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Pubblicazioni recenti - cardiac arrest
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Osteocalcin, Ovarian senescence, and Brain health.
Front Neuroendocrinol2020 Aug;():100861. doi: S0091-3022(20)30052-2.
Schatz Marc, Saravanan Sharnikha, d'Adesky Nathan D, Bramlett Helen, Perez-Pinzon Miguel A, Raval Ami P,
Abstract
Menopause, an inevitable event in a woman's life, significantly increases risk of bone resorption and diseases such as Alzheimer's, vascular dementia, cardiac arrest, and stroke. The sole role of bones, as traditionally regarded, is to provide structural support for skeletal muscles and allow for ambulation, however this concept is becoming quickly outdated. New literature has emerged that suggests the bone cell-derived hormone osteocalcin (OCN) plays a pivotal role in cognition. OCN levels are correlated with bone mass density and bone turnover, and thus are strongly influenced by the changes associated with menopause. The goal of the current review is to discuss potential gaps in our knowledge of OCN and cognition, discrepancies in methods of OCN quantification, and therapies to enhance circulating OCN. A discussion on implementing exercise or low frequency vibration interventions at the menopausal transition to reduce risk and severity of neurological diseases and associated cognitive decline is included.
Copyright © 2020. Published by Elsevier Inc.
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An inhibitor role of Nrf2 in the regulation of myocardial senescence and dysfunction after myocardial infarction.
Life Sci2020 Aug;():118199. doi: S0024-3205(20)30951-6.
Luo Xinxia, Zhou Junyang, Wang Zhixiao, He Yun, Yu Li, Ma Shinan, Wang Shan, Wang Xiaoli, Yuan Yahong, Li Dongsheng, Cui Taixing, Ding Yan,
Abstract
Cellular senescence, a process whereby cells enter a state of permanent growth arrest, appears to regulate cardiac pathological remodeling and dysfunction in response to various stresses including myocardial infarction (MI). However, the precise role as well as the underlying regulatory mechanism of cardiac cellular senescence in the ischemic heart disease remain to be further determined. Herein we report an inhibitory role of Nrf2, a key transcription factor of cellular defense, in regulating cardiac senescence in infarcted hearts as well as a therapeutic potential of targeting Nrf2-mediated suppression of cardiac senescence in the treatment of MI-induced cardiac dysfunction. MI was induced by left coronary artery ligation for 28?days in mice. Heart tissues from the infarct border zone were used for the analyses. The MI-induced cardiac dysfunction was associated with increased myocardial cell senescence, oxidative stress and apoptosis in adult wild type (WT) mice. In addition, a downregulated Nrf2 activity was associated with upregulated Keap1 levels and increased phosphorylation of JAK and FYN in the infarcted border zone heart tissues. Nrf2 Knockout (Nrf2) enhanced the MI-induced myocardial, cardiac dysfunction and senescence. Qiliqiangxin (QLQX), a herbal medicine which could reverse the MI-induced suppression of Nrf2 activity, significantly inhibited the MI-induced cardiac senescence, apoptosis, and cardiac dysfunction in WT mice but not in Nrf2 mice. These results indicate that MI downregulates Nrf2 activity thus promoting oxidative stress to accelerate cellular senescence in the infarcted heart towards cardiac dysfunction and Nrf2 may be a drug target for suppressing the cellular senescence-associated pathologies in infarcted hearts.
Copyright © 2020. Published by Elsevier Inc.
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Thrombolysis and use of argatroban for the treatment of massive pulmonary embolism following anticoagulation failure in a patient with COVID-19.
Am J Health Syst Pharm2020 Aug;():. doi: zxaa287.
Sagardia Lisa M, Daniels Lisa M,
Abstract
DISCLAIMER:
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
PURPOSE:
Successful use of alteplase and argatroban to treat a patient with coronavirus disease 2019 (COVID-19)-associated massive pulmonary embolism with cardiac arrest is reported.
SUMMARY:
This case report describes a 42-year-old male with COVID-19 who developed a massive pulmonary embolism resulting in cardiac arrest after suspected failure of low-molecular-weight heparin therapy for a deep venous thrombosis. Administration of two 50-mg doses of intravenous alteplase resulted in return of spontaneous circulation, and low-dose argatroban was used as follow-up anticoagulation therapy without complications. This is the first case report of use of argatroban in a patient with COVID-19 with cardiac arrest-associated massive pulmonary embolism after failure of previous anticoagulation efforts.
