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Pubblicazioni recenti - cardiopulmonary
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Effectiveness of dispatcher instructions-dependent or independent bystander cardiopulmonary resuscitation on neurological survival among patients with out-of-hospital cardiac arrest.
J Cardiol2019 Sep;():. doi: S0914-5087(19)30266-7.
Hatakeyama Toshihiro, Kiguchi Takeyuki, Kobayashi Daisuke, Nakamura Naotoshi, Nishiyama Chika, Hayashida Sumito, Kiyohara Kosuke, Kitamura Tetsuhisa, Kawamura Takashi, Iwami Taku,
Abstract
BACKGROUND:
We evaluated the association between survival and bystandercardiopulmonary resuscitation (CPR) with or without dispatcher instructions (DI) considering the time from emergency call receipt by the dispatch center to emergency medical services (EMS) personnel's contact with the patient (i.e. time to EMS arrival).
METHODS:
This prospective study conducted in Osaka City, Japan, from 2009 to 2015 included patients with medical cause-related out-of-hospital cardiac arrest who were ?18 years old. The primary outcome was one-month favorable neurological survival. Using multiple logistic regression models, the adjusted odds ratios (AOR) of independent and DI-dependent CPR for the primary outcome were compared with no CPR. Adjustments were made for patients' age, sex, activities of daily living before the cardiac arrest, year of cardiac arrest, location, presence or absence of witnesses, etiology of cardiac arrest, and the time from EMS contact with the patient to patient's arrival at the hospital. The effective estimated "time to EMS arrival" was also calculated.
RESULTS:
For analyses 10,925 individuals were eligible. Independent CPR had a significantly higher one-month favorable neurological survival than no CPR whereas there was no significant difference between DI-dependent CPR and no CPR (AOR, 1.90 [1.47-2.46] and 1.16 [0.91-1.47], respectively). The estimated "time to EMS arrival" for a one-month favorable neurological survival after independent CPR was ?13min.
CONCLUSIONS:
Bystander CPR that did not need DI was associated with significantly higher one-month favorable neurological survival than no CPR, with an effective estimated "time to EMS arrival" of ?13min.
Copyright © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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Spirometry: A Need for Periodic Updates of National Reference Values.
Adv Exp Med Biol2019 Sep;():. doi: 10.1007/5584_2019_432.
Chcia?owski Andrzej, Gólczewski Tomasz,
Abstract
The aim of the study was to assess the need for changes in spirometry reference values in the Polish population with time lapse, as the aftereffect of a radical socioeconomic overturn of the 1990. We retrospectively analyzed data files on forced expiratory volume in 1 s (FEV1), vital capacity (VC), and forced VC (FVC) in healthy, never-smoking Caucasians (731 females and 327 males) obtained in in 1993-1998. We assessed a discrepancy between the then measured values of these variables, on the one side, and the corresponding European Community for Steel and Coal (ECSC) predicted values or the current updated predicted values for the Polish population, on the other side. We found that those old measured values approximately corresponded to the ECSC reference, but they were appreciably lower than the current Polish reference values; the younger the subjects the greater the difference. The current Polish reference values of FVC were much closer to the old measured VC than to the old measured FVC values, which introduces a substantial discrepancy between the past and present FVCs. We conclude that the spirometry reference values may change with time lapse. Thus, accuracy of prediction equations should be periodically updated, which seems to particularly concern the equations elaborated for the nations that undergo rapid economic developments connected with changes in living standards.
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Surgical management of large undifferentiated cardiac sarcoma involving the right ventricle to pulmonary trunk.
Gen Thorac Cardiovasc Surg2019 Sep;():. doi: 10.1007/s11748-019-01208-1.
Furukawa Hiroshi, Honda Takeshi, Yamasawa Takahiko, Kanaoka Yuji, Tanemoto Kazuo,
Abstract
A large intra-cardiac tumor from the right ventricle to pulmonary trunk was detected by contrast-enhanced computed tomography and transthoracic echocardiography in a 59-year-old woman with progressive dyspnea on effort and acute congestive right-sided heart failure. Emergent surgical management was performed with cardiopulmonary bypass under cardiac arrest, however, tumor resection was incomplete, because it originated from the interventricular septum. Concomitant tricuspid valve replacement using a bioprosthesis was required due to the involvement of the septal leaflet of the tricuspid valve. Although large pulmonary thromboembolism was initially suspected, a pathological examination confirmed undifferentiated cardiac sarcoma. The patient did not consent to additional neoadjuvant chemotherapy or radiation therapy. After palliative surgical management, she was discharged. Recurrence rapidly progressed and the patient died approximately 2 months after surgery. We herein present a successful palliative surgical case of large cardiac undifferentiated sarcoma originating from the intraventricular septum and involving the right ventricle to pulmonary trunk.
