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Pubblicazioni recenti - cardiac arrest
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Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements.
J Pers Med2023 Feb;13(3):. doi: 381.
Vargas Roth A A, Moscatelli Marco, Vaz de Lima Marcos, Ramírez León Jorge Felipe, Lorio Morgan P, Fiorelli Rossano Kepler Alvim, Telfeian Albert E, Fiallos John, Braxton Ernest, Song Michael, Lewandrowski Kai-Uwe,
Abstract
: Seizures, neurological deficits, bradycardia, and, in the worst cases, cardiac arrest may occur following incidental durotomy during routine lumbar endoscopy. Therefore, we set out to measure the intraoperative epidural pressure during lumbar endoscopic decompression surgery. : We conducted a retrospective observational cohort study to obtain intraoperative epidural measurements with an epidural catheter-pressure transducer assembly through the spinal endoscope on 15 patients who underwent lumbar endoscopic decompression of symptomatic lumbar herniated discs and spinal stenosis. The endoscopic interlaminar technique was employed. : There were six (40.0%) female and nine (60.0%) male patients aged 49.0667 ± 11.31034, ranging from 36 to 72 years, with an average follow-up of 35.15 ± 12.48 months. Three of the fifteen patients had seizures with durotomy and one of these three had intracranial air on their postoperative brain CT. Another patient developed spinal headaches and diplopia on postoperative day one when her deteriorating neurological function was investigated with a brain computed tomography (CT) scan, showing an intraventricular hemorrhage consistent with a Fisher Grade IV subarachnoid hemorrhage. A CT angiogram did not show any abnormalities. Pressure recordings in the epidural space in nine patients ranged from 20 to 29 mm Hg with a mean of 24.33 mm Hg. : Most incidental durotomies encountered during lumbar interlaminar endoscopy can be managed without formal repair and supportive care measures. The intradural spread of irrigation fluid and intraoperatively used drugs and air entrapment through an unrecognized durotomy should be suspected if patients deteriorate in the recovery room. Ascending paralysis may cause nausea, vomiting, upper and lower motor neuron symptoms, cranial nerve palsies, hypotension, bradycardia, and respiratory and cardiac arrest. The recovery team should be prepared to manage these complications.
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Unusual Evolution of Hypertrophic Cardiomyopathy in Non-Compaction Myocardium in a Pompe Disease Patient.
J Clin Med2023 Mar;12(6):. doi: 2365.
Gragnaniello Vincenza, Rizzardi Caterina, Commone Anna, Gueraldi Daniela, Maines Evelina, Salviati Leonardo, Di Salvo Giovanni, Burlina Alberto B,
Abstract
Classic infantile Pompe disease is characterized by a severe phenotype with cardiomyopathy and hypotonia. Cardiomyopathy is generally hypertrophic and rapidly regresses after enzyme replacement therapy. In this report, for the first time, we describe a patient with infantile Pompe disease and hypertrophic cardiomyopathy that evolved into non-compaction myocardium after treatment. The male newborn had suffered since birth with hypertrophic cardiomyopathy and heart failure. He was treated with standard enzyme replacement therapy (ERT) (alglucosidase alfa) and several immunomodulation cycles due to the development of anti-ERT antibodies, without resolution of the hypertrophic cardiomyopathy. At the age of 2.5 years, he was treated with a new combination of ERT therapy (cipaglucosidase alfa) and a chaperone (miglustat) for compassionate use. After 1 year, the cardiac hypertrophy was resolved, but it evolved into non-compaction myocardium. Non-compaction cardiomyopathy is often considered to be a congenital, primitive cardiomyopathy, due to an arrest of compaction of the myocardium wall during the embryonal development. Several genetic causes have been identified. We first describe cardiac remodeling from hypertrophic cardiomyopathy to a non-compaction form in a patient with infantile Pompe disease treated with a new ERT. This has important implications both for the monitoring of Pompe disease patients and for the understanding of the pathophysiological basis of non-compaction myocardium.
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A Soccer Shot with Lengthy Consequences-Case Report & Current Literature Review of Commotio Cordis.
J Clin Med2023 Mar;12(6):. doi: 2323.
