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Pubblicazioni recenti - cardiac arrest
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Association Between Vitamin D Deficiency and Neurologic Outcomes in Patients After Cardiopulmonary Resuscitation.
Shock2022 Jan;():. doi: 10.1097/SHK.0000000000001909.
Chae Bora, Shin Yo Sep, Kim Sang Min, Hong Seok-In, Kim Youn-Jung, Ryoo Seung Mok, Kim Won Young,
Abstract
AIM:
We investigated the association between vitamin D deficiency and neurologic outcomes after cardiopulmonary resuscitation.
METHOD:
Data from the prospective cardiac arrest registry in the emergency department between October 2019 and April 2021 were retrospectively analyzed. Blood samples were obtained during cardiopulmonary resuscitation wherein 25-hydroxyvitamin D serum levels were analyzed; deficiency was defined as levels
RESULT:
A total of 195 patients (mean age, 64.5?±?16.1?years; 135 [69.2%] men) were included. A significantly greater proportion of patients with poor outcomes had vitamin D deficiency compared with those with good outcomes (49.4% vs. 18.2%, P?=?0.001). The area under the curve for a sustained return of spontaneous circulation and 3-month poor neurologic outcomes was 0.595 (P?=?0.031) and 0.704 (P?0.001), respectively. In a multivariate analysis, vitamin D deficiency (odds ratio (OR): 10.22; 95% confidence interval (CI): 1.47-70.82, P?=?0.019), initial shockable rhythm (OR: 0.03; 95% CI: 0.00-0.84, P?=?0.040), low flow time (OR: 1.10; 95% CI: 1.03-1.16, P?=?0.003), and thrombocytopenia (OR: 10.66; 95% CI: 1.13-100.41, P?=?0.039) were significantly associated with 3-month poor neurologic outcomes.
CONCLUSION:
The prevalence of vitamin D deficiency in patients with cardiac arrest was 44% and was associated with poor neurological outcomes at 3?months.
Copyright © 2022 by the Shock Society.
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Systemic administration of dendrimer N-acetyl cysteine improves outcomes and survival following cardiac arrest.
Bioeng Transl Med2022 Jan;7(1):e10259. doi: 10.1002/btm2.10259.
Modi Hiren R, Wang Qihong, Olmstead Sarah J, Khoury Elizabeth S, Sah Nirnath, Guo Yu, Gharibani Payam, Sharma Rishi, Kannan Rangaramanujam M, Kannan Sujatha, Thakor Nitish V,
Abstract
Cardiac arrest (CA), the sudden cessation of effective cardiac pumping function, is still a major clinical problem with a high rate of early and long-term mortality. Post-cardiac arrest syndrome (PCAS) may be related to an early systemic inflammatory response leading to exaggerated and sustained neuroinflammation. Therefore, early intervention with targeted drug delivery to attenuate neuroinflammation may greatly improve therapeutic outcomes. Using a clinically relevant asphyxia CA model, we demonstrate that a single (i.p.) dose of dendrimer-N-acetylcysteine conjugate (D-NAC), can target "activated" microglial cells following CA, leading to an improvement in post-CA survival rate compared to saline (86% vs. 45%). D-NAC treatment also significantly improved gross neurological score within 4 h of treatment (?0.05) and continued to show improvement at 48?h (?0.05). Specifically, there was a substantial impairment in motor responses after CA, which was subsequently improved with D-NAC treatment (?0.05). D-NAC also mitigated hippocampal cell density loss seen post-CA in the CA1 and CA3 subregions (?0.001). These results demonstrate that early therapeutic intervention even with a single D-NAC bolus results in a robust sustainable improvement in long-term survival, short-term motor deficits, and neurological recovery. Our current work lays the groundwork for a clinically relevant therapeutic approach to treating post-CA syndrome.
© 2021 The Authors. Bioengineering & Translational Medicine published by Wiley Periodicals LLC on behalf of American Institute of Chemical Engineers.