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Completion of the medical certificate of cause of death in Madrid: A descriptive cross-sectional study.
Rev Clin Esp2019 Sep;():. doi: S0014-2565(19)30165-1.
Pinto Pastor P, Santiago-Saéz A, Guijarro-Castro C, Dorado Fernández E, Albarrán Juan E,
Abstract
BACKGROUND:
The medical certificate of cause of death is a dual-purpose document: an official registration of an individual's death and a statistical analysis of the populational causes of death. However, the completion of this document in clinical practice creates significant conflicts.
OBJECTIVES:
To analyse the completion and detect the main errors that occur when filling in these documents. We then compared the most important variables between the various types of documents analysed.
MATERIAL AND METHODS:
We conducted a descriptive cross-sectional study that analysed 513 certificates in the municipality of Madrid, Spain. The analysis included official documents (new and old versions) and hospital documents.
RESULTS:
The study's main finding was that 316 documents employed the term "cardiopulmonary arrest" as the immediate cause of death. In 98 other cases, other poorly defined immediate causes were listed. We were able to conclude that the hospital documents do not always have the required sections for the certificate to be legally functional. In the Professional Medical Association certificates, there is poorer completion of the current document because the document itself hinders its appropriate completion and requires better physician training to complete.
CONCLUSIONS:
We propose possible improvements to the official document so that it meets the legal requirements, facilitates its completion and fulfils its function. We also offer recommendations for hospitals that have their own document and suggestions for improving its completion.
Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.
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Glutathione Blood Concentrations: A Biomarker of Oxidative Damage Protection during Cardiopulmonary Bypass in Children.
Diagnostics (Basel)2019 Sep;9(3):. doi: E118.
Satriano Angela, Franchini Simone, Lapergola Giuseppe, Pluchinotta Francesca, Anastasia Luigi, Baryshnikova Ekaterina, Livolti Giovanni, Gazzolo Diego,
Abstract
BACKGROUND:
Pediatric open-heart surgery with cardiopulmonary bypass (CPB) still remains a risky interventional procedure at high mortality/morbidity. To date, there are no clinical, laboratory, and/or monitoring parameters providing useful information on perioperative stress. We therefore investigated whether blood concentrations of glutathione (GSH), a powerful endogenous antioxidant, changed in the perioperative period.
METHODS:
We conducted an observational study in 35 congenital heart disease (CHD) children in whom perioperative standard laboratory and monitoring parameters and GSH blood levels were assessed at five monitoring time points.
RESULTS:
GSH showed a pattern characterized by a progressive increase from pre-surgery up to 24 h after surgery, reaching its highest peak at the end of CPB. GSH measured at the end of CPB correlated with CPB duration, cross-clamping, arterial oxygen partial pressure, and with body core temperature.
CONCLUSIONS:
The increase in GSH levels in the perioperative period suggests a compensatory mechanism to oxidative damage during surgical procedure. Caution is needed in controlling different CPB phases, especially systemic reoxygenation in a population that is per se more prone to oxidative stress/damage. The findings may point the way to detecting the optimal temperature and oxygenation target by biomarker monitoring.
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Prehospital advanced airway management for paediatric patients with out-of-hospital cardiac arrest: A nationwide cohort study.
Resuscitation2019 Sep;():. doi: S0300-9572(19)30614-8.
Okubo Masashi, Komukai Sho, Izawa Junichi, Gibo Koichiro, Kiyohara Kosuke, Matsuyama Tasuku, Kiguchi Takeyuki, Iwami Taku, Callaway Clifton W, Kitamura Tetsuhisa,
Abstract
BACKGROUND:
Although prehospital advanced airway management (AAM) (i.e., endotracheal intubation [ETI] and insertion of supraglottic airways [SGA]) has been performed for paediatric out-of-hospital cardiac arrest (OHCA), the effect of AAM has not been fully studied. We evaluated the association between prehospital AAM for paediatric OHCA and patient outcomes.
