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Pubblicazioni recenti - cardiac arrest
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Intracranial Pressure and Cerebral Hemodynamic Monitoring After Cardiac Arrest in Pediatric Pigs Using Contrast Ultrasound-Derived Parameters.
J Ultrasound Med2021 Sep;():. doi: 10.1002/jum.15825.
Shin Samuel S, Sridharan Anush, Khaw Kristina, Hallowell Thomas, Morgan Ryan W, Kilbaugh Todd J, Hwang Misun,
Abstract
OBJECTIVES:
We explore the correlation of contrast-enhanced ultrasound (CEUS) parameters to intracranial pressure (ICP) in a porcine experimental model of pediatric cardiac arrest.
METHODS:
Eleven pediatric pigs underwent electrically induced cardiac arrest followed by cardiopulmonary resuscitation. ICP was measured using intracranial bolt monitor and CEUS was monitored through a cranial window. Various CEUS parameters were monitored at baseline, immediately post return of spontaneous circulation (ROSC), 1?hour-post ROSC, and 3?hours post-ROSC.
RESULTS:
There was significant ICP correlation with wash-out slope assessed by CEUS time intensity curve analysis at immediate post-ROSC. At 3?hours post-ROSC there was also significant negative correlation between ICP and peak enhancement which may be due to the evolution of anoxic injury.
CONCLUSION:
The use of CEUS in assessing disruption of cerebral hemodynamics and ICP post cardiac arrest will need future validation and comparison to other imaging modalities. The correlation between CEUS parameters and ICP may be due to the alterations in cerebral autoregulation that result from anoxic brain injury.
© 2021 American Institute of Ultrasound in Medicine.
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Treatment and survival following in-hospital cardiac arrest: does patient ethnicity matter?
Eur J Cardiovasc Nurs2021 Sep;():. doi: zvab079.
Agerström Jens, Carlsson Magnus, Bremer Anders, Herlitz Johan, Rawshani Araz, Årestedt Kristofer, Israelsson Johan,
Abstract
AIMS :
Previous research on racial/ethnic disparities in relation to cardiac arrest has mainly focused on black vs. white disparities in the USA. The great majority of these studies concerns out-of-hospital cardiac arrest (OHCA). The current nationwide registry study aims to explore whether there are ethnic differences in treatment and survival following in-hospital cardiac arrest (IHCA), examining possible disparities towards Middle Eastern and African minorities in a European context.
METHODS AND RESULTS:
In this retrospective registry study, 24 217 patients from the IHCA part of the Swedish Registry of Cardiopulmonary Resuscitation were included. Data on patient ethnicity were obtained from Statistics Sweden. Regression analysis was performed to assess the impact of ethnicity on cardiopulmonary resuscitation (CPR) delay, CPR duration, survival immediately after CPR, and the medical team's reported satisfaction with the treatment. Middle Eastern and African patients were not treated significantly different compared to Nordic patients when controlling for hospital, year, age, sex, socioeconomic status, comorbidity, aetiology, and initial heart rhythm. Interestingly, we find that Middle Eastern patients were more likely to survive than Nordic patients (odds ratio = 1.52).
CONCLUSION:
Overall, hospital staff do not appear to treat IHCA patients differently based on their ethnicity. Nevertheless, Middle Eastern patients are more likely to survive IHCA.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
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ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity.
Curr Sports Med Rep2021 Sep;20(9):470-484. doi: 10.1249/JSR.0000000000000878.
Roberts William O, Armstrong Lawrence E, Sawka Michael N, Yeargin Susan W, Heled Yuval, O'Connor Francis G,
Abstract
ABSTRACT:
Exertional heat stroke (EHS) is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and EHS. Identifying the athlete with suspected EHS early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from EHS is variable, and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.
Copyright © 2021 by the American College of Sports Medicine.
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Late Awakening Is Common in Settings Without Withdrawal of Life-Sustaining Therapy in Out-of-Hospital Cardiac Arrest Survivors Who Undergo Targeted Temperature Management.
Crit Care Med2021 Sep;():. doi: 10.1097/CCM.0000000000005274.
Lee Dong Hun, Cho Yong Soo, Lee Byung Kook, Lee Hyoung Youn, Jeung Kyung Woon, Jung Yong Hun, Park Kyu Nam, Kim Youn-Jung, Chae Minjung Kathy, Seo Dong-Woo, ,
Abstract
OBJECTIVES:
We investigated awakening time and characteristics of awakening compared nonawakening and factors contributing to poor neurologic outcomes in out-of-hospital cardiac arrest survivors in no withdrawal of life-sustaining therapy settings.