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Successful Coil Embolization Using Percutaneous Cardiopulmonary Support in a Patient with Refractory Out-of-hospital Cardiac Arrest Caused by Aneurysmal Subarachnoid Hemorrhage.
NMC Case Rep J2021 ;8(1):393-398. doi: 10.2176/nmccrj.cr.2020-0379.
Kano Hitoshi, Takigami Masayoshi, Matsui Toshihisa, Bando Keisuke, Endo Akio, Nagama Masaki,
Abstract
In recent years, extracorporeal cardiopulmonary resuscitation (ECPR) has been reported to be an effective alternative to conventional CPR for treating patients with reversible causes of cardiac arrest. Nevertheless, the definite indication for ECPR and also surgical interventions during ECPR treatment have not been established, especially in patients with out-of-hospital cardiac arrest (OHCA) caused by subarachnoid hemorrhage (SAH). We treated a comatose 50-year-old woman with refractory cardiac arrest due to aneurysmal SAH-induced takotsubo cardiomyopathy (TCM). The initial cardiac rhythm was ventricular fibrillation. This is the first case report on coil embolization being successfully performed on a patient undergoing ECPR and therapeutic hypothermia (TH) while the patient was still in cardiac arrest, which resulted in complete social rehabilitation. Moreover, the success of this treatment suggests that ECPR and endovascular therapy should be considered for highly selected patients when cardiopulmonary and neurological functions are potentially reversible even in the setting of SAH.
© 2021 The Japan Neurosurgical Society.
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Comparison of a virtual reality compression-only Cardiopulmonary Resuscitation (CPR) course to the traditional course with content validation of the VR course - A randomized control pilot study.
Ann Med Surg (Lond)2022 Jan;73():103241. doi: 10.1016/j.amsu.2022.103241.
Hubail Dalal, Mondal Ankita, Al Jabir Ahmed, Patel Bijendra,
Abstract
Introduction:
Technology has been a major contributor to recent changes in education, where simulation plays a huge role by providing a unique safe environment, especially with the recent incorporation of immersive virtual reality (VR) training. Cardiopulmonary Resuscitation (CPR) is said to double, even triple survival from cardiac arrest, and hence it is crucial to ensure optimal acquisition and retention of these skills. In this study, we aim to compare a VR CPR teaching program to current teaching methods with content validation of the VR course.
Methods:
A randomized single-blinded simulation-based pilot study where 26 participants underwent baseline assessment of their CPR skills using a validated checklist and Laerdal QCPR®. Participants were randomly allocated and underwent their respective courses. This was followed by a final assessment and a questionnaire for content validation, knowledge and confidence. The data was analysed using STATA 16.2 to determine the standardized mean difference using paired and unpaired -test.
Results:
Subjective assessment using the checklist showed statistically significant improvement in the overall scores of both groups (traditional group mean improved from 6.92 to 9.61 0.0005, VR group from 6.61 to 8.53 0.0016). However, no statistically significant difference was noted between the final scores in both the subjective and objective assessments. As for the questionnaire, knowledge and confidence seemed to improve equally. Finally, the content validation showed statistically significant improvement in ease of use (mean score 3 to 4.23 - of 0.0144), while for content, positivity of experience, usefulness and appropriateness participants showed similar satisfaction before and after use.
Conclusion:
This pilot study suggests that VR teaching could deliver CPR skills in an attractive manner, with no inferiority in acquisition of these skills compared to traditional methods. To corroborate these findings, we suggest a follow-up study with a larger sample size after adding ventilation and Automated External Defibrillator (AED) skills to the VR course with re-examination after 3-6 months to test retention of the skills.
© 2022 The Authors.
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Diagnostic and therapeutic characteristics of diabetes mellitus and risk of out-of-hospital cardiac arrest.
Sci Rep2022 Jan;12(1):1293. doi: 10.1038/s41598-022-05390-w.
