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Sample records for out-of hospital cardiac

  1. Electronic registration of out-of-hospital cardiac arrests

    DEFF Research Database (Denmark)

    Nielsen, Niels Dalsgaard; Dahl, Michael; Gade, John; Thorgaard, Per

    2007-01-01

    Introduction: The reported incidences of out-of-hospital cardiac arrests (OHCA) in western countries vary considerably. According to the latest report from Danish Cardiac Arrest Database (DCAD) the incidence rate in Denmark in 2004 was 51/100,000/year. The report states however that this number is uncertain. As the first region in the country, North Denmark Region has introduced a prehospital electronic healthcare record (designated amPHI™) in all of its 50 emergency ambulances. We used data fro...

  2. Out-of-hospital cardiac arrests in children and adolescents

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik; Hansen, Carolina Malta; Lippert, Freddy K; Weeke, Peter; Karlsson, Lena; Søndergaard, Kathrine Bach; Kragholm, Kristian; Christensen, Erika Frischknecht; Nielsen, Søren L; Kober, Lars; Gislason, Gunnar H; Torp-Pedersen, Christian

    2015-01-01

    BACKGROUND: There is insufficient knowledge of out-of-hospital cardiac arrest (OHCA) in the very young. OBJECTIVES: This nationwide study sought to examine age-stratified OHCA characteristics and the role of parental socioeconomic differences and its contribution to mortality in the young population. METHODS: All OHCA patients in Denmark, ?21 years of age, were identified from 2001 to 2010. The population was divided into infants (<1 year); pre-school children (1-5 years); school children (6-15 ...

  3. Out-of-Hospital Cardiac Arrests in Children and Adolescents

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik; Hansen, Carolina Malta; Lippert, Freddy K; Weeke, Peter; Karlsson, Lena; Søndergaard, Kathrine Bach; Sørensen, Kristian Dahl Kragholm; Christensen, Erika Frischknecht; Nielsen, Søren L; Kober, Lars; Gislason, Gunnar H; Torp-Pedersen, Christian

    2015-01-01

    BACKGROUND: There is insufficient knowledge of out-of-hospital cardiac arrest (OHCA) in the very young. OBJECTIVES: This nationwide study sought to examine age-stratified OHCA characteristics and the role of parental socioeconomic differences and its contribution to mortality in the young population. METHODS: All OHCA patients in Denmark, ?21 years of age, were identified from 2001 to 2010. The population was divided into infants (<1 year); pre-school children (1-5 years); school children (6-15 ...

  4. Out-of-hospital therapeutic hypothermia in cardiac arrest victims

    Directory of Open Access Journals (Sweden)

    Holzer Michael

    2009-10-01

    Full Text Available Abstract Despite many years of research, outcome after cardiac arrest is dismal. Since 2005, the European Resuscitation Council recommends in its guidelines the use of mild therapeutic hypothermia (32-34° for 12 to 24 hours in patients successfully resuscitated from cardiac arrest. The benefit of resuscitative mild hypothermia (induced after resuscitation is well established, while the benefit of preservative mild to moderate hypothermia (induced during cardiac arrest needs further investigation before recommending it for clinical routine. Animal data and limited human data suggest that early and fast cooling might be essential for the beneficial effect of resuscitative mild hypothermia. Out-of-hospital cooling has been shown to be feasible and safe by means of intravenous infusion with cold fluids or non-invasively with cooling pads. A combination of these cooling methods might further improve cooling efficacy. If out-of-hospital cooling will further improve functional outcome as compared with in-hospital cooling needs to be determined in a prospective, randomised, sufficiently powered clinical trial.

