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Pubblicazioni recenti - cardiac arrest
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Reversible myocardial dysfunction in a dog after resuscitation from cardiopulmonary arrest.
J Vet Cardiol2020 Dec;34():1-7. doi: S1760-2734(20)30113-2.
Magagnoli I, Romito G, Troia R, Murgia E, Giunti M,
Abstract
A 4-year-old Dachshund was referred for management of a mandibular fracture. The dog underwent cardiopulmonary arrest after sedation for skull radiography. Cardiopulmonary resuscitation was started immediately, and return of spontaneous circulation was rapidly obtained. However, after resuscitation, the dog was hemodynamically unstable. Additionally, global left ventricular systolic dysfunction and a focal hyperechoic myocardial lesion were found echocardiographically, and serum cardiac troponin I was severely elevated (82.80 ng/mL, upper hospital limit <0.7 ng/mL). The dog remained hospitalized in the intensive care unit and received supportive medical therapies, including intravenous inotropes (pimobendan, dobutamine). Over the following days, progressive hemodynamic and echocardiographic improvement was achieved in response to treatment. Moreover, after 72 h, a significant reduction of serum cardiac troponin I (9.80 ng/mL) was documented. On recheck, 3 weeks after discharge, the dog was clinically stable, and both left ventricular systolic function and serum cardiac troponin I (0.10 ng/mL) were normal. Based on clinical and instrumental findings after cardiopulmonary resuscitation, a probable diagnosis of reversible postresuscitation myocardial dysfunction associated with transient myocardial injury was made.
Copyright © 2020 Elsevier B.V. All rights reserved.
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Venoarterial extracorporeal membrane oxygenation for ruptured sinus of Valsalva aneurysm.
Ann Thorac Surg2021 Jan;():. doi: S0003-4975(21)00097-7.
Singh Jyotindra, Fong Laura, Ellenberger Katherine, Swil Kevin, Chung Shona, Grant Peter,
Abstract
Sinus of Valsalva aneurysm rupture is a potentially fatal condition that requires urgent surgical intervention. We report a case of right sinus of Valsalva aneurysm rupture into the right atrium, in a patient with a monocuspid aortic valve successfully managed with femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) after pulseless electrical activity (PEA) cardiac arrest to facilitate complete surgical repair. The patient made a full recovery and was discharged home with no neurological deficit and had no limitations at one-year follow-up. This case highlights the utility of VA-ECMO in facilitating successful surgical repair when patients present in extremis.
Copyright © 2021. Published by Elsevier Inc.
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Solid-Organ Transplantations After Carbon Monoxide Poisoning Treated with Hyperbaric Oxygen Therapy: Case Series.
Clin Transplant2021 Jan;():e14231. doi: 10.1111/ctr.14231.
Kot Jacek, Lenkiewicz Ewa, Milecka Anna, Owczuk Radoslaw,
Abstract
The general worldwide trend is that more patients join waiting lists for solid organ donations than receive a donation. As of September 2020, over 108,000 patients comprised the Organ Procurement and Transplantation Network (OPTN) waiting list; over 6,000 patients die every year while waiting for an available organ . Severe poisoning, especially combined with cardiac arrest, is generally considered a contraindication for organ recovery.
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Analysis of bupivacaine and ropivacaine-related cardiac arrests in regional anesthesia: a systematic review of case reports.
Rev Esp Anestesiol Reanim2021 Jan;():. doi: S0034-9356(20)30289-9.
Viderman D, Ben-David B, Sarria-Santamera A,
Abstract
Regional anesthesia as a component of multimodal analgesia protocols has become more and more a part of modern perioperative pain management. The widespread adoption of ultrasound guidance in regional anesthesia has surely played an important role in that growth and it has significantly improved patient safety, decreased the incidence of block failure, cardiac arrest, and reduced complication rates. The objective of this systematic review is to extract, analyze, and synthesize clinical information about bupivacaine and ropivacaine related cardiac arrest that we might have a clearer picture of the clinical presentation. The literature search identified 268 potentially relevant publications and 22 relevant case reports were included in the review. Patients' demographics, types of regional anesthesia, hypotension, heart rhythm disorders, seizures, cardiac arrest, fatal outcome, recommendations and limitations on prevention and treatment of bupivacaine and ropivacaine related cardiac arrest are analyzed and discussed in the systematic review. Both bupivacaine and ropivacaine-induced local anesthetic toxicity can result in cardiac arrest. Lipid emulsion, telemetry, local anesthetic toxicity resuscitation training appears to be promising in improvement of survival but more research is needed. Improvement and encouragement of reporting the local anesthetic toxicity are warranted to improve the quality of information that can be analyzed in order to make more precise conclusion.
