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Pubblicazioni recenti - cardiopulmonary
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Assessment of Exercise Intolerance in Patients with Pre-Dialysis CKD with Cardiopulmonary Function Testing: Translation to Everyday Practice.
Am J Nephrol2021 Apr;():1-15. doi: 10.1159/000515384.
Pella Eva, Boutou Afroditi, Theodorakopoulou Marieta P, Sarafidis Pantelis,
Abstract
BACKGROUND:
Chronic kidney disease (CKD) is often characterized by increased prevalence of cardiovascular risk factors and increased incidence of cardiovascular events and death. Reduced cardiovascular reserve and exercise intolerance are common in patients with CKD and are associated with adverse outcomes.
SUMMARY:
The gold standard for identifying exercise limitation is cardiopulmonary exercise testing (CPET). CPET provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic function during maximal or submaximal exercise. It is useful in clinical setting for differentiation of the causes of exercise intolerance, risk stratification, and assessment of response to relevant treatments. A number of recent studies have used CPET in patients with pre-dialysis CKD, aiming to assess the cardiovascular reserve of these individuals, as well as the effect of interventions such as exercise training programs on their functional capacity. This review provides an in-depth description of CPET methodology and an overview of studies that utilized CPET technology to assess cardiovascular reserve in patients with pre-dialysis CKD. Key Messages: CPET can delineate multisystem changes and offer comprehensive phenotyping of factors determining overall cardiovascular risk. Potential clinical applications of CPET in CKD patients range from objective diagnosis of exercise intolerance to preoperative and long-term risk stratification and providing intermediate endpoints for clinical trials. Future studies should delineate the association of CPET indexes, with cardiovascular and respiratory alterations and hard outcomes in CKD patients, to enhance its diagnostic and prognostic utility in this population.
© 2021 S. Karger AG, Basel.
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Readmissions and mortality in pediatric tracheostomy patients: Are we doing enough?
Int J Pediatr Otorhinolaryngol2021 Apr;145():110704. doi: S0165-5876(21)00097-5.
Tarfa Rahilla A, Morris Jymirah, Melder Katie L, McCoy Jennifer L, Tobey Allison B J,
Abstract
OBJECTIVES:
Pediatric patients who undergo tracheostomy tube placement are medically complex with a high risk of morbidity and mortality. They are often premature with multiple cardiopulmonary comorbidities. This study reviews the demographics and outcomes within this population to identify at-risk patient groups at our hospital.
METHODS:
A retrospective chart review of those with pediatric tracheostomy placement from 2015 to 2016 at our hospital was performed (n = 92). Demographic and post-discharge data were collected at 30, 60, and 90-days during the global period.
RESULTS:
Ventilator dependence was the most common reason for placement. 79.3% of patients had two or more major comorbidities. 44% had an emergency department (ED) visit and subsequent hospital admission within the first 90 days post-discharge, with 36% being trach/respiratory-related. The 90-day mortality was 19.6%; however, at the time of chart review, mortality was 35% with only 1 (1.1%) being from trach-related complications. Patients with longer admissions were more likely to die prior to discharge, p = .001. Lastly, patients who died were 3 times more likely to have > 25% no-shows to their outpatient appointments compared to those living throughout the study period.
CONCLUSION:
Our population had a high incidence of ED visits, readmission rates, and mortality; however, trach-related causes remained low. Mortality risk increased with more no-show appointments and residing a further distance from our hospital. Furthermore, multiple co-morbidities, with longer hospital stays also increased risk of mortality. Identifying those with the highest risk for complications will enable us to target families for increased home-care education to decrease readmissions and mortality.
LEVEL OF EVIDENCE:
4.
Copyright © 2021 Elsevier B.V. All rights reserved.
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Syncope and electrocardiogram.
Minerva Med2021 Apr;():. doi: 10.23736/S0026-4806.21.07531-5.
Bo Mario, Del Rosso Attilio,
Abstract
INTRODUCTION:
Suspected transient loss of consciousness (T-LOC) and syncope are common causes of hospitalization in older patients. Arrhythmias are the most common cardiac causes of syncope. Although a number of instrumental diagnostic procedures are usually routinely performed in patients with suspected syncope, a 12 leads electrocardiogram (ECG) is the only instrumental test recommended for the initial evaluation of these patients.
EVIDENCE ACQUISITION:
In this paper current literature on this topic will be reviewed, including ECG diagnostic criteria and findings suggestive of cardiac syncope.
