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Pubblicazioni recenti - cardiac arrest
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Examining anti-inflammatory therapies in the prevention of cardiovascular events: protocol for a systematic review and network meta-analysis of randomised controlled trials.
BMJ Open2022 Jun;12(6):e062702. doi: 10.1136/bmjopen-2022-062702.
Boczar Kevin Emery, Shin Sheojung, Bezzina Kathryn A, Geejo Aishwarya, Pearson Alexander Liam, Shahab Saba, Fehlmann Christophe A, Visintini Sarah, Beanlands Rob, Wells George A,
Abstract
INTRODUCTION:
Inflammation is emerging as an important risk factor for atherosclerotic cardiovascular disease and has been a recent target for many novel therapeutic agents. However, comparative evidence regarding efficacy of these anti-inflammatory treatment options is currently lacking.
METHODS AND ANALYSIS:
This systematic review will include randomised controlled trials evaluating the effect of anti-inflammatory agents on cardiovascular outcomes in patients with known cardiovascular disease. Studies will be retrieved from Medline, Embase, the Cochrane Central Register of Controlled Trials, as well as clinical trial registry websites, Europe PMC and conference abstract handsearching. No publication date or language restrictions will be imposed. Eligible interventions must have some component of anti-inflammatory agent. These include (but are not limited to): non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, prednisone, methotrexate, canakinumab, pexelizumab, anakinra, succinobucol, losmapimod, inclacumab, atreleuton, LP-PLA (darapladib) and sPLA (varespladib). The primary outcomes will include major adverse cardiac events (MACE), and each individual component of MACE (myocardial infarction, stroke and cardiovascular death). Key secondary outcomes will include unstable angina, heart failure, all-cause mortality, cardiac arrest and revascularisation. Screening, inclusion, data extraction and quality assessment will be performed independently by two reviewers. Network meta-analysis based on the random effects model will be conducted to compare treatment effects both directly and indirectly. The quality of the evidence will be assessed with appropriate tools including the Grading of Recommendations, Assessment, Development and Evaluation profiler or Confidence in Network Meta-Analysis tool.
ETHICS AND DISSEMINATION:
Ethics approval is not required for this systematic review. The findings will be disseminated through a peer-reviewed journal.
PROSPERO REGISTRATION NUMBER:
CRD42022303289.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Factors influencing prehospital physicians' decisions to initiate advanced resuscitation for asystolic out-of-hospital cardiac arrest patients.
Resuscitation2022 Jun;():. doi: S0300-9572(22)00580-9.
Gamberini Lorenzo, Alberto Mazzoli Carlo, Allegri Davide, Scquizzato Tommaso, Baroncini Simone, Guarnera Martina, Tartaglione Marco, Chiarini Valentina, Picoco Cosimo, Fiorenzo Semeraro Federico, Gordini Giovanni, Coniglio Carlo,
Abstract
BACKGROUND:
The decision to initiate or continue advanced life support (ALS) in out-of-hospital cardiac arrest (OHCA) could be difficult due to the lack of information and contextual elements, especially in non-shockable rhythms. This study aims to explore factors associated with clinicians' decision to initiate or continue ALS and the conditions associated with higher variability in asystolic patients.
METHODS:
This retrospective observational study enrolled 2653 asystolic patients on whom either ALS was attempted or not by the emergency medical services (EMS) physician. A multivariable logistic regression analysis was performed to find the factors associated with the decision to access ALS. A subgroup analysis was performed on patients with a predicted probability of ALS between 35% and 65%. The single physicians' behaviour was compared to that predicted by the model taking into account the entire agency.
RESULTS:
Age, location of event, bystander CPR and EMS-witnessed event were independent factors influencing physicians' choices about ALS. Non-medical OHCA, younger patients, less experienced physicians, presence of breath activity at the emergency call and a longer time for ALS arrival were more frequent among cases with an expected higher variability in behaviours with ALS. Significant variability was detected between physicians.
CONCLUSIONS:
Significant inter-physician variability in access to ALS could be present within the same EMS, especially among less experienced physicians, non-medical OHCA and in presence of signs of life during emergency call. This arbitrariness has been observed and should be properly addressed by EMS team members as it raises ethical issues regarding the disparity in treatment.