METHODS:
We conducted an observational cohort study, using the All-Japan Utstein Registry between 2014 and 2016. We included paediatric patients (age <18 years) with OHCA. We calculated time-dependent propensity score at each minute after initiation of cardiopulmonary resuscitation by EMS providers, using a Fine-Gray regression model. We sequentially matched patients who received AAM during cardiac arrest to patients at risk of receiving AAM within the same minute (risk-set matching). The primary outcome was 1-month survival. Secondary outcome was 1-month survival with favourable functional status, defined as Cerebral Performance Category score of 1 or 2.
RESULTS:
We analysed 3,801 paediatric patients with OHCA. 481 patients (12.7%) received AAM and 3,320 (87.3%) did not. Among the 3,801 analysed patients, 912 patients underwent risk-set matching. In the matched cohort, AAM was not associated with 1-month survival (AAM: 52/456 [11.4%] vs. no AAM: 44/456 [9.6%]; risk ratio [RR], 1.15 [95% CI, 0.76-1.73]; risk difference [RD], 1.5% [-3.0 to 6.1%]) or favourable functional status (AAM: 9/456 [2.0%] vs. no AAM: 10/456 [2.2%]; RR, 0.69 [95% CI, 0.26-1.79]; RD, -0.8% [-2.9 to 1.3%]).
CONCLUSION:
Among paediatric patients with OHCA, we found that prehospital AAM was not associated with 1-month survival or favourable functional status.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Evaluation and Prognostic Relevance of Right Ventricular-Arterial Coupling in Pulmonary Hypertension.
Am J Respir Crit Care Med2019 Sep;():. doi: 10.1164/rccm.201906-1195LE.
Richter Manuel J, Peters Dana, Ghofrani Hossein A, Naeije Robert, Roller Fritz, Sommer Natascha, Gall Henning, Grimminger Friedrich, Seeger Werner, Tello Khodr,
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Intraoperative Events in Liver Transplantation using Donation after Cardiac Death Donors.
Liver Transpl2019 Sep;():. doi: 10.1002/lt.25643.
Chadha Ryan M, Croome Kristopher P, Aniskevich Stephen, Pai Sher-Lu, Nguyen Justin, Burns Justin, Perry Dana, Taner C Burcin,
Abstract
BACKGROUND:
Liver grafts from donation after cardiac death are a source of organs to decrease waitlist mortality. While there have been lower rates of graft loss, there are concerns of an increased incidence of intraoperative events in recipients of DCD grafts. We aim to look at the incidence of intraoperative events between recipients of livers from DCD and donation after brain death (DBD) donors.
METHODS:
We collected data for 235 DCD liver recipients between 2006-2017. We performed a 1:1 propensity match between these patients and patients with DBD donors. Variables included: recipient age, liver disease etiology, biologic MELD, allocation MELD, diagnosis of HCC, and year of transplantation.
RESULTS:
DCD and DBD groups had no significant differences in incidence of postreperfusion syndrome (p = 0.75), arrhythmia requiring cardiopulmonary resuscitation (p = 0.65), and treatments for hyperkalemia (p = 0.83). In the DCD group, there was a significant increase in amount of total intraoperative and postreperfusion blood products utilized (p < 0.05 for all products), significant differences in post reperfusion thromboelastography parameters, as well as inotropes and vasopressors used (p < 0.05 for all infusions). There was no difference in patient (p = 0.49) and graft survival (p = 0.10) at 1, 3, and 5 years. (Patient survival: DCD: 93.5%, 88.9% and 81.2%; DBD: 92.6%, 87.9% and 85.6%; Graft survival: DCD: 90.5%, 86.1% and 77.1%; DBD: 92.2%, 87.6% and 85.1%) CONCLUSION: DCD grafts compared to a cohort of DBD grafts have a similar low incidence of major intraoperative events, but increased incidence of transient vasopressor/inotropic usage and increased blood transfusion requirements. This does not result in differences in long-term outcomes. While centers should continue to look at DCD liver donors, they should be cognizant regarding intraoperative care to prevent adverse outcomes.