DESIGN:
Retrospective analysis of the Korean Hypothermia Network Pro registry.
SETTING:
Multicenter ICU.
PATIENTS:
Adult (? 18 yr) comatose out-of-hospital cardiac arrest survivors who underwent targeted temperature management at 33-36°C between October 2015 and December 2018.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
We measured the time from the end of rewarming to awakening, defined as a total Glasgow Coma Scale score greater than or equal to 9 or Glasgow Coma Scale motor score equals to 6. The primary outcome was awakening time. The secondary outcome was 6-month neurologic outcomes (poor outcome: Cerebral Performance Category 3-5). Among 1,145 out-of-hospital cardiac arrest survivors, 477 patients (41.7%) regained consciousness 30 hours (6-71 hr) later, and 116 patients (24.3%) awakened late (72 hr after the end of rewarming). Young age, witnessed arrest, shockable rhythm, cardiac etiology, shorter time to return of spontaneous circulation, lower serum lactate level, absence of seizures, and multisedative requirement were associated with awakening. Of the 477 who woke up, 74 (15.5%) had poor neurologic outcomes. Older age, liver cirrhosis, nonshockable rhythm, noncardiac etiology, a higher Sequential Organ Failure Assessment score, and higher serum lactate levels were associated with poor neurologic outcomes. Late awakeners were more common in the poor than in the good neurologic outcome group (38/74 [51.4%] vs 78/403 [19.4%]; p
CONCLUSIONS:
Late awakening after out-of-hospital cardiac arrest was common in no withdrawal of life-sustaining therapy settings and the probability of awakening decreased over time.
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
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[Myocardial Infarction and resuscitation of an adolescent: consequences of an unexplained disease].
Ned Tijdschr Geneeskd2021 Aug;165():. doi: D5368.
de Jong Jaap Jan D, Slenter Roel H J, van Lierop Pieter, Wagenaar Lodewijk J,
Abstract
BACKGROUND:
Morbus Kawasaki is defined by unexplained fever combined with at least 4 out of 5 classic symptoms: bilateral conjunctivitis, polymorphic exanthema, strawberry tongue and red swollen lips, extremity changes and cervical lymphadenopathy. However, these symptoms do not always occur completely or simultaneously.
CASE DESCRIPTION:
An 18-year old man was admitted after an out of hospital cardiac arrest caused by an occluded aneurysmatic LAD, which was treated with a percutanious coronary intervention. Coronary angiogram however also revealed coronary aneurysms of all coronaries, identifying an episode of unexplained fever and vasculitis 4 years prior as Morbus Kawasaki.
CONCLUSION:
Echocardiogram, CTA and MRA can reveal coronary malformations and thus identify M. Kawasaki when there is an incomplete M. Kawasaki. An early diagnosis and treatment with high dose aspirin and intravenous immunoglobulines is essential to reduce the risk of cardiovascular complications later in life.
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The predictive value of high-sensitive troponin I for perioperative risk in patients undergoing gastrointestinal tumor surgery.
EClinicalMedicine2021 Oct;40():101128. doi: 10.1016/j.eclinm.2021.101128.
Zhang Yitao, Xue Jiaojie, Zhou Ling, Si Jinhong, Cheng Shiyao, Cheng Kanglin, Yu Shuqi, Ouyang Mao, Chen Zhichong, Chen Daici, Zeng Weijie,
Abstract
Background:
The incidence of cardiovascular events in perioperative period of gastrointestinal tumor surgery cannot be ignored, and studies have shown that level of postoperative troponin is related to the postoperative risk of non-cardiac surgery. However, the relationship between pre-operative troponin levels and perioperative risk of gastrointestinal tumor surgery is unclear. Thus, we aimed to evaluate the value of high-sensitive cardiac troponin I (hs-cTnI) prior to gastrointestinal tumor surgery for perioperative risk assessment.
Methods:
In this retrospective cohort study, 1259 patients who underwent gastrointestinal tumor surgery and had been tested for hs-cTnI on admission within 7 days prior to surgery were retrospectively recruited from January 2018 to June 2020. The primary combined endpoint including in-hospital all-cause mortality, acute myocardial infarction, cardiac arrest or ventricular fibrillation and acute decompensated heart failure. The secondary endpoint included total hospital stay and requirement of intensive care treatment.