Spitaler Philipp, Stühlinger Markus, Adukauskaite Agne, Bauer Axel, Dichtl Wolfgang,
Abstract
(1) Background: Commotio cordis, caused by objects being directly delivered to the chest, may cause cardiac arrest in young athletes, even without identifiable structural damage to the sternum, ribs or heart itself. Its prevention and management often remain suboptimal, resulting in dismal outcomes. (2) Case summary: A 32-year semi-professional goalkeeper suffered from a non-penetrating blunt thoracic trauma after being struck by a high-velocity shot during a regional league soccer game. He immediately lost consciousness, collapsed, and was successfully resuscitated through early defibrillation of ventricular fibrillation. After an uneventful follow-up for approximately 6 years, recurrent episodes of ventricular tachycardia occurred, which could ultimately only be prevented by epicardial ablation. (3) Conclusion: Very late recurrences of ventricular tachyarrhythmias may occur after ventricular fibrillation due to blunt chest trauma, even in the primary absence of evident structural myocardial damage.
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Artificial Intelligence in Resuscitation: A Scoping Review.
J Clin Med2023 Mar;12(6):. doi: 2254.
Viderman Dmitriy, Abdildin Yerkin G, Batkuldinova Kamila, Badenes Rafael, Bilotta Federico,
Abstract
INTRODUCTION:
Cardiac arrest is a significant cause of premature mortality and severe disability. Despite the death rate steadily decreasing over the previous decade, only 22% of survivors achieve good clinical status and only 25% of patients survive until their discharge from the hospital. The objective of this scoping review was to review relevant AI modalities and the main potential applications of AI in resuscitation.
METHODS:
We conducted the literature search for related studies in PubMed, EMBASE, and Google Scholar. We included peer-reviewed publications and articles in the press, pooling and characterizing the data by their model types, goals, and benefits.
RESULTS:
After identifying 268 original studies, we chose 59 original studies (reporting 1,817,419 patients) to include in the qualitative synthesis. AI-based methods appear to be superior to traditional methods in achieving high-level performance.
CONCLUSION:
AI might be useful in predicting cardiac arrest, heart rhythm disorders, and post-cardiac arrest outcomes, as well as in the delivery of drone-delivered defibrillators and notification of dispatchers. AI-powered technologies could be valuable assistants to continuously track patient conditions. Healthcare professionals should assist in the research and development of AI-powered technologies as well as their implementation into clinical practice.
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One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials.
J Clin Med2023 Mar;12(6):. doi: 2235.
Penna Alessio, Magliocca Aurora, Merigo Giulia, Stirparo Giuseppe, Silvestri Ivan, Fumagalli Francesca, Ristagno Giuseppe,
Abstract
Cardiac arrest, one of the leading causes of death, accounts for numerous clinical studies published each year. This review summarizes the findings of all the randomized controlled clinical trials (RCT) on cardiac arrest published in the year 2022. The RCTs are presented according to the following categories: out-of- and in-hospital cardiac arrest (OHCA, IHCA) and post-cardiac arrest care. Interestingly, more than 80% of the RCTs encompassed advanced life support and post-cardiac arrest care, while no studies focused on the treatment of IHCA, except for one that, however, explored the temperature control after resuscitation in this population. Surprisingly, 9 out of 11 RCTs led to neutral results demonstrating equivalency between the newly tested interventions compared to current practice. One trial was negative, showing that oxygen titration in the immediate pre-hospital post-resuscitation period decreased survival compared to a more liberal approach. One RCT was positive and introduced new defibrillation strategies for refractory cardiac arrest. Overall, data from the 2022 RCTs discussed here provide a solid basis to generate new hypotheses to be tested in future clinical studies.
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Association of Major Adverse Cardiac Events and Beta-Blockers in Patients with and without Atherosclerotic Cardiovascular Disease: Long-Term Follow-Up Results of the T-SPARCLE and T-PPARCLE Registry in Taiwan.
J Clin Med2023 Mar;12(6):. doi: 2162.