EVIDENCE SYNTHESIS:
The ECG may disclose an arrhythmia associated with a high likelihood of syncope, avoiding further evaluations and permitting institution of specific treatment in 7% of patients referred to emergency department. When the cause of syncope remains uncertain after initial evaluation the next step is to assess the risk of major cardiovascular events or sudden cardiac death. An abnormal ECG selected patients with high probabiliry of cardiac syncope. ECG diagnostic criteria and ECG findings suggesting arrhythmic syncope are presented. Indications and potential clinical implications of ECG monitoring will be discussed too.
CONCLUSIONS:
A careful, well-conducted medical history focused on the suspected syncopal event is crucial for the diagnosis. In this setting, the ECG is a mandatory diagnostic tool which, although normal in the majority of patients of syncope, has the potential to identify patients with high likelihood of cardiac syncope due to arrhythmic or cardiopulmonary disorder.
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[Training and knowledge on basic life support by civil guards.]
Rev Esp Salud Publica2021 Apr;95():. doi: e202104069.
Carcedo Argüelles Lucía, Pérez Regueiro Irene, García Fernández José Antonio, Lana Alberto,
Abstract
OBJECTIVE:
Civil Guards are deployed throughout Spain and susceptible to being the first responders in out-of-hospital cardiorespiratory arrest. However, their level of training to perform Basic Life Support (BLS) is unknown. The aim of this work was to evaluate the level of knowledge on BLS of Civil Guards, and to explore the association between periodicity of training and knowledge.
METHODS:
Cross-sectional study of 839 Civil Guards in Asturias (Spain). A questionnaire with 14 multiple-choice questions assessed knowledge on cardiopulmonary resuscitation (CPR) and use of automatic defibrillator, which were transferred to 0-10 points scales (higher score indicted higher knowledge). Multiple linear regressions were used to estimate mean knowledge scores according to training on BLS (never, >2 years ago and ?2 years ago), adjusted by sociodemographic and occupational variables.
RESULTS:
Around 1 out of 10 Civil Guards performed some real CPR (11.2%). Regarding training, 42.5% had never participated in courses and 33.4% were trained >2 years ago. There was a discordance between willingness to perform BLS (65.6%) and self-perception of preparation (21.8%). A dose-response association was detected between training periodicity and knowledge: 4.26 points (95% CI: 4.07-4.45) of those never formed, 5.93 (95% CI: 5.71-6, 15) of those trained >2 years ago, 7.18 (95% CI: 6.92-7.44) of those trained ?2 years ago (p-trend <0.001).
CONCLUSIONS:
The level of training and knowledge on BLS of the Civil Guards is low. Receiving training every two years is significantly associated with greater knowledge.
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Association between age and neurological outcomes in out-of-hospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation: a nationwide multicentre observational study.
Eur Heart J Acute Cardiovasc Care2021 Apr;():. doi: zuab021.
Miyamoto Yuki, Matsuyama Tasuku, Goto Tadahiro, Ohbe Hiroyuki, Kitamura Tetsuhisa, Yasunaga Hideo, Ohta Bon,
Abstract
AIMS:
Little is known about the difference in outcomes between young and old patients who received extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA). Therefore, we aimed to investigate the differences in outcomes between those aged ?75?years and <75?years who experienced OHCA and were resuscitated with ECPR.
METHODS AND RESULTS:
We performed a secondary analysis of a nationwide prospective cohort study using the Japanese Association for Acute Medicine OHCA registry. We identified patients aged ?18?years with OHCA who received ECPR. The patients were classified into three age groups (18-59?years, 60-74?years, and ?75?years). The primary outcome was a 1-month neurological outcome. To examine the association between age and 1-month neurological outcome, we performed logistic regression analyses fitted with generalized estimating equations. From 2014 to 2017, we identified 875 OHCA patients aged ?18?years who received ECPR. The proportion of patients who survived with favourable neurological outcome in the patients aged 18-59?years, 60-74?years, and ?75?years were 15% (64/434), 8.9% (29/326), and 1.7% (2/115), respectively. In the multivariable analysis, compared with the age of 18-59?years, the proportions of favourable neurological outcomes were significantly lower in patients aged 60-74?years [adjusted odds ratio (OR), 0.44; 95% confidence interval (CI), 0.32-0.61] and those aged ?75?years (adjusted OR, 0.26; 95% CI, 0.11-0.59).
CONCLUSION:
Advanced age (age ?75?years in particular) was significantly associated with poor neurological outcomes in patients with OHCA who received ECPR.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
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Endoscopic Retrograde Cholangiopancreatography in Patients With Versus Without Prior Myocardial Infarction or Coronary Revascularization: A Nationwide Cohort Study.
Cureus2021 Mar;13(3):e13921. doi: 10.7759/cureus.13921.