Copyright © 2020 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.
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Takotsubo syndrome: Does "Diabetes Paradox" exist?
Heart Lung2021 Jan;50(2):316-322. doi: S0147-9563(21)00006-6.
Ahuja Keerat Rai, Nazir Salik, Jain Vardhmaan, Isogai Toshiaki, Saad Anas M, Verma Beni R, Shekhar Shashank, Kumar Ravi, Eltahawy Ehab A, Madias John E,
Abstract
BACKGROUND:
Previous small-scale studies have reported conflicting findings regarding the prevalence of diabetes mellitus (DM) and its association with outcomes in patients with takotsubo syndrome (TTS) OBJECTIVE: We sought to assess the prevalence of DM and its association with outcomes in TTS patients.
METHODS:
Nationwide inpatient sample (NIS) was queried to extract patient information from January 1, 2009 to September 30, 2015. Propensity score matching (PSM) was done to compare mortality and other in-hospital outcomes.
RESULTS:
A total of 40,327 hospitalizations for TTS were included. The prevalence of DM in TTS was 19.3% vs 23.1% (p-value < 0.01) in patients without TTS in the NIS from 2009 to 2015. In the PSM cohort, there was no difference in in-hospital mortality (1.1% vs 1.4%; p = 0.76), stroke (1.2% vs 0.9%; p = 0.09), cardiogenic shock (3.7% vs 3.9%; p = 0.61), cardiac arrest (1.2% vs 1.2%; p = 0.94), ventricular arrhythmias (3.7% vs 3.3%; p = 0.23), circulatory support (2.1% vs 1.8%; p = 0.17), and invasive mechanical ventilation (4.9% vs 4.7%; p = 0.54) in TTS patients with versus without diabetes. In sub-group analysis, diabetes with chronic complications patients were found to have lower mortality (0.7% vs 2.0%; p = 0.04) compared to patients without diabetes and those with uncomplicated diabetes (0.6% vs 2.6%; p = 0.002).
CONCLUSIONS:
Prevalence of DM was lower in TTS in comparison to patients without TTS. In addition, complicated DM patients were found to have lower in-hospital mortality. Further studies are needed to assess the mid and long-term outcomes of DM with and without chronic complications in TTS.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Successful use of the impella ventricular assist device for management of reverse Takotsubo Cardiomyopathy in the setting of acute intracranial hemorrhage.
Heart Lung2021 Jan;50(2):313-315. doi: S0147-9563(21)00007-8.
Barsoum Emad, Elhosseiny Sherif, Patel Brijesh, Pathak Sankalp, Patel Ankitkumar, Vaidya Pranaychandra,
Abstract
Reverse Takotsubo Cardiomyopathy (rTTC) is a rare variant of Takotsubo Cardiomyopathy (TTC) that is characterized by hypokinesis of the base and sparing of the mid to apical wall of the left ventricle best seen on echocardiogram. Intracranial hemorrhage (ICH) has been identified as a risk factor rTTC. Nearly around 10% of the patients with TTC develop cardiogenic shock. We hereby report the successful use of the Impella Ventricular Assist Device (Impella CP®) for management of rTTC in the setting of acute ICH. Our patient is a young female who presented with loss of consciousness after an acute headache and imaging studies revealed left posterior cerebral artery aneurysm with intraventricular hemorrhage. Subsequently the patient developed hypoxia, severe hypotension and cardiac arrest. After resuscitation, an echocardiogram showed that the patient had rTTC and a cardiac angiogram showed patent coronary arteries. The Impella CP® was successfully inserted followed by immediate cerebral angiography and aneurysmal coiling. Systemic anticoagulation was started during coiling. In the next three days, the patient's left ventricular function recovered, and she was discharged home. Up to our knowledge, this is the first case report to mark the successful placement of the Impella CP® with delayed initial anticoagulation for management of rTTC. Our patient was challenging as there are no current guidelines in the management of cardiogenic shock secondary to rTTC in the setting of acute ICH.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Sudden Cardiac Death During Nighttime Hours.