Liu Patrick Yan-Tyng, Lin Fang-Ju, Yeh Chih-Fan, Hsiao Yu-Chung, Hsuan Chin-Feng, Chang Wei-Tien, Kao Hsien-Li, Jeng Jiann-Shing, Wu Yen-Wen, Hsieh I-Chang, Fang Ching-Chang, Wang Kuo-Yang, Chang Kuan-Cheng, Lin Tsung-Hsien, Sheu Wayne Huey-Herng, Li Yi-Heng, Yin Wei-Hsian, Yeh Hung-I, Chen Jaw-Wen, Wu Chau-Chung, ,
Abstract
Beta-blockers are widely used, but the benefit is now challenged in patients at risk of atherosclerotic cardiovascular disease (ASCVD) in the present coronary reperfusion era. We aimed to identify the risk factors of a major adverse cardiac event (MACE) and the long-term effect of beta-blockers in two large cohorts in Taiwan. Two prospective observational cohorts, including patients with known atherosclerosis cardiovascular disease (T-SPARCLE) and patients with at least one risk factor of ASCVD but without clinically evident ASCVD (T-PPARCLE), were conducted in Taiwan. The primary endpoint is the time of first occurrence of a MACE (cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, and cardiac arrest with resuscitation). Between December 2009 and November 2014, with a median 2.4 years follow-up, 11,747 eligible patients (6921 and 4826 in T-SPARCLE and T-PPARCLE, respectively) were enrolled. Among them, 273 patients (2.3%) met the primary endpoint. With multivariate Cox PH model analysis, usage of beta-blocker was lower in patients with MACE (42.9% vs. 52.4%,
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Association of Hyperkalemia and Hypokalemia with Patient Characteristics and Clinical Outcomes in Japanese Hemodialysis (HD) Patients.
J Clin Med2023 Mar;12(6):. doi: 2115.
Iwagami Masao, Kanemura Yuka, Morita Naru, Yajima Toshitaka, Fukagawa Masafumi, Kobayashi Shuzo,
Abstract
This study aimed to examine the characteristics and clinical outcomes of Japanese hemodialysis patients with dyskalemia. A retrospective study was conducted using a large Japanese hospital group database. Outpatients undergoing thrice-a-week maintenance hemodialysis were stratified into hyperkalemia, hypokalemia, and normokalemia groups based on their pre-dialysis serum potassium (sK) levels during the three-month baseline period. Baseline characteristics of the three groups were described and compared for the following outcomes during follow-up: all-cause mortality, all-cause hospitalization, major adverse cardiovascular events (MACE), cardiac arrest, fatal arrythmia, and death related to arrhythmia. The study included 2846 eligible patients, of which 67% were men with a mean age of 65.65 (SD: 12.63) years. When compared with the normokalemia group ( = 1624, 57.06%), patients in the hypokalemia group ( = 313, 11.00%) were older and suffered from malnutrition, whereas patients in the hyperkalemia group ( = 909, 31.94%) had longer dialysis vintage. The hazard ratios for all-cause mortality and MACE in the hypokalemia group were 1.47 (95% confidence interval [CI], 1.13-1.92) and 1.48 (95% CI, 1.17-1.86), respectively, whereas that of death related to arrhythmia in the hyperkalemia group was 3.11 (95% CI, 1.03-9.33). Thus, dyskalemia in maintenance hemodialysis patients was associated with adverse outcomes, suggesting the importance of optimized sK levels.
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Brain Hypothermia Therapy and Targeted Temperature Management for Acute Encephalopathy in Children: Status and Prospects.
J Clin Med2023 Mar;12(6):. doi: 2095.
Imataka George, Fujita Yuji, Kikuchi Jin, Wake Koji, Ono Kazuyuki, Yoshihara Shigemi,
Abstract
In adult intensive care, brain hypothermia therapy (BHT) was reported to be effective in neuroprotection after resuscitation and cardiac arrest. By contrast, in neonatal intensive care, the pathophysiology of brain damage caused by hypoxic-ischemic encephalopathy (HIE) is attributed to circulatory disturbances resulting from ischemia/reperfusion, for which neonatal brain cryotherapy is used. The , 2010, recommends cerebral cryotherapy for HIE associated with severe neonatal pseudoparenchyma death. The usefulness of BHT for neuroprotection in infants and children, especially in pediatric acute encephalopathy, is expected. Theoretically, BHT could be useful in basic medical science and animal experiments. However, there are limitations in clinical planning for treating pediatric acute encephalopathy. No international collaborative study has been conducted, and no clinical evidence exists for neuroprotection using BHT. In this review, we will discuss the pathogenesis of neuronal damage in hypoxic and hypoperfused brains; the history of BHT, its effects, and mechanisms of action; the success of BHT; cooling and monitoring methods of BHT; adverse reactions to BHT; literature on BHT. We will review the latest literature on targeted temperature management, which is used for maintaining and controlling body temperature in adults in intensive care. Finally, we will discuss the development of BHT and targeted temperature management as treatments for pediatric acute encephalopathy.
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Prenatal Detection of a Deletion in a Fetus with ACDMPV and Hydronephrosis.