Copyright © 2022. Published by Elsevier B.V.
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Out-of-hospital cardiac arrest in pregnant women: a 55-patient French cohort study.
Resuscitation2022 Jun;():. doi: S0300-9572(22)00581-0.
Canon Valentine, Recher Morgan, Lafrance Martin, Wawrzyniak Perrine, Vilhelm Christian, Agostinucci Jean-Marc, Thiriez Sylvain, Mansouri Nadia, Morel-Maréchal Emanuel, Lagadec Steven, Leroy Antoine, Vermersch Céline, Javaudin François, Hubert Hervé, ,
Abstract
AIM:
To describe a cohort of pregnant women having suffered an out-of-hospital cardiac arrest (OHCA) and to compare them with nonpregnant women of childbearing age having suffered OHCA.
METHODS:
Study data were extracted from the French National OHCA Registry between 2011 and 2021. We compared patients in terms of characteristics, care and survival.
RESULTS:
We included 3,645 women of childbearing age (15-44) who had suffered an OHCA; 55 of the women were pregnant. Pregnant women were younger than nonpregnant victims (30 vs. 35 years, p=0.006) and were more likely to have a medical history (76.4% vs. 50.5%, p
CONCLUSIONS:
Our results show that resuscitation performance does not meet European Resuscitation Council's specific guidelines on OHCA in pregnant women. Although OHCA in pregnancy is rare, the associated prognosis is poor for both woman and fetus. Preventive measures should be reinforced, especially when pregnant women have medical history.
Copyright © 2022 Elsevier B.V. All rights reserved.
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Omega-3 fatty acids, subclinical atherosclerosis, and cardiovascular events: Implications for primary prevention.
Atherosclerosis2022 Jun;353():11-19. doi: S0021-9150(22)01316-8.
Alfaddagh Abdulhamied, Kapoor Karan, Dardari Zeina A, Bhatt Deepak L, Budoff Matthew J, Nasir Khurram, Miller Michael, Welty Francine K, Miedema Michael D, Shapiro Michael D, Tsai Michael Y, Blumenthal Roger S, Blaha Michael J,
Abstract
BACKGROUND AND AIMS:
High-dose eicosapentaenoic acid (EPA) therapy was beneficial in high-risk patients without clinical cardiovascular disease (CVD). Whether higher plasma levels of EPA and docosahexaenoic acid (DHA) have similar benefits in those without subclinical CVD is unclear. We aim to evaluate the interplay between plasma omega-3 fatty acids and coronary artery calcium (CAC) in relation to CVD events.
METHODS:
We examined 6568 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with plasma EPA and DHA levels and CAC measured at baseline. The primary outcome was incident CVD events (myocardial infarction, angina, cardiac arrest, stroke, CVD death). Hazard ratios for the primary outcome were adjusted for potential confounder using Cox regression.
RESULTS:
Mean ± SD age was 62.1 ± 10.2 years and 52.9% were females. The median follow-up time was 15.6 years. Higher log(EPA) (adjusted hazard ratio, aHR = 0.83; 95% CI, 0.74-0.94) and log(DHA) (aHR = 0.79; 95% CI, 0.66-0.96) were independently associated with fewer CVD events. The difference in absolute CVD event rates between lowest vs. highest EPA tertile increased at higher CAC levels. The adjusted HR for highest vs. lowest EPA tertile within CAC = 0 was 1.02 (95% CI, 0.72-1.46), CAC = 1-99 was 0.71 (95% CI, 0.51-0.99), and CAC?100 was 0.67 (95% CI, 0.52-0.84). A similar association was seen in tertiles of DHA by CAC category.
CONCLUSIONS:
In an ethnically diverse population free of clinical CVD, higher plasma omega-3 fatty acid levels were associated with fewer long-term CVD events. The absolute decrease in CVD events with higher omega-3 fatty acid levels was more apparent at higher CAC scores.
Copyright © 2022 Elsevier B.V. All rights reserved.
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Length of Stay and 30-Day Postoperative Complications Following Minimally Invasive Apical Prolapse Repair.
Female Pelvic Med Reconstr Surg2022 Jun;():. doi: 10.1097/SPV.0000000000001205.