Heart Rhythm2021 Jan;():. doi: S1547-5271(21)00036-9.
Ramireddy Archana, Chugh Harpriya, Reinier Kyndaron, Uy-Evanado Audrey, Stecker Eric C, Jui Jonathan, Chugh Sumeet S,
Abstract
BACKGROUND:
In the absence of apparent triggers, sudden cardiac death (SCD) during nighttime hours is a perplexing and devastating phenomenon. There are few published reports in the general population with insufficient numbers to perform sex-specific analyses. Smaller studies of rare nocturnal SCD syndromes suggest a male predominance and implicate sleep-disordered breathing.
OBJECTIVE:
To identify mechanisms of nighttime SCD in the general population.
METHODS:
From the population-based Oregon Sudden Unexpected Death Study, we evaluated SCD cases that occurred in the community between 10 PM and 6 AM (nighttime) and compared them with daytime cases. Univariate comparisons were evaluated using Pearson's chi-square tests and independent samples t-tests. Logistic regression was used to further assess independent SCD risk.
RESULTS:
A total of 4126 SCD cases (66.2% Male, 33.8% Female) met criteria for analysis, and 22.3% (n=918) occurred during nighttime hours. Women were more likely to present with nighttime SCD than men (25.4% vs. 20.6%, p<0.001). In a multivariate regression model, female sex [OR 1.3 (1.1-1.5)] (p=0.001), medications associated with somnolence/respiratory depression, [OR 1.2 (1.1-1.4)] (p=0.008), and COPD/asthma [OR 1.4 (1.1-1.6)] (p<0.001) were independently associated with nighttime SCD. Women were taking more CNS-affecting medications than men (1.9±1.7 vs 1.4±1.4, p=0.001).
CONCLUSION:
In the general population, women were more likely than men to suffer SCD during nighttime hours, and female sex was an independent predictor of nighttime events. Respiratory suppression is a concern, and caution is advisable when prescribing CNS-affecting medications to patients at increased risk of SCD, especially women.
Copyright © 2021. Published by Elsevier Inc.
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New evidence supports multi-modal neuroprognostication after cardiac arrest.
Resuscitation -
Impact of Prehospital Airway Interventions on Outcome in Cardiac Arrest Following Drowning: a study from the CARES Surveillance Group.
Resuscitation2021 Jan;():. doi: S0300-9572(21)00015-0.
Ryan Kevin M, Bui Matthew D, Dugas Julianne N, Zvonar Ivan, Tobin Joshua M,
Abstract
INTRODUCTION:
Drowning results in more than 360,000 deaths annually, making it the 3rd leading cause of unintentional injury death worldwide. Prior studies have examined airway interventions affecting patient outcomes in cardiac arrest, but less is known about drowning patients in arrest. This study evaluated the outcomes of drowning patients in the Cardiac Arrest Registry to Enhance Survival (CARES) who received advanced airway management.
METHODS:
A retrospective analysis of the CARES database identified cases of drowning etiology between 2013 and 2018. Patients were stratified by airway intervention performed by EMS personnel. Demographics, sustained return of spontaneous circulation [ROSC], survival to hospital admission, survival to hospital discharge, and neurological outcomes were compared between airway groups using chi-squared tests and logistic regression.
RESULTS:
Among 2,388 drowning patients, 70.4% were male, 41.8% white, and 13.1% survived to hospital discharge. Patients that received supraglottic airways [SGA] had statistically significantly lower odds of survival to hospital admission compared to endotracheal tube [ETT] use (adjusted odds ratio [aOR]?=?0.56, 95% confidence interval [CI] 0.42-0.76) as well as lower odds of survival to discharge compared to bag valve mask [BVM] use (aOR?=?0.40, 95% CI 0.19-0.86) when accounting for relative ROSC timing.
CONCLUSION:
In this national cohort of drowning patients in cardiac arrest, SGA use was associated with significantly lower odds of survival to hospital admission and discharge. However, survival to discharge with favorable neurological outcome did not differ significantly between airway management techniques. Further studies will need to examine if airway intervention order or time to intervention affects outcomes.
Copyright © 2021. Published by Elsevier B.V.
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Duration of Exposure to a Prehospital Advanced Airway and Neurological Outcome for Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Study.