Genes (Basel)2023 Feb;14(3):. doi: 563.
Bzd?ga Katarzyna, Kutkowska-Ka?mierczak Anna, Deutsch Gail H, Plaskota Izabela, Smyk Marta, Niemiec Magdalena, Barczyk Artur, Obersztyn Ewa, Modzelewski Jan, Lipska Iwona, Stankiewicz Pawe?, Gajecka Marzena, Rydzanicz Ma?gorzata, P?oski Rafa?, Szczapa Tomasz, Karolak Justyna A,
Abstract
Alveolar capillary dysplasia with misalignment of pulmonary veins (ACDMPV) is a lethal lung developmental disorder caused by the arrest of fetal lung formation, resulting in neonatal death due to acute respiratory failure and pulmonary arterial hypertension. Heterozygous single-nucleotide variants or copy-number variant (CNV) deletions involving the gene and/or its lung-specific enhancer are found in the vast majority of ACDMPV patients. ACDMPV is often accompanied by extrapulmonary malformations, including the gastrointestinal, cardiac, or genitourinary systems. Thus far, most of the described ACDMPV patients have been diagnosed post mortem, based on histologic evaluation of the lung tissue and/or genetic testing. Here, we report a case of a prenatally detected de novo CNV deletion (~0.74 Mb) involving the gene in a fetus with ACDMPV and hydronephrosis. Since ACDMPV is challenging to detect by ultrasound examination, the more widespread implementation of prenatal genetic testing can facilitate early diagnosis, improve appropriate genetic counselling, and further management.
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Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs.
Children (Basel)2023 Mar;10(3):. doi: 575.
Sankaran Deepika, Giusto Evan M, Lesneski Amy L, Hardie Morgan E, Joudi Houssam M, Lane Emily C A, Hammitt Victoria L, Tully Kirstie C, Vali Payam, Lakshminrusimha Satyan,
Abstract
The combination of perinatal acidemia with postnatal hyperoxia is associated with a higher incidence of hypoxic-ischemic encephalopathy (HIE) in newborn infants. In neonatal cardiac arrest, current International Liaison Committee on Resuscitation (ILCOR) and Neonatal Resuscitation Program (NRP) guidelines recommend increasing inspired O to 100% during chest compressions (CC). Following the return of spontaneous circulation (ROSC), gradual weaning from 100% O based on pulse oximetry (SpO) can be associated with hyperoxia and risk for cerebral tissue injury owing to oxidative stress. We hypothesize that compared to gradual weaning from 100% O with titration based on preductal SpO, abrupt or rapid weaning of inspired O to 21% after ROSC or use of 21% O during CC followed by upward titration of inspired O to achieve target SpO after ROSC will limit hyperoxia after ROSC. Nineteen lambs were randomized before delivery and asphyxial arrest was induced by umbilical cord occlusion. There was no difference in oxygenation during chest compressions between the three groups. Gradual weaning of inspired O from 100% O after ROSC resulted in supraphysiological PaO and higher cerebral oxygen delivery compared to 21% O during CC or 100% O during CC followed by abrupt weaning to 21% O after ROSC. The use of 21% O during CC was associated with very low PaO after ROSC and higher brain tissue lactic acid compared to other groups. Our findings support the current recommendations to use 100% O during CC and additionally suggest the benefit of abrupt decrease in inspired oxygen to 21% O after ROSC. Clinical studies are warranted to investigate optimal oxygen titration after chest compressions and ROSC during neonatal resuscitation.
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The Effect of Early Application of Synthetic Peptides 19-2.5 and 19-4LF to Improve Survival and Neurological Outcome in a Mouse Model of Cardiac Arrest and Resuscitation.
Biomedicines2023 Mar;11(3):. doi: 855.