Dieter Alexis A, Moore Kristin J, Willis-Gray Marcella G, Gutman Robert E, Iglesia Cheryl B, Carey Erin T,
Abstract
IMPORTANCE:
Data on the correlation between length of stay and postoperative complications following urogynecologic surgery are limited.
OBJECTIVES:
The objective of this study was to use a nationwide database to examine the correlation between length of stay and 30-day postoperative complications following minimally invasive apical prolapse repair.
STUDY DESIGN:
This retrospective cohort study included women in the American College of Surgeons National Surgical Quality Improvement Program database from 2008 to 2018 who underwent laparoscopic/robotic sacrocolpopexy or uterosacral/sacrospinous repair and were discharged on postoperative day 0 (POD0) or 1 (POD1). The primary outcome was 30-day postoperative complication rate.
RESULTS:
Of the 28,269 women discharged home on POD0/1, 12,663 (45%) underwent laparoscopic/robotic sacrocolpopexy, and 15,606 (55%) underwent uterosacral/sacrospinous repair. Women discharged on POD0 were less likely to be White, less likely to have diabetes or hypertension, had lower mean body mass index, and were less likely to have undergone a hysterectomy (P
CONCLUSIONS:
In women undergoing minimally invasive reconstructive apical repair, discharge on POD0 is correlated with similar or better (lower) 30-day postoperative complication rates compared with women discharged on POD1.
Copyright © 2022 American Urogynecologic Society. All rights reserved.
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Whole Blood Selective Aortic Arch Perfusion for Exsanguination Cardiac Arrest: Assessing Myocardial Tolerance to the Duration of Cardiac Arrest.
Shock2022 Jun;57(6):243-250. doi: 10.1097/SHK.0000000000001946.
Madurska Marta J, Abdou Hossam, Elansary Noha N, Edwards Joseph, Patel Neerav, Stonko David P, Richmond Michael J, Scalea Thomas M, Rasmussen Todd E, Morrison Jonathan J,
Abstract
INTRODUCTION:
Selective aortic arch perfusion (SAAP) is an endovascular technique that consists of aortic occlusion with perfusion of the coronary and cerebral circulation. It been shown to facilitate return of spontaneous circulation (ROSC) after exanguination cardiac arrest (ECA), but it is not known how long arrest may last before the myocardium can no longer be durably recovered. The aim of this study is to assess the myocardial tolerance to exsanguination cardiac arrest before successful ROSC with SAAP.
METHODS:
Male adult swine (n?=?24) were anesthetized, instrumented, and hemorrhaged to arrest. Animals were randomized into three groups: 5, 10, and 15 min of cardiac arrest before resuscitation with SAAP. Following ROSC, animals were observed for 60 min in a critical care environment. Primary outcomes were ROSC, and survival at 1-h post-ROSC.
RESULTS:
Shorter cardiac arrest time was associated with higher ROSC rate and better 1-h survival. ROSC was obtained for 100% (8/8) of the 5-min ECA group, 75% (6/8) of the 10-min group, 43% (3/7) of the 15-min group (P?=?0.04). One-hour post-ROSC survival was 75%, 50%, and 14% in 5-, 10-, and 15-min groups, respectively (P?=?0.02). One-hour survivors in the 5-min group required less norepinephrine (1.31 mg?±?0.83?mg) compared with 10-SAAP (0.76 mg?±?0.24?mg), P?=?0.008.
CONCLUSION:
Whole blood SAAP can accomplish ROSC at high rates even after 10 min of unsupported cardiac arrest secondary to hemorrhage, with some viability beyond to 15 min. This is promising as a tool for ECA, but requires additional optimization and clinical trials.Animal Use Protocol, IACUC: 0919015.
Copyright © 2022 by the Shock Society.
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Total Anomalous Pulmonary Venous Connection Repair: Single-Center Outcomes in a Lower-Middle Income Region.
World J Pediatr Congenit Heart Surg2022 Jul;13(4):458-465. doi: 10.1177/21501351221103492.