Patel Harsh K, Desai Rupak, Doshi Shreyans, Haider Mohammad, Lakhani Neet, Abu Hassan Falah, Doshi Rajkumar, Thoguluva Chandrasekar Viveksandeep,
Abstract
Background Endoscopic retrograde cholangiopancreatography (ERCP) can be associated with complications, including precipitation of peri-procedural myocardial ischemia. However, data regarding the trends and impact of previous myocardial infarction (MI) and/or percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) on ERCP outcomes remains unknown. Methods Using the National Inpatient Sample (2007-2014) and relevant ICD-9-CM codes, we identified adults who underwent ERCP with (Group 1) and without (Group 2) prior history of MI/PCI/CABG, and compared their demographics, comorbidities, and inpatient outcomes. Primary endpoints were inpatient mortality and post-ERCP complications. The secondary endpoints were discharge disposition, the mean length of stay, and total hospital charges. Results Of 1,374,773 ERCP procedures performed, 120,418 (8.8%) were performed in adult patients with a prior history of MI/PCI/CABG with an increasing trend from 2007-2014 (7.5% to 9.5%, p=0.022). Group 1 consisted of older, white, males compared to Group 2. Group 1 demonstrated a higher prevalence of all-cause mortality (1.7% vs. 1.5%, p<0.001), other cardiovascular comorbidities, post-ERCP cardiopulmonary complications (5.6% vs. 3.8%, p<0.001), sepsis (10.2% vs. 8.2%, p<0.001) and hemorrhage (1.5% vs.1.2%, p<0.001) as compared to Group 2. However, post-ERCP pancreatitis (14.1% vs. 15.4%, p<0.001) was lower in Group 1 without any difference in frequency of cholecystitis (0.4% vs. 0.4%, p=0.180). The mean length of stay was marginally higher in Group 1, without any difference in the hospitalization charges between the groups. Conclusions This nationwide study revealed higher inpatient mortality, sepsis, and hemorrhage in adult patients who underwent ERCP with a prior history of MI/PCI/CABG.
Copyright © 2021, Patel et al.
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Self-monitored versus supervised walking programs for older adults.
Medicine (Baltimore)2021 Apr;100(16):e25561. doi: 10.1097/MD.0000000000025561.
Hsu Ching-Yi, Wu Hsin-Hsien, Liao Hung-En, Liao Tai-Hsiang, Su Shin-Chang, Lin Pay-Shin,
Abstract
ABSTRACT:
Walking is an effective, well accepted, inexpensive, and functional intervention. This study compared the outcomes and changes in walking behavior of self-monitored (SM) and supervised (SU) walking interventions for older adults.Participants were assigned to SM (n?=?21) and SU (n?=?21) walking groups according to their place of residence. Both groups exercised and wore a pedometer for 3 months.The outcome measures were step count, body mass index (BMI), and physical function. Two-way repeated-measure ANOVA and independent t tests were used to compare the intervention effects. We also plotted the trends and analyzed the walking steps weekly.Only BMI exhibited a group?×?time interaction. The pre-posttest differences showed knee extension muscle strength (KEMS) and Timed Up and Go test were significantly improved in the SM group, whereas BMI, KEMS, 30-s sit-to-stand, functional reach were significantly improved, but 5-m gait speed significantly slower in the SU group. For participants attending ?50% of the sessions, those in the SM and SU groups had similar results for all variables, except for 2-min step (2MS) and daily walking step counts.Both self-monitored and supervised walking benefit older adults in most physical functions, especially lower-extremity performance, such as muscle strength, balance, and mobility. The effects of both programs do not differ significantly, except for BMI and 2MS (ie cardiopulmonary endurance). We recommend pedometer-assisted self-monitored walking for older adults because of its ability to cultivate exercise habits over the long term, whereas supervised walking to establish effective exercise intensity.
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
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Correlation between real-time heart rate and fatigue in chest compression providers during cardiopulmonary resuscitation: A simulation-based interventional study.
Medicine (Baltimore)2021 Apr;100(16):e25425. doi: 10.1097/MD.0000000000025425.
Bae Go Eun, Choi Arom, Beom Jin Ho, Kim Min Joung, Chung Hyun Soo, Min In Kyung, Chung Sung Phil, Kim Ji Hoon,
Abstract
BACKGROUND:
The American Heart Association guidelines recommend switching chest compression providers at least every 2 min depending on their fatigue during cardiopulmonary resuscitation (CPR). Although the provider's heart rate is widely used as an objective indicator for detecting fatigue, the accuracy of this measure is debatable.
OBJECTIVES:
This study was designed to determine whether real-time heart rate is a measure of fatigue in compression providers.
STUDY DESIGN:
A simulation-based prospective interventional study including 110 participants.