Bajorat Rika, Danckert Lena, Ebert Florian, Bancken Theresa, Bergt Stefan, Klawitter Felix, Vollmar Brigitte, Reuter Daniel A, Schürholz Tobias, Ehler Johannes,
Abstract
The synthetic antimicrobial peptides (sAMPs) Pep19-2.5 and Pep19-4LF have been shown in vitro and in vivo to reduce the release of pro-inflammatory cytokines, leading to the suppression of inflammation and immunomodulation. We hypothesized that intervention with Pep19-2.5 and Pep19-4LF immediately after cardiac arrest and resuscitation (CA-CPR) might attenuate immediate systemic inflammation, survival, and long-term outcomes in a standardized mouse model of CA-CPR. Long-term outcomes up to 28 days were assessed between a control group (saline) and two peptide intervention groups. Primarily, survival as well as neurological and cognitive parameters were assessed. In addition, systemic inflammatory molecules and specific biomarkers were analyzed in plasma as well as in brain tissue. Treatment with sAMPs did not provide any short- or long-term benefits for either survival or neurological outcomes, and no significant benefit on inflammation in the CA-CPR animal model. While no difference was found in the plasma analysis of early cytokines between the intervention groups four hours after resuscitation, a significant increase in UCH-L1, a biomarker of neuronal damage and blood-brain barrier rupture, was measured in the Pep19-4LF-treated group. The theoretical benefit of both sAMPs tested here for the treatment of post-cardiac arrest syndrome could not be proven.
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Cannabinoid Receptor Agonist WIN55, 212-2 Attenuates Injury in the Hippocampus of Rats after Deep Hypothermic Circulatory Arrest.
Brain Sci2023 Mar;13(3):. doi: 525.
Yu Ming-Huan, Yang Qin, Zhang You-Peng, Wang Jia-Hui, Zhang Ren-Jian-Zhi, Liu Zhi-Gang, Liu Xiao-Cheng,
Abstract
OBJECTIVES:
Postoperative neurological deficits remain a challenge in cardiac surgery employing deep hypothermic circulatory arrest (DHCA). This study aimed to investigate the effect of WIN55, 212-2, a cannabinoid agonist, on brain injury in a rat model of DHCA.
METHODS:
Twenty-four male Sprague Dawley rats were randomly divided into three groups: a control group (which underwent cardiopulmonary bypass (CPB) only), a DHCA group (CPB with DHCA), and a WIN group (WIN55, 212-2 pretreatment before CPB with DHCA). Histopathological changes in the brain were evaluated by hematoxylin-eosin staining. Plasma levels of superoxide dismutase (SOD) and proinflammatory cytokines including interleukin (IL)-1?, IL-6, and tumor necrosis factor-alpha (TNF-a) were determined using an enzyme-linked immunosorbent assay (ELISA). The expression of SOD in the hippocampus was detected by Western blot and immunofluorescence staining. Levels of apoptotic-related protein caspase-3 and type 1 cannabinoid receptor (CB1R) in the hippocampus were evaluated by Western blot.
RESULTS:
WIN55, 212-2 administration attenuated histopathological injury of the hippocampus in rats undergoing DHCA, associated with lowered levels of IL-1?, IL-6, and TNF-? (
CONCLUSIONS:
the administration of WIN55, 212-2 alleviates hippocampal injury induced by DHCA in rats by regulating intrinsic inflammatory and oxidative stress responses through a CB1R-dependent mechanism.
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Effect of location on out-of-hospital cardiac arrests involving older adults in Hong Kong: secondary analysis of a territory-wide cohort.
Hong Kong Med J2023 Mar;():. doi: 10.12809/hkmj209140.
Wong R T M,
Abstract
INTRODUCTION:
Most out-of-hospital cardiac arrests in Hong Kong involve older adults. The likelihood of survival varies among locations. This study investigated patient and bystander characteristics, as well as the timing of interventions, that affect the prevalences of shockable rhythm and survival outcomes among cardiac arrests involving older adults in homes, on streets, and in other public places.
METHODS:
This secondary analysis of a territory-wide historical cohort used data collected by the Fire Services Department of Hong Kong from 1 August 2012 to 31 July 2013.
RESULTS:
Bystander cardiopulmonary resuscitation was primarily performed by relatives in homes but not in non-residential locations. The intervals in terms of receipt of emergency medical services (EMS) call, initiation of bystander cardiopulmonary resuscitation, and receipt of defibrillation were longer for cardiac arrests that occurred in homes. The median interval for EMS to reach patients was 3 minutes longer in homes than on streets (P
CONCLUSION:
There were significant location-related differences in patient and bystander characteristics, interventions, and outcomes among cardiac arrests involving older adults. A large proportion of patients had a shockable rhythm in the early period after cardiac arrest. Good survival outcomes in out-of-hospital cardiac arrests involving older adults can be achieved through early bystander defibrillation and intervention.
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Amplitude Spectrum Area of ventricular fibrillation to guide defibrillation: a small open-label, pseudo-randomized controlled multicenter trial.
EBioMedicine2023 Mar;90():104544. doi: 10.1016/j.ebiom.2023.104544.