Bayya Praveen Reddy, Varghese Shruti, Jayashankar Jessin Puliparambil, Sudhakar Abish, Balachandran Rakhi, Kottayil Brijesh Parayaru, Srimurugan Balaji, Varma Praveen Kerala, Neema Praveen Kumar, Krishna Kumar R,
Abstract
BACKGROUND:
The management of total anomalous pulmonary venous connection (TAPVC) in neonates and infants is resource-intensive. We describe early and follow-up outcomes after surgical repair of isolated TAPVC at a single institution in a resource-limited setting.
METHODS:
The data of 316 consecutive patients with isolated TAPVC undergoing repair (January 2010-September 2020) were reviewed. The study setting was a tertiary hospital in southern India that provides subsidized or charitable care. Standard surgical technique was used for repair, circulatory arrest was avoided, and suture-less anastomosis was reserved for small or stenotic pulmonary veins. Surgical and postoperative strategies were directed toward minimizing intensive care unit (ICU) stay.
RESULTS:
302 (95.6%) patients were infants and 128 patients (40.5%) were neonates; median weight was 3.3?kg (IQR 2.8-4.0?kg). Obstruction of the TAPVC was seen in 176 patients (56%) and pulmonary hypertension in 278 patients (88%). Seventeen (5.4%) underwent delayed sternal closure. The median postoperative ICU stay was 120?h (IQR 96-192?h), mechanical ventilation was 45?h (IQR 24-82?h), and hospital stay was 13 days (IQR 9-17 days). There were three in-hospital deaths (0.9%). Over a median follow-up period of 53.3 months (IQR 22.9-90.4), pulmonary vein restenosis was seen in 32 patients (10.1%) after a mean of 2.2 months (1-6 months). No perioperative risk factors for restenosis were identified.
CONCLUSIONS:
Using specific perioperative strategies, it is possible to correct TAPVC with excellent surgical outcomes in low-resource environments. Late pulmonary vein restenosis remains an important complication.
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Invited Commentary: An Ounce of Prevention Is Worth a Pound of Cure: Advancing the Search for Modifiable Factors Associated With Cardiac Arrest.
World J Pediatr Congenit Heart Surg2022 Jul;13(4):482-484. doi: 10.1177/21501351221102069.
Dhillon Gurpreet S, Lasa Javier J,
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Cardiac Arrest in Children Following Cardiac Surgery: A Scoping Review of Contributing Factors.
World J Pediatr Congenit Heart Surg2022 Jul;13(4):475-481. doi: 10.1177/21501351221100791.
Riley Christine M, Murphy Lee D, Mastropietro Christopher W,
Abstract
Nearly half of children experiencing cardiac arrest following cardiac surgery do not survive hospital discharge and patients who survive often experience significant neurological impairment. Additionally, increased resource utilization following cardiac arrest translates into adverse logistical and financial consequences. Although some studies have identified patient characteristics that increase the risk of cardiac arrest after pediatric cardiac surgery, modifiable risk factors, which could provide a foundation for effective prevention strategies, have been elusive. This scoping review explores the current knowledge surrounding risk factors associated with cardiac arrest in children following cardiac surgery and provides recommendations for future research.
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Staffing models in the cardiac intensive care unit.
Curr Opin Crit Care2022 Jun;():. doi: 10.1097/MCC.0000000000000958.
Quien Mary, Thomas Alexander, Ludmir Jonathan, Miller P Elliott,
Abstract
PURPOSE OF REVIEW:
The modern cardiac intensive care unit (CICU) has evolved into a high-intensity unit that cares for critically ill patients. Despite this transformation, changes to the staffing model and organizational structure in these specialized units have only recently begun to meet these challenges. We describe the most recent evidence which will inform future CICU staffing models.
RECENT FINDINGS:
In the United States, the majority of CICUs are open as opposed to closed units, yet recent data suggests that transition to a closed staffing model is associated with a decrease in mortality. These reductions in mortality in closed CICUs are most pronounced in the most critically ill populations, such as patients with mechanical circulatory support, cardiac arrest, and respiratory failure. In addition, one study has shown that transition to a cardiac intensivist staffed CICU was associated with a reduction in mortality. Finally, multidisciplinary and protocolized teams imbedded within the CICU, specifically 'shock teams,' have recently been developed and may reduce mortality in this particularly sick patient population.