CONCLUSION:
Argatroban may be used as an alternate anticoagulation strategy in COVID-19 patients who fail low-molecular weight therapy. A risk versus benefit discussion should be had regarding appropriateness of therapy as well as dosing. More data is needed to understand the unique hypercoagulable condition in COVID-19 patients as well as research that further highlights the role of argatroban and bivalirudin therapy in this patient population.
© American Society of Health-System Pharmacists 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Pulse rate as an alternative, real-time feedback indicator for chest compression rate: a porcine model of cardiac arrest.
J Clin Monit Comput2020 Aug;():. doi: 10.1007/s10877-020-00576-x.
Fu Yangyang, Yin Lu, Seery Samuel, Dai Jiayuan, Zhu Huadong, Jin Kui, Li Yi, Yu Shanshan, Zhang Lili, Xu Jun, Yu Xuezhong,
Abstract
Feedback indicators can improve chest compression quality during cardiopulmonary resuscitation (CPR). However, the application of feedback indicators in the clinic practice is rare. Pulse oximetry has been widely used and reported to correlate spontaneous circulation restoration during CPR. However, it is unclear if pulse oximetry can monitor the quality of chest compression. We hypothesized that pulse rate monitored by pulse oximetry can be used as a feedback indicator of the chest compression rate during CPR in a porcine model of cardiac arrest. Seven domestic male pigs (30-35 kg) were utilized in this study. Eighteen intermittent chest compression periods of 2 min were performed on each animal. Chest compression and pulse oximetry plethysmographic waveforms were recorded simultaneously. Chest compression and pulse rates were calculated based on both waveforms. Compression interruption and synchronous pulse interruption times were also measured. Agreement was analyzed between pulse rates and synchronous chest compression rates, as well as between compression interruption times and synchronous pulse interruption times. A total of 126 compression periods of 2 min were performed on seven animals. Interclass correlation coefficients and Bland-Altman analysis revealed reliable agreement between pulse rates and synchronous chest compression rates. Similarly, compression interruption and synchronous pulse interruption times obtained also showed high agreement. Pulse rate can be used as an alternative indicator of chest compression rate during CPR in a porcine model of cardiac arrest. Pulse interruption time also can be used to reflect compression interruption time precisely in this model.
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The role of coronary angiography in out-of-hospital cardiac arrest patients in the absence of ST-segment elevation: A literature review.
Neth Heart J2020 Aug;28(Suppl 1):108-114. doi: 10.1007/s12471-020-01460-8.
Spoormans E M, Lemkes J S, Janssens G N, van der Hoeven N W, Bonnes J L, van Royen N,
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major cause of death. Although the aetiology of cardiac arrest can be diverse, the most common cause is ischaemic heart disease. Coronary angiography and percutaneous coronary intervention, if indicated, has been associated with improved long-term survival for patients with initial shockable rhythm. However, in patients without ST-segment elevation on the post-resuscitation electrocardiogram, the optimal timing of performing this invasive procedure is uncertain. One important challenge that clinicians face is to appropriately select patients that will benefit from immediate coronary angiography, yet avoid unnecessary delay of intensive care support and targeted temperature management. Observational studies have reported contradictory results and until recently, randomised trials were lacking. The Coronary Angiography after Cardiac Arrest without ST-segment elevation (COACT) was the first randomised trial that provided comparative information between coronary angiography treatment strategies. This literature review will provide the current knowledge and gaps in the literature regarding optimal care for patients successfully resuscitated from OHCA in the absence of ST-segment elevation and will primarily focus on the role and timing of coronary angiography in this high-risk patient population.
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A neglected cause of recurrent rhabdomyolysis, LPIN1 gene defect: a rare case from Turkey.
Turk J Pediatr2020 ;62(4):647-651. doi: 10.24953/turkjped.2020.04.015.