Park Jeong Ho, Ro Young Sun, Shin Sang Do, Cha Kyoung-Chul, Song Kyoung Jun, Hwang Sung Oh, ,
Abstract
This study aimed to evaluate the risks of diabetes mellitus (DM) on out-of-hospital cardiac arrest (OHCA) and to investigate whether the risks of DM on OHCA varied according to the diagnostic and therapeutic characteristics of diabetes. We conducted a multicenter prospective case-control study in 17 University hospitals in Korea from September 2017 to December 2020. Cases were EMS-treated OHCA patients aged 20 to 79 with a presumed cardiac etiology. Community-based controls were recruited at a 1:2 ratio after matching for age, sex, and urbanization level of residence. A structured questionnaire and laboratory findings were collected from cases and controls. Multivariable conditional logistic regression analyses were conducted to estimate the risk of DM on OHCA by characteristics. A total of 772 OHCA cases and 1544 community-based controls were analyzed. A total of 242 (31.3%) OHCAs and 292 (18.9%) controls were previously diagnosed with DM. The proportions of type I DM (10.7% vs. 2.1%) and insulin therapy (15.3% vs. 6.5%) were higher in OHCAs with DM than in controls with DM. The duration of DM was longer in OHCAs than in controls (median 12 vs. 7 years). DM was associated with an increased risk of OHCA (aOR (95% CI), 2.13 (1.64-2.75)). Compared to the no diabetes group, the risks of OHCA increased in the diabetes patients with type I DM (5.26 (1.72-16.08)) and type II DM group (1.63 (1.18-2.27)), a long duration of DM prevalence (1.04 (1.02-1.06) per 1-year prevalence duration), and a high HbA1c level (1.38 (1.19-1.60) per 1% increase). By treatment modality, the aOR (95% CI) was lowest in the oral hypoglycemic agent (1.47 (1.08-2.01)) and highest in the insulin (6.63 (3.04-14.44)) groups. DM was associated with an increased risk of OHCA, and the risk magnitudes varied according to the diagnostic and therapeutic characteristics.
© 2022. The Author(s).
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A machine learning approach for modeling decisions in the out of hospital cardiac arrest care workflow.
BMC Med Inform Decis Mak2022 Jan;22(1):21. doi: 10.1186/s12911-021-01730-4.
Harford Samuel, Del Rios Marina, Heinert Sara, Weber Joseph, Markul Eddie, Tataris Katie, Campbell Teri, Vanden Hoek Terry, Darabi Houshang,
Abstract
BACKGROUND:
A growing body of research has shown that machine learning (ML) can be a useful tool to predict how different variable combinations affect out-of-hospital cardiac arrest (OHCA) survival outcomes. However, there remain significant research gaps on the utilization of ML models for decision-making and their impact on survival outcomes. The purpose of this study was to develop ML models that effectively predict hospital's practice to perform coronary angiography (CA) in adult patients after OHCA and subsequent neurologic outcomes.
METHODS:
We utilized all (N?=?2398) patients treated by the Chicago Fire Department Emergency Medical Services included in the Cardiac Arrest Registry to Enhance Survival (CARES) between 2013 and 2018 who survived to hospital admission to develop, test, and analyze ML models for decisions after return of spontaneous circulation (ROSC) and patient survival. ML classification models, including the Embedded Fully Convolutional Network (EFCN) model, were compared based on their ability to predict post-ROSC decisions and survival.
RESULTS:
The EFCN classification model achieved the best results across tested ML algorithms. The area under the receiver operating characteristic curve (AUROC) for CA and Survival were 0.908 and 0.896 respectively. Through cohort analyses, our model predicts that 18.3% (CI 16.4-20.2) of patients should receive a CA that did not originally, and 30.1% (CI 28.5-31.7) of these would experience improved survival outcomes.
CONCLUSION:
ML modeling effectively predicted hospital decisions and neurologic outcomes. ML modeling may serve as a quality improvement tool to inform system level OHCA policies and treatment protocols.
© 2022. The Author(s).
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Increased weight in patients with time-sensitive diagnosis is associated with longer prehospital on-scene times.