Findings:
Compared with patients with normal hs-cTnI, those with elevated hs-cTnI (> 0·028 ng/ml) were more likely to experience the combined endpoint (28·2% 2·7%, 0·028 ng/ml was associated with significantly higher cardiovascular event rate in patients with the revised cardiac index ? 1. The positive likelihood ratio of hs-cTnI (> 0·028 ng/ml) for predicting combined endpoint reaches 10.5 in patients with Lee index = 0. In multivariate logistic analyses, hs-cTnI was one of the best predictors for the combined endpoint [odds ratio (OR) 5·924 (95%CI: 2·869-12·233),
Interpretation:
Hs-cTnI provides powerful prognostic information for patients undergoing gastrointestinal tumor surgery, and therefore provides reliable prognostic information incremental to revised cardiac index.
© 2021 The Authors.
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Calcinosis Cutis as an Unsuspecting Complication of Hyperkalemia Treatment.
Cureus2021 Aug;13(8):e17018. doi: 10.7759/cureus.17018.
Gresham Lauren N, Alallaf Jwan, Shah Jignesh,
Abstract
Calcinosis cutis is a known but rare complication from the extravasation of intravenous calcium preparations. Calcium gluconate is a commonly used medication to prevent cardiac arrhythmias in the setting of hyperkalemia and cardiac arrest during resuscitation and life support. Extravasation of calcium gluconate may result in skin necrosis and a bullous reaction in its most severe form, which should be promptly recognized so that treatment can be provided. Pediatric patients are more susceptible to this caustic effect while cases in adults are rare. We report the case of a patient who developed bullous skin lesions with skin necrosis and eschar formation after receiving intravenous calcium gluconate for the treatment of hyperkalemia. The patient required an extensive hospital stay and multiple surgical interventions. This case demonstrates that common medications such as calcium gluconate can lead to significant adverse effects that can be mitigated with proper administration and appropriate education about adverse events.
Copyright © 2021, Gresham et al.
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Emergency Medical Services (EMS) Calls During COVID-19: Early Lessons Learned for Systems Planning (A Narrative Review).
Open Access Emerg Med2021 ;13():407-414. doi: 10.2147/OAEM.S324568.
Al Amiry Alaa, Maguire Brian J,
Abstract
Background:
Over the course of the COVID-19 progress, reports from many locations around the world indicated major increases in EMS call volume, which imposed great pressure on EMS dispatch centers (EMSDC) globally. No studies yet have been done to examine this phenomenon.
Objective:
This paper examines the interrelated effects of the unprecedented global increase of EMS call, the effect of the COVID-19 crisis on responding to non-COVID-19 emergencies, and the concurrent effects of having overwhelmed dispatch centers. It tries to explain the current evidence of the bottleneck of EMS calls during the early phase of the worldwide pandemic.
Eligibility Criteria:
We examine the numbers of EMS calls internationally between March and June 2020, derived from published literature and news media. Only articles in English were selected, with certain keywords related to EMS calls, ambulance delay, stroke and cardiac arrest.
Source of Evidence:
Google Scholar was the main searching source.
Results:
After applying the selection criteria, a total of 29 citations were chosen, and a pattern of knowledge resulted in the emergence of five themes: EMS calls during COVID-19, Reduced EMS operator response time, Ambulance response delays, Collateral mortality and morbidity among non-COVID-19 cases, and Total ambulance call time.
Conclusion:
Over the course of COVID-19 progress, there was a global phenomenon of exponential increases in EMS calls, which is expected to impose a great pressure on EMS dispatch centers. Several factors contributing to the bottleneck of EMS calls are identified and explained.
© 2021 Al Amiry and Maguire.
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Unique clinical features and long term follow up of survivors of sudden cardiac death in an Asian multicenter study.
Sci Rep2021 Sep;11(1):18250. doi: 10.1038/s41598-021-95975-8.
Huang Pang-Shuo, Cheng Jen-Fang, Ko Wen-Chin, Chang Shu-Hsuan, Lin Tin-Tse, Chen Jien-Jiun, Chiu Fu-Chun, Lin Lian-Yu, Lai Ling-Ping, Lin Jiunn-Lee, Tsai Chia-Ti,
Abstract
There has been no long-term clinical follow-up data of survivors or victims of sudden cardiac death (SCD). The Taiwan multi-center sudden arrhythmia death syndrome follow-up and clinical study (TFS-SADS) is a collaborative multi-center study with median follow-up time 43 months. In this cohort, the clinical characteristics of these SADS patients were compared with those with ischemic heart disease (IHD). In this SCD cohort, around half (42%) were patients with IHD, which was different from Caucasian SCD cohorts. Among those with normal heart, most had Brugada syndrome (BrS). Compared to those with SADS, patients with IHD were older, more males and more comorbidities, more arrhythmic death, and lower left ventricular ejection fraction. In the long-term follow-up, patients with SADS had a better survival than those with IHD (p?0.001). In the Cox regression analysis to identify the independent predictors of mortality, older age, lower LVEF, prior myocardial infarction and history of out-of-hospital cardiac arrest were associated with higher mortality and beta blocker use and idiopathic ventricular fibrillation or tachycardia (IVF/IVT) with a better survival during follow-up. History of prior MI was associated with more arrhythmic death. Several distinct features of SCD were found in the Asia-Pacific region, such as higher proportion of SADS, poorer prognosis of LQTS and better prognosis of IVF/IVT. Patients with SADS had a better survival than those with IHD. For those with SADS, patients with channelopathy had a better survival than those with cardiomyopathy.
