacement-had significant associations with each of the four outcome variables and yielded TENS. In multivariable logistic regression models adjusted for potential confounders, TENS was associated with poor discharge CPC (OR 2.15, 95%CI 1.16-3.98, p?=?.015), poor disposition (OR 2.62, 95%CI 1.37-5.02, p?=?.004), in-hospital mortality (OR 1.99, 95%CI 1.09-3.62, p?=?.024), and ICU mortality (OR 1.89, 95%CI 1.12-3.20, p?=?.018).
CONCLUSION:
Imaging prior to TTM may help identify post-cardiac arrest patients with severe anoxic brain injury and poor outcomes.
Copyright © 2019 Elsevier B.V. All rights reserved.
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The Many Faces of Early Repolarization Syndrome:A Single Center Case-Series.
Heart Rhythm2019 Sep;():. doi: S1547-5271(19)30834-3.
Voskoboinik Aleksandr, Hsia Henry, Moss Joshua, Vedantham Vasanth, Tanel Ronn E, Patel Akash, Wojciak Julianne, Downs Natalie, Scheinman Melvin M,
Abstract
BACKGROUND:
Early repolarization syndrome (ERS) is a rare but increasingly recognized cause of malignant ventricular arrhythmias.
OBJECTIVE:
To characterize the presentations and treatments of ERS at our institution.
METHODS:
We performed a retrospective chart review of all patients presenting to our institution between 2008-2019 with ERS. Exclusion criteria included Brugada syndrome, positive provocative testing with class I antiarrhythmics, metabolic disturbances or structural heart disease.
RESULTS:
Of 10 patients identified with ERS, 8 were male with age 30±17 years at diagnosis. Documented arrhythmias included ventricular fibrillation in 7/10, polymorphic ventricular tachycardia (VT) in 3/10 and monomorphic VT in 3/10 patients. Atrial fibrillation was diagnosed in 3/10 and AV block was seen in 2/10. J waves and/or electrocardiographic early repolarization patterns were dynamic in 7/10. Arrhythmias occurred at rest in 8/10 and with exertion in 2/10. Only 1 patient had a family history of sudden death and 4/10 patients had variants of uncertain significance on genetic testing. Quinidine effectively suppressed arrhythmias in 5/5 patients, but required dose escalation to >1g/day in 3/5 patients. Abnormal epicardial electrograms were recorded over the inferolateral left ventricle in 2 patients who underwent mapping and were successfully ablated. Premature ventricular contraction (PVC) triggers were also targeted for ablation in 3 patients.
CONCLUSION:
ERS is a heterogeneous condition and may be associated with both atrial and ventricular arrhythmias, AV block, dynamic electrocardiographic changes and variable triggers. In addition to targeting PVC triggers, mapping and ablation of abnormal epicardial electrograms may be a potential future treatment strategy.
Copyright © 2019. Published by Elsevier Inc.
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Cardiac arrest in the intensive care unit: An assessment of preventability.
Resuscitation2019 Sep;():. doi: S0300-9572(19)30607-0.
Moskowitz Ari, Berg Katherine M, Cocchi Michael N, Chase Maureen, Yang Jesse, Sarge Jennifer, Grossestreuer Anne, Sarge Todd, O' Donoghue Sharon, Donnino Michael W,
Abstract
AIM:
Cardiac arrest in the intensive care unit (ICU-CA) is a common and highly morbid event. We investigated the preventability of ICU-CAs and identified targets for future intervention.
METHODS:
This was a prospective, observational study of ICU-CAs at a tertiary care center in the United States. For each arrest, the clinical team was surveyed regarding arrest preventability. An expert, multi-disciplinary team of physicians and nurses also reviewed each arrest. Arrests were scored 0 (not at all preventable) to 5 (completely preventable). Arrests were considered 'unlikely but potentially preventable' or 'potentially preventable' if at least 50% of reviewers assigned a score of ?1 or ?3 respectively. Themes of preventability were assessed for each arrest.
RESULTS:
43 patients experienced an ICU-CA and were included. A total of 14 (32.6%) and 13 (30.2%) arrests were identified as unlikely but potentially preventable by the expert panel and survey respondents respectively, and an additional 11 (25.6%) and 10 (23.3%) arrests were identified as potentially preventable. Timing of response to clinical deterioration, missed/incorrect diagnosis, timing of acidemia correction, timing of escalation to a more senior clinician, and timing of intubation were the most commonly cited contributors to potential preventability. Additional themes identified included the administration of anxiolytics/narcotics for agitation later identified to be due to clinical deterioration and misalignment between team and patient/family perceptions of prognosis and goals-of-care.