Copyright © 2019 by the American Association for the Study of Liver Diseases.
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Continuous Renal Replacement Therapy in Preterm Infants.
Yonsei Med J2019 Oct;60(10):984-991. doi: 10.3349/ymj.2019.60.10.984.
Noh Eu Seon, Kim Hyun Ho, Kim Hye Seon, Han Yea Seul, Yang Misun, Ahn So Yoon, Sung Se In, Chang Yun Sil, Park Won Soon,
Abstract
PURPOSE:
Despite the increasing use of continuous renal replacement therapy (CRRT) in the neonatal intensive care unit (NICU), few studies have investigated its use in preterm infants. This study evaluated the prognosis of preterm infants after CRRT and identified risk factors of mortality after CRRT.
MATERIALS AND METHODS:
A retrospective review was performed in 33 preterm infants who underwent CRRT at the NICU of Samsung Medical Center between 2008 and 2017. Data of the demographic characteristics, predisposing morbidity, cardiopulmonary function, and CRRT were collected and compared between surviving and non-surviving preterm infants treated with CRRT. Univariable and multivariable analyses were performed to identify factors affecting mortality.
RESULTS:
Compared with the survivors, the non-survivors showed younger gestational age (29.3 vs. 33.6 weeks), lower birth weight (1359 vs. 2174 g), and lower Apgar scores at 1 minute (4.4 vs. 6.6) and 5 minutes (6.5 vs. 8.6). At the initiation of CRRT, the non-survivors showed a higher incidence of inotropic use (93% vs. 40%, =0.017) and fluid overload (16.8% vs. 4.0%, =0.031). Multivariable analysis revealed that fluid overload >10% at CRRT initiation was the primary determinant of mortality after CRRT in premature infants, with an adjusted odds ratio of 14.6 and a 95% confidence interval of 1.10-211.29.
CONCLUSION:
Our data suggest that the degree of immaturity, cardiopulmonary instability, and fluid overload affect the prognosis of preterm infants after CRRT. Preventing fluid overload and earlier initiation of CRRT may improve treatment outcomes.
© Copyright: Yonsei University College of Medicine 2019.
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Right Atrial Blood Cyst with Stones Suspended from the Coronary Sinus.
Sultan Qaboos Univ Med J2019 May;19(2):e161-e163. doi: 10.18295/squmj.2019.19.02.014.
Sabzi Feridoun, Heydari Aghigh, Asadmobini Atefeh, Heidari Mohammad B,
Abstract
Cardiac blood cysts are rare benign neoplasms, usually involving the cardiac valves and are remnants of the Chiari network. They are usually detected in the first six months of life and rarely occur in children or adults. We report a 76-year-old male patient who was referred to the Imam Ali Hospital affiliated with Kermanshah University of Medical Sciences, Kermanshah, Iran, in 2018 with dyspnoea. Transthoracic echocardiography revealed a small patent (PFO) and a circumferential mobile cystic mass in the right atrium, with the impression of a tumour or thrombus. The patient underwent open-heart surgery with cardiopulmonary bypass to repair to PFO and remove the intra-atrial lesion. During surgical examination of the right atrial cavity, a blood cyst containing small stone-like structures on the coronary sinus valve of the right atrium was found. The post-operative course was uneventful and no recurrence of tumour was detected during six months of follow-up. To the best of our knowledge, this is the first reported case of a right atrial blood cyst with a few nodule-like stones in an adult with PFO in Iran and the second case in an adult with PFO worldwide.
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From accelerometer output to physical activity intensities in breast cancer patients.
J Sci Med Sport2019 Sep;():. doi: S1440-2440(19)30298-1.
Sweegers Maike G, Buffart Laurien M, Huijsmans Rosalie J, Konings Inge R, van Zweeden Annette A, Brug Johannes, Chinapaw Mai J M, Altenburg Teatske M,
Abstract
OBJECTIVES:
We aimed to investigate accelerometer output corresponding to physical activity intensity cut-points based on percentage of peak oxygen consumption (%VOpeak) and Metabolic Equivalent of Task (MET) value in women treated for breast cancer.
DESIGN:
Laboratory study.