Topal Sevgi, Köse Melis Demir, A??n Hasan, Sar? Ferhat, Çolak Mustafa, Atakul Gülhan, Karaarslan Utku, ??güder Rana,
Abstract
BACKGROUND:
Rhabdomyolysis; can occur due to toxic, infectious, metabolic, and genetic causes. Severe rhabdomyolysis may progress to several clinical manifestations such as cardiac arrest and may pose a risk of mortality if it is not treated timely.
CASE:
In this article, we presented a 26-month-old patient who was admitted with an acute rhabdomyolysis attack and a venovenous hemodiafiltration (CVVHDF) was initiated on the 5th hour of hospitalization. Creatine kinase (CK) levels of the patient continued to increase (max: 943 452 IU/L) until the 5th day of treatment and hereafter began to decrease. As the common causes of rhabdomyolysis were excluded and the CK levels were the highest values reported in the literature, although, LPIN1 deficiency was the most suspected diagnosis, to facilitate the diagnostic procedures a whole-exome sequencing was performed. A homozygous [c.1696G > C p. (Asp566His)] mutation was detected on LPIN1 gene. This variant has not been described previously, however, when examined with programs such as SIFT and Mutation taster, it has been considered as pathogenic.
CONCLUSION:
In the pediatric age group, especially in infants presenting with severe rhabdomyolysis, LPIN1 deficiency should also be considered; as early diagnosis and appropriate treatment may reduce mortality.
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Gasping during refractory out-of-hospital cardiac arrest is a prognostic marker for favourable neurological outcome following extracorporeal cardiopulmonary resuscitation: a retrospective study.
Ann Intensive Care2020 Aug;10(1):112. doi: 10.1186/s13613-020-00730-3.
Bunya Naofumi, Ohnishi Hirofumi, Wada Kenshiro, Kakizaki Ryuichiro, Kasai Takehiko, Nagano Nobutaka, Kokubu Nobuaki, Miyata Kei, Uemura Shuji, Harada Keisuke, Narimatsu Eichi,
Abstract
BACKGROUND:
Gasping during cardiac arrest is associated with favourable neurological outcomes for out-of-hospital cardiac arrest. Moreover, while extracorporeal cardiopulmonary resuscitation (ECPR) performed for refractory cardiac arrest can improve outcomes, factors for favourable neurological outcomes remain unknown. This study aimed to examine whether gasping during cardiac arrest resuscitation during transport by emergency medical services (EMS) was independently associated with a favourable neurological outcome for patients who underwent ECPR. This retrospective study was based on medical records of all adult patients who underwent ECPR due to refractory cardiac arrest. The primary endpoint was neurologically intact survival at discharge. The study was undertaken at Sapporo Medical University Hospital, a tertiary care centre approved by the Ministry of Health, Labour and Welfare, located in the city of Sapporo, Japan, between January 2012 and December 2018.
RESULTS:
Overall, 166 patients who underwent ECPR were included. During transportation by EMS, 38 patients exhibited gasping, and 128 patients did not. Twenty patients who exhibited gasping during EMS transportation achieved a favourable neurological outcome (20/38; 52.6%); 14 patients who did not exhibit gasping achieved a favourable neurological outcome (14/128; 10.9%). Gasping during transportation by EMS was independently associated with favourable neurological outcome irrespective of the type of analysis performed (multiple logistic regression analysis, odds ratio [OR] 9.52; inverse probability of treatment weighting using propensity score, OR 9.14).
CONCLUSIONS:
The presence of gasping during transportation by EMS was independently associated with a favourable neurological outcome in patients who underwent ECPR. The association of gasping with a favourable neurological outcome in patients with refractory cardiac arrest suggests that ECPR may be considered in such patients.
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Secondary Endoleak Management Following TEVAR and EVAR.
Cardiovasc Intervent Radiol2020 Aug;():. doi: 10.1007/s00270-020-02572-9.
Ameli-Renani Seyed, Pavlidis Vyzantios, Morgan Robert A,
Abstract
Endovascular abdominal and thoracic aortic aneurysm repair and are widely used to treat increasingly complex aneurysms. Secondary endoleaks, defined as those detected more than 30 days after the procedure and after previous negative imaging, remain a challenge for aortic specialists, conferring a need for long-term surveillance and reintervention. Endoleaks are classified on the basis of their anatomic site and aetiology. Type 1 and type 2 endoleaks (EL1 and EL2) are the most common endoleaks necessitating intervention. The management of these requires an understanding of their mechanics, and the risk of sac enlargement and rupture due to increased sac pressure. Endovascular techniques are the main treatment approach to manage secondary endoleaks. However, surgery should be considered where endovascular treatments fail to arrest aneurysm growth. This chapter reviews the aetiology, significance, management strategy and techniques for different endoleak types.