Am J Emerg Med2022 Jan;53():236-239. doi: S0735-6757(22)00025-0.
Supples Michael W, Vaizer Julia, Liao Mark, Faris Gregory W, O'Donnell Daniel P, Glober Nancy K,
Abstract
BACKGROUND:
Obesity is a growing epidemic associated with higher rates of metabolic disease, heart disease and all-cause mortality. Heavier patients may require more advanced resources and specialized equipment. We hypothesize that increasing patient weight will be associated with longer prehospital on-scene times.
METHODS:
We reviewed electronic patient care records for patients transported by two urban 9-1-1 emergency medical services (EMS) agencies. We collected age, sex, estimated patient weight, vital signs (systolic blood pressure, heart rate, pulse oximetry), provider impression, method of moving patient to ambulance, and on-scene times. We selected patients with time-sensitive diagnoses of stroke, ST-segment elevation myocardial infarction (STEMI), and trauma and compared on-scene times for patients who weighed above or below 300 pounds. We performed descriptive statistics, Mann-Whitney U tests for continuous variables and Chi-square tests for discrete variables. We constructed a generalized linear model to determine the effect of patient weight adjusted for covariates.
RESULTS:
For a three-year period (May 1, 2018 to April 30, 2021) 48,203 patients were transported with an EMS impression of stroke, ST-segment elevation myocardial infarction (STEMI), and trauma. 23,654 (49.1%) patients were female, and the median age was 52 (IQR 34-68) years. The median weight was 175.0 (IQR 150.0-205.0) pounds. Patients above a dichotomous weight categorization of 300 pounds experienced a longer median scene time with any time-sensitive diagnosis (12.6 versus 11.9 min p
CONCLUSION:
Patient weight above 300 pounds was associated with significantly longer on-scene time. These patients were more likely to be hypoxic, sustain a cardiac arrest, and less likely to walk to the ambulance.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Cardiac Arrest Systems of Care; Shining in the Spotlight.
Resuscitation -
The epidemiology of out-of-hospital cardiac arrest in Australia and New Zealand: A binational report from the Australasian Resuscitation Outcomes Consortium (Aus-ROC).
Resuscitation2022 Jan;():. doi: S0300-9572(22)00012-0.
Bray Janet, Howell Stuart, Ball Stephen, Doan Tan, Bosley Emma, Smith Karen, Dicker Bridget, Faddy Steven, Thorrowgood Melanie, Swain Andy, Thomas Andrew, Wilson Alexander, Shipp Carol, Walker Tony, Bailey Paul, Finn Judith, ,
Abstract
INTRODUCTION:
The Australasian Resuscitation Outcomes Consortium (Aus-ROC) out-of-hospital cardiac arrest (OHCA) Epistry (Epidemiological Registry) now covers 100% of Australia and New Zealand (NZ). This study reports and compares the Utstein demographics, arrest characteristics and outcomes of OHCA patients across our region.
METHODS:
We included all OHCA cases throughout 2019 as submitted to the Epistry by the eight Australian and two NZ emergency medical services (EMS). We calculated crude and age-standardised incidence rates and performed a national and EMS regional comparison.
RESULTS:
We obtained data for 31,778 OHCA cases for 2019: 26,637 in Australia and 5,141 in NZ. Crude incidence was 107.9 per 100,000 person-years in Australia and 103.2/100,000 in NZ. Overall, the majority of OHCAs occurred in adults (96%), males (66%), private residences (76%), were unwitnessed (63%), of presumed medical aetiology (83%), and had an initial monitored rhythm of asystole (64%). In non-EMS-witnessed cases, 38% received bystander CPR and 2% received public defibrillation. Wide variation was seen between EMS regions for all OHCA demographics, arrest characteristics and outcomes. In patients who received an EMS-attempted resuscitation (13,664/31,778): 28% (range across EMS=13.1% to 36.7%) had return of spontaneous circulation (ROSC) at hospital arrival and 13% (range across EMS=9.9% to 20.7%) survived to hospital discharge/30-days. Survival in the Utstein comparator group (bystander-witnessed in shockable rhythm) varied across the EMS regions between 27.4% to 42.0%.