Ruggeri Laura, Fumagalli Francesca, Bernasconi Filippo, Semeraro Federico, Meessen Jennifer M T A, Blanda Adriana, Migliari Maurizio, Magliocca Aurora, Gordini Giovanni, Fumagalli Roberto, Sechi Giuseppe, Pesenti Antonio, Skrifvars Markus B, Li Yongqin, Latini Roberto, Wik Lars, Ristagno Giuseppe,
Abstract
BACKGROUND:
Ventricular fibrillation (VF) waveform analysis has been proposed as a potential non-invasive guide to optimize timing of defibrillation.
METHODS:
The AMplitude Spectrum Area (AMSA) trial is an open-label, multicenter randomized controlled study reporting the first in-human use of AMSA analysis in out-of-hospital cardiac arrest (OHCA). The primary efficacy endpoint was the termination of VF for an AMSA ? 15.5 mV-Hz. Adult shockable OHCAs randomly received either an AMSA-guided cardiopulmonary resuscitation (CPR) or a standard-CPR. Randomization and allocation to trial group were carried out centrally. In the AMSA-guided CPR, an initial AMSA ? 15.5 mV-Hz prompted for immediate defibrillation, while lower values favored chest compression (CC). After completion of the first 2-min CPR cycle, an AMSA
FINDINGS:
The trial was early discontinued for low recruitment due to the COVID-19 pandemics. A total of 31 patients were recruited in 3 Italian cities, 19 in AMSA-CPR and 12 in standard-CPR, and included in the data analysis. No difference in primary outcome was observed between the two groups. Termination of VF occurred in 74% of patients in the AMSA-CPR compared to 75% in the standard CPR (OR 0.93 [95% CI 0.18-4.90]). No adverse events were reported.
INTERPRETATION:
AMSA was used prospectively in human patients during ongoing CPR. In this small trial, an AMSA-guided defibrillation provided no evidence of an improvement in termination of VF.
TRIAL REGISTRATION:
NCT03237910.
FUNDING:
European Commission - Horizon 2020; ZOLL Medical Corp., Chelmsford, USA (unrestricted grant); Italian Ministry of Health - Current research IRCCS.
Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.
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Risperidone Administration Attenuates Renal Ischemia and Reperfusion Injury following Cardiac Arrest by Antiinflammatory Effects in Rats.
Vet Sci2023 Feb;10(3):. doi: 184.
Kim Yang Hee, Lee Tae-Kyeong, Lee Jae-Chul, Kim Dae Won, Tae Hyun-Jin, Park Joon Ha, Ahn Ji Hyeon, Lee Choong-Hyun, Won Moo-Ho, Hong Seongkweon,
Abstract
Multi-organ dysfunction following cardiac arrest is associated with poor outcome as well as high mortality. The kidney, one of major organs in the body, is susceptible to ischemia and reperfusion; however, there are few studies on renal ischemia and reperfusion injury (IRI) following the return of spontaneous circulation (ROSC) after cardiac arrest. Risperidone, an atypical antipsychotic drug, has been discovered to have some beneficial effects beyond its original effectiveness. Therefore, the aim of the present study was to investigate possible therapeutic effects of risperidone on renal IRI following cardiac arrest. Rats were subjected to cardiac arrest induced by asphyxia for five minutes followed by ROSC. When serum biochemical analyses were examined, the levels of serum blood urea nitrogen, creatinine, and lactate dehydrogenase were dramatically increased after cardiac arrest, but they were significantly reduced by risperidone administration. Histopathology was examined using hematoxylin and eosin staining. Histopathological injury induced by cardiac arrest was apparently attenuated by risperidone administration. Furthermore, alterations in pro-inflammatory cytokines (interleukin-6 and tumor necrosis factor-?) and anti-inflammatory cytokines (interleukin-4 and interleukin-13) were examined by immunohistochemistry. Pro-inflammatory and anti-inflammatory cytokine immunoreactivities were gradually and markedly increased and decreased, respectively, in the kidneys following cardiac arrest; however, risperidone administration after cardiac arrest significantly attenuated the increased pro-inflammatory cytokine immunoreactivities and the decreased anti-inflammatory cytokine immunoreactivities. Collectively, our current results revealed that, in rats, risperidone administration after cardiac arrest protected kidneys from IRI induced by cardiac arrest and ROSC through anti-inflammatory effects.