Resuscitation2021 Jan;():. doi: S0300-9572(21)00017-4.
Benoit Justin L, Stolz Uwe, McMullan Jason T, Wang Henry E,
Abstract
BACKGROUND:
Out-of-hospital cardiac arrest (OHCA) studies have focused on the benefits and harms of placing an intra-arrest advanced airway, but few studies have evaluated the benefits and harms after successful placement. We hypothesize that increased time in the tumultuous prehospital environment after intra-arrest advanced airway placement results in reduced patient survival.
METHODS:
This was a secondary analysis of adult, non-traumatic, OHCA patients with an advanced airway placed in the PRIMED trial. The exposure variable was the time interval between successful advanced airway placement and Emergency Department (ED) arrival. The outcome was cerebral performance category (CPC) 1 or 2 at hospital discharge. Multivariable logistic regression, adjusted for Utstein variables and resuscitation-associated time intervals, was used to estimate adjusted odds ratios (aOR).
RESULTS:
The cohort of complete cases included 4,779 patients. The median time exposed to a prehospital advanced airway was 27?minutes (IQR 20-35). The total prehospital time was 39.4?minutes (IQR 32.3-48.1). An advanced airway was placed intra-arrest in 3,830 cases (80.1%) and post-return of spontaneous circulation (post-ROSC) in 949 cases (19.9%). Overall, 486 (10.2%) of the cohort achieved the CPC outcome, but this was higher in the post-ROSC (21.7%) versus intra-arrest (7.5%) cohort. CPC was not associated with the time interval from advanced airway placement to ED arrival in the intra-arrest airway cohort (aOR 0.98, 95%CI 0.94-1.01).
CONCLUSIONS:
In OHCA patients who receive an intra-arrest advanced airway, longer time intervals exposed to a prehospital advanced airway are not associated with reduced patient survival.
Copyright © 2021. Published by Elsevier B.V.
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Randomized blinded trial of automated REBOA during CPR in a porcine model of cardiac arrest.
Resuscitation2021 Jan;():. doi: S0300-9572(21)00018-6.
Olsen Markus Harboe, Olesen Niels D, Karlsson Michael, Holmlöv Theodore, Søndergaard Lars, Boutelle Martyn, Mathiesen Tiit, Møller Kirsten,
Abstract
BACKGROUND:
Resuscitative endovascular balloon occlusion of the aorta (REBOA) reportedly elevates arterial blood pressure (ABP) during non-traumatic cardiac arrest.
OBJECTIVES:
This randomized, blinded trial of cardiac arrest in pigs evaluated the effect of automated REBOA two minutes after balloon inflation on ABP (primary endpoint) as well as arterial blood gas values and markers of cerebral haemodynamics and metabolism.
METHODS:
Twenty anesthetized pigs were randomized to REBOA inflation or sham-inflation (n?=?10 in each group) followed by insertion of invasive monitoring and a novel, automated REBOA catheter (NEURESCUE® Catheter & NEURESCUE® Assistant). Cardiac arrest was induced by ventricular pacing. Cardiopulmonary resuscitation was initiated three min after cardiac arrest, and the automated REBOA was inflated or sham-inflated (blinded to the investigators) five min after cardiac arrest.
RESULTS:
In the inflation compared to the sham group, mean ABP above the REBOA balloon after inflation was higher (inflation: 54 (95%CI:43-65)mmHg; sham: 44 (33-55)mmHg; P?=?0.06), and diastolic ABP was higher (inflation: 38 (29-47)mmHg; sham: 26 (20-33)mmHg; P?=?0.02), and the arterial to jugular oxygen content difference was lower (P?=?0.04). After return of spontaneous circulation, mean ABP (inflation: 111 (95%CI:94-128)mmHg; sham: 94 (95%CI:65-123)mmHg; P?=?0.04), diastolic ABP (inflation: 95 (95%CI:78-113)mmHg; sham: 78 (95%CI:50-105)mmHg; P?=?0.02), CPP (P?=?0.01), and brain tissue oxygen tension (inflation: 315 (95%CI:139-491)% of baseline; sham: 204 (95%CI:75-333)%; P?=?0.04) were higher in the inflation compared to the sham group.