© 2021. The Author(s).
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Risk of out-of-hospital cardiac arrest among sepsis survivors in Taiwan: analysis of a nationwide population-based cohort.
BMJ Open2021 Sep;11(9):e051502. doi: 10.1136/bmjopen-2021-051502.
Hsu Wan-Ting, Sherrod Charles Fox, Tehrani Babak, Papaila Alexa, Porta Lorenzo, Hsu Tzu-Chun, Sheng Wang-Huei, Lee Chien-Chang,
Abstract
OBJECTIVES:
There is minimal literature examining the association of sepsis with out-of-hospital cardiac arrest (OHCA). Using a large national database, we aimed to quantify the risk of OHCA among sepsis patients after hospital discharge.
DESIGN:
Population-based cohort study.
SETTING:
Nationwide sepsis cohort retrieved from the National Health Insurance Research Database of Taiwan between 2000 and 2013.
PARTICIPANTS:
We included 17?304 patients with sepsis. After hospital discharge, 144 patients developed OHCA within 30 days and 640 between days 31 and 365.
PRIMARY AND SECONDARY OUTCOME MEASURES:
The main outcomes were OHCA events following hospital discharge for sepsis. To evaluate the independent association between sepsis and OHCA after a sepsis hospitalisation, we constructed two non-sepsis comparison cohorts using risk set sampling and propensity score matching techniques (non-infection cohort, non-sepsis infection cohort). We plotted the daily number and daily risk of OHCA within 1?year of hospital discharge between sepsis and matched non-sepsis cohorts. We used Cox regression to evaluate the risk of early and late OHCA, comparing sepsis to non-sepsis patients.
RESULTS:
Compared with non-infected patients, sepsis patients had a higher rate of early (HR 1.66, 95%?CI: 1.27 to 2.16) and late (HR 1.19, 95%?CI: 1.06 to 1.33) OHCA events. This association was independent of age, sex or cardiovascular history. Compared with non-sepsis patients with infections, sepsis patients had a higher rate of both early (HR 1.28, 95%?CI: 1.00 to 1.63) and late (HR 1.13, 95%?CI: 1.01 to 1.27) OHCA events, especially among patients with cardiovascular disease (OR 1.35, 95%?CI: 1.01 to 1.81).
CONCLUSIONS:
Sepsis patients had increased risk of OHCA compared with matched non-sepsis controls, which lasted up to 1?year after hospital discharge.
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Contemporary outcomes of aortic arch hypoplasia and coarctation repair in a tertiary paediatric cardiac surgery centre.
Cardiol Young2021 Sep;():1-6. doi: 10.1017/S1047951121003747.
Ashry Amr, Harky Amer, Tarmahomed Abdulla, Ugwu Christopher, Mohammed Heba M, Kutty Ramesh, Lotto Attilio, Guerrero Rafael, Dhannapuneni Ramana,
Abstract
OBJECTIVES:
There are several studies reporting the outcomes of hypoplastic aortic arch and aortic coarctation repair with combination of techniques. However, only few studies reported of aortic arch and coarctation repair using a homograft patch through sternotomy and circulatory arrest with retrograde cerebral perfusion. We report our experience and outcomes of this cohort of neonates and infants.
METHODS:
We performed retrospective data collection for all neonates and infants who underwent aortic arch reconstruction between 2015 and 2020 at our institute. Data are presented as median and inter-quartile range (IQR).
RESULTS:
The cohort included 76 patients: 49 were males (64.5%). Median age at operation was 16 days (IQR 9-43.25 days). Median weight was 3.5 kg (IQR 3.10-4 kg). There was no 30 days mortality. Three patients died in hospital after 30 days (3.95%), neurological adverse events occurred in only one patient (1.32%) and recurrent laryngeal nerve injury was noted in four patients (5.26%). Only three patients required the support of extracorporeal membrane oxygenation (ECMO) with a median ECMO run of 4 days. Median follow-up was 35 months (IQR 18.9-46.4 months); 5 years survival was 93.42% (n = 71). The rate of re-intervention on the aortic arch was 9.21% (n = 7).