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Impact of Ultrasonography on Chest Compression Fraction and Survival in Patients with Out-of-hospital Cardiac Arrest.
West J Emerg Med2023 Feb;24(2):322-330. doi: 10.5811/westjem.2023.1.58796.
Lien Wan-Ching, Chong Kah-Meng, Chang Chih-Heng, Cheng Su-Fen, Chang Wei-Tien, Ma Matthew Hwei-Ming, Chen Wen-Jone,
Abstract
INTRODUCTION:
Whether ultrasonography (US) contributes to delays in chest compressions and hence a negative impact on survival is uncertain. In this study we aimed to investigate the impact of US on chest compression fraction (CCF) and patient survival.
METHODS:
We retrospectively analyzed video recordings of the resuscitation process in a convenience sample of adult patients with non-traumatic, out-of-hospital cardiac arrest. Patients receiving US once or more during resuscitation were categorized as the US group, while the patients who did not receive US were categorized as the non-US group. The primary outcome was CCF, and the secondary outcomes were the rates of return of spontaneous circulation (ROSC), survival to admission and discharge, and survival to discharge with a favorable neurological outcome between the two groups. We also evaluated the individual pause duration and the percentage of prolonged pauses associated with US.
RESULTS:
A total of 236 patients with 3,386 pauses were included. Of these patients, 190 received US and 284 pauses were related to US. Longer resuscitation duration was observed in the US group (median, 30.3 vs 9.7 minutes, P<.001 the us group had comparable ccf vs p="0.29)" with non-us group. although a better rate of rosc rates survival to admission discharge and favorable neurological outcome did not differ between two groups. pause duration pulse checks was longer than alone seconds percentage prolonged pauses similar groups>
CONCLUSION:
When compared to the non-ultrasound group, patients receiving US had comparable chest compression fractions and rates of survival to admission and discharge, and survival to discharge with a favorable neurological outcome. The individual pause was lengthened related to US. However, patients without US had a shorter resuscitation duration and a better rate of ROSC. The trend toward poorer results in the US group was possibly due to confounding variables and nonprobability sampling. It should be better investigated in further randomized studies.
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Evaluation of Use of Epinephrine and Time to First Dose and Outcomes in Pediatric Patients With Out-of-Hospital Cardiac Arrest.
JAMA Netw Open2023 Mar;6(3):e235187. doi: 10.1001/jamanetworkopen.2023.5187.
Amoako Jeffrey, Komukai Sho, Izawa Junichi, Callaway Clifton W, Okubo Masashi,
Abstract
IMPORTANCE:
While epinephrine has been widely used in prehospital resuscitation for pediatric patients with out-of-hospital cardiac arrest (OHCA), the benefit and optimal timing of epinephrine administration have not been fully investigated.
OBJECTIVES:
To evaluate the association between epinephrine administration and patient outcomes and to ascertain whether the timing of epinephrine administration was associated with patient outcomes after pediatric OHCA.
DESIGN, SETTING, AND PARTICIPANTS:
This cohort study included pediatric patients (
EXPOSURES:
The main exposures were prehospital intravenous or intraosseous epinephrine administration and the interval between arrival of an advanced life support (ALS)-capable EMS clinician (ALS arrival) and the first administration of epinephrine.
MAIN OUTCOMES AND MEASURES:
The primary outcome was survival to hospital discharge. Patients who received epinephrine at any given minute after ALS arrival were matched with patients who were at risk of receiving epinephrine within the same minute using time-dependent propensity scores calculated from patient demographics, arrest characteristics, and EMS interventions.
RESULTS:
Of 1032 eligible individuals (median [IQR] age, 1 [0-10] years), 625 (60.6%) were male. 765 patients (74.1%) received epinephrine and 267 (25.9%) did not. The median (IQR) time interval between ALS arrival and epinephrine administration was 9 (6.2-12.1) minutes. In the propensity score-matched cohort (1432 patients), survival to hospital discharge was higher in the epinephrine group compared with the at-risk group (epinephrine: 45 of 716 [6.3%] vs at-risk: 29 of 716 [4.1%]; risk ratio, 2.09; 95% CI, 1.29-3.40). The timing of epinephrine administration was also not associated with survival to hospital discharge after ALS arrival (P for the interaction between epinephrine administration and time to matching?=?.34).
CONCLUSIONS AND RELEVANCE:
In this study of pediatric patients with OHCA in the US and Canada, epinephrine administration was associated with survival to hospital discharge, while timing of the administration was not associated with survival.