  5. Post-resuscitation care following out-of-hospital and in-hospital cardiac arrest.

    Science.gov (United States)

    Girotra, Saket; Chan, Paul S; Bradley, Steven M

    2015-12-15

    Cardiac arrest is a leading cause of death in developed countries. Although a majority of cardiac arrest patients die during the acute event, a substantial proportion of cardiac arrest deaths occur in patients following successful resuscitation and can be attributed to the development of post-cardiac arrest syndrome. There is growing recognition that integrated post-resuscitation care, which encompasses targeted temperature management (TTM), early coronary angiography and comprehensive critical care, can improve patient outcomes. TTM has been shown to improve survival and neurological outcome in patients who remain comatose especially following out-of-hospital cardiac arrest due to ventricular arrhythmias. Early coronary angiography and revascularisation if needed may also be beneficial during the post-resuscitation phase, based on data from observational studies. In addition, resuscitated patients usually require intensive care, which includes mechanical ventilator, haemodynamic support and close monitoring of blood gases, glucose, electrolytes, seizures and other disease-specific intervention. Efforts should be taken to avoid premature withdrawal of life-supporting treatment, especially in patients treated with TTM. Given that resources and personnel needed to provide high-quality post-resuscitation care may not exist at all hospitals, professional societies have recommended regionalisation of post-resuscitation care in specialised 'cardiac arrest centres' as a strategy to improve cardiac arrest outcomes. Finally, evidence for post-resuscitation care following in-hospital cardiac arrest is largely extrapolated from studies in patients with out-of-hospital cardiac arrest. Future studies need to examine the effectiveness of different post-resuscitation strategies, such as TTM, in patients with in-hospital cardiac arrest. PMID:26385451

  6. Pharmacotherapy and hospital admissions before out-of-hospital cardiac arrest: a nationwide study

    DEFF Research Database (Denmark)

    Weeke, Peter; Folke, Fredrik; Gislason, Gunnar H; Lippert, Freddy K; Olesen, Jonas B; Andersson, Charlotte; Fosbøl, Emil L; Charlot, Mette G; Kanters, Jørgen K.; Poulsen, Henrik E; Nielsen, Søren Loumann; Køber, Lars; Torp-Pedersen, Christian

    2010-01-01

    For out-of-hospital cardiac arrest (OHCA) to be predicted and prevented, it is imperative the healthcare system has access to those vulnerable before the event occurs. We aimed to determine the extent of contact to the healthcare system before OHCA.

  7. Temporal Differences in Out-of-Hospital Cardiac Arrest Incidence and Survival

    DEFF Research Database (Denmark)

    Bagai, Akshay; McNally, Bryan F; Al-Khatib, Sana M; Myers, J Brent; Kim, Sunghee; Karlsson, Lena; Torp-Pedersen, Christian; Wissenberg, Mads; van Diepen, Sean; Fosbol, Emil L; Monk, Lisa; Abella, Benjamin S; Granger, Christopher B; Jollis, James G

    2013-01-01

    Understanding temporal differences in the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) has important implications for developing preventative strategies and optimizing systems for OHCA care.

  8. Return to Work in Out-of-Hospital Cardiac Arrest Survivors

    DEFF Research Database (Denmark)

    Sørensen, Kristian Dahl Kragholm; Wissenberg, Mads; Mortensen, Rikke Normark; Fonager, Kirsten; Jensen, Svend Eggert; Rajan, Shahzleen; Lippert, Freddy Knudsen; Christensen, Erika Frischknecht; Hansen, Poul Anders; Lang-Jensen, Torsten; Hendriksen, Ole Mazur; Køber, Lars; Gislason, Gunnar; Torp-Pedersen, Christian; Rasmussen, Bodil Steen

    2015-01-01

    BACKGROUND: -Data on long-term function of out-of-hospital cardiac arrest survivors are sparse. We examined return to work as proxy of preserved function without major neurological deficits in survivors. METHODS AND RESULTS: -In Denmark, out-of-hospital cardiac arrests are systematically reported to the Danish Cardiac Arrest Register since 2001. During 2001-2011, we identified 4,354 patients employed before arrest among 12,332 working age patients (18-65 years), of which 796 survived to day 30. ...

  9. Out-of-hospital cardiac arrests in Helsinki: Utstein style reporting.

    OpenAIRE

    Kuisma, M.; Määttä, T.