METHODS:
Fifty female patients shortly after completion of treatment for breast cancer were included. VOpeak was determined during a cardiopulmonary exercise test. Subsequently, patients performed ten activities with different intensities while wearing an accelerometer on the right hip and a mobile oxycon to assess oxygen consumption. We studied the relationship between energy expenditure (expressed as %VOpeak and MET-value) and accelerometer output (in counts per minute (cpm)) with linear regression analyses. We determined accelerometer output corresponding to physical activity intensity cut-points (40% and 60%VOpeak; 3 and 6 MET) using regression equations.
RESULTS:
VOpeak was 22.4mL/kg/min (SD 5.2) and resting metabolic rate was 3.1mL/kg/min (SD 0.6). Accelerometer output corresponding to the cut-points for moderate (40% VOpeak) and vigorous intensity (60% VOpeak) were 1123 and 1911, respectively. The analyses based on MET-values resulted in accelerometer output of 1189cpm for the moderate (3 MET) and 2768 cpm for the vigorous intensity cut-point (6 MET).
CONCLUSIONS:
Accelerometer outputs for moderate and vigorous intensity physical activity were lower than commonly used cut-points (i.e. 1952 and 5724 cpm), irrespective of the method used to express energy expenditure (%VOpeak versus MET-value). Thus, categorizing physical activity intensities based on general-population cut-points, may underestimate physical activity intensities for women treated for breast cancer.
Copyright © 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
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Cardiopulmonary Performance After Left Cardiac Sympathetic Denervation for Long QT Syndromes: Yes We Can!
JACC Clin Electrophysiol2019 Sep;5(9):1091-1092. doi: S2405-500X(19)30587-0.
Dusi Veronica, Ajijola Olujimi A,
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The Effect of Left Cardiac Sympathetic Denervation on Exercise in Patients With Long QT Syndrome.
JACC Clin Electrophysiol2019 Sep;5(9):1084-1090. doi: S2405-500X(19)30418-9.
Anderson Heather N, Bos J Martijn, Rohatgi Ram K, Ackerman Michael J,
Abstract
OBJECTIVES:
This study evaluated the effect of left cardiac sympathetic denervation (LCSD) on heart rate, cardiac contractility, and cardiopulmonary fitness in human subjects.
BACKGROUND:
The primary treatment for long QT syndrome (LQTS) is beta-blocker (BB) therapy, but some patients experience breakthrough cardiac events or intolerable side effects. LCSD provides a significant antifibrillatory, protective effect in LQTS. However, the effect of LCSD on cardiopulmonary fitness in humans has not been previously described.
METHODS:
A retrospective analysis of patients with LQTS and LCSD (2006 to 2017) who had both pre- and post-LCSD exercise stress tests (N = 55; 39 females; mean age at LCSD 22 ± 12 years; mean follow-up 5.1 ± 2.5 years; 36 patients with LQT1; 15 patients with LQT2). Forty patients (73%) were receiving BBs pre-LCSD.
RESULTS:
Mean peak heart rate before LCSD was 143 ± 23 beats/min, mean peak oxygen consumption (VO) was 32 ± 10 ml/kg/min, and mean peak respiratory exchange ratio was 1.14 ± 0.12. There was no difference in peak heart rate, peak VO, peak QTc, or respiratory exchange ratio pre- and post-LCSD. To evaluate the isolated effect of LCSD, the study performed a subset analysis of patients with LCSD monotherapy (n = 10) or no change in BB dose (n = 12). Patient-matched pre- and post-LCSD exercise testing showed no difference in heart rate, VO, or left ventricular function following LCSD.
CONCLUSIONS:
LCSD provides increased protection from an LQTS-triggered event without negatively affecting peak heart rate, cardiopulmonary fitness, or cardiac contractility, as assessed by both treadmill exercise stress testing and echocardiography.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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[Effects of reinfusion of the remaining blood filtered by leukocyte depletion filter on postoperative cellar immune function after cardiopulmonary bypass].
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue2019 Aug;31(8):989-993. doi: 10.3760/cma.j.issn.2095-4352.2019.08.015.
Luo Lin, Wang Dan, Chen Meizhu, Li Meixia,
Abstract
OBJECTIVE:
To evaluate effects of reinfusion of the remaining blood filtered by leukocyte depletion filter on postoperative cellular immune function after cardiopulmonary bypass (CPB).