CONCLUSIONS:
ICU-CAs may have preventable elements. Themes of preventability were identified and addressing these themes through data-driven quality improvement initiatives could potentially reduce CA incidence in critically-ill patients.
Copyright © 2019. Published by Elsevier B.V.
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Association between acute kidney injury and neurological outcome or death at 6?months in out-of-hospital cardiac arrest: A prospective, multicenter, observational cohort study.
J Crit Care2019 Aug;54():197-204. doi: S0883-9441(19)30610-0.
Oh Je Hyeok, Lee Dong Hoon, Cho In Soo, Youn Chun Song, Lee Byung Kook, Wee Jung Hee, Cha Kyoung-Chul, Chae Minjung Kathy, Shin Jonghwan, ,
Abstract
PURPOSE:
This study aimed to evaluate the association between acute kidney injury (AKI) and 6?months neurological outcome after out-of-hospital cardiac arrest (OHCA).
MATERIALS AND METHODS:
Prospective multi-center observational cohort included adult OHCA patients treated with targeted temperature management (TTM) across 20 hospitals in the South Korea between October 2015 and October 2017. The diagnosis of AKI was made using the Kidney Disease: Improving Global Outcomes criteria. The outcome was neurological outcome at 6?months evaluated using the modified Rankin scale (MRS).
RESULTS:
Among 5676 patients with OHCA, 583 patients were enrolled. AKI developed in 348 (60%) patients. Significantly more non-AKI patients had good neurological outcome at 6?months (MRS 0-3) than AKI patients (134/235 [57%] vs. 69/348 [20%], P?
CONCLUSIONS:
AKI is associated with poor neurological outcome (MRS 4-6) at 6?months in OHCA patients treated with TTM.
TRIAL REGISTRATION:
NCT02827422.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Calcium/Calmodulin-Dependent Kinase (CaMKII) Inhibition Protects Against Purkinje Cell Damage Following CA/CPR in Mice.
Mol Neurobiol2019 Sep;():. doi: 10.1007/s12035-019-01765-9.
Chalmers Nicholas E, Yonchek Joan, Steklac Kathryn E, Ramsey Matthew, Bayer K Ulrich, Herson Paco S, Quillinan Nidia,
Abstract
Ischemic brain damage is triggered by glutamate excitotoxicity resulting in neuronal cell death. Previous research has demonstrated that N-methly-D-aspartate (NMDA) receptor activation triggers downstream calcium-dependent signaling pathways, specifically Ca/calmodulin-dependent protein kinase II (CaMKII). Inhibiting CaMKII is protective against hippocampal ischemic injury, but there is little known about its role in the cerebellum. To examine the neuroprotective potential of CaMKII inhibition in Purkinje cells, we subjected C57BL/6 or CaMKII? KO male mice (8-12 weeks old) to cardiac arrest followed by cardiopulmonary resuscitation (CA/CPR). We performed a dose-response study for tat-CN19 and cerebellar injury was analyzed at 7 days after CA/CPR. Acute signaling was assessed at 6 h after CA/CPR using Western blot analysis. We observed increased phosphorylation of the T286 residue of CaMKII, suggesting increased autonomous activation. Analysis of Purkinje cell density revealed a decrease in cell density at 7 days after CA/CPR that was prevented with tat-CN19 at doses of 0.1 and 1 mg/kg. However, neuroprotection in the cerebellum required doses that were 10-fold higher than what was needed in the hippocampus. CaMKII? KO mice subjected to sham surgery or CA/CPR had similar Purkinje cell densities, suggesting CaMKII? is required for CA/CPR-induced injury in the cerebellum. We also observed a CA/CPR-induced activation of death-associated protein kinase (DAPK1) that tat-CN19 did not block. In summary, our findings indicate that inhibition of autonomous CaMKII activity is a promising therapeutic approach that is effective across multiple brain regions.
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Emergency department thoracotomy of severely injured patients: an analysis of the TraumaRegister DGU.
Eur J Trauma Emerg Surg2019 Sep;():. doi: 10.1007/s00068-019-01212-3.