    1996-01-01

    OBJECTIVE: To determine the epidemiology of out-of-hospital cardiac arrests and survival after resuscitation and to apply the Utstein style of reporting to data collection. DESIGN: Prospective cohort study. SETTING: A middle-sized urban city (population 516,000) served by a single emergency medical services system. PATIENTS: Consecutive prehospital cardiac arrests occurring between 1 January and 31 December 1994. INTERVENTION: Advanced cardiac life support according to the recommendations of ...

  10. Barriers to recognition of out-of-hospital cardiac arrest during emergency medical calls

    DEFF Research Database (Denmark)

    Alfsen, David; Møller, Thea Palsgaard; Egerod, Ingrid; Lippert, Freddy K

    2015-01-01

    BACKGROUND: The chance of surviving out-of-hospital cardiac arrest (OHCA) depends on early and correct recognition of cardiac arrest by the emergency medical dispatcher during the emergency call. When cardiac arrest is identified, telephone guided cardiopulmonary resuscitation (CPR) and referral to an automated external defibrillator should be initiated. Previous studies have investigated barriers to recognition of OHCA, and found the caller's description of sign of life, the type of caller, cal...

  11. Invasive coronary treatment strategies for out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Noc, Marko; Fajadet, Jean; Lassen, Jens F; Kala, Petr; MacCarthy, Philip; Olivecrona, Goran K; Windecker, Stephan; Spaulding, Christian

    2014-01-01

    Due to significant improvement in the pre-hospital treatment of patients with out-of-hospital cardiac arrest (OHCA), an increasing number of initially resuscitated patients are being admitted to hospitals. Because of the limited data available and lack of clear guideline recommendations, experts from the EAPCI and "Stent for Life" (SFL) groups reviewed existing literature and provided practical guidelines on selection of patients for immediate coronary angiography (CAG), PCI strategy, concomitan...

  12. Prognostication after out-of-hospital cardiac arrest, a clinical survey

    OpenAIRE

    Busch Michael; Søreide Eldar

    2008-01-01

    Abstract Background Numerous parameters and tests have been proposed for outcome prediction in comatose out-of-hospital cardiac arrest survivors. We conducted a survey of clinical practice of prognostication after therapeutic hypothermia (TH) became common practice in Norway. Methods By telephone, we interviewed the consultants who were in charge of the 25 ICUs admitting cardiac patients using 6 structured questions regarding timing, tests used and medical specialties involved in prognosticat...

  13. Antidepressant Use and Risk of Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Weeke, P; Jensen, A; Folke, F; Gislason, G H; Olesen, J B; Andersson, C; Fosbøl, E L; Larsen, J K; Lippert, Freddy; Nielsen, Søren Loumann; Gerds, Thomas Alexander; Andersen, Peter; Kanters, Jørgen; Poulsen, H E; Pehrson, S; Køber, L; Torp-Pedersen, C

    2012-01-01

    Treatment with some types of antidepressants has been associated with sudden cardiac death. It is unknown whether the increased risk is due to a class effect or related to specific antidepressants within drug classes. All patients in Denmark with an out-of-hospital cardiac arrest (OHCA) were identified (2001-2007). Association between treatment with specific antidepressants and OHCA was examined by conditional logistic regression in case-time-control models. We identified 19,110 patients with an...

  14. Factors Affecting the Occurrence of Out-of-Hospital Sudden Cardiac Arrest

    OpenAIRE

    Uchmanowicz, Izabella; Bartkiewicz, Wies?aw; Sowizdraniuk, Jaros?aw; Rosi?czuk, Joanna

    2015-01-01

    Objective. This paper aims to discover the risk factors for sudden cardiac arrest (out-of-hospital sudden cardiac arrest (OHSCA)) which significantly affect the decision about prioritizing emergency interventions before dispatching medical emergency teams, risk of deterioration of the patient's condition at the scene, and emergency procedures. Methods. A retrospective study taking into account the international classification of diseases ICD-10 based on an analysis of medical records of Emerg...