CONCLUSION:
OHCA across Australia and NZ has varied incidence, characteristics and survival. Understanding the variation in survival and modifiable predictors is key to informing strategies to improve outcomes.
Copyright © 2022 Elsevier B.V. All rights reserved.
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Resuscitation highlights in 2021.
Resuscitation2022 Jan;():. doi: S0300-9572(22)00016-8.
Nolan J P, Ornato J P, Parr M J A, Perkins G D, Soar J,
Abstract
BACKGROUND:
This review is the latest in a series of regular annual reviews undertaken by the editors and aims to highlight some of the key papers published in Resuscitation during 2021.
METHODS:
Hand-searching by the editors of all papers published in Resuscitation during 2021. Papers were selected based on then general interest and novelty and were categorised into themes.
RESULTS:
98 papers were selected for brief mention.
CONCLUSIONS:
Resuscitation science continues to evolve and incorporates all links in the chain of survival.
Copyright © 2022. Published by Elsevier B.V.
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Out-of-Hospital Cardiac Arrests Terminated without full Resuscitation Attempts: Characteristics and Regional Variability.
Resuscitation2022 Jan;():. doi: S0300-9572(22)00014-4.
Hutton Gillian, Kawano Takahisa, Scheuermeyer Frank X, Panchal Ashish R, Asamoah-Boaheng Michael, Christenson Jim, Grunau Brian,
Abstract
BACKGROUND:
Out-of-hospital cardiac arrest (OHCA) investigations may elect to exclude cases with resuscitation terminated for reasons other than a full resuscitative attempt. We sought to examine characteristics of these cases and regional variability in classification.
METHODS:
Using the North American Resuscitation Outcomes Consortium Epistry, we included adult emergency medical services (EMS)-treated cases, examining the rationale ("futility", do-not resuscitate (DNR) order, "verbal directive", or "obvious death") and timing of resuscitation termination, and the timing of ROSC among hospital-discharge survivors. We tested regional variability in EMS patient arrival-to-termination intervals with one-way ANOVA.
RESULTS:
Of 63,554 included cases, 27,232 were declared dead in the prehospital setting: (1) 23,009 (36%) for futility (after a median of 24 minutes (IQR 19-31) of professional resuscitation); (2) 1622 (2.6%) for a DNR order (at 6.3 minutes [IQR 3.0-11]); (3) 1018 (1.6%) for a verbal directive (at 12 minutes [IQR 7.0-17]); and, (4) 1583 (2.5%) for obvious death (at 5.4 minutes [IQR 3.0-9.0]). The EMS patient arrival-to-ROSC interval among hospital-discharge survivors was 7.7 (3.8 - 13) minutes. Among regions, 0.20-12% and 0.20-5.3% were terminated to due to obvious death or verbal directives, respectively. There were significant regional differences in the EMS patient arrival-to-termination interval for futility (p
CONCLUSION:
There is significant variation in the rationale and interval until termination of resuscitation between regions. Cases terminated due to obvious death or DNR orders/verbal directives often are treated with similar durations of resuscitation as survivors. These data highlight a considerable risk of bias in between-region comparisons or observational analyses.
Copyright © 2022 Elsevier B.V. All rights reserved.
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Dispatcher-assisted CPR for cardiac arrest in children - conventional versus compression-only CPR.
Resuscitation2022 Jan;():. doi: S0300-9572(22)00013-2.
Maconochie Ian, Thompson Neil,
Abstract
This study should that conventional CPR outcomes in Cerebral Performance Category was achieved at 1 month post resuscitation. There was no difference in those with an initial shockable rhythm, requiring CPR for 20 minutes before hospital arrival, public defibrillation, advanced airway care or epinephrine administration. However, survival rates in paediatric CPR is low. Ways in which to improve the outcomes are suggested which included bystander CPR, teaching and training of dispatchers and additional technologies.