METHODS:
Participants performed chest compressions in pairs for four cycles using advanced cardiovascular life support simulation. Each participant's heart rate was measured using wearable healthcare devices, and qualitative variables regarding individual compressions were obtained from computerized devices. The primary outcome was correct depth of chest compressions. The main exposure was the change in heart rate, defined as the difference between the participant's heart rate during individual compressions and that before the simulation was initiated.
RESULTS:
With a constant compression duration for one cycle, the overall accuracy of compression depth significantly decreased with increasing heart rate. Female participants displayed significantly decreased accuracy of compression depth with increasing heart rate (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.95-0.98; P?
CONCLUSION:
Increasing heart rate could reflect fatigue in providers performing chest compressions with a constant duration for one cycle. Thus, provider rotation should be considered according to objectively measured fatigue during CPR.
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
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Factors contributing to exercise capacity in chronic thromboembolic pulmonary hypertension with near-normal hemodynamics.
J Heart Lung Transplant2021 Mar;():. doi: S1053-2498(21)02222-1.
Tobita Kazuki, Goda Ayumi, Nishida Yuichiro, Takeuchi Kaori, Kikuchi Hanako, Inami Takumi, Kohno Takashi, Yamada Shin, Soejima Kyoko, Satoh Toru,
Abstract
BACKGROUND:
Despite improved survival for patients with chronic thromboembolic pulmonary hypertension (CTEPH) due to progressive medical and interventional treatment, impaired exercise capacity remains common due to poorly understood mechanisms. We aimed to clarify the exercise capacity of CTEPH patients with near-normal pulmonary hemodynamics and evaluate its determinants among the hemodynamic, peripheral (e.g., oxygen use by the peripheral tissues), and muscular (e.g., skeletal muscle strength) factors.
METHODS:
Three hundred and twenty-nine patients with CTEPH (mean age, 63 ± 12 years; men/women, 73/256) with a near-normal mean pulmonary artery pressure (?30 mm Hg) at rest were enrolled. We assessed exercise capacity by peak oxygen consumption (peak VO) using cardiopulmonary exercise testing with a right heart catheter. We also measured the 6-minute walk distance (6MWD) and quadriceps muscle strength.
RESULTS:
The mean pulmonary artery pressure was 19 ± 4 mmHg and mean cardiac output was 4.8 ± 1.5 L/min at rest. The mean 6MWD was 444 ± 101 m, while the mean peak VO was 14.4 ± 3.9 mL/min/kg. A multivariate model that predicted 6MWD included quadriceps strength (??=?0.45, p < 0.001) and peak arterial venous oxygen difference (??=?0.29, p < 0.001). In contrast, the peak VO was best correlated with mPAP-CO slope (??=?-0.30, p < 0.001), followed by quadriceps strength and peak arterial venous oxygen difference.
CONCLUSIONS:
The 6MWD performance may be significantly influenced by peripheral oxygen use and muscular factors, while peak VO is influenced by hemodynamic and peripheral factors in CTEPH patients with near-normal hemodynamics.
Copyright © 2021. Published by Elsevier Inc.
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Cardio-Pulmonary Resuscitation (CPR) in Children Between 5 and 8 Years Old: Psychometric Properties of Nonide Scale.
Psicothema2021 May;33(2):337-344. doi: 10.7334/psicothema2020.405.
Nonide-Robles Marta, Postigo Álvaro, Arguelles Juan, Vigil-Lagranda Ruth, Poyán-Poo Azucena, García-Fernández José Antonio,
Abstract
BACKGROUND:
Early intervention in a cardiorespiratory arrest by a witness significantly increases survival. That is why early training in cardiopulmonary resuscitation (CPR) may be essential. Therefore, the aim of this study is the development and validation of an instrument to assess CPR knowledge and skills for schoolchildren from 5 to 8 years old.
METHOD:
We used a Spanish sample with 164 children aged between 5 and 8 years old. These children received a workshop called the “CPR from my school” program and their knowledge of CPR was assessed pre- and post-Workshop. We examined the scale through psychometric analyses within the framework of Classical Test Theory.
RESULTS:
The Nonide Scale provided evidence of content validity, revealed an essentially unidimensional internal structure, as well as excellent reliability (Ω = .87). Furthermore, a significant improvement was observed in scores, before and after the CPR Workshop.
CONCLUSIONS:
The Nonide Scale, designed to measure CPR knowledge and acquired skills in children from 5 to 8 years old, shows adequate psychometric properties, hence it can be used as professional and research contexts require.
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Research on clinical characteristics and prognostic analysis of heparin-induced thrombocytopenia after surgery for acute type a aortic dissection.
J Cardiothorac Surg2021 Apr;16(1):96. doi: 10.1186/s13019-021-01482-2.