SUMMARY:
Although the preponderance of data suggests improved outcomes with a closed, intensivist staffed CICU model, future multicenter studies are needed to better define the ideal staffing models for the contemporary CICU.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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Comment on: Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression.
Ann Med Surg (Lond)2022 Jul;79():103970. doi: 10.1016/j.amsu.2022.103970.
Braz Leandro G, Tiradentes Teófilo Augusto A, Braz Jose R C,
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Role of Adenoviruses in Cancer Therapy.
Front Oncol2022 ;12():772659. doi: 10.3389/fonc.2022.772659.
Tseha Sintayehu Tsegaye,
Abstract
Cancer is one of the leading causes of death in the world, which is the second after heart diseases. Adenoviruses (Ads) have become the promise of new therapeutic strategy for cancer treatment. The objective of this review is to discuss current advances in the applications of adenoviral vectors in cancer therapy. Adenoviral vectors can be engineered in different ways so as to change the tumor microenvironment from cold tumor to hot tumor, including; 1. by modifying Ads to deliver transgenes that codes for tumor suppressor gene (p53) and other proteins whose expression result in cell cycle arrest 2. Ads can also be modified to express tumor specific antigens, cytokines, and other immune-modulatory molecules. The other strategy to use Ads in cancer therapy is to use oncolytic adenoviruses, which directly kills tumor cells. Gendicine and Advexin are replication-defective recombinant human p53 adenoviral vectors that have been shown to be effective against several types of cancer. Gendicine was approved for treatment of squamous cell carcinoma of the head and neck by the Chinese Food and Drug Administration (FDA) agency in 2003 as a first-ever gene therapy product. Oncorine and ONYX-015 are oncolytic adenoviral vectors that have been shown to be effective against some types of cancer. The Chiness FDA agency has also approved Oncorin for the treatment of head and neck cancer. Ads that were engineered to express immune-stimulatory cytokines and other immune-modulatory molecules such as TNF-?, IL-2, BiTE, CD40L, 4-1BBL, GM-CSF, and IFN have shown promising outcome in treatment of cancer. Ads can also improve therapeutic efficacy of immune checkpoint inhibitors and adoptive cell therapy (Chimeric Antigen Receptor T Cells). In addition, different replication-deficient adenoviral vectors (Ad5-CEA, Ad5-PSA, Ad-E6E7, ChAdOx1-MVA and Ad-transduced Dendritic cells) that were tested as anticancer vaccines have been demonstrated to induce strong antitumor immune response. However, the use of adenoviral vectors in gene therapy is limited by several factors such as pre-existing immunity to adenoviral vectors and high immunogenicity of the viruses. Thus, innovative strategies must be continually developed so as to overcome the obstacles of using adenoviral vectors in gene therapy.
Copyright © 2022 Tseha.
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Real-Time Prediction of Mortality, Cardiac Arrest, and Thromboembolic Complications in Hospitalized Patients With COVID-19.
JACC Adv2022 Jun;1(2):100043. doi: 10.1016/j.jacadv.2022.100043.
Shade Julie K, Doshi Ashish N, Sung Eric, Popescu Dan M, Minhas Anum S, Gilotra Nisha A, Aronis Konstantinos N, Hays Allison G, Trayanova Natalia A,
Abstract
Background:
COVID-19 infection carries significant morbidity and mortality. Current risk prediction for complications in COVID-19 is limited, and existing approaches fail to account for the dynamic course of the disease.
Objectives:
The purpose of this study was to develop and validate the COVID-HEART predictor, a novel continuously updating risk-prediction technology to forecast adverse events in hospitalized patients with COVID-19.
Methods:
Retrospective registry data from patients with severe acute respiratory syndrome coronavirus 2 infection admitted to 5 hospitals were used to train COVID-HEART to predict all-cause mortality/cardiac arrest (AM/CA) and imaging-confirmed thromboembolic events (TEs) (n = 2,550 and n = 1,854, respectively). To assess COVID-HEART's performance in the face of rapidly changing clinical treatment guidelines, an additional 1,100 and 796 patients, admitted after the completion of development data collection, were used for testing. Leave-hospital-out validation was performed.