  15. Survival after out-of-hospital cardiac arrest in relation to sex

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Hansen, Carolina Malta; Folke, Fredrik; Lippert, Freddy K; Weeke, Peter; Karlsson, Lena; Rajan, Shahzleen; Søndergaard, Kathrine Bach; Kragholm, Kristian; Christensen, Erika Frischknecht; Nielsen, Søren L; Køber, Lars; Gislason, Gunnar H; Torp-Pedersen, Christian

    2014-01-01

    AIM: Crude survival has increased following an out-of-hospital cardiac arrest (OHCA). We aimed to study sex-related differences in patient characteristics and survival during a 10-year study period. METHODS: Patients?12 years old with OHCA of a presumed cardiac cause, and in whom resuscitation was attempted, were identified through the Danish Cardiac Arrest Registry 2001-2010. A total of 19,372 patients were included. RESULTS: One-third were female, with a median age of 75 years (IQR 65-83). Com...

  16. Out-of-Hospital Cardiac Arrests and Outdoor Air Pollution Exposure in Copenhagen, Denmark

    DEFF Research Database (Denmark)

    Wichmann, Janine; Folke, Fredrik; Torp-Pedersen, Christian; Lippert, Freddy; Ketzel, Matthias; Ellermann, Thomas; Loft, Steffen

    2013-01-01

    Cardiovascular disease is the number one cause of death globally and air pollution can be a contributing cause. Acute myocardial infarction and cardiac arrest are frequent manifestations of coronary heart disease. The objectives of the study were to investigate the association between 4 657 out-of-hospital cardiac arrests (OHCA) and hourly and daily outdoor levels of PM(10), PM(2.5), coarse fraction of PM (PM(10-2.5)), ultrafine particle proxies, NO(x), NO(2), O(3) and CO in Copenhagen, Denmark,...

  17. Antipsychotics and associated risk of out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Weeke, Peter; Jensen, Aksel; Folke, Fredrik; Gislason, Gunnar Hilmar; Olesen, Jonas Bjerring; Fosbøl, Emil L; Wissenberg, Mads; Lippert, Freddy K; Christensen, Erika Frischknecht; Nielsen, Søren Loumann; Holm, Ellen; Kanters, Jørgen K; Poulsen, Henrik Enghusen; Køber, Lars; Torp-Pedersen, Christian

    2014-01-01

    Antipsychotic drugs have been associated with sudden cardiac death, but differences in the risk of out-of-hospital cardiac arrest (OHCA) associated with different antipsychotic drug classes are not clear. We identified all OHCA in Denmark (2001-2010). Risk of OHCA associated with antipsychotic drug use was evaluated by conditional logistic regression analysis in case-time-control models. In total, 2,205 (7.6%) of 28,947 OHCA patients received treatment with an antipsychotic drug at the time of e...

  18. Antipsychotics and Associated Risk of Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Weeke, Peter; Jensen, Aksel; Folke, Fredrik; Gislason, Gunnar Hilmar; Olesen, Jonas Bjerring; Fosbøl, Emil L; Wissenberg, Mads; Lippert, Freddy K; Christensen, Erika Frischknecht; Nielsen, Søren Loumann; Holm, Ellen; Kanters, Jørgen K.; Poulsen, Henrik Enghusen; Køber, Lars; Torp-Pedersen, Christian

    2014-01-01

    Antipsychotic drugs have been associated with sudden cardiac death, but differences in the risk of out-of-hospital cardiac arrest (OHCA) associated with different antipsychotic drug classes are not clear. We identified all OHCA in Denmark (2001-2010). Risk of OHCA associated with antipsychotic drug use was evaluated by conditional logistic regression analysis in case-time-control models. In total, 2,205 (7.6%) of 28,947 OHCA patients received treatment with an antipsychotic drug at the time of e...