Copyright © 2022. Published by Elsevier B.V.
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Validation of cardiogenic shock phenotypes in a mixed cardiac intensive care unit population.
Catheter Cardiovasc Interv2022 Jan;():. doi: 10.1002/ccd.30103.
Jentzer Jacob C, Soussi Sabri, Lawler Patrick R, Kennedy Jason N, Kashani Kianoush B,
Abstract
BACKGROUND:
Proposed phenotypes have recently been identified in cardiogenic shock (CS) populations using unsupervised machine learning clustering methods. We sought to validate these phenotypes in a mixed cardiac intensive care unit (CICU) population of patients with CS.
METHODS:
We included Mayo Clinic CICU patients admitted from 2007 to 2018 with CS. Agnostic K means clustering was used to assign patients to three clusters based on admission values of estimated glomerular filtration rate, bicarbonate, alanine aminotransferase, lactate, platelets, and white blood cell count. In-hospital mortality and 1-year mortality were analyzed using logistic regression and Cox proportional-hazards models, respectively.
RESULTS:
We included 1498 CS patients with a mean age of 67.8?±?13.9 years, and 37.1% were females. The acute coronary syndrome was present in 57.3%, and cardiac arrest was present in 34.0%. Patients were assigned to clusters as follows: Cluster 1 (noncongested), 603 (40.2%); Cluster 2 (cardiorenal), 452 (30.2%); and Cluster 3 (hemometabolic), 443 (29.6%). Clinical, laboratory, and echocardiographic characteristics differed across clusters, with the greatest illness severity in Cluster 3. Cluster assignment was associated with in-hospital mortality across subgroups. In-hospital mortality was higher in Cluster 3 (adjusted odds ratio [OR]: 2.6 vs. Cluster 1 and adjusted OR: 2.0 vs. Cluster 2, both p?0.001). Adjusted 1-year mortality was incrementally higher in Cluster 3 versus Cluster 2 versus Cluster 1 (all p?0.01).
CONCLUSIONS:
We observed similar phenotypes in CICU patients with CS as previously reported, identifying a gradient in both in-hospital and 1-year mortality by cluster. Identifying these clinical phenotypes can improve mortality risk stratification for CS patients beyond standard measures.
© 2022 Wiley Periodicals LLC.
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Neural oscillations track recovery of consciousness in acute traumatic brain injury patients.
Hum Brain Mapp2022 Jan;():. doi: 10.1002/hbm.25725.
Frohlich Joel, Crone Julia S, Johnson Micah A, Lutkenhoff Evan S, Spivak Norman M, Dell'Italia John, Hipp Joerg F, Shrestha Vikesh, Ruiz Tejeda Jesús E, Real Courtney, Vespa Paul M, Monti Martin M,
Abstract
Electroencephalography (EEG), easily deployed at the bedside, is an attractive modality for deriving quantitative biomarkers of prognosis and differential diagnosis in severe brain injury and disorders of consciousness (DOC). Prior work by Schiff has identified four dynamic regimes of progressive recovery of consciousness defined by the presence or absence of thalamically-driven EEG oscillations. These four predefined categories (ABCD model) relate, on a theoretical level, to thalamocortical integrity and, on an empirical level, to behavioral outcome in patients with cardiac arrest coma etiologies. However, whether this theory-based stratification of patients might be useful as a diagnostic biomarker in DOC and measurably linked to thalamocortical dysfunction remains unknown. In this work, we relate the reemergence of thalamically-driven EEG oscillations to behavioral recovery from traumatic brain injury (TBI) in a cohort of N = 38 acute patients with moderate-to-severe TBI and an average of 1?week of EEG recorded per patient. We analyzed an average of 3.4 hr of EEG per patient, sampled to coincide with 30-min periods of maximal behavioral arousal. Our work tests and supports the ABCD model, showing that it outperforms a data-driven clustering approach and may perform equally well compared to a more parsimonious categorization. Additionally, in a subset of patients (N = 11), we correlated EEG findings with functional magnetic resonance imaging (fMRI) connectivity between nodes in the mesocircuit-which has been theoretically implicated by Schiff in DOC-and report a trend-level relationship that warrants further investigation in larger studies.