Results:
Over 20 iterations of temporally divided testing, the mean area under the receiver operating characteristic curve were 0.917 (95% confidence interval [CI]: 0.916-0.919) and 0.757 (95% CI: 0.751-0.763) for prediction of AM/CA and TE, respectively. The interquartile ranges of median early warning times were 14 to 21 hours for AM/CA and 12 to 60 hours for TE. The mean area under the receiver operating characteristic curve for the left-out hospitals were 0.956 (95% CI: 0.936-0.976) and 0.781 (95% CI: 0.642-0.919) for prediction of AM/CA and TE, respectively.
Conclusions:
The continuously updating, fully interpretable COVID-HEART predictor accurately predicts AM/CA and TE within multiple time windows in hospitalized COVID-19 patients. In its current implementation, the predictor can facilitate practical, meaningful changes in patient triage and resource allocation by providing real-time risk scores for these outcomes. The potential utility of the predictor extends to COVID-19 patients after hospitalization and beyond COVID-19.
© 2022 The Authors.
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The impact of myocardial infarction on basal and stress-induced heart rate variability and cortisol secretion in women: A pilot study.
Compr Psychoneuroendocrinol2022 Feb;9():100113. doi: 10.1016/j.cpnec.2022.100113.
Narvaez Linares N F, Munelith-Souksanh K, Tanguay A F N, Plamondon H,
Abstract
Coronary heart disease (CHD), of which myocardial infarction (MI) is a subtype, is the leading cause of death for women. Nonetheless, women remain neglected in CHD research, resulting in treatments and recommendations being primarily based on data collected in men. Pre-clinical and clinical studies have supported dysregulation of the hypothalamic-pituitary-adrenal axis (HPAA) following cardiac arrest and MI to promote the development of mental health disorders (e.g., major depressive disorder, post-traumatic stress disorder). However, studies addressing changes in HPAA activation under basal and stress-induced conditions in women samples have been lacking. Thus, we conducted this study to determine basal and stress-induced changes in heart rate, respiration and cortisol secretion (via 8 saliva samples) in a sample of women with a history of MI ( = 13) and a control group ( = 16). We measured altered stress reactivity through exposure to the Trier Social Stress Test. In addition, participants completed questionnaires assessing perceived stress and mental health status (i.e., anxiety and mood). Overall, our findings indicated comparable assessments of perceived situational stress in both groups. Interestingly, salivary cortisol secretion support reduced stress-induced HPAA activation related to TSST exposure in MI women compared to control counterparts. Our observations are consistent with findings supporting glucocorticoid resistance noted following MI and cardiac arrest. Akin to cardiac arrest survivors, HPAA dysregulation in MI survivors could have an impact on the development of mental health disorders. More studies are needed to address this critical question.
© 2022 The Authors.
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Thrombolytic therapy in cardiac arrest caused by cardiac etiologies or presumed pulmonary embolism: An updated systematic review and meta-analysis.
Res Pract Thromb Haemost2022 May;6(4):e12745. doi: 10.1002/rth2.12745.
Alshaya Omar A, Alshaya Abdulrahman I, Badreldin Hisham A, Albalawi Sarah T, Alghonaim Sarah T, Al Yami Majed S,
Abstract
Background:
Many cardiac arrest cases are encountered annually worldwide, with poor survival. The use of systemic thrombolysis during cardiopulmonary resuscitation for the treatment of cardiac arrest remains controversial.
Objectives:
Evaluate the safety and efficacy of systemic thrombolysis in patients with cardiac arrest due to presumed or confirmed pulmonary embolism or cardiac etiology.
Methods:
We searched the PubMed and Cochrane databases from inception through April 2021 to identify relevant randomized controlled trials and observational studies. The primary efficacy and safety outcomes were survival to hospital discharge and reported bleeding, respectively. Sensitivity analysis was performed on the basis of study design and etiology of cardiac arrest.