  19. Strategic Placement of Ambulance Drones for Delivering Defibrillators to Out of Hospital Cardiac Arrest Victims

    OpenAIRE

    Lennartsson, Josefin

    2015-01-01

    The number of out of hospital cardiac arrest (OHCAs) that occur in Sweden every year is really high and there are very few survivors. When a cardiac arrest happens the heart loses its original rhythm and to find it again the heart needs to be shocked within minutes. There is on going research to see what can be done to improve the survival rate. Publicly accessible defibrillators are one thing that is being implemented. Another solution being considered right now is the possibility of deliver...

  20. Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest - implementation and clinical management

    OpenAIRE

    Busch, Michael

    2012-01-01

    Background: With the publication of two randomized controlled trials (RCTs) in 2002, therapeutic hypothermia (TH) was re-introduced in postresuscitation care of comatose out-of-hospital cardiac arrest (OHCA) patients. Many issues, however, were unresolved, including implementation protocol, cooling technique, clinical management, implications of TH treatment on prognostic accuracy and therapeutic benefit in subgroups of OHCA excluded from the initial RCTs. Objectives: We wan...

  1. Improved survival after an out-of-hospital cardiac arrest using new guidelines

    DEFF Research Database (Denmark)

    Steinmetz, Jacob; Barnung, S.; Nielsen, S.L.; Risom, M.; Rasmussen, L.S.

    2008-01-01

    BACKGROUND: An out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. We hypothesized that the implementations of 2005 European Resuscitation Council resuscitation guidelines were associated with improved 30-day survival after OHCA. METHODS: We prospectively recorded data on all patients with OHCA treated by the Mobile Emergency Care Unit of Copenhagen in two periods: 1 June 2004 until 31 August 2005 (before implementation) and 1 January 2006 until 31 March 2007 (after implem...

  2. Debriefing Bystanders of Out-of-hospital Cardiac Arrest is Valuable

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Hansen, Carolina Malta; Fjordholt, Martin Collin; Pedersen, Birgitte Dahl; Ostergaard, Doris; Lippert, Freddy K

    2014-01-01

    AIM OF THE STUDY: 1) To explore the concept of debriefing bystanders after participating in an out-of-hospital cardiac arrest resuscitation attempt including 1) bystanders' most commonly addressed reactions after participating in a resuscitation attempt when receiving debriefing from medical dispatchers; 2) their perception of effects of receiving debriefing and 3) bystanders' recommendations for a systematic debriefing concept. METHODS: Qualitative study based on telephone debriefing to bystand...

  3. Debriefing bystanders of out-of-hospital cardiac arrest is valuable

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Hansen, Carolina Malta; Fjordholt, Martin; Pedersen, Birgitte Dahl; Østergaard, Doris; Lippert, Freddy K

    2014-01-01

    AIM OF THE STUDY: To explore the concept of debriefing bystanders after participating in an out-of-hospital cardiac arrest resuscitation attempt including (1) bystanders' most commonly addressed reactions after participating in a resuscitation attempt when receiving debriefing from medical dispatchers; (2) their perception of effects of receiving debriefing and (3) bystanders' recommendations for a systematic debriefing concept. METHODS: Qualitative study based on telephone debriefing to bystand...

  4. Helicopter emergency medical services (HEMS) response to out-of-hospital cardiac arrest

    OpenAIRE

    Lyon Richard M; Nelson Magnus J

    2013-01-01

    Abstract Background Out-of-hospital cardiac arrest (OHCA) is a common medical emergency with significant mortality and significant neurological morbidity. Helicopter emergency medical services (HEMS) may be tasked to OHCA. We sought to assess the impact of tasking a HEMS service to OHCA and characterise the nature of these calls. Method Retrospective case review of all HEMS calls to Surrey and Sussex Air Ambulance, United Kingdom, over a 1-year period (1/9/2010-1/9/2011). All missions to case...