Zhou Chu-Zhi, Feng Dong-Jie, Fang Yuan, Zha Feng-Yan, Wang Er-Hui, Li Yan-Zhen, Wei Min-Xin, Wen Jun-Min,
Abstract
PURPOSE:
The present study aimed to explore the clinical characteristics of heparin-induced thrombocytopenia (HIT) after surgery for acute type A aortic dissection and perform a relevant prognostic analysis.
METHODS:
After continuous observation and analysis of 204 patients who underwent acute type A aortic dissection, we found that blood platelets decreased significantly after surgery and that these patients can be suspected to suffer HIT based on relevant 4Ts scores. For these suspected HIT patients, a latex particle-enhanced immunoturbidimetric assay was conducted to detect heparin-induced antibodies. Perioperative clinical data of patients in HIT and non-HIT groups were recorded as were blood platelet counts, HIT antibody test results, 4Ts scores, thromboembolic complications, clinical prognosis and outcomes.
RESULTS:
In the present study, 38 suspected HIT patients, 16 HIT patients and 188 non-HIT patients were selected in the clinical setting. Among them, HIT patients were found to have prolonged cardiopulmonary bypass time (223?min on average vs. 164?min) and delayed aortic cross-clamp time (128?min on average vs. 107?min), and these differences between HIT patients and non-HIT patients were significant (P??0.05). The transfusions of blood platelets in the HIT group and non-HIT group were 18.7?±?5.0u and 15.6?±?7.34 u, respectively. In the HIT group, the mechanic ventilation time and the length of ICU stay were longer comparing the non-HIT group(P??0.05). The incidence of continuous renal replacement therapy in HIT group was higher than the non-HIT group (P??0.05). However, the HIT antibody titer in the HIT group was significantly higher than that in the Suspected HIT group (2.7?±?0.8?U/mL vs. 0.3?±?0.2?U/mL) (P?
CONCLUSIONS:
After surgery for acute type A aortic dissection, HIT patients developed postoperative complications, the duration of ventilatory support and length of ICU stay were extended, and the incidence of thromboembolism increased. HIT antibody detection and risk classification should be implemented for high-risk patients showing early clinical characteristics.
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Assessment of the knowledge level and experience of healthcare personnel concerning CPR and early defibrillation: an internal survey.
BMC Cardiovasc Disord2021 Apr;21(1):195. doi: 10.1186/s12872-021-02009-2.
Spinelli G, Brogi E, Sidoti A, Pagnucci N, Forfori F,
Abstract
BACKGROUND:
In-hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. Rapid cardiopulmonary resuscitation and early defibrillation is extremely connected to patient outcome. In this study, we aimed to assess the effects of a basic life support and defibrillation course in improving knowledge in IHCA management.
METHODS:
We performed a prospective observational study recruiting healthcare personnel working at Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. Study consisted in the administration of two questionnaires before and after BLS-D course. The course was structured as an informative meeting and it was held according to European Resuscitation Council guidelines.
RESULTS:
78 participants completed pre- and post-course questionnaires. Only 31.9% of the participants had taken part in a BLS-D before our study. After the course, we found a significative increase in the percentage of participants that evaluated their skills adequate in IHCA management (17.9% vs 42.3%; p?
CONCLUSIONS:
The training course resulted in significant increase in the level of knowledge about the general management of IHCA in hospital staff. Therefore, a simple intervention such as an informative meetings improved significantly the knowledge about IHCA and, consequently, can lead to a reduction of morbidity and mortality.
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Altered Fibrinolysis during and after Surgery.
Semin Thromb Hemost2021 Apr;():. doi: 10.1055/s-0041-1722971.
Colomina Maria J, Méndez Esther, Sabate Antoni,
Abstract
Major surgery induces hemostatic changes related to surgical stress, tissue destruction, and inflammatory reactions. These changes involve a shift of volume from extravascular space to intravascular and interstitial spaces, a "physiologic" hemodilution of coagulation proteins, and an increase of plasmatic fibrinogen concentration and platelets. Increases in fibrinogen and platelets together with a simultaneous dilution of pro- and anticoagulant factors and development of a hypofibrinolytic status result in a postoperative hypercoagulable state. This profile is accentuated in more extensive surgery, but the balance can shift toward hemorrhagic tendency in specific types of surgeries, for example, in prolonged cardiopulmonary bypass or in patients with comorbidities, especially liver diseases, sepsis, and hematological disorders. Also, acquired coagulopathy can develop in patients with trauma, during obstetric complications, and during major surgery as a result of excessive blood loss and subsequent consumption of coagulation factors as well as hemodilution. In addition, an increasing number of patients receive anticoagulants and antiplatelet drugs preoperatively that might influence the response to surgical hemostasis. This review focuses on those situations that may change normal hemostasis and coagulation during surgery, producing both hyperfibrinolysis and hypofibrinolysis, such as overcorrection with coagulation factors, bleeding and hyperfibrinolysis that may occur with extracorporeal circulation and high aortic-portal-vena cava clamps, and hyperfibrinolysis related to severe maintained hemodynamic disturbances. We also evaluate the role of tranexamic acid for prophylaxis and treatment in different surgical settings, and finally the value of point-of-care testing in the operating room is commented with regard to investigation of fibrinolysis.