Results:
Eleven studies were included, with 4696 patients (1178 patients received systemic thrombolysis, and 3518 patients received traditional therapy). There was a higher rate of survival to hospital discharge in patients who received systemic thrombolysis versus no systemic thrombolysis (risk ratio [RR], 1.35; 95% confidence interval [CI], 0.95-1.91). There were also higher rates of survival at 24 hours (RR, 1.24; 95% CI, 0.97-1.59) and hospital admission (RR, 1.53; 95% CI, 1.04-2.24), and return of spontaneous circulation (ROSC) (RR, 1.34; 95% CI, 1.05-1.71) with the use of systemic thrombolysis. Impacts on survival to discharge and survival at 24 hours were not statistically significant. Patients receiving systemic thrombolysis had a 65% increase in bleeding events compared with no systemic thrombolysis (RR, 1.65; 95% CI, 1.20-2.27).
Conclusion:
Systemic thrombolysis in cardiac arrest did not improve survival to hospital discharge and led to more bleeding events. However, it increased the rates of hospital admission and ROSC achievement.
© 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).
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Aortic Thrombosis and Ischemic Stroke With Hemorrhagic Conversion in a Patient With Remote COVID-19 Infection: A Treatment Dilemma.
Cureus2022 May;14(5):e25272. doi: 10.7759/cureus.25272.
Riasat Maria, Khan Arshan, Ehtesham Moiz, Mustafa Syed Farrukh, Qureshi Natasha,
Abstract
Coronavirus disease 2019 (COVID-19) is primarily known to affect the lungs; however, several studies indicate that it can be a multisystem disease. There is documentation detailing different sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients affected with this virus have been seen to develop a hypercoagulable state leading to systemic thrombosis in some cases or embolism leading to catastrophic outcomes in others. Data regarding anticoagulation in these patients is limited. Further research needs to be carried out for management and prophylaxis for patients with COVID-19 at risk of aortic thrombosis. We present a case of a middle-aged man with multiple comorbidities and remote COVID-19 infection who came to the emergency room with signs and symptoms worrisome for a cerebrovascular accident (CVA). Brain imaging revealed multiple cortical infarcts suggestive of a cardioembolic etiology. During his hospitalization, he underwent a transesophageal echocardiogram (TEE) that showed a 1x1 cm mobile thrombus in the distal descending aorta. Laboratory workup was negative for any hypercoagulable condition; it was thought that this patient might have a hypercoagulable state post-COVID-19 infection. After a thorough risk vs. benefit discussion, patient was started on apixaban. He remains alive and is doing well in a recent follow-up in our clinic.
Copyright © 2022, Riasat et al.
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Autoregulation of Cerebral Blood Flow During 3-h Continuous Cardiopulmonary Resuscitation at 27°C.
Front Physiol2022 ;13():925292. doi: 10.3389/fphys.2022.925292.
Valkov Sergei, Nilsen Jan Harald, Mohyuddin Rizwan, Schanche Torstein, Kondratiev Timofei, Sieck Gary C, Tveita Torkjel,
Abstract
Victims of accidental hypothermia in hypothermic cardiac arrest (HCA) may survive with favorable neurologic outcome if early and continuous prehospital cardiopulmonary resuscitation (CPR) is started and continued during evacuation and transport. The efficacy of cerebral autoregulation during hypothermic CPR is largely unknown and is aim of the present experiment. Anesthetized pigs ( = 8) were surface cooled to HCA at 27°C before 3 h continuous CPR. Central hemodynamics, cerebral O delivery (DO) and uptake (VO), cerebral blood flow (CBF), and cerebral perfusion pressure (CPP) were determined before cooling, at 32°C and at 27°C, then at 15 min after the start of CPR, and hourly thereafter. To estimate cerebral autoregulation, the static autoregulatory index (sARI), and the CBF/VO ratio were determined. After the initial 15-min period of CPR at 27°C, cardiac output (CO) and mean arterial pressure (MAP) were reduced significantly when compared to corresponding values during spontaneous circulation at 27°C (-66.7% and -44.4%, respectively), and remained reduced during the subsequent 3-h period of CPR. During the first 2-h period of CPR at 27°C, blood flow in five different brain areas remained unchanged when compared to the level during spontaneous circulation at 27°C, but after 3 h of CPR blood flow in 2 of the 5 areas was significantly reduced. Cooling to 27°C reduced cerebral DO by 67.3% and VO by 84.4%. Cerebral VO was significantly reduced first after 3 h of CPR. Cerebral DO remained unaltered compared to corresponding levels measured during spontaneous circulation at 27°C. Cerebral autoregulation was preserved (sARI > 0.4), at least during the first 2 h of CPR. Interestingly, the CBF/VO ratio during spontaneous circulation at 27°C indicated the presence of an affluent cerebral DO, whereas after CPR, the CBF/VO ratio returned to the level of spontaneous circulation at 38°C. Despite a reduced CO, continuous CPR for 3 h at 27°C provided sufficient cerebral DO to maintain aerobic metabolism and to preserve cerebral autoregulation during the first 2-h period of CPR. This new information supports early start and continued CPR in accidental hypothermia patients during rescue and transportation for in hospital rewarming.