  5. Out-of-Hospital Cardiac Arrest and Acute Coronary Syndromes: Reviewing Post-Resuscitation Care Strategies.

    Science.gov (United States)

    Randhawa, Varinder K; Nagpal, A Dave; Lavi, Shahar

    2015-12-01

    Out-of-hospital cardiac arrest (OHCA) carries an enormous global burden of mortality and morbidity. The post-cardiac arrest syndrome consists of complex pathophysiological changes that result in hypoxic brain injury, myocardial and peripheral organ dysfunction, and the systemic ischemia-reperfusion response. We review common cardiac arrest cases to highlight key management issues and recommendations in post-resuscitation care, including therapeutic hypothermia, coronary angiography and revascularization, and circulatory support. Guidelines still suggest mild therapeutic hypothermia be administered for OHCA over targeted temperature management preventing pyrexia. Similarly, early invasive coronary angiography is particularly beneficial when there is ST-elevation on the post-resuscitation electrocardiogram, but might be considered in the absence of ST-elevation if there is no noncardiac cause to explain the OHCA. However, there remain a large number of unanswered questions that require ongoing research. PMID:26243352

  6. Pathway for the management of survivors of out-of-hospital cardiac arrest.

    Science.gov (United States)

    Herzog, Eyal; Shapiro, Janet; Aziz, Emad F; Chong, Ji; Hong, Mun K; Wiener, Dan; Lee, Richard; Janis, Gregory; Azrieli, Yevgeny; Velazquez, Barbara; Lacdao, Leonida; Mittal, Suneet

    2010-06-01

    The estimated number of out-of-hospital care arrest cases is about 300,000 per year in the United States. Two landmark studies published in 2002 demonstrated that the use of therapeutic hypothermia after cardiac arrest decreased mortality and improved neurologic outcome. Based on these studies, the International Liaison Committee on Resuscitation and the American Heart Association recommended the use of therapeutic hypothermia after cardiac arrest. Therapeutic hypothermia is defined as a controlled lowering of core body temperature to 32 degrees C to 34 degrees C. This temperature goal represents the optimal balance between clinical effect and cardiovascular toxicity. Therapeutic hypothermia does require resources to implement-including device, close nursing care, and monitoring. It is important to select patients who have potential for benefit from this technique which is a limited resource and carries potential complications. A collaborative team approach involving physicians and nurses is critical for successful development and implementation of this kind of a protocol. In 2004, the "Advanced Cardiac Admission Program" was launched at the St. Luke's Roosevelt Hospital Center of Columbia University in New York. The program consists of a series of projects, which have been developed to bridge the gap between published guidelines and implementation during "real world" patient care. In this article, we are reporting our latest project for the comprehensive management of survivors of out-of-hospital cardiac arrest. The pathway is divided into 3 steps: Step I, From the field through the emergency department into the cardiac catherization laboratory and to the critical care unit; Step II, Induced invasive hypothermia protocol in the critical care unit (this step is divided into 3 phases: 1, invasive cooling for the first 24 hours; 2, rewarming; 3, maintenance); Step III, Management post the rewarming phase including the recommendation for out-of-hospital therapy and the ethical decision to define goal of care. We hope that this novel pathway will bridge the gap between the complex guidelines and the actual clinical practice and will improve the survival and neurologic condition of patients suffering cardiac arrest. PMID:20520213

  7. Tertiary centres have improved survival compared to other hospitals in the Copenhagen area after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Søholm, Helle; Wachtell, Kristian; Nielsen, Søren Loumann; Bro-Jeppesen, John; Pedersen, Frants; Wanscher, Michael; Boesgaard, Søren; Møller, Jacob Eifer; Hassager, Christian; Kjaergaard, Jesper

    2013-01-01

    AIMS: Out-of-hospital cardiac arrest (OHCA) has been reported to carry very varying morbidity and mortality. However, it remains unclear whether this is caused by intrinsic factors of the OHCA or due to the level of in-hospital care. The aim of this study is to compare 30-day and long-term mortality after OHCA at tertiary heart centres and non-tertiary university hospitals. METHODS AND RESULTS: Data from the Copenhagen OHCA registry from June 2002 through December 2010 included a total of 1218 c...