Thieme. All rights reserved.
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Identifying prognostic factors and developing accurate outcome predictions for in-hospital cardiac arrest by using artificial neural networks.
J Neurol Sci2021 Apr;425():117445. doi: S0022-510X(21)00139-8.
Chung Chen-Chih, Chiu Wei-Ting, Huang Yao-Hsien, Chan Lung, Hong Chien-Tai, Chiu Hung-Wen,
Abstract
BACKGROUND:
Accurate estimation of neurological outcomes after in-hospital cardiac arrest (IHCA) provides crucial information for clinical management. This study used artificial neural networks (ANNs) to determine the prognostic factors and develop prediction models for IHCA based on immediate preresuscitation parameters.
METHODS:
The derived cohort comprised 796 patients with IHCA between 2006 and 2014. We applied ANNs to develop prediction models and evaluated the significance of each parameter associated with favorable neurological outcomes. An independent dataset of 108 IHCA patients receiving targeted temperature management was used to validate the identified parameters. The generalizability of the models was assessed through fivefold cross-validation. The performance of the models was assessed using the area under the curve (AUC).
RESULTS:
ANN model 1, based on 19 baseline parameters, and model 2, based on 11 prearrest parameters, achieved validation AUCs of 0.978 and 0.947, respectively. ANN model 3 based on 30 baseline and prearrest parameters achieved an AUC of 0.997. The key factors associated with favorable outcomes were the duration of cardiopulmonary resuscitation; initial cardiac arrest rhythm; arrest location; and whether the patient had a malignant disease, pneumonia, and respiratory insufficiency. On the basis of these parameters, the validation performance of the ANN models achieved an AUC of 0.906 for IHCA patients who received targeted temperature management.
CONCLUSION:
The ANN models achieved highly accurate and reliable performance for predicting the neurological outcomes of successfully resuscitated patients with IHCA. These models can be of significant clinical value in assisting with decision-making, especially regarding optimal postresuscitation strategies.
Copyright © 2021. Published by Elsevier B.V.
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Pediatric Emergency Medical Care in Yerevan, Armenia: A Knowledge and Attitudes Survey of Out-of-hospital Emergency Nurses.
Int Emerg Nurs2021 Apr;56():100998. doi: S1755-599X(21)00036-7.
Sim Reese, Cockrell Hannah, Best Al M, Baghdassarian Aline,
Abstract
BACKGROUND:
Emergency Medical Services (EMS) system in Armenia follows the Franco-German model in which physician - nurse dyads staff ambulances. This study aims to evaluate the knowledge and attitudes of EMS nurses regarding pediatric rapid assessment and resuscitation.
METHODS:
This is a cross-sectional, anonymous, self-administered survey study of a convenience sample of 200 out-of-hospital emergency nurses in June and July 2015.
RESULTS:
Response rate was 87.5%. Half of respondents failed to achieve the pre-defined passing score of 70% on the 10-question knowledge test (sample mean 6.32 ± 1.85 SD). Test score was positively correlated with pediatric training, current pediatric continuing medical education (CME), years with EMS and female gender. Questions regarding recognition of shock and initiation of neonatal and pediatric cardiopulmonary resuscitation were most frequently missed. Nurses were least confident in their ability to care for neonates and infants. 79.4% indicated that they would benefit from further pediatric training, and 86.1% indicated that knowledge from the Anglo-American model of emergency medicine could improve pediatric emergency care (PEC) in Armenia.
CONCLUSIONS:
There is a need for additional PEC training and continuing education for EMS nurses in Yerevan, Armenia. Training EMS nurses would improve first responder awareness of pediatric acute management and resuscitation and enhance the quality of emergency care of children.
Copyright © 2021 Elsevier Ltd. All rights reserved.
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[Real-world analysis of obstructive respiratory tract disorders: characterization, health care and costs.]
Recenti Prog Med2021 Apr;112(4):285-293. doi: 10.1701/3584.35687.