© 2021 The Authors. Human Brain Mapping published by Wiley Periodicals LLC.
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Unforeseen rupture of pseudoaneurysm of common carotid artery: An arduous anesthetic challenge.
Ann Card Anaesth;25(1):119-122. doi: 10.4103/aca.aca_257_20.
Das Devishree, Chauhan Sandeeep, Das Sambhunath, Praveen P,
Abstract
Pseudoaneurysm of the common carotid artery (CCA) is exceptionally unstable and unpredictable; it mandates quick medical attention in order to circumvent neurologic sequelae or hemorrhage. Unanticipated rupture is extremely lethal and a potential provocation for the anesthesia caregiver. It is an arduous challenge for an anesthetist to establish emergency airway when a huge bleeding pseudoaneurysm is compressing and deviating the trachea, securing invasive lines in collapsing vessels, volume and vasopressor resuscitation in deteriorating hemodynamics in order to maintain cerebral perfusion without compromising other vital organs, arranging huge amount of blood and blood products in a short span of time, and transferring an exsanguinating patient for the rapid institution of cardiopulmonary bypass. Not only preoperatively it also necessitates appropriate neuromonitoring and neuroprotection during and after surgery. The association of unforeseen rupture of common carotid artery pseudoaneurysm secondary to the tubercular spine and lifesaving management by the rapid institution of cardiopulmonary bypass (CPB) is a rare occasion. To the best of the authors' knowledge, there is not any similar case in the peer-reviewed literature. Therefore, the authors enumerate the clinical experience of an unexpected rupture of CCA pseudoaneurysm requiring lifesaving CPB and emphasize the "Timely Teamed Effort Approach" that can sustain a life in such an inevitable situation.
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Extracorporeal cardiopulmonary resuscitation for an out-of-hospital cardiac arrest.
Ann Card Anaesth;25(1):73-76. doi: 10.4103/aca.aca_308_20.
Nair Suresh G, Abraham Jobin, Varghese Johnson, Nair Manoj P, Varma Raja Shekar,
Abstract
Extra corporeal membrane oxygenation (ECMO) for refractory out-of-hospital cardiac arrest (OHCA) has been shown to improve outcome in many Western countries. There are no reports of ECMO being used to support OHCA in India till date. We report a case of a young man who developed cardiac arrest (CA) while driving and was given bystander cardiac massage. He was brought to tertiary care center where an ECMO was utilized for refractory CA. The patient subsequently underwent emergency coronary artery stenting and was weaned off ECMO and ventilation. We discuss the case and highlight the role of bystander cardiopulmonary resuscitation.
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Clinical outcomes of del nido cardioplegia and st thomas blood cardioplegia in neonatal congenital heart surgery.
Ann Card Anaesth;25(1):54-60. doi: 10.4103/aca.aca_220_20.
Mohammed Sameer, Menon Sabarinath, Gadhinglajkar Shrinivas V, Baruah Sudip D, Ramanan Soumya V, Gopalakrishnan K Arun, Suneel P R, Dharan Baiju S,
Abstract
Objectives:
Cardioplegia is essential for adequate myocardial protection. There continues to remain ambiguity regarding the ideal cardioplegia for adequate myocardial protection in congenital heart surgery. This study compares clinical outcomes using St Thomas II solution and Del Nido cardioplegia in neonates undergoing cardiac surgery.