  8. Safety of therapeutic hypothermia combined with primary percutaneous coronary intervention after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Chisholm, Gro E; Grejs, Anders; Thim, Troels; Christiansen, Evald H; Kaltoft, Anne; Lassen, Jens F; Kristensen, Steen D; Bøtker, Hans Erik; Maeng, Michael

    2014-01-01

    BACKGROUND: The safety of therapeutic hypothermia combined with percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest has been challenged after reports of high risk of stent thrombosis. METHODS: We searched the Western Denmark Heart Registry to identify patients with an acute coronary angiography due to out-of-hospital cardiac arrest performed at our institution between September 2010 and September 2013. We identified 68 unconscious patients, who were resuscitated after o...

  9. Out-of-hospital cardiac arrest (OHCA) survival in rural Northwest Ireland: 17 years' experience.

    LENUS (Irish Health Repository)

    Masterson, Siobhán

    2011-05-01

    SAVES, the name used to describe a register of survivors of out-of-hospital cardiac arrest (OHCA), was established in rural Northwest Ireland in 1992. From 1992 to 2008, 80 survivors were identified (population 239,000 (2006)). Most incidents were witnessed (69\\/70) and all were in shockable rhythm at the time of first rhythm analysis (66\\/66). Of 66 patients who could be traced, 46 were alive in December 2008. Average survival rates appeared to increase over the lifetime of the database. SAVES has also contributed to the development of a national OHCA register.

  10. Interposed Abdominal Compression CPR for an Out-of-Hospital Cardiac Arrest Victim Failing Traditional CPR

    Directory of Open Access Journals (Sweden)

    Christian D. McClung

    2015-10-01

    Full Text Available Interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR is an alternative technique to traditional cardiopulmonary resuscitation (CPR that can improve perfusion and lead to restoration of circulation in patients with chest wall deformity either acquired through vigorous CPR or co-morbidity such as chronic obstructive pulmonary disease. We report a case of out-of-hospital cardiac arrest where IAC-CPR allowed for restoration of spontaneous circulation and eventual full neurologic recovery when traditional CPR was failing to generate adequate pulses with chest compression alone.

  11. Factors Affecting the Occurrence of Out-of-Hospital Sudden Cardiac Arrest.

    Science.gov (United States)

    Uchmanowicz, Izabella; Bartkiewicz, Wies?aw; Sowizdraniuk, Jaros?aw; Rosi?czuk, Joanna

    2015-01-01

    Objective. This paper aims to discover the risk factors for sudden cardiac arrest (out-of-hospital sudden cardiac arrest (OHSCA)) which significantly affect the decision about prioritizing emergency interventions before dispatching medical emergency teams, risk of deterioration of the patient's condition at the scene, and emergency procedures. Methods. A retrospective study taking into account the international classification of diseases ICD-10 based on an analysis of medical records of Emergency Medical Service in Wroclaw (Poland). Results. The main risk factor of OHSCA is coexistence of external cause leading to illness or death (ICD Group V-10) as well as the occurrence of diseases from the group of endocrine disorders (group E), in particular diabetes. The increase in the risk of OHSCA incidence is affected by nervous system diseases (group G), especially epilepsy of various etiologies, respiratory diseases (group J), mainly COPD, and bronchial asthma or mental and behavioral disorders (group F), with particular emphasis on the drugs issue. The procedure for receiving calls for Emergency Notification Centre does not take into account clinical risk factors for sudden cardiac arrest (SCA). Conclusion. Having knowledge of OHSCA risk factors can increase the efficiency of rescue operations from rapid assessment and provision of appropriate medical team, through effective performance of medical emergency treatment and prevention of SCA or finally reducing the costs. PMID:25705520

  12. Serum Potassium Changes During Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest-Should It Be Treated?

    DEFF Research Database (Denmark)

    Soeholm, Helle; Kirkegaard, Hans

    2012-01-01

    Background: Therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) is associated with adverse events, for example hypokalemia and arrhythmias. In the present study, we report the impact of serum potassium changes related to the rate of cardiac arrhythmias, and the advantages and disadvantages of potassium supplementation are discussed. Methods: Fifty-four consecutive patients suffering from OHCA and treated with TH (32-34°C) for 24 hours at one University Hospital were included...