Calabria Silvia, Ronconi Giulia, Dondi Letizia, Pedrini Antonella, Piccinni Carlo, Esposito Immacolata, Canonica Giorgio Walter, Martini Nello,
Abstract
INTRODUCTION:
This analysis has described the burden of patients with asthma, chronic obstructive pulmonary disease (COPD), asthma/COPD mixed conditions or undefined obstructive diseases (UODs), from the Italian National Health System point of view.
METHODS:
In the accrual period (2015), starting from the ReS database, a record linkage among demographic, pharmaceuticals, hospitalizations and outpatient specialist services databases has identified patients affected by only asthma, only COPD, asthma/COPD and UODs. From the less recent date of identification, each patient was analyzed in one previous year and in two years of follow-up (at most up to 12/31/2017). In the accrual period, in the previous one and in 2-year follow-up sinus polyps was researched. One-year free filled respiratory (ATC code R03) and concomitant prescriptions, outpatient specialist services, hospitalizations were described. Two-year costs were assessed annually.
RESULTS:
In 2015, 110,453 subjects with asthma (16.6 x1000 ?12 years old), 229,747 with COPD, 8828 with asthma/COPD (55.5 x1000 and 2.1 x1000 ?40 years, respectively) and 75,072 with UODs (27.2 x1000 subjects aged 40 to 65) were selected. Sinus polyps was found in 753 patients with asthma, 181 with COPD and 122 with asthma/COPD. A very high use of inhaled corticosteroids - ICS (R03AB) as monotherapy and as fixed association ICS/LABA and of cardiovascular drugs was highlighted among patients with COPD and asthma/COPD. The spirometry test was used in 21.4% patients with asthma/COPD, in 9.2% with asthma, in 8.6% with COPD and in 5.8% with UODs. Subjects with COPD and asthma/COPD were the most frequently hospitalized, mainly due to respiratory and cardiovascular causes, and those with the longest in-hospital stay. On average, the mean overall one-year expenditure per COPD or asthma/COPD patient was three times higher than per asthma or UOD one (?3508/?3613 vs ?942/?1394, respectively).
CONCLUSIONS:
Concomitant drugs and hospitalizations due to other causes than respiratory ones accounted for the highest expenses. In general, comorbidities and cardiopulmonary complications played a key role in obstructive airway disease managing and controlling, by determining unsustainable socio-economic impacts.
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Definity, echo contrast, induced cardiac arrest: brief review of the literature.
BMJ Case Rep2021 Apr;14(4):. doi: e240492.
Mir Tanveer, Uddin Mohammed M, Watson Kayleigh, Meir Eliezer Bar, Abdo Alward,
Abstract
Definity is a contrast media used to enhance the endocardium during echocardiography. Cardiac arrest as an adverse reaction to Definity is still a debate. We are presenting a rare case of a 69-year-old male patient who developed cardiopulmonary arrest immediately after Definity injection during resting echocardiography.
© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.
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Hyperoxia After Return of Spontaneous Circulation in Cardiac Arrest Patients.
J Cardiothorac Vasc Anesth2021 Mar;():. doi: S1053-0770(21)00209-3.
Latif Rana K, Clifford Sean P, Byrne Keith R, Maggard Brittany, Chowhan Yaruk, Saleem Jawad, Huang Jiapeng,
Abstract
Current guidelines emphasize the use of 100% oxygen during cardiopulmonary resuscitation after cardiac arrest. When patients are ventilated for variable periods after return of spontaneous circulation (ROSC), hyperoxia causes increased morbidity and mortality by overproduction of reactive oxygen species. Various patient, volunteer, and animal studies have shown the harmful effects of hyperoxia. This mini-review article aims to expand the potential clinical spectrum of hyperoxia on individual organ systems leading to organ dysfunction. A framework to achieve and maintain normoxia after ROSC is proposed. Despite the harmful considerations of hyperoxia in critically ill patients, additional safety studies including dose-effect, level and onset of the reactive oxygen species effect, and safe hyperoxia applicability period after ROSC, need to be performed in various animal and human models to further elucidate the role of oxygen therapy after cardiac arrest.
Copyright © 2021 Elsevier Inc. All rights reserved.
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[Risk factors of low cardiac output syndrome after cardiac valvular surgery in elderly patients with valvular disease complicated with giant left ventricle].
Zhonghua Xin Xue Guan Bing Za Zhi2021 Apr;49(4):368-373. doi: 10.3760/cma.j.cn112148-20210302-00187.