METHODS:
Forty patients who underwent selective cardiac valve replacement surgery with CPB in department of anesthesiology of Haikou Municipal Hospital from January to June in 2018 were enrolled. All the patients were divided into the control group and experimental group according to the random number table method, with 20 patients in each group. In the experimental group, patients received residual pump blood transfusion which had been filtered by leukocyte depletion filter and stored in sterile blood collection bags. In the control group, patients received residual pump blood transfusion which was stored in sterile blood collection bags without being filtered. The remaining blood was reinfused after CPB in two groups. Blood samples were taken before CPB (T1), 2 hours following CPB (T2), and 1, 3, 5 days after reinfusion of the remaining blood (T3, T4, T5), the levels of T lymphocyte subsets CD3, CD4, CD8 and natural killer cells (NK cells) were detected by flow cytometer, and CD4/CD8 ratio was calculated. The levels of plasma tumor necrosis factor-? (TNF-?), interleukins (IL-2, IL-6, IL-8) were measured by enzyme linked immunosorbent essay (ELISA). The duration of mechanical ventilation, the length of intensive care unit (ICU) stay, the length of hospital stay, and incidence of wound and pulmonary infection after surgery were compared between two groups.
RESULTS:
Among 40 patients, there were 22 males and 18 females; with an age of (47.88±12.29) years old; and with 25 cases of American Society of Anesthesiologists (ASA) physical status II, and 15 cases of ASA III. There was no statistical difference in the volume of the remaining blood between the two groups (mL: 959.00±116.84 vs. 971.50±115.68, P > 0.05). Compared with T1, the levels of T lymphocyte subsets CD3, CD4, CD8, NK cells and plasma levels of IL-2 were significantly decreased from T2, the CD4/CD8 ratio was significantly decreased from T3 in two groups, but there was no statistical difference in CD3, CD4, CD8, NK cells, CD4/CD8 ratio or plasma level of IL-2 at each time between the two groups. Compared with T1, the plasma levels of TNF-?, IL-6 and IL-8 were significantly increased at T2 in two groups and then decreased gradually. The plasma levels of TNF-?, IL-6 and IL-8 from T3 in experimental group were lower than those in control group [TNF-? (ng/L): 28.49±4.66 vs. 33.82±4.30, IL-6 (ng/L): 25.98±4.51 vs. 31.38±5.42, IL-8 (ng/L): 38.98±4.67 vs. 45.76±5.33, all P < 0.05], they restored to the level of T1 at T5. In addition, compared with control group, the duration of mechanical ventilation, the length of ICU stay in experimental group were significantly decreased (hours: 8.07±1.30 vs. 9.16±1.52, 28.22±2.78 vs. 31.25±3.18, both P < 0.05), and there was no statistical difference in the length of hospital stay (days: 20.65±2.76 vs. 22.45±3.22), incidence of wound and pulmonary infection (25.0% vs. 15.0%, 5.0% vs. 15.0%) between the two groups (all P > 0.05).
CONCLUSIONS:
Reinfusion of the remaining blood filtered by leukocyte depletion filtercan inhibit inflammatory responses and don't affect the function of cellular immunity, and don't increase the incidence of infection.
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[Compose the splendid passages of "heart" for the age of health: theory and practice of "three construction" strategy of cardiopulmonary resuscitation in China].
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue2019 Aug;31(8):923-927. doi: 10.3760/cma.j.issn.2095-4352.2019.08.001.
Wang Lixiang,
Abstract
OBJECTIVE:
Cardiac arrest is an emergency that threatens the safety of human life. Cardiopulmonary resuscitation, as the key technology, has always attracted much attention. Based on the practice on the health of life, the Cardiopulmonary Resuscitation Specialized Committee of Chinese Research Hospital Association, Cardiopulmonary Resuscitation Specialized Committee of Chinese Aging Well Association, Health Culture Committee of Chinese Health Association, the 10th Science Popularization Branch of the Chinese Medical Association, is facing the life of the people's "to die in an old age". From the force "to bring back to life" of the cardiopulmonary resuscitation, the author constructs the scientific theory of cardiopulmonary resuscitation, the base of the scientific and technical personnel of the cardiopulmonary resuscitation, and the mass of the popularization of the cardiopulmonary resuscitation. The scientific theory system, the technological team, and the benefit to the people are focused. It has promoted the popularization and promotion of the cardiopulmonary resuscitation science and technology, and obtained the great achievements of the scientific and technological innovation and the scientific popularization of the cardiopulmonary resuscitation, which arethe cultural connotations of the "heart" of the life and health.