Schulz-Drost Stefan, Merschin David, Gümbel Denis, Matthes Gerrit, Hennig Friedrich Frank, Ekkernkamp Axel, Lefering Rolf, Krinner Sebastian, ,
Abstract
AIM OF THE STUDY:
Emergency department thoracotomy (EDT) may be the last chance for survival in some severe thoracic trauma. This study investigates a representative collective with the aim to compare the findings in Europe to the international experience. Moreover, the influence of different levels of trauma care is investigated.
METHODS:
All emergency thoracotomies in patients with an ISS???9 from TR-DGU (2009-2014) within the first 60 min after arrival were identified. EDTs were identified separately, and mini thoracotomies and drainage systems were excluded.
RESULTS:
99,013 patients with sufficient data were observed. 1736 (1.8%) received thoracotomy during their hospital stay. 887 patients had a thoracotomy within the first hour in the emergency department (ED). 52.5% were treated in supraregional trauma centers (STC), 36.4% in regional (RTC) and 11.0% in local trauma centers (LTC). The mortality rates were 39.4% (STC), 20.9% (RTC) and 20.8% (LTC). The overall mortality rate showed no significant differences for blunt (28.2%) and penetrating trauma (31.3%). In case of cardiac arrest in the ED, a survival rate of 4.8% for blunt trauma and 20.7% for penetrating trauma was determined if EDT was carried out. Those patients showed a higher rate in severe thoracic organ injuries due to penetrating trauma but less extrathoracic injuries.
CONCLUSION:
Just over half of EDTs were performed in STC. Emergency room resuscitation followed by EDT had survival rates of 4.8% and 20.7% for blunt and penetrating trauma patients, respectively.
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Propensity and impact of autologous platelet rich plasma use in acute type A dissection.
J Thorac Cardiovasc Surg2019 Jun;():. doi: S0022-5223(19)31205-X.
Sandhu Harleen K, Tanaka Akiko, Dahotre Shruti, Charlton-Ouw Kristofer M, Miller Charles C, Estrera Anthony L, Sheinbaum Roy, Safi Hazim J, Zhou Shao-Feng,
Abstract
BACKGROUND:
Coagulopathy in patients undergoing open repair of acute type A aortic dissection using cardiopulmonary bypass and hypothermic circulatory arrest is a common complication. Autologous platelet rich plasma is an intraoperative blood conservation technique, which has been shown in previous studies to promote hemostasis, leading to a reduction of blood product transfusions during elective aortic surgery. The purpose of this study is to evaluate the effectiveness of autologous platelet rich plasma as a blood conservation technique during open surgical repair of acute type A aortic dissection.
METHODS:
We reviewed all acute type A aortic dissection cases using hypothermic circulatory arrest, excluding patients presenting in extremis. Perioperative transfusion requirements and clinical outcomes were analyzed. The end points analyzed included early mortality, postoperative stroke, renal dysfunction, prolonged ventilation, coagulopathy, and length of postoperative intensive care unit stay. Parsimonious and saturated propensity scores were calculated for platelet rich plasma use, and all outcomes were propensity adjusted.
RESULTS:
Between 2003 and 2014, 85 of 391 acute type A aortic dissection repairs used autologous platelet rich plasma. Mean age of patients was 58 ± 15 years, and 70% were male. Obstructive sleep apnea (22% vs 13%, P = .04) and baseline ejection fraction (57% ± 6.7% vs 55% ± 10%; P = .014) were higher in the autologous platelet rich plasma group. Intraoperative propensity-adjusted blood products, 2 units fewer packed red blood cells (P = .001), 4 units fewer fresh-frozen plasma (P = .001), 6 units fewer platelets (P = .001), 1.3 units fewer cell-savers (P = .002), and 5 units fewer cryoprecipitate (P = .001) were significantly reduced by autologous platelet rich plasma use. Significant unadjusted reduction in postoperative reoperation for bleeding (8% vs 17%, P = .046) after autologous platelet rich plasma was reported, although propensity adjustment eliminated significance (P = .079). No difference in stroke, cardiac, or renal complications was observed. Postoperative transfusion needed during the first 3 days was significantly reduced in the autologous platelet rich plasma group: 2 units fewer packed red blood cells (P = .13), 2 units fewer fresh-frozen plasma (P = .018), and 5 units fewer platelets (P = .001), when compared with those without autologous platelet rich plasma. Ventilation time was reduced by 3 days (P = .002), and intensive care length of stay was reduced by 3 days (P = .063) after intraoperative autologous platelet rich plasma use.