Li Z, Zhang G B, Li T W, Zhang Y, Li M D, Wu Y,
Abstract
To explore the risk factors of low cardiac output syndrome (LCOS) after cardiac valvular surgery in elderly patients with valvular disease complicated with giant left ventricle. This was a retrospective study. The clinical data of patients over 60 years old with giant left ventricle who underwent cardiac valvular surgery in Henan Provincial People's Hospital (Fuwai Central China Cardiovascular Hospital) from January 2016 to January 2020 were collected in this study. Patients were divided into LCOS group and non-LCOS group. The clinical data, preoperative echocardiographic results and surgical data of all patients were collected. Taking LCOS as dependent variable and statistically significant variables in univariate analysis as independent variable, multivariate logistic regression equation was constructed to identify the risk factors of LCOS after cardiac valvular surgery in elderly patients with valvular disease complicated with giant left ventricle. On the basis of logistic regression, the risk factors of continuous variables were put into the regression model for trend test. A total of 112 patients were included, among whom 76 patients were male, the mean age was (65.3±3.8) years. There were 21 cases in LCOS group and 91 cases in non LCOS group. Univariate analysis showed that age?70 years, preoperative NYHA cardiac function class ?, preoperative renal dysfunction, preoperative cerebrovascular disease, preoperative LVEF<40%, blood loss/total blood volume>20%, cardiopulmonary bypass (CPB) time>130 minutes and aortic cross-clamp time>90 minutes all had statistically significant differences between the two groups (all <0.05). Multivariate logistic regression analysis showed that age?70 years (=5.067, 95% 1.320-19.456, =0.018), preoperative NYHA cardiac function class ? (=3.100, 95% 1.026-9.368, =0.045), renal dysfunction (=3.627, 95% 1.018-12.926, =0.047), CPB time>130 minutes (=4.539, 95% 1.483-13.887, =0.008) were the independent risk factors of LCOS after cardiac valvular surgery in elderly patients with giant left ventricle. Risk of LCOS was significantly higher in patients aged from 65 to 70 years (=1.784, 95% 0.581-5.476) and aged 70 years and above (=4.400, 95% 1.171-16.531) than in patients aged from 60 to 65 years. The trend test results showed that the risk of LCOS increased significantly in proportion with the increase of age ( for trend=0.024). Risk of LCOS was significantly higher in patients with CPB time between 90 and 110 minutes (=1.917, 95% 0.356-10.322), 110 and 130 minutes (=1.437, 95% 0.114-18.076) and 130 minutes and above (=5.750, 95% 1.158-28.551) than in patients with CPB time ? 90 minutes ( for trend=0.009). The risk factors of LCOS after cardiac valvular surgery are age?70 years, preoperative NYHA cardiac function class ?, renal dysfunction, CPB time>130 minutes in elderly patients with giant left ventricle.
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Hybrid Anterior Column Realignment - Pedicle Subtraction Osteotomy for Severe Rigid Sagittal Deformity.
World Neurosurg2021 Apr;():. doi: S1878-8750(21)00568-4.
Sadrameli Saeed S, Davidov Vitaliy, Lee Jonathan J, Huang Meng, Kizek Dominic J, Mambelli Dorian, Rajendran Sibi, Barber Sean M, Holman Paul J,
Abstract
OBJECTIVE:
Recently, a hybrid anterior column realignment-pedicle subtraction osteotomy (ACR-PSO) approach has been conceived for patients with severe rigid sagittal deformity, the clinical and radiographic outcomes of which require further investigation compared to ACR only.
METHODS:
A single-center, retrospective chart review identified patients undergoing a combination of hyperlordotic lateral lumbar interbody grafting (ACR) and concurrent Schwab grade 3 three-column osteotomy and propensity-matched patients undergoing ACR only in the same timeframe. Anterior longitudinal ligament was directly released or partially sectioned in all patients. Chart data included demographics, Oswestry Disability Index (ODI) scores, ACR and osteotomy locations, cage dimensions, fusion length, and complications. Radiographic measurements included lumbar lordosis, sagittal vertical axis (SVA), pelvic tilt (PT), and proximal junctional kyphosis (PJK).
RESULTS:
14 patients were enrolled in the ACR+PSO group and 36 in the ACR-only group. Mean ages were 68.5 and 63.9 years, 64% and 67% female, average BMI was 27.9 and 29.2, and cardiopulmonary comorbidities were 21% and 17%, respectively. There was no difference in complications (p = 0.347). The average follow-up for the ACR+PSO and ACR-only groups were 22 and 18 months, respectively. Excluding two mortalities, fusion occurred in all patients. Average change in lumbar lordosis measured -40.8 ± 9.2° and -19.1 ± 15.7° (p = 0.0006) and PT correction measured 10.5 ± 3.4° and 27.3 ± 1.6° (p < 0.0001), respectively.
CONCLUSION:
For patients with severe rigid sagittal deformity, the hybrid ACR-PSO approach offers significant restoration of lumbar lordosis compared to ACR only, with similar complications but reduced PT correction.
Copyright © 2021. Published by Elsevier Inc.
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