CONCLUSION:
Inflation of REBOA in a porcine model of non-traumatic cardiac arrest improves central diastolic arterial pressure as a surrogate marker of coronary artery pressure, and cerebral perfusion.
INSTITUTIONAL PROTOCOL NUMBER:
2017-15-0201-01371.
Copyright © 2021. Published by Elsevier B.V.
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Timing of Intravenous Epinephrine Administration during Out-of-Hospital Cardiac Arrest.
Shock2021 Jan;():. doi: 10.1097/SHK.0000000000001731.
Fukuda Tatsuma, Ohashi-Fukuda Naoko, Inokuchi Ryota, Kondo Yutaka, Taira Takayuki, Kukita Ichiro,
Abstract
BACKGROUND:
Current guidelines for cardiopulmonary resuscitation (CPR) recommend that standard dose of epinephrine be administered every 3 to 5 minutes during cardiac arrest. However, there is controversy about the association between timing of epinephrine administration and outcomes after out-of-hospital cardiac arrest (OHCA). This study aimed to determine whether the timing of intravenous epinephrine administration is associated with outcomes after OHCA.
METHODS:
We analyzed Japanese government-led nationwide population-based registry data for OHCA. Adult OHCA patients who received intravenous epinephrine by EMS personnel in the prehospital setting from 2011 to 2017 were included. Multivariable logistic regression models were used to assess the associations between time to first epinephrine administration and outcomes after OHCA. Subsequently, associations between early (?20?min) vs delayed (>20?min) epinephrine administration and outcomes after OHCA were examined using propensity score-matched analyses. The primary outcome was one-month neurologically favorable survival.
RESULTS:
A total of 119,946 patients (mean [SD] age, 75.2 [14.8] years; 61.4% male) were included. The median time to epinephrine was 23?min (IQR, 19-29). Longer time to epinephrine was significantly associated with a decreased chance of one-month neurologically favorable survival (multivariable adjusted OR per minute delay, 0.91 [95%CI, 0.90-0.92]). In the propensity score-matched cohort, when compared with early (?20?min) epinephrine, delayed (>20?min) epinephrine was associated with a decreased chance of one-month neurologically favorable survival (959/42,804 [2.2%] vs 330/42,804 [0.8%]; RR, 0.34; 95%CI, 0.30-0.39; NNT, 69).
CONCLUSIONS:
Delay in epinephrine administration was associated with a decreased chance of one-month neurologically favorable survival among patients with OHCA.
Copyright © 2021 by the Shock Society.
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DEXMEDETOMIDINE, BUTORPHANOL, AND MIDAZOLAM AS A REVERSIBLE INDUCTION PROTOCOL IN NORTH AMERICAN RIVER OTTERS ().
J Zoo Wildl Med2021 Jan;51(4):834-840. doi: 10.1638/2019-0177.
Householder Hilary M, Henry Jessica, Zaffarano Bianca, Gall Andrew J, Nixon Bridget, Olds June E,
Abstract
Captured free-ranging North American river otters () were immobilized for the placement of intra-abdominal radio transmitters in cooperation with the Iowa Department of Natural Resources. Twenty-four otters were induced with dexmedetomidine (0.03 mg/kg, IM), butorphanol (0.2 mg/kg, IM), and midazolam (0.15 mg/kg, IM) combined in one syringe. The otters were maintained on isoflurane during the surgical procedure. Heart rate and rhythm, respiratory rate, rectal temperature, and peripheral capillary oxygen saturation were recorded every 5 min for the duration of the procedures. The otters were reversed with atipamezole (0.3-2 mg/kg, IM), naltrexone (0.6 mg/kg, IM), and flumazenil (0.05 mg/kg, IM). Rapid and smooth induction was seen, with lateral recumbency reached within 6.2 ± 5.6 min. Episodes of resedation were seen in four otters that received 0.3 mg/kg atipamezole so the dose was increased to 1 mg/kg, and no further resedation events were noted. Two fatal complications occurred secondary to suspected respiratory arrest during recovery. This drug protocol provided a smooth and rapid induction in free-ranging river otters, but further research is required to determine the safety of this protocol for river otters in both zoo and free-ranging situations.
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SCN5A-C683R exhibits combined gain-of-function and loss-of-function properties related to epinephrine-triggered ventricular arrhythmia.
Exp Physiol2021 Jan;():. doi: 10.1113/EP089088.