CONCLUSIONS:
The use of autologous platelet rich plasma in patients undergoing open repair of acute type A aortic dissection was associated with a reduction in intraoperative and postoperative blood transfusions, as well as decreased early postoperative morbidity.
Copyright © 2019. Published by Elsevier Inc.
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Low incidence of avalanche victims in cardiac arrest calls for multi-centre studies and registries for the validation of resuscitation guidelines.
Resuscitation2019 Sep;():. doi: S0300-9572(19)30599-4.
Brugger Hermann, Strapazzon Giacomo, Wallner Bernd, Paal Peter,
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Perioperative anaphylaxis in children: aetiology, time sequence and patterns of clinical reactivity.
Pediatr Allergy Immunol2019 Sep;():. doi: 10.1111/pai.13124.
Khaleva Ekaterina, Franz Amber, Garvey Lene Heise, Jay Nicola, Ylescupidez Alyssa, Bahnson Henry Tee, du Toit George,
Abstract
BACKGROUND:
Perioperative anaphylaxis (PA) in children is an uncommon but potentially life-threatening complication associated with anaesthesia. Early identification and management of PA is essential to optimize clinical outcomes.
METHODS:
We performed a retrospective study of anaesthesia records from paediatric patients with PA from centres in the United Kingdom, France, and the United States over a period of ten years. Time-sequence of clinical signs and physiological variables during PA were collected, along with results of allergy testing.
RESULTS:
Twenty-nine children with PA were included. Median age was 11 years. Based on the modified Ring and Messmer Grading Scale, severe reactions were seen in 25 (86%) members of this cohort, with 4 (14%) experiencing cardiac arrest. Cardiovascular collapse was the first clinical sign of PA in 59% of cases, followed by tachycardia and bronchospasm. In 16 (55%) cases, the initial signs of PA involved multiple organ systems. When the initial signs of PA were cardiovascular and/or respiratory, more epinephrine doses were administered. Average time from initial sign of PA to treatment with epinephrine was 6 min (SD 6, range 1-25). The causative allergen was identified in 15 patients.
CONCLUSION:
Severe hypotension is the most common presenting sign of PA in children. Initial cardiovascular and/or respiratory signs are associated with the need for increased epinephrine doses. Further studies should optimise the prediction, identification, and early management of PA in children.
© 2019 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.
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Out-of-hospital cardiac arrest (OHCA) Survey in Lombardy: data analysis through prospective short time period assessment.
Acta Biomed2019 Sep;90(9-S):64-70. doi: 10.23750/abm.v90i9-S.8710.
Villa Guido Francesco, Kette Fulvio, Balzarini Federica, Riccò Matteo, Manera Matteo, Solaro Nadia, Pagliosa Andrea, Zoli Alberto, Migliori Maurizio, Sechi Giuseppe Maria, Odone Anna, Signorelli Carlo,
Abstract
BACKGROUND AND AIM OF THE WORK:
The results of out-of-hospital cardiac arrests (OHCA) are usually reported through data collected collected via "ad hoc" registries, but in large populations, samples of short time periods can be used to apply the results to the entire population. We would like to describe the situation of Lombardy to provide evidence on successful procedures, which may be carried out in a larger context.
METHODS:
Observational, prospective, analytical, single cohort study in Lombardy population. Data of OHCA of cardiac aetiology, according to "Utstein Style", with resuscitation attempts started by the Emergency Medical Service (EMS), were collected for 40 days subdivided in 10-day-periods in all seasons 2014-15 via Operating System "Emergency Management" (EmMa).
RESULTS:
Of 1219 cases, 536 events of witnessed OHCA of presumed cardiac etiology were analyzed. Outcomes were: sustained Return Of Spontaneous Circulation ROSC (25.6%), Survival Event in Emergency Department (22.8%), Survival after 24 hours (21.2%) and Survival after hospital discharge at home 30 days after (11.2%). Statistically significant results were found in age, rhythm of presentation, and resuscitation by bystanders. Sex, seasonality and rescue timing did not differ statistically.
CONCLUSIONS:
Overall the thirty-day survival rate was similar to studies with larger databases. Our data are consistent with the concept that all emergency service should provide CPR instructions for every citizen who activate the EMS in the suspect of a SCA; further investigation should clarify how long interval could be useful for ROSC and sustained ROSC in patients resuscitated by lay people using CPR instructions.