CONCLUSION:
Our experience shows excellent outcomes in repairing aortic arch hypoplasia with homograft patch under moderate to deep hypothermia with low in-hospital and 5 years mortality rates.
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Incidence, Mechanism, and Outcomes of On-Plane Versus Off-Plane Cardiac Arrest in Air Travelers.
J Am Heart Assoc2021 Sep;():e021360. doi: 10.1161/JAHA.120.021360.
Chatterjee Neal A, Kume Kosuke, Drucker Christopher, Kudenchuk Peter J, Rea Thomas D,
Abstract
Background Air travel affords an opportunity to evaluate resuscitation performance and outcome in a setting where automated external defibrillators (AEDs) are readily available. Methods and Results The study cohort included people aged ?18 years with out of hospital cardiac arrest (OHCA) traveling through Seattle-Tacoma International Airport between January 1, 2004 and December 31, 2019 treated by emergency medical services (EMS). The primary outcomes were pre-EMS therapies (cardiopulmonary resuscitation, application of AED), return of spontaneous circulation, and survival to hospital discharge. Over the 16-year study period, there were 143 OHCA occurring before EMS arrival, 34 (24%) on-plane and 109 (76%) off-plane. Cardiac etiology (81%) was the most common mechanism of arrest. The majority of arrests were bystander-witnessed and presented with a shockable rhythm; these characteristics were more common in off-plane OHCA compared with on-plane (witnessed: 89% versus 74% and shockable: 72% versus 50%). Pre-EMS therapies including cardiopulmonary resuscitation and AED application were common regardless of arrest location. Compared with on-plane OHCA, off-plane OHCA was associated with greater rates of return of spontaneous circulation (68% versus 44%) and 3-fold higher rate of survival to hospital discharge (44% versus 15%). All survivors of on-plane OHCA had AED application with defibrillation before EMS arrival. Conclusions When applied to air travel volumes, we estimate 350 air travel-associated OHCA occur in the United States and 2000 OHCA worldwide each year, nearly a quarter of which happen on-plane. These events are survivable when early arrest interventions including rapid arrest recognition, AED application, and CPR are deployed.
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The Comparison of Emergency Medical Service Responses to and Outcomes of Out-of-hospital Cardiac Arrest before and during the COVID-19 Pandemic in an Area of Korea.
J Korean Med Sci2021 Sep;36(36):e255. doi: 10.3346/jkms.2021.36.e255.
Lim Daesung, Park Song Yi, Choi Byungho, Kim Sun Hyu, Ryu Ji Ho, Kim Yong Hwan, Sung Ae Jin, Bae Byung Kwan, Kim Han Byeol,
Abstract
BACKGROUND:
Since the declaration of the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 has affected the responses of emergency medical service (EMS) systems to cases of out-of-hospital cardiac arrest (OHCA). The purpose of this study was to identify the impact of the COVID-19 pandemic on EMS responses to and outcomes of adult OHCA in an area of South Korea.
METHODS:
This was a retrospective observational study of adult OHCA patients attended by EMS providers comparing the EMS responses to and outcomes of adult OHCA during the COVID-19 pandemic to those during the pre-COVID-19 period. Propensity score matching was used to compare the survival rates, and logistic regression analysis was used to assess the impact of the COVID-19 pandemic on the survival of OHCA patients.
RESULTS:
A total of 891 patients in the pre-COVID-19 group and 1,063 patients in the COVID-19 group were included in the final analysis. During the COVID-19 period, the EMS call time was shifted to a later time period (16:00-24:00,
CONCLUSION:
During the COVID-19 period, there were significant changes in the EMS responses to OHCA. These changes are considered to be partly due to social distancing measures. As a result, the proportion of patients with an initial shockable rhythm in the COVID-19 period was greater than that in the pre-COVID-19 period, but the final survival rate and favorable neurological outcome were lower.
© 2021 The Korean Academy of Medical Sciences.
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Modified double nasopharyngeal airway used with a double lumen connector: A case report.
Paediatr Anaesth2021 Sep;():. doi: 10.1111/pan.14296.