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Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest: A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia).
Resuscitation2019 Aug;():. doi: S0300-9572(19)30582-9.
Nolan Jerry P, Berg Robert A, Andersen Lars W, Bhanji Farhan, Chan Paul S, Donnino Michael W, Lim Swee Han, Ma Matthew Huei-Ming, Nadkarni Vinay M, Starks Monique A, Perkins Gavin D, Morley Peter T, Soar Jasmeet, ,
Abstract
Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research.
Copyright © 2019 Elsevier B.V. All rights reserved.
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CHEST COMPRESSION COMPONENTS (RATE, DEPTH, CHEST WALL RECOIL AND LEANING): A SCOPING REVIEW.
Resuscitation2019 Sep;():. doi: S0300-9572(19)30608-2.
Considine Julie, Gazmuri Raúl J, Perkins Gavin D, Kudenchuk Peter J, Olasveengen Theresa M, Vaillancourt Christian, Nishiyama Chika, Hatanaka Tetsuo, Mancini Mary E, Chung Sung Phil, Escalante-Kanashiro Raffo, Morley Peter,
Abstract
AIM:
To understand whether the science to date has focused on single or multiple chest compression components and identify the evidence related to chest compression components to determine the need for a full systematic review.
METHODS:
This review was undertaken by members of the International Liaison Committee on Resuscitation and guided by a specific methodological framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were peer-reviewed human studies that examined the effect of different chest compression depths or rates, or chest wall or leaning, on physiological or clinical outcomes. The databases searched were MEDLINE complete, Embase, and Cochrane.
RESULTS:
Twenty-two clinical studies were included in this review: five observational studies involving 879 patients examined both chest compression rate and depth; eight studies involving 14,285 patients examined chest compression rate only; seven studies involving 12,010 patients examined chest compression depth only, and two studies involving 1,848 patients examined chest wall recoil. No studies were identified that examined chest wall leaning. Three studies reported an inverse relationship between chest compression rate and depth.
CONCLUSION:
This scoping review did not identify sufficient new evidence that would justify conducting new systematic reviews or reconsideration of current resuscitation guidelines. This scoping review does highlight significant gaps in the research evidence related to chest compression components, namely a lack of high-level evidence, paucity of studies of in-hospital cardiac arrest, and failure to account for the possibility of interactions between chest compression components.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Short And Midterm Outcome Of Fallot's Tetralogy Repair In Infancy: A Single Center Experience In A Developing Country.
J Ayub Med Coll Abbottabad;31(3):383-387.
Younis Memon Muhammad Kamran, Akhtar Saleem, Mohsin Muhammad, Ahmad Waris, Arshad Aleena, Ahmed Mehnaz Atiq,
Abstract
BACKGROUND:
Primary repair of ToF between 3-12 months is the preferred mode of treatment worldwide, with low surgical mortality. This study reviews our experience of ToF repair in infancy and its short and midterm outcomes in a single centre from a developing country.
METHODS:
Data of all patients with Tetralogy of Fallot repair during infancy from January 2007 to Feb 2018 was reviewed. Preoperative, operative, and postoperative data was analysed. Outcome of the infants was assessed through discharge/death, low cardiac output syndrome (LCOS), prolonged intubation, duration of cardiac intensive care unit (CICU) and hospital stay.
RESULTS:
Forty-four patients who underwent TOF repair in infancy during this period were included. The mean age and weight were 9.39±2.32 and 7.20±1.30 respectively, 77.3% (34 patients) were male, 68.18% (30 patients) had saturation >75%. Mean intubation period was 4.05±6.58 days, 12 (27.3%) patients developed LCOS, mean cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and ionotropic score were 133.52±62.4, 98.66±58.62 and 33.27±71.13 respectively. Mean CICU and hospital stay was 6.60±7.18 and 12.05±7.74 respectively. Five (11.3%) patients expired in postoperative period. Baseline saturation ?75% is independent risk factor for LCOS and prolong intubation period. In the last six years our mortality decreased to 8% from 15.7% during the previous six years, while our mean intubation duration, CPB time, ACC, hospital stay and CICU stay have all shown improvement.