Copyright © 2022 Valkov, Nilsen, Mohyuddin, Schanche, Kondratiev, Sieck and Tveita.
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Glossopharyngeal Neuralgia Associated With Bradycardia and syncope-a Case Report.
Neurohospitalist2022 Jul;12(3):553-555. doi: 10.1177/19418744221091112.
Naeem Ayesha, Adelman Eric E,
Abstract
We describe a case of 76-year-old woman with glossopharyngeal neuralgia who developed bradycardia and syncope after decreased carbamazepine dosing due to worsening renal function. Telemetry and EKG showed bradycardia and sinus pauses associated with paroxysms of typical glossopharyngeal neuralgia pain. With the addition of gabapentin to carbamazepine, her glossopharyngeal neuralgia pain as well as bradycardia resolved. A pacemaker was placed to prevent bradycardia and syncope. Clinicians should be mindful of the association between glossopharyngeal neuralgia and bradycardia and cardiac syncope so appropriate treatment can be offered in a timely manner to prevent adverse outcomes associated with syncope and cardiac arrest.
© The Author(s) 2022.
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Cardiac tamponade secondary to iatrogenic needle decompression in blunt force trauma.
Proc (Bayl Univ Med Cent)2022 ;35(4):524-525. doi: 10.1080/08998280.2022.2063628.
Faizi Zaheer, Morales Joseph, Hlopak Joseph, Batool Amber, Ratnasekera Asanthi,
Abstract
The proper treatment for tension pneumothorax is rapid needle decompression. This procedure is frequently performed in the field for trauma patients who have clinical symptoms of pneumothorax. The procedure itself has a high rate of failure due to improper placement, operator inexperience, or chest wall thickness. A 22-year-old unrestrained driver in a high-speed motor vehicle collision was found unconscious and subsequently had needle decompression for decreased breath sounds in the field. The patient was initially stable upon arrival but progressed to cardiac arrest. She had a thoracotomy in the emergency department that showed cardiac tamponade followed by return of spontaneous circulation. On formal thoracotomy, it was discovered that the patient had an iatrogenic cardiac injury from the angiocatheter placed during needle decompression. Needle decompression is a lifesaving procedure, but it is associated with high failure rates and possibility for iatrogenic injury.
Copyright © 2022 Baylor University Medical Center.
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Cryopreservation of Animals and Cryonics: Current Technical Progress, Difficulties and Possible Research Directions.
Front Vet Sci2022 ;9():877163. doi: 10.3389/fvets.2022.877163.
Ekpo Marlene Davis, Boafo George Frimpong, Gambo Suleiman Shafiu, Hu Yuying, Liu Xiangjian, Xie Jingxian, Tan Songwen,
Abstract
The basis of cryonics or medical cryopreservation is to safely store a legally dead subject until a time in the future when technology and medicine will permit reanimation after eliminating the disease or cause of death. Death has been debunked as an event occurring after cardiac arrest to a process where interjecting its progression can allow for reversal when feasible. Cryonics technology artificially halts further damages and injury by restoring respiration and blood circulation, and rapidly reducing temperature. The body can then be preserved at this extremely low temperature until the need for reanimation. Presently, the area has attracted numerous scientific contributions and advancement but the practice is still flooded with challenges. This paper presents the current progression in cryonics research. We also discuss obstacles to success in the field, and identify the possible solutions and future research directions.
Copyright © 2022 Ekpo, Boafo, Gambo, Hu, Liu, Xie and Tan.
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