Dogra Neeti, Sharma Arun, Sidhu Bharti,
Abstract
The pediatric difficult intubation (PeDI) registry gave us one very important insight; the most common severe complication during difficult endotracheal intubation is cardiac arrest (2%) which was preceded in all cases by hypoxemia (8-15%). The apparent implication of this finding is that every pediatric anesthesiologist must consider oxygenation before and during successive intubation attempts.
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Myocardial extracellular volume by T1 mapping: a new marker of arrhythmia in mitral valve prolapse.
J Cardiovasc Magn Reson2021 Sep;23(1):102. doi: 10.1186/s12968-021-00797-2.
Pavon Anna Giulia, Arangalage Dimitri, Pascale Patrizio, Hugelshofer Sarah, Rutz Tobias, Porretta Alessandra Pia, Le Bloa Mathieu, Muller Olivier, Pruvot Etienne, Schwitter Juerg, Monney Pierre,
Abstract
OBJECTIVES:
We aimed to evaluate the relationship between mitral annular disjunction (MAD) severity and myocardial interstitial fibrosis at the left ventricular (LV) base in patients with mitral valve prolapse (MVP), and to assess the association between severity of interstitial fibrosis and the occurrence of ventricular arrhythmic events.
BACKGROUND:
In MVP, MAD has been associated with myocardial replacement fibrosis and arrhythmia, but the importance of interstitial fibrosis remains unknown.
METHODS:
In this retrospective study, 30 patients with MVP and MAD (MVP-MAD) underwent cardiovascular magnetic resonance (CMR) with assessment of MAD length, late gadolinium enhancement (LGE), and basal segments myocardial extracellular volume (ECVsyn). The control group included 14 patients with mitral regurgitation (MR) but no MAD (MR-NoMAD) and 10 patients with normal CMR (NoMR-NoMAD). Fifteen MVP-MAD patients underwent 24 h-Holter monitoring.
RESULTS:
LGE was observed in 47% of MVP-MAD patients and was absent in all controls. ECVsyn was higher in MVP-MAD (30?±?3% vs 24?±?3% MR-NoMAD, p?0.001 and vs 24?±?2% NoMR-NoMAD, p?0.001), even in MVP-MAD patients without LGE (29?±?3% vs 24?±?3%, p?0.001 and vs 24?±?2%, p?0.001, respectively). MAD length correlated with ECVsyn (rho?=?0.61, p?0.001), but not with LGE extent. Four patients had history of out-of-hospital cardiac arrest; LGE and ECVsyn were equally performant to identify those high-risk patients, area under the receiver operating characteristic (ROC) curve 0.81 vs 0.83, p?=?0.84). Among patients with Holter, 87% had complex ventricular arrhythmia. ECVsyn was above the cut-off value in all while only 53% had LGE.
CONCLUSION:
Increase in ECVsyn, a marker of interstitial fibrosis, occurs in MVP-MAD even in the absence of LGE, and was correlated with MAD length and increased risk of out-of-hospital cardiac arrest. ECV should be includedin the CMR examination of MVP patients in an effort to better assess fibrous remodelling as it may provide additional value beyond the assessment of LGE in the arrhythmic risk stratification.
© 2021. The Author(s).
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Association of the duration of on-scene advanced life support with good neurological recovery in out-of-hospital cardiac arrest.
Am J Emerg Med2021 Sep;50():486-491. doi: S0735-6757(21)00741-5.
Jang Dong-Hyun, Jo You Hwan, Park Seung Min, Lee Kui Ja, Kim Yu Jin, Lee Dong Keon,
Abstract
BACKGROUND:
As advanced life support (ALS) provided by emergency medical services (EMS) on scene becomes more common, the scene time interval (STI) for which EMS providers stay on scene tends to lengthen. We investigated the relationship between the STI and neurological outcome of patients at hospital discharge when ALS was provided by EMS on scene.
METHODS:
We conducted a retrospective analysis of prospectively collected out-of-hospital cardiac arrest (OHCA) data between August 2015 and December 2018. A restricted cubic spline curve was used to investigate the relationship between the STI and neurologic outcome, and patients were divided into two groups based on the cut-off value obtained through receiver operating characteristic (ROC) analysis. Comparisons of outcomes between the two groups were performed before and after propensity score matching.
RESULTS:
4548 patients were included in the analysis. In ROC analysis, the optimal cut-off value for STI was 19 min. For the group with an STI
CONCLUSIONS:
A duration of on-scene ALS more than 19 min was associated with a poor neurologic outcome of patients at hospital discharge in OHCA.
Copyright © 2021. Published by Elsevier Inc.
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Prevalence and clinical outcomes of myocarditis and pericarditis in 718,365 COVID-19 patients.