Steinberg Christian, Pilote Sylvie, Philippon François, Laksman Zachary W, Champagne Jean, Simard Chantale, Krahn Andrew D, Drolet Benoît,
Abstract
NEW FINDINGS:
SCN5A-C683R is a novel variant associated with an uncommon phenotype of epinephrine-triggered ventricular arrhythmia in the absence of a distinct ECG phenotype. Functional cellular studies demonstrated that Nav1.5/C683R results in a mixed electrophysiological phenotype with gain-of-function (GOF) and loss-of-function (LOF) properties compared to Nav1.5/WT. Gain-of-function properties are characterized by a significant increase of the maximal current density and a hyperpolarizing shift of the steady-state activation The LOF effect of Nav1.5/C683R is characterized by increased closed-state inactivation. Electrophysiological properties and clinical manifestation of SCN5A-C683R are different from LQT-3 or Brugada syndrome and may represent a distinct inherited arrhythmia syndrome.
ABSTRACT:
Background Mutations of SCN5A have been identified as genetic substrate of various inherited arrhythmia syndromes including Long-QT-3 and Brugada syndrome. We recently identified a novel SCN5A variant (C683R) in two genetically unrelated families. The index patients of both families experienced epinephrine-triggered ventricular arrhythmia with cardiac arrest but did not show a specific electrocardiographic phenotype, raising the hypothesis that SCN5A C683R might be a susceptibility variant and the genetic substrate of distinct inherited arrhythmia. Objective We conducted functional cellular studies to characterize the electrophysiological properties of Na 1.5/C683R in order to explore the potential pathogenicity of this novel variant. Methods The C683R variant was engineered by site-directed mutagenesis. Na 1.5/wild type (WT) and Na 1.5/C683R were expressed in tsA201 cells. Electrophysiological characterization of C683R was performed using whole cell patch-clamp technique. Adrenergic stimulation was mimicked by exposure to the protein kinase A (PKA) activator 8-CPT-cAMP. The impact of beta-blockers was tested, exposing Na 1.5/WT and Na 1.5/C683R currents to propranolol and nadolol. Results C683R results in a co-association of gain-of-function (GOF) and loss-of-function (LOF) properties of Na 1.5. Gain-of-function properties are characterized by a significant increase of the maximal Na 1.5 current density compared to Na 1.5/WT (861 ± 309 pA/pF vs 627 ± 489 pA/pF; p < 0.05, n ? 9) that was further potentiated in Na 1.5/C683R with 8-CPT-cAMP stimulation (869 ± 287 pA/pF vs 607 ± 320 pA/pF; p < 0.05, n ? 12). C683R also resulted in a significant hyperpolarizing shift in the voltage of steady-state activation (-65.4 ± 3.0 mV vs -57.2 ± 4.8 mV; p < 0.001) resulting in an increased window current compared to WT. The LOF effect of Na 1.5/C683R was characterized by significantly increased closed-state inactivation compared to Na 1.5/WT (p < 0.05). Conclusion C683R is a novel SCN5A variant resulting in a co-association of gain-of-function and loss-of-function properties of the cardiac sodium channel Na 1.5. The phenotype is characterized by epinephrine-triggered ventricular arrhythmias. Electrophysiological properties and clinical manifestation are different from LQT-3 or Brugada syndrome and may represent a distinct inherited arrhythmia syndrome. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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[Patients with sudden cardiac death receiving an implantable cardiac device: survival at 30 days and one year].
Rev Med Chil2020 Jun;148(6):772-777. doi: S0034-98872020000600772.
Carvajal Sandra, Quintero Jaime, Ocampo Edward, Perafán Pablo, Carvajal Daniel, Pava Luis Fernando,
Abstract
BACKGROUND:
The use of implantable cardiac devices in patients with sudden cardiac arrest has contributed to their survival.
AIM:
To determine the survival rate at 30 days and one year after hospital discharge of patients who had a cardiac arrest with subsequent placement of an implantable cardiac device.
MATERIAL AND METHODS:
Twenty-three patients older than 18 years who presented sudden extra-institutional or intra-institutional death with subsequent implantation of an implantable cardiac device and whose survival was recorded at 30 days and one year, were included. A univariate analysis was performed.