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Early vasopressor administration in pediatric blunt liver and spleen injury: An ATOMAC+ study.
J Pediatr Surg2020 Jul;():. doi: S0022-3468(20)30485-1.
Notrica David M, Sussman Bethany L, Sayrs Lois W, St Peter Shawn D, Maxson R Todd, Alder Adam C, Eubanks James W, Johnson Jeremy J, Ostlie Daniel J, Ponsky Todd, Naiditch Jessica A, Leys Charles M, Lawson Karla A, Greenwell Cynthia, Bhatia Amina, Garcia Nilda M,
Abstract
BACKGROUND:
No prior studies have examined the outcomes of early vasopressor use in children sustaining blunt liver or spleen injury (BLSI).
METHODS:
A planned secondary analysis of vasopressor use from a 10-center, prospective study of 1004 children with BLSI. Inverse probability of treatment weighting (IPTW) was used to compare patients given vasopressors <48?h after injury to controls based on pretreatment factors. A logistic regression was utilized to assess survival associated with vasopressor initiation factors on mortality and nonoperative management (NOM) failure.
RESULTS:
Of 1004 patients with BLSI, 128 patients were hypotensive in the Pediatric Trauma Center Emergency Department (ED); 65 total patients received vasopressors. Hypotension treated with vasopressors was associated with a sevenfold increase in mortality (AOR?=?7.6 [p?
CONCLUSION:
After propensity matching, early vasopressor use for hypotension in the ED was associated with an increased risk of death, but did not increase the risk of failure of NOM.
LEVEL OF EVIDENCE:
Level III prognostic and epidemiological, prospective.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Ventricular Arrhythmia and Life-Threatening Events in Patients With Repaired Tetralogy of Fallot.
Am J Cardiol2020 Jul;():. doi: S0002-9149(20)30682-2.
Atallah Joseph, Gonzalez Corcia M Cecilia, Walsh Edward P, ,
Abstract
Risk stratification for malignant arrhythmias and risk of sudden cardiac death in tetralogy of Fallot (TOF) remains challenging. We aimed to ascertain factors associated with life-threatening arrhythmic events. A multicenter retrospective case-control study including 72 TOF patients with documented cardiac arrest and/or sustained ventricular tachycardia, compared with 216 controls matched for era of surgery. The mean age at event in the cases was 27.3 ± 12.5 years. The majority (57%) presented with sustained ventricular tachycardia. Fatal events occurred in 9. Random forest analysis and a decision tree demonstrated surgical era specific risk factors (< vs ? 1980). For both eras, arrhythmic symptoms and left ventricular dysfunction were strongly associated with malignant arrhythmias. In addition, right ventricular dysfunction and age at repair ? 6.5 years preceded by a shunt were associated with a higher risk group in the early era, whereas a trans-annular patch type repair was associated with a lower risk group in the recent era. For the moderate and high-risk groups, the decision tree showed a sensitivity of 88.4% and specificity of 68.1%. An "importance factor" was calculated for each predictor, creating a risk score and 4 risk categories. In conclusions, this risk stratification scheme, based on clinical history and noninvasive testing, allows categorization of TOF patients at high risk of malignant arrhythmia. A multicenter prospective evaluation of the accuracy of this scoring system is now being planned.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Reply to letter "A fatal adverse event upon adenotonsillectomy in a child. Are Brugada syndrome and propofol real accomplices?"
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Esmolol in the management of pre-hospital refractory ventricular fibrillation: A systematic review and meta-analysis.
Am J Emerg Med2020 May;38(9):1921-1934. doi: S0735-6757(20)30444-7.
Miraglia Dennis, Miguel Lourdes A, Alonso Wilfredo,
Abstract
BACKGROUND:
Esmolol has been proposed as a viable adjunctive therapy for pre-hospital refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT).