Eur J Clin Invest2021 Sep;():e13679. doi: 10.1111/eci.13679.
Buckley Benjamin J R, Harrison Stephanie L, Fazio-Eynullayeva Elnara, Underhill Paula, Lane Deirdre A, Lip Gregory Y H,
Abstract
BACKGROUND:
COVID-19 has a wide spectrum of cardiovascular sequelae including myocarditis and pericarditis; however, the prevalence and clinical impact is unclear. We investigated the prevalence of new-onset myocarditis/pericarditis and associated adverse cardiovascular events in patients with COVID-19.
METHODS AND RESULTS:
A retrospective cohort study was conducted using electronic medical records from a global federated health research network. Patients were included based on a diagnosis of COVID-19 and new-onset myocarditis or pericarditis. Patients with COVID-19 and myocarditis/pericarditis were 1:1 propensity score matched for age, sex, race and co-morbidities to patients with COVID-19 but without myocarditis/pericarditis. The outcomes of interest were 6-month all-cause mortality, hospitalisation, cardiac arrest, incident heart failure, incident atrial fibrillation, and acute myocardial infarction, comparing patients with and without myocarditis/pericarditis. Of 718,365 patients with COVID-19, 35,820 (5.0%) developed new onset myocarditis and 10,706 (1.5%) developed new onset pericarditis. Six-month all-cause mortality was 3.9% (n=702) in patients with myocarditis and 2.9% (n=523) in matched controls (P
CONCLUSIONS:
Patients with COVID-19 who present with myocarditis/pericarditis associate with increased odds of major adverse events and new-onset cardiovascular sequelae.
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Preclinical short QT syndrome models: studying the phenotype and drug-screening.
Europace2021 Sep;():. doi: euab214.
Fan Xuehui, Yang Guoqiang, Kowitz Jacqueline, Duru Firat, Saguner Ardan M, Akin Ibrahim, Zhou Xiaobo, El-Battrawy Ibrahim,
Abstract
Cardiovascular diseases are the main cause of sudden cardiac death (SCD) in developed and developing countries. Inherited cardiac channelopathies are linked to 5-10% of SCDs, mainly in the young. Short QT syndrome (SQTS) is a rare inherited channelopathy, which leads to both atrial and ventricular tachyarrhythmias, syncope, and even SCD. International European Society of Cardiology guidelines include as diagnostic criteria: (i) QTc ? 340 ms on electrocardiogram, (ii) QTc ? 360 ms plus one of the follwing, an affected short QT syndrome pathogenic gene mutation, or family history of SQTS, or aborted cardiac arrest, or family history of cardiac arrest in the young. However, further evaluation of the QTc ranges seems to be required, which might be possible by assembling large short QT cohorts and considering genetic screening of the newly described pathogenic mutations. Since the mechanisms underlying the arrhythmogenesis of SQTS is unclear, optimal therapy for SQTS is still lacking. The disease is rare, unclear genotype-phenotype correlations exist in a bevy of cases and the absence of an international short QT registry limit studies on the pathophysiological mechanisms of arrhythmogenesis and therapy of SQTS. This leads to the necessity of experimental models or platforms for studying SQTS. Here, we focus on reviewing preclinical SQTS models and platforms such as animal models, heterologous expression systems, human-induced pluripotent stem cell-derived cardiomyocyte models and computer models as well as three-dimensional engineered heart tissues. We discuss their usefulness for SQTS studies to examine genotype-phenotype associations, uncover disease mechanisms and test drugs. These models might be helpful for providing novel insights into the exact pathophysiological mechanisms of this channelopathy and may offer opportunities to improve the diagnosis and treatment of patients with SQT syndrome.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
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Impact of left ventricular unloading using a peripheral Impella®-pump in eCPR patients.
Artif Organs2021 Sep;():. doi: 10.1111/aor.14067.
Gaisendrees Christopher, Djordjevic Ilija, Sabashnikov Anton, Adler Christopher, Eghbalzadeh Kaveh, Ivanov Borko, Walter Sebastian, Schlachtenberger Georg, Merkle Julia, Gerfer Stephen, Carstens Henning, Deppe Antje-Christin, Kuhn Elmar, Wahlers Thorsten,
Abstract
OBJECTIVES:
Extracorporeal cardiopulmonary resuscitation (eCPR) is a rapidly growing treatment strategy due to increasing survival rates in selected patients. Additional left ventricular mechanical unloading, using a transfemoral micro-axial blood pump (Impella® Denver, Massachusetts, USA), might improve patients' outcomes. In this regard, we sought to investigate patients who suffered OHCA (out-of hospital cardiac arrest) or IHCA (in-hospital cardiac arrest) with subsequent eCPR (extracorporeal cardiopulmonary resuscitation) via VA-ECMO (veno-arterial extracorporeal membrane oxygenation) and concomitant Impella® implantation based on survival and feasibility of ECMO weaning.