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Contemporary prevalence, trends, and outcomes of coronary chronic total occlusions in acute myocardial infarction with cardiogenic shock.
Int J Cardiol Heart Vasc2019 Sep;24():100414. doi: 10.1016/j.ijcha.2019.100414.
Vallabhajosyula Saraschandra, Prasad Abhiram, Gulati Rajiv, Barsness Gregory W,
Abstract
Background:
There are limited data on the prevalence and outcomes of chronic total occlusions (CTO) of the coronary artery in acute myocardial infarction with cardiogenic shock (AMI-CS) patients.
Methods:
Using the National Inpatient Sample, all admissions with AMI-CS that underwent diagnostic angiography between January 1, 2008, and December 31, 2014, were included. CTO, percutaneous coronary intervention (PCI), comorbidities and concomitant cardiac arrest was identified for all admissions. Outcomes of interest included temporal trends, in-hospital mortality, and resource utilization in cohorts with and without CTO.
Results:
In this 7-year period, 163,628 admissions with AMI-CS admissions met the inclusion criteria, with 68% being ST-elevation AMI-CS. CTO was noted in 27,343 (16.7%) admissions, with an increase in prevalence during the study period. The cohort with CTOs was more likely to be male and bearing private insurance. The CTO cohort had higher cardiovascular comorbidity, higher rates of cardiac arrest and higher use of PCI and mechanical circulatory support. The presence of a CTO was independently associated with higher in-hospital mortality (adjusted odds ratio 1.20 [95% confidence interval 1.16-1.23]; ?
Conclusions:
In this cohort of AMI-CS admissions that underwent diagnostic angiography, the presence of a CTO identified a higher risk cohort that had higher in-hospital mortality.
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Thoracic electrical impedance tomography to minimize right heart strain following cardiac arrest.
Ann Pediatr Cardiol;12(3):315-317. doi: 10.4103/apc.APC_189_18.
Hansen Gregory, Holt Tanya, Dmytrowich Jeffrey,
Abstract
Titrating ventilator settings to minimize pulmonary arterial pressures and optimize both ventilation and oxygen delivery can be challenging following cardiac arrest. Erroneous ventilator adjustments can lead to unnecessary strain on the right ventricle that may be particularly vulnerable during the acute recovery. We report a child with fulminant myocarditis who was mechanically ventilated using thoracic electrical impedance tomography to optimize regional lung inflation and possibly curtail right ventricular afterload following cardiac arrest.
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Simple risk score based on the China Acute Myocardial Infarction registry for predicting in-hospital mortality among patients with non-ST-segment elevation myocardial infarction: results of a prospective observational cohort study.
BMJ Open2019 Sep;9(9):e030772. doi: 10.1136/bmjopen-2019-030772.
Song Chenxi, Fu Rui, Li Sidong, Yang Jingang, Wang Yan, Xu Haiyan, Gao Xiaojin, Liu Jia, Liu Qianqian, Wang Chunyue, Dou Kefei, Yang Yuejin,
Abstract
OBJECTIVES:
To simplify our previous risk score for predicting the in-hospital mortality risk in patients with non-ST-segment elevation myocardial infarction (NSTEMI) by dropping laboratory data.
DESIGN:
Prospective cohort.
SETTING:
Multicentre, 108 hospitals across three levels in China.
PARTICIPANTS:
A total of 5775 patients with NSTEMI enrolled in the China Acute Myocardial Infarction (CAMI) registry.
PRIMARY OUTCOME MEASURES:
In-hospital mortality.
RESULTS:
The simplified CAMI-NSTEMI (SCAMI-NSTEMI) score includes the following nine variables: age, body mass index, systolic blood pressure, Killip classification, cardiac arrest, ST-segment depression on ECG, smoking status, previous angina and previous percutaneous coronary intervention. Within both the derivation and validation cohorts, the SCAMI-NSTEMI score showed a good discrimination ability (C-statistics: 0.76 and 0.83, respectively); further, the SCAMI-NSTEMI score had a diagnostic performance superior to that of the Global Registry of Acute Coronary Events risk score (C-statistics: 0.78 and 0.73, respectively; p<0.0001 for comparison). The in-hospital mortality increased significantly across the different risk groups.
CONCLUSIONS:
The SCAMI-NSTEMI score can serve as a useful tool facilitating rapid risk assessment among a broader spectrum of patients admitted owing to NSTEMI.
TRIAL REGISTRATION NUMBER:
NCT01874691.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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