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Persistent methicillin resistant bacteremia from an infected superior vena cava thrombus.
Future Cardiol2023 Mar;():. doi: 10.2217/fca-2023-0004.
El-Andari Ryaan, Nagendran Jayan, Aklabi Mohammed Al, Wang Wei,
Abstract
Infection is among the leading causes of mortality for patients with end-stage renal disease. The placement of catheters for hemodialysis are common culprits of infection and have been associated with the development of complications such as venous thrombosis, bacteremia and thromboembolism. Calcification of a venous thrombus is a rare complication and infection of a right-sided thrombus can result in life-threatening septicemia and embolic complications. Herein, we describe the case of a 46-year-old patient found to have a calcified superior vena cava thrombus and bacteremia refractory to antibiotic therapy requiring surgical intervention under circulatory arrest to remove the infected thrombus gaining infectious source control and preventing future complications.
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Advances in Ion Channel, Non-Desmosomal Variants and Autophagic Mechanisms Implicated in Arrhythmogenic Cardiomyopathy.
Curr Issues Mol Biol2023 Mar;45(3):2186-2200. doi: 10.3390/cimb45030141.
Li Kexin, Jiang Yufeng, Zeng Yiyao, Zhou Yafeng,
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a heterogeneous disorder characterized by the replacement of cardiac myocytes with fibro-fatty tissues, leading to abnormal excitation-contraction (EC) coupling and a range of malignant events, such as ventricular tachycardia (VT), sudden cardiac death/arrest (SCD/A) and heart failure (HF). The concept of ACM has recently been ex-tended to include right ventricular cardiomyopathy (ARVC), left ventricular cardiomyopathy (ALVC) and biventricular cardiomyopathy. ARVC is generally seen as the most common type of ACM. The pathogenesis of ACM involves mutation variants in desmosomal or non-desmosomal gene loci, as well as various external factors, such as intense exercise, stress and infections. Ion channel alterations, autophagy and non-desmosomal variants are also important components in the development of ACM. As clinical practice enters the era of precision therapy, it is important to review recent studies on these topics to better diagnose and treat the molecular phase of ACM.
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Do They Have a Choice? Surrogate Decision-Making After Severe Acute Brain Injury.
Crit Care Med2023 Mar;():. doi: 10.1097/CCM.0000000000005850.
Goss Adeline L, Voumard Rachel Rutz, Engelberg Ruth A, Curtis J Randall, Creutzfeldt Claire J,
Abstract
OBJECTIVES:
In the early phase of severe acute brain injury (SABI), surrogate decision-makers must make treatment decisions in the face of prognostic uncertainty. Evidence-based strategies to communicate uncertainty and support decision-making are lacking. Our objective was to better understand surrogate experiences and needs during the period of active decision-making in SABI, to inform interventions to support SABI patients and families and improve clinician-surrogate communication.
DESIGN:
We interviewed surrogate decision-makers during patients' acute hospitalization for SABI, as part of a larger (n = 222) prospective longitudinal cohort study of patients with SABI and their family members. Constructivist grounded theory informed data collection and analysis.
SETTING:
One U.S. academic medical center.
PATIENTS:
We iteratively collected and analyzed semistructured interviews with 22 surrogates for 19 patients.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
Through several rounds of coding, interview notes, reflexive memos, and group discussion, we developed a thematic model describing the relationship between surrogate perspectives on decision-making and surrogate experiences of prognostic uncertainty. Patients ranged from 20 to 79 years of age (mean = 55 years) and had primary diagnoses of stroke (n = 13; 68%), traumatic brain injury (n = 5; 26%), and anoxic brain injury after cardiac arrest (n = 1; 5%). Patients were predominantly male (n = 12; 63%), whereas surrogates were predominantly female (n = 13; 68%). Two distinct perspectives on decision-making emerged: one group of surrogates felt a clear sense of agency around decision-making, whereas the other group reported a more passive role in decision-making, such that they did not even perceive there being a decision to make. Surrogates in both groups identified prognostic uncertainty as the central challenge in SABI, but they managed it differently. Only surrogates who felt they were actively deciding described time-limited trials as helpful.
CONCLUSIONS:
In this qualitative study, not all surrogate "decision-makers" viewed themselves as making decisions. Nearly all struggled with prognostic uncertainty. Our findings underline the need for longitudinal prognostic communication strategies in SABI targeted at surrogates' current perspectives on decision-making.
Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
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