OBJECTIVES:
We performed a systematic review and meta-analysis to assess the effectiveness of esmolol on pre-hospital refractory VF/pVT, compared with standard of care.
METHODS:
MEDLINE, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for eligible studies. Two investigators independently extracted relevant data and assessed the methodological quality of each included study using the ROBINS-I tool. The quality of evidence for summary estimates was assessed according to GRADE guidelines. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) for each outcome of interest were calculated.
RESULTS:
The search yielded 3253 unique records, of which two studies were found to be in accordance with the research purpose, totaling 66 patients, of whom 33.3% (n = 22) received esmolol. Additional evidence was provided in the paper but was not relevant to the analysis and was therefore not included. Esmolol was likely associated with an increased rate of survival to discharge (RR 2.82, 95% CI 1.01-7.93, p = 0.05) (GRADE: Very low) and survival with favorable neurological outcome (RR 3.44, 95% CI 1.11-10.67, p = 0.03) (GRADE: Very low). Similar results were found for return of spontaneous circulation (ROSC) (RR 2.63, 95% CI 1.37-5.07, p = 0.004) (GRADE: Very low) and survival to intensive care unit (ICU)/hospital admission (RR 2.63, 95% CI 1.37-5.07, p = 0.004) (GRADE: Very low).
CONCLUSION:
The effectiveness of esmolol for refractory VF/pVT remains unclear. Trial sequential analysis (TSA) indicates that the evidence is inconclusive and that further trials are required in order to reach a conclusion. Therefore, it is imperative to continue to accumulate evidence in order to obtain a higher level of scientific evidence.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Extrapulmonary Involvement in Sarcoidosis: A Case Report.
Am J Med Case Rep2020 ;8(7):210-215.
Connelly Courtney, Hasan Abida, Chung Zachary, Mingomataj Erli, Velayudhan Vinodkumar, McFarlane Isabel M,
Abstract
Sarcoidosis is an idiopathic multisystem granulomatous disease that affects patients of all races and ethnic groups however predilection for women and African Americans is apparent. Extrapulmonary manifestations of sarcoidosis occur in up to 50% of cases. The most common sites of extrapulmonary involvement are the skin, eyes, liver, and reticuloendothelial system followed bt renal, cardiac, and neurological involvement. We present the case of a middle age man with exclusive extrapulmonary sarcoidosis affecting the renal, cardiac, hepatic, splenic and central nervous system. The patient sustained a second episode of venous thromboembolism which highlights a frequently seen complication of sarcoidosis. We discuss the proposed pathophysiology for the prothrombotic state seen in sarcoidosis and imaging modalities that can be utilized to assess extrapulmonary involvement in sarcoidosis. Lastly, sarcoidosis management is reviewed, highlighting that immunosuppressants and tumor necrosis factor inhibitors are being proposed to arrest disease progression and reduce glucocorticoid doses.
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Different Manifestations in Familial Isolated Left Ventricular Non-compaction: Two Case Reports and Literature Review.
Front Pediatr2020 ;8():370. doi: 10.3389/fped.2020.00370.
Al Hussein Hamida, Al Hussein Hussam, Stroe Valentin, Harpa Marius, Ghiragosian Claudiu, Goia Cristina Maria, Opris Carmen Elena, Suciu Horatiu,
Abstract
Left ventricular non-compaction (LVNC) is a form of cardiomyopathy characterized by prominent trabeculae and deep intertrabecular recesses which form a distinct "non-compacted" layer in the myocardium. It results from intrauterine arrest of the compaction process of the left ventricular myocardium. Clinical manifestations vary from asymptomatic to heart failure (HF), arrhythmias, or thromboembolic events. We present a case of mother and son diagnosed with isolated LVNC (ILVNC). A 4-years-old male patient, diagnosed at 3 months with ILVNC, and NYHA functional class IV HF, was admitted to the Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, Romania, for cardiologic reevaluation, and diagnosis confirmation. ILVNC was confirmed using echocardiography, revealing a non-compaction to compaction (NC/C) ratio of > 2.7. His evolution was stationary until the age of 8 years, when severe pneumonia caused hemodynamic decompensation, and he was listed for heart transplantation (HT). The patient underwent HT at the age of 11 years with favorable postoperative outcome. Meanwhile, a 22-years-old female patient, mother of the aforementioned patient, was also admitted to our institute due to severe fatigue, dyspnea, and recurrent palpitations with multiple implantable cardioverter defibrillator (ICD) shock delivery. Extensive medical history revealed that a presumptive ILVNC diagnosis was established when she was 11 years old. She was asymptomatic until 18 years old, when 3 months post-partum, she developed NYHA functional class III HF, and subsequently underwent ICD implantation. Her diagnosis was confirmed using multi-detector computed tomography angiography, which revealed a NC/C ratio of > 3.3. ICD adjustments were carried out with a favorable evolution under chronic drug therapy. The last evaluation, at 27 years old, revealed that she was in NYHA functional class II HF. In conclusion, ILVNC, even when familial, can present different clinical pictures and therefore requires different medical approaches.