METHODS:
From January 2016 until December 2020, 108 patients underwent eCPR at our institution. Data prior to eCPR and early outcome parameters were analyzed comparing patients who were supported with an additional Impella® (2.5 or CP) (ECMO+Impella®, n= 18) and patients without additional (ECMO, n=90) support during V-A ECMO therapy. The primary endpoint was in-hospital mortality; secondary endpoints were, amongst others: ECMO-explantation, need for hemodialysis, stroke, and need for blood transfusions.
RESULTS:
Low-flow time was significantly lower in the ECMO+Impella group (60 min vs. 55 min, p=0.01). All-cause mortality was significantly lower in the ECMO+Impella® group (82% vs. 56%, p= 0.01). The time of circulatory support was shorter in the ECMO cohort (2.0±1.73 vs. 4.76±2.88 p=0.05). ECMO decannulation was significantly more feasible in patients with ECMO+Impella® (72% vs. 32%, p =0.01). Patients treated with additional Impella® showed significantly more acute kidney injury (AKI) with the need for dialysis (72% vs. 18%, p=
CONCLUSION:
Concomitant Impella® support might positively influence survival and ECMO weaning in eCPR patients. Treatment-associated complications such as the need for dialysis were more common in this highly selected patient group. Further studies with larger numbers are necessary to evaluate the clinical relevance of concomitant LV-unloading in eCPR patients using an Impella® device.
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Predicting the Mortality and Readmission of In-Hospital Cardiac Arrest Patients With Electronic Health Records: A Machine Learning Approach.
J Med Internet Res2021 Sep;23(9):e27798. doi: 10.2196/27798.
Chi Chien-Yu, Ao Shuang, Winkler Adrian, Fu Kuan-Chun, Xu Jie, Ho Yi-Lwun, Huang Chien-Hua, Soltani Rohollah,
Abstract
BACKGROUND:
In-hospital cardiac arrest (IHCA) is associated with high mortality and health care costs in the recovery phase. Predicting adverse outcome events, including readmission, improves the chance for appropriate interventions and reduces health care costs. However, studies related to the early prediction of adverse events of IHCA survivors are rare. Therefore, we used a deep learning model for prediction in this study.
OBJECTIVE:
This study aimed to demonstrate that with the proper data set and learning strategies, we can predict the 30-day mortality and readmission of IHCA survivors based on their historical claims.
METHODS:
National Health Insurance Research Database claims data, including 168,693 patients who had experienced IHCA at least once and 1,569,478 clinical records, were obtained to generate a data set for outcome prediction. We predicted the 30-day mortality/readmission after each current record (ALL-mortality/ALL-readmission) and 30-day mortality/readmission after IHCA (cardiac arrest [CA]-mortality/CA-readmission). We developed a hierarchical vectorizer (HVec) deep learning model to extract patients' information and predict mortality and readmission. To embed the textual medical concepts of the clinical records into our deep learning model, we used Text2Node to compute the distributed representations of all medical concept codes as a 128-dimensional vector. Along with the patient's demographic information, our novel HVec model generated embedding vectors to hierarchically describe the health status at the record-level and patient-level. Multitask learning involving two main tasks and auxiliary tasks was proposed. As CA-mortality and CA-readmission were rare, person upsampling of patients with CA and weighting of CA records were used to improve prediction performance.
RESULTS:
With the multitask learning setting in the model learning process, we achieved an area under the receiver operating characteristic of 0.752 for CA-mortality, 0.711 for ALL-mortality, 0.852 for CA-readmission, and 0.889 for ALL-readmission. The area under the receiver operating characteristic was improved to 0.808 for CA-mortality and 0.862 for CA-readmission after solving the extremely imbalanced issue for CA-mortality/CA-readmission by upsampling and weighting.
CONCLUSIONS:
This study demonstrated the potential of predicting future outcomes for IHCA survivors by machine learning. The results showed that our proposed approach could effectively alleviate data imbalance problems and train a better model for outcome prediction.
©Chien-Yu Chi, Shuang Ao, Adrian Winkler, Kuan-Chun Fu, Jie Xu, Yi-Lwun Ho, Chien-Hua Huang, Rohollah Soltani. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 13.09.2021.
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