RESULTS:
Eighteen patients had an extra institutional cardiac arrest. All patients were discharged alive. We could not ascertain the health status of one patient at follow-up. Twenty-one patients had a Cerebral Performance Category (CPC) of 1 at discharge. One patient died of a stroke within 30 days and one patient died due to an arrhythmic electrical storm one year later. Twenty patients survived at least one year after hospital discharge.
CONCLUSIONS:
Survival at 30 days and one year, was high in patients with sudden death or cardiac arrest who required intracardiac devices.
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Out-of-Hospital Cardiac Arrest Response and Outcomes During the COVID-19 Pandemic.
JACC Clin Electrophysiol2021 Jan;7(1):6-11. doi: S2405-500X(20)30729-5.
Uy-Evanado Audrey, Chugh Harpriya S, Sargsyan Arayik, Nakamura Kotoka, Mariani Ronald, Hadduck Katy, Salvucci Angelo, Jui Jonathan, Chugh Sumeet S, Reinier Kyndaron,
Abstract
OBJECTIVES:
The purpose of this study was to evaluate the potential impact of the coronavirus disease-2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) responses and outcomes in 2 U.S. communities with relatively low infection rates.
BACKGROUND:
Studies in areas with high COVID-19 infection rates indicate that the pandemic has had direct and indirect effects on community responses to OHCA and negative impacts on survival. Data from areas with lower infection rates are lacking.
METHODS:
Cases of OHCA in Multnomah County, Oregon, and Ventura County, California, with attempted resuscitation by emergency medical services (EMS) from March 1 to May 31, 2020, and from March 1 to May 31, 2019, were evaluated.
RESULTS:
In a comparison of 231 OHCA in 2019 to 278 in 2020, the proportion of cases receiving bystander cardiopulmonary resuscitation (CPR) was lower in 2020 (61% to 51%, respectively; p = 0.02), and bystander use of automated external defibrillators (AEDs) declined (5% to 1%, respectively; p = 0.02). EMS response time increased (6.6 ± 2.0 min to 7.6 ± 3.0 min, respectively; p < 0.001), and fewer OHCA cases survived to hospital discharge (14.7% to 7.9%, respectively; p = 0.02). Incidence rates did not change significantly (p > 0.07), and coronavirus infection rates were low (Multnomah County, 143/100,000; Ventura County, 127/100,000 as of May 31) compared to rates of ?1,600 to 3,000/100,000 in the New York City region at that time.
CONCLUSIONS:
The community response to OHCA was altered from March to May 2020, with less bystander CPR, delays in EMS response time, and reduced survival from OHCA. These results highlight the pandemic's indirect negative impact on OHCA, even in communities with relatively low incidence of COVID-19 infection, and point to potential opportunities for countering the impact.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Cardiac Arrests During the COVID-19 Pandemic: The Perfect Storm.
JACC Clin Electrophysiol2021 Jan;7(1):12-15. doi: S2405-500X(20)30843-4.
Mitrani Raul D, Goldberger Jeffrey J,
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Unplanned Percutaneous Coronary Revascularization After TAVR: A Multicenter International Registry.
JACC Cardiovasc Interv2021 Jan;14(2):198-207. doi: S1936-8798(20)32163-4.
Stefanini Giulio G, Cerrato Enrico, Pivato Carlo Andrea, Joner Michael, Testa Luca, Rheude Tobias, Pilgrim Thomas, Pavani Marco, Brouwer Jorn, Lopez Otero Diego, Munoz Garcia Erika, Barbanti Marco, Biasco Luigi, Varbella Ferdinando, Reimers Bernhard, Jimenez Diaz Victor Alfonso, Leoncini Massimo, Salido Tahoces Maria Luisa, Ielasi Alfonso, de la Torre Hernandez Jose M, Mylotte Darren, Garot Philippe, Chieffo Alaide, Nombela-Franco Luis, ,
Abstract
OBJECTIVES:
This study sought to evaluate the incidence and causes of percutaneous coronary intervention (PCI) at different time periods following transcatheter aortic valve replacement (TAVR).
BACKGROUND:
Coronary artery disease (CAD) and aortic stenosis frequently coexist, but the optimal management of CAD following TAVR remains incompletely elucidated.
METHODS:
Patients undergoing unplanned PCI after TAVR were retrospectively included in an international multicenter registry.