Copyright © 2020 Al Hussein, Al Hussein, Stroe, Harpa, Ghiragosian, Goia, Opris and Suciu.
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Outcomes and Utilization of Therapeutic Hypothermia in Post-Cardiac Arrest Patients in Teaching Versus Non-Teaching Hospitals: Retrospective Study of the Nationwide Inpatient Sample Database (2016).
Cureus2020 Aug;12(8):e9545. doi: 10.7759/cureus.9545.
Jha Anil, Thota Ajit, Buda Kevin G, Goel Akshay, Sharma Ashish, Krishnan Anand M, Patel Hardik K, Wu Fangcheng,
Abstract
Background Using therapeutic hypothermia (TH) reduces the core body temperature of survivors of cardiac arrest to minimize the neurological damage caused by severe hypoxia. The TH protocol is initiated following return of spontaneous circulation (ROSC) in non-responsive patients. Clinical trials examining this technique have shown significant improvement in neurological function among survivors of cardiac arrests. Though there is strong evidence to support TH use to improve the neurologic outcomes in shockable and nonshockable rhythms, predictors of TH utilization are not well-characterized. Our study tried to evaluate TH utilization, as well as the effect of the teaching status of hospitals, on outcomes, including mortality, length of stay, and total hospitalization charges. Method We conducted a retrospective analysis of the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) database. Patients with an admitting diagnosis of cardiac arrest, as identified by the corresponding International Classification of Disease, 10 Revision (ICD-10) code for the year 2016 were analyzed. In addition, we identified TH using the ICD-10 procedure code. A weighted descriptive analysis was performed to generate national estimates. Groups of patients admitted to teaching hospitals were compared to those admitted in non-teaching hospitals. Patients were stratified by age, sex, race, and demographic and clinical data, including the Charlson Comorbidity Index (CCI), for these two groups, and statistical analysis was done for the primary outcome, in-hospital mortality, as well as the secondary outcomes, including length of stay (LOS) and total hospitalization charges. Fisher's exact test was used to compare proportions and student's t-test for continuous variables. Statistical analysis was completed by linear regression analysis. Results A total of 13,780 patients met the inclusion criteria for cardiac arrest admission. The number of patients with cardiac arrest admitted to a teaching hospital was 9285. A total of 670 patients received TH, with 495 admissions to teaching hospitals. The population of females in the hypothermia group was 270. The mean age of patients received TH was 59.4 years. In patients who received TH, 65% were Caucasians followed by Hispanics (16%), with no significant statistical racial differences in groups (p=0.30). The majority of patients with TH in both groups (teaching vs. non-teaching admissions) had Medicare (58.8% vs 49.5%; p=0.75). Hospitals in the southern region had the most admissions in both groups (45.7% and 31.3%), with the northeast region having the least non-teaching hospital admissions (8.5%) and approximately similar teaching hospital admissions in other regions (~22%) (p=0.27). The total number of deaths in this group was 510, out of which 370 were in a teaching hospital. After adjusting for age, sex, race, income, the CCI, hospital location, and bed size, mortality was not significantly different between these two groups (p=0.797). We found increased LOS in patients admitted to teaching hospitals (p=0.021). With a p-value of 0.097, there were no differences in total hospitalization charges in both groups. Conclusion There were no significant differences in mortality or total hospitalization charge between patients admitted with cardiac arrest to a teaching hospital and received TH as compared to a non-teaching hospital although patients admitted to teaching hospitals stayed longer.