Methods:
All neonates (
Results:
Two groups were similar in age, gender, pre-operative diagnosis, and risk category. Cardiopulmonary bypass (CPB) time (P = 0.002), aortic cross-clamp (ACC) time (P = 0.018), and the number of doses of cardioplegia (P
Conclusion:
When compared to St. Thomas solution, the use of Del Nido cardioplegia solution in neonates is associated with a significant decrease in CPB and ACC times and VIS in the first 24 h after surgery. The choice of cardioplegia (St Thomas/Del Nido) in neonates does not affect early mortality and early postoperative clinical outcomes.
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Time Limiting Boundaries of Reversible Clinical Death in Rats Subjected to Ultra-Deep Hypothermia.
Ann Card Anaesth;25(1):41-47. doi: 10.4103/aca.ACA_189_20.
Gagarinskiy Evgeniy L, Averin Aleksey S, Uteshev Viktor K, Sherbakov Pavel V, Telpuhov Vladimir I, Shvirst Nikolay E, Karpova Yulya A, Gurin Artem E, Varlachev Aleksandr V, Kovtun Anatoliy L, Fesenko Eugeny E,
Abstract
Background:
It is well known that body temperature maintenance between 20 and 35°C prevents hypoxic damage. However, data regarding the ideal duration and permissible temperature boundaries for ultra-deep hypothermia below 20°C are rather fragmentary. The aim of the present study was to determine the time limits of reversible clinical death in rats subjected to ultra-deep hypothermia at 1-8°C.
Results:
Rat survival rates were directly dependent on the duration of clinical death. If clinical death did not exceed 35 min, animal viability could be restored. Extending the duration of clinical death longer than 45 min led to rat death, and cardiac functioning in these animals was not recovered. The rewarming rate and the lowest temperature of hypothermia experienced did not directly influence survival rates.
Conclusions:
In a rat model, reversible ultra-deep hypothermia as low as 1-8°C could be achieved without the application of hypercapnia or pharmacological support. The survival of animals was dependent on the duration of clinical death, which should not exceed 35 min.
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Incidence of cardiac complications following COVID-19 infection: An umbrella meta-analysis study.
Heart Lung2022 Jan;52():136-145. doi: S0147-9563(22)00001-2.
Jafari-Oori Mehdi, Moradian Seyed Tayeb, Ebadi Abbas, Jafari Mojtaba, Dehi Manijeh,
Abstract
BACKGROUND:
COVID-19 causes fatal cardiac damages. Despite many overwhelming meta-analysis related to cardiac complications following COVID-19 disease, no umbrella meta-analysis study has been conducted.
OBJECTIVES:
We aimed to report the summarized pooled incidences of cardiac complications in the overall, critically ill, and deceased patients, compare the cardiac complications between the severe/non-severe or deceased/non-deceased patients, and also compare poor outcomes between patients with/without acute myocardial injury (AMI).
METHODS:
PubMed, Scopus, web of science, Cochrane, ProQuest, Springer, Sage journals were searched before April 2021. After assessing the quality and duplicate data, data were run by the random/fixed-effect models, I2 heterogeneity index, Egger's test, and sensitivity analysis.
RESULTS:
After removing duplicate data, in the overall COVID-19 patients, the pooled incidence of AMI, heart failure, arrhythmia, cardiac arrest, and acute coronary syndrome (ACS) were 21%, 14%, 16%, 3.46%, and 1.3%, respectively. In the patients with severe disease, the pooled incidence of AMI and shock were 33 and 35%, respectively. Similarly, in the deceased COVID-19 patients, the pooled incidence rate of AMI and arrhythmia were 56% and 47.5%, respectively. The patients with severe disease were at higher risk of AMI (RR = 5.27) and shock (OR = 20.18) compared with the non-severe cases. Incidence of AMI was associated with transfer to the intensive care units (ICU) (RR = 2.92) and mortality (RR = 2.57, OR = 8.36), significantly.
CONCLUSION:
Cardiac complications were found to be increased alarmingly in COVID-19 patients. Baseline and during hospitalization checking with electrocardiography, echocardiography, and measuring of cardiac biomarkers should be applied.
Copyright © 2022 Elsevier Inc. All rights reserved.
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