CONCLUSIONS:
TOF repair during infancy is safe procedure in expert hands with acceptable morbidity and mortality. Baseline saturation ?75% is independent risk factor for LCOS and prolonged intubation period. Last six years have shown considerable improvement in our surgical morbidity and mortality due to improvement in surgical expertise.
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Changes in cardiac Aquaporin expression during aortic valve replacement surgery with cardiopulmonary bypass.
Eur J Cardiothorac Surg2019 Sep;():. doi: ezz249.
Politi María Teresa, Ochoa Federico, Netti Vanina, Ferreyra Raúl, Bortman Guillermo, Sanjuan Norberto, Morales Celina, Piazza Antonio, Capurro Claudia,
Abstract
OBJECTIVES:
Cardiopulmonary bypass (CPB) use is an essential strategy for many cardiovascular surgeries. However, its use and duration have been associated with a higher rate of postoperative complications, such as low cardiac output syndrome due to myocardial oedema and dysfunction. Though Aquaporin water channels have been implicated in myocardial water balance, their specific role in this clinical scenario has not been established.
METHODS:
In a consecutive study of 17 patients with severe aortic stenosis undergoing aortic valve replacement surgery, 2 myocardial biopsies of the left ventricle were taken: 1 before and 1 after CPB use. Sociodemographic, clinical and laboratory data were collected. Western blot and immunohistochemistry studies were performed.
RESULTS:
After CPB use, there was a mean increase of ?62% in Aquaporin 1 protein levels (P?=?0.001) and a mean reduction of ?38% in Aquaporin 4 protein levels (P?=?0.030). In immunohistochemistry assays, Aquaporin 1 was found lining small blood vessels, while Aquaporin 4 formed a circular label in cardiomyocytes. There were no changes in the localization of either protein following CPB use. During the observed on-pump time interval, there was a 1.7%/min mean increase in Aquaporin 1 (P?=?0.021) and a 2.5%/min mean decrease in Aquaporin 4 (P?=?0.018). Myocardial interstitial oedema increased by 42% (95% confidence interval 31-54%) after CPB use. Patients who developed low cardiac output syndrome were in the upper half of the median percentage change of Aquaporin expression.
CONCLUSION:
Time-dependent changes in cardiac Aquaporin expression may be associated with myocardial oedema and dysfunction related to CPB use.
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Effect of cardiac arrest with aortic cross-clamping during left ventricular assist device implantation.
Interact Cardiovasc Thorac Surg2019 Sep;():. doi: ivz223.
Kawabori Masashi, Kurihara Chitaru, Critsinelis Andre, Chou Brendan Pen-Haw, Zhang Qianzi, Kaku Yuji, Civitello Andrew B, Morgan Jeffrey A,
Abstract
OBJECTIVES:
Some patients who undergo continuous-flow left ventricular assist device (CF-LVAD) implantation require concomitant procedures that can be performed with or without cardiac arrest under aortic cross-clamping (AXC). Procedures normally performed with cardiac arrest are sometimes avoided or performed without cardiac arrest because it may be detrimental to right heart function. However, the effects of cardiac arrest on patients with advanced heart failure necessitating CF-LVAD support have not been thoroughly studied. We examined our single-centre experience to determine whether cardiac arrest during CF-LVAD implantation was associated with worse patient outcomes.
METHODS:
From November 2003 to March 2016, a total of 526 patients with chronic end-stage heart failure underwent primary CF-LVAD implantation. Preoperative demographics, postoperative complications and mortality rates were compared between patients who required cardiac arrest with AXC (n?=?50) and those who did not (n?=?476).
RESULTS:
The most frequently performed procedure requiring AXC was aortic valve closure (n?=?23, 26.1%). Although the AXC group had longer cardiopulmonary bypass times (P?
CONCLUSIONS:
Cardiac arrest with AXC during CF-LVAD implantation did not negatively affect long-term survival or the incidence of right ventricular failure or stroke. These findings should be considered in deciding surgical strategies. Additional investigation may be warranted to further understand the effects of cardiac arrest during LVAD implantation.
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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