Copyright © 2020, Jha et al.
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Haloperidol Induced Sudden Cardiac Arrest-Report of a Very Rare Case and Review of Literature.
Case Rep Psychiatry2020 ;2020():1836716. doi: 10.1155/2020/1836716.
Dar Parvez Mohi-Ud-Din, Kaur Supreet, Boddeda Jogendra, Wani Sajid Mohammad,
Abstract
Haloperidol is a typical antipsychotic drug. This drug is still widely used in emergency medicine, psychiatry, and general medicine departments. It is mostly used for acute confusional state, psychotic disorders, agitation, delirium, and aggressive behaviour. Overdose of haloperidol can cause sudden deaths. Cardiopulmonary arrest related to use of haloperidol had been reported in literature as case reports but are very few. No such cases have been reported in India till now. We report a case of cardiac arrest due to the use of haloperidol.
Copyright © 2020 Parvez Mohi-Ud-Din Dar et al.
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Cardiac Arrest and Successful Extracorporeal Cardiopulmonary Resuscitation as a Result of a Refeeding Syndrome in a Young Female with Anorexia Nervosa.
Case Rep Cardiol2020 ;2020():8217583. doi: 10.1155/2020/8217583.
Waddell Daniela, Meincke Felix, Hakmi Samer, van der Schalk Hendrick, Schenker Niklas, Hahn Jonas, Moschner Anna, Bohné Mintje, Chung Da-Un, Willems Stephan, Kivelitz Dietmar, Bahlmann Edda,
Abstract
Anorexia nervosa is a potentially life-threatening eating disorder, characterized by an abnormally low body weight. This case report illustrates a 22-year old female with cardiac arrest due to a refeeding syndrome in a patient with anorexia nervosa. It features the successful use of extracorporeal cardiopulmonary resuscitation in a case of severe left ventricular dysfunction resulting in a favorable outcome. . We present the first case of a cardiac arrest due to a refeeding syndrome in anorexia nervosa featuring the successful use of an extracorporeal cardiopulmonary resuscitation approach as a bridge to full recovery.
Copyright © 2020 Daniela Waddell et al.
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Indian Resuscitation Council (IRC) suggested guidelines for Comprehensive Cardiopulmonary Life Support (CCLS) for suspected or confirmed coronavirus disease (COVID-19) patient.
Indian J Anaesth2020 May;64(Suppl 2):S91-S96. doi: 10.4103/ija.IJA_481_20.
Singh Baljit, Garg Rakesh, Chakra Rao S S C, Ahmed Syed M, Divatia J V, Ramakrishnan T V, Mehdiratta Lalit, Joshi Muralidhar, Malhotra Naveen, Bajwa Sukhminder Jit Singh,
Abstract
Management of the recent outbreak of the novel coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) remains challenging. The challenges are not only limited to its preventive strategies, but also extend to curative treatment, and are amplified during the management of critically ill patients with COVID-19. Older persons with comorbidities like diabetes mellitus, cardiac diseases, hepatic impairment, renal disorders and respiratory pathologies or immune impairing conditions are more vulnerable and have a higher mortality from COVID-19. Earlier, the Indian Resuscitation Council (IRC) had proposed the Comprehensive Cardiopulmonary Life Support (CCLS) for management of cardiac arrest victims in the hospital setting. However, in patients with COVID-19, the guidelines need to be modified,due to various concerns like differing etiology of cardiac arrest, virulence of the virus, risk of its transmission to rescuers, and the need to avoid or minimize aerosolization from the patient due to various interventions. There is limited evidence in these patients, as the SARS-CoV-2 is a novel infection and not much literature is available with high-level evidence related to CPR in patients of COVID-19. These suggested guidelines are a continuum of CCLS guidelines by IRC with an emphasis on the various challenges and concerns being faced during the resuscitative management of COVID-19 patients with cardiopulmonary arrest.
Copyright: © 2020 Indian Journal of Anaesthesia.
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Cranial Nerve IX and X Weakness: An Unusual Initial Presentation of Myasthenia Gravis.