RESULTS:
Between July 2008 and March 2019, a total of 133 patients (0.9%; from a total cohort of 15,325) underwent unplanned PCI after TAVR (36.1% after balloon-expandable bioprosthesis, 63.9% after self-expandable bioprosthesis). The median time to PCI was 191 days (interquartile range: 59 to 480 days). The daily incidence of PCI was highest during the first week after TAVR and then declined over time. Overall, the majority of patients underwent PCI due to an acute coronary syndrome, and specifically 32.3% had non-ST-segment elevation myocardial infarction, 15.4% had unstable angina, 9.8% had ST-segment elevation myocardial infarction, and 2.2% had cardiac arrest. However, chronic coronary syndromes are the main indication beyond 2 years. PCI success was reported in almost all cases (96.6%), with no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% vs. 94.9%; p = 0.150).
CONCLUSIONS:
Unplanned PCI after TAVR is rare, with an incidence declining over time after TAVR. The main indication to PCI is acute coronary syndrome in the first 2 years after TAVR, and thereafter chronic coronary syndromes become prevalent. Unplanned PCIs are frequently successfully performed after TAVR, with no apparent differences between balloon-expandable and self-expandable bioprostheses. (Revascularization After Transcatheter Aortic Valve Implantation [REVIVAL]; NCT03283501).
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Severe Hypotension, Bradycardia and Asystole after Sugammadex Administration in an Elderly Patient.
Medicina (Kaunas)2021 Jan;57(1):. doi: E79.
Fierro Carmen, Medoro Alessandro, Mignogna Donatella, Porcile Carola, Ciampi Silvia, Foderà Emanuele, Flocco Romeo, Russo Claudio, Martucci Gennaro,
Abstract
Sugammadex is a modified ?-cyclodextrin largely used to prevent postoperative residual neuromuscular blockade induced by neuromuscular aminosteroid blocking agents. Although Sugammadex is considered more efficacious and safer than other drugs, such as Neostigmine, significant and serious complications after its administration, such as hypersensitivity, anaphylaxis and, more recently, severe cardiac events, are reported. In this report, we describe the case of an 80-year-old male with no medical history of cardiovascular disease who was scheduled for percutaneous nephrolithotripsy under general anesthesia. The intraoperative course was uneventful; however, the patient developed a rapid and severe hypotension, asystole and cardiac arrest after Sugammadex administration. Spontaneous cardiac activity and hemodynamic stability was restored with pharmacological therapy and chest compression. The patient was stabilized and discharged uneventfully on postoperative day 10. The potential causes of cardiac arrest after Sugammadex administration have been carefully considered, yet all indications point to Sugammadex as the direct causative agent. On the basis of laboratory and clinical tests, we can exclude among the cause of bradycardia, Kounis syndrome, acute myocardial infarction, coronary spasm and other arrhythmias, but not anaphylaxis. Although Sugammadex is considered an increasingly important option in the prevention of postoperative residual neuromuscular blockade, anesthesiologists should consider it a causative agent of cardiac arrest during surgery. This case highlights the necessity of increased pharmacovigilance and further studies to examine Sugammadex safety and mechanism through which it may cause severe bradycardia, hypotension and cardiac arrest.
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Potential Effects of Poloxamer 188 on Rat Isolated Brain Mitochondria after Oxidative Stress In Vivo and In Vitro.
Brain Sci2021 Jan;11(1):. doi: E122.
Pille Johannes A, Riess Matthias L,
Abstract
Outcome after cerebral ischemia is often dismal. Reperfusion adds significantly to the ischemic injury itself. Therefore, new strategies targeting ischemia/reperfusion (I/R) injury are critically needed. Poloxamer (P)188, an amphiphilic triblock copolymer, is a highly promising pharmacological therapeutic as its capability to insert into injured cell membranes has been reported to protect against I/R injury in various models. Although mitochondrial function particularly profits from P188 treatment after I/R, it remains unclear if this beneficial effect occurs directly or indirectly. Here, rat isolated brain mitochondria underwent oxidative stress in vivo by asphyxial cardiac arrest or in vitro by the addition of hydrogen peroxide (HO) after isolation. Mitochondrial function was assessed by adenosine triphosphate synthesis, oxygen consumption, and calcium retention capacity. Both asphyxia and HO exposure significantly impaired mitochondrial function. P188 did not preserve mitochondrial function after either injury mechanism. Further research is indicated.
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