Am J Case Rep2020 Aug;21():e923750. doi: 10.12659/AJCR.923750.
Balabbigari Nikhita, Purewal Jaskaran, Sakul Nfn, Purewal Anam, Kankanala Vijaya, Califano Tiziana,
Abstract
BACKGROUND Myasthenia gravis (MG) is an autoimmune disease characterized by antibodies binding skeletal muscle acetylcholine receptors (AChR). Rarely does the disease manifest with orolaryngeal symptoms before ocular ones. We present a case of MG that on initial presentation had symptoms of cranial nerves (CN) IX and X weakness, including dysphagia and dysphonia. CASE REPORT A 51-year-old woman with panic attacks presented to the Emergency Department (ED) with complaints of her throat closing, swallowing difficulty, and hoarse voice. Multiple ED visits revealed no etiology. However, she developed stridor, which prompted further evaluation. Laryngoscopy and imaging studies revealed no gross abnormalities; therefore, her symptoms of dysphonia and difficulty breathing were attributed to anxiety. Her hospital course was complicated by a cardiac arrest requiring intubation. ECHO, CTA chest, and MRI brain were unremarkable. Her cardiac arrest was hypothesized as being secondary to laryngeal spasm. During her ICU course, she failed extubation multiple times due to acute respiratory failure. An autoimmune etiology was suspected, prompting a paraneoplastic screen, which revealed elevated levels of AChR antibodies at 124 mmol/L. MG was diagnosed and treatment with plasmapheresis and steroids was initiated. However, complications of thrombocytopenia, anemia, and ARDS ensued, so MG treatment was discontinued. The patient was eventually transferred to a LTACH. Thereafter, at outpatient followup, her MG was treated with mycophenolate and prednisone, which led to significant symptom improvement. CONCLUSIONS MG commonly presents in the third decade with clinical features of ptosis, diplopia, and facial weakness. However, initial and isolated symptoms of dysphagia and dysphonia are rare, leading to missed diagnoses. Our case of a middle-aged woman posed a diagnostic challenge because of her uncommon presentation and comorbidities of panic attacks and obesity. This case highlights the crucial need for a high index of clinical suspicion for MG in any patient presenting with symptoms of CN IX and X weakness.
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Increased QT Dispersion Is Linked to Worse Outcomes in Patients Hospitalized for Out-of-Hospital Cardiac Arrest.
J Am Heart Assoc2020 Aug;():e016485. doi: 10.1161/JAHA.120.016485.
Kosmopoulos Marinos, Roukoz Henri, Sebastian Pierre, Kalra Rajat, Goslar Tomaz, Bartos Jason A, Yannopoulos Demetris, Benditt David G,
Abstract
Background The incidence and mortality of out-of-hospital cardiac arrest (OHCA) remains high, but predicting outcomes is challenging. Being able to better assess prognosis of hospitalized patients after return of spontaneous circulation would enable improved management of survival expectations. In this study, we assessed the predictive value of ECG indexes in hospitalized patients with OHCA. Methods and Results PR interval and QT interval corrected by the Bazett formula (QTc) for all leads were calculated from standard 12-lead ECGs 24 hours after return of spontaneous circulation in 93 patients who were hospitalized following OHCA. PR interval and QT and QTc duration did not differentiate OHCA survivors and nonsurvivors. However, QT and QTc dispersion was significantly increased in patients who died during hospitalization compared with survivors discharged from the hospital (<0.01). Logistic regression indicated a strong association between increased QT dispersion and in-hospital mortality (<0.0001; area under the curve, 0.8918 for QT dispersion and 0.8673 for QTc dispersion). Multinomial logistic regression indicated that the increase of QTc dispersion correlated with worse Cerebral Performance Category scores at discharge (<0.001; likelihood ratio, 51.42). There was also significant correlation between dispersion measures and serum potassium at the time of measurement and between dispersion measures and cumulative epinephrine administration. No difference existed regarding the number of measurable leads. Conclusions Lesser QT and QTc dispersion at 24 hours after return of spontaneous circulation was significantly associated with survival and neurologic status at discharge. Routine evaluation of QT and QTc dispersion during hospitalization following return of spontaneous circulation might improve outcome prognostication for patients hospitalized for OHCA.
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