  13. Antipsychotics and associated risk of out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Weeke, Peter; Jensen, Aksel

    2014-01-01

    Antipsychotic drugs have been associated with sudden cardiac death, but differences in the risk of out-of-hospital cardiac arrest (OHCA) associated with different antipsychotic drug classes are not clear. We identified all OHCA in Denmark (2001-2010). Risk of OHCA associated with antipsychotic drug use was evaluated by conditional logistic regression analysis in case-time-control models. In total, 2,205 (7.6%) of 28,947 OHCA patients received treatment with an antipsychotic drug at the time of event. Overall treatment with any antipsychotic was associated with OHCA (odds ratio [OR]= 1.53, 95% confidence interval [CI]:1.23-1.89) as was use with typical antipsychotics (OR= 1.66, CI: 1.27-2.17). By contrast, overall atypical antipsychotics drug use was not (OR= 1.29, CI: 0.90-1.85). Two individual typical antipsychotic drugs were associated with OHCA, haloperidol (OR= 2.43, CI: 1.20-4.93) and levomepromazine (OR= 2.05, CI: 1.18-3.56) as was one atypical antipsychotic, quetiapine (OR= 3.64, CI: 1.59-8.30).Clinical Pharmacology & Therapeutics (2014); Accepted article preview online 24 June 2014; doi:10.1038/clpt.2014.139.

  14. Antipsychotics and Associated Risk of Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Weeke, P.; Jensen, A.

    2014-01-01

    Antipsychotic drugs have been associated with sudden cardiac death, but differences in the risk of out-of-hospital cardiac arrest (OHCA) associated with different antipsychotic drug classes are not clear. We identified all OHCAs in Denmark (2001-2010). The risk of OHCA associated with antipsychotic drug use was evaluated by conditional logistic regression analysis in case-time-control models. In total, 2,205 (7.6%) of 28,947 OHCA patients received treatment with an antipsychotic drug at the time of the event. Overall, treatment with any antipsychotic drug was associated with OHCA (odds ratio (OR) = 1.53, 95% confidence interval (CI): 1.23-1.89), as was use with typical antipsychotics (OR = 1.66, CI: 1.27-2.17). By contrast, overall, atypical antipsychotic drug use was not (OR = 1.29, CI: 0.90-1.85). Two individual typical antipsychotic drugs, haloperidol (OR = 2.43, CI: 1.20-4.93) and levomepromazine (OR = 2.05, CI: 1.18-3.56), were associated with OHCA, as was one atypical antipsychotic drug, quetiapine (OR = 3.64, CI: 1.59-8.30).

  15. Out-of-Hospital Cardiac Arrests and Outdoor Air Pollution Exposure in Copenhagen, Denmark

    DEFF Research Database (Denmark)

    Wichmann, Janine; Folke, Fredrik

    2013-01-01

    Cardiovascular disease is the number one cause of death globally and air pollution can be a contributing cause. Acute myocardial infarction and cardiac arrest are frequent manifestations of coronary heart disease. The objectives of the study were to investigate the association between 4 657 out-of-hospital cardiac arrests (OHCA) and hourly and daily outdoor levels of PM10, PM2.5, coarse fraction of PM (PM10-2.5), ultrafine particle proxies, NOx, NO2, O3 and CO in Copenhagen, Denmark, for the period 2000–2010. Susceptible groups by age and sex was also investigated. A case-crossover design was applied. None of the hourly lags of any of the pollutants were significantly associated with OHCA events. The strongest association with OHCA events was observed for the daily lag4 of PM2.5, lag3 of PM10, lag3 of PM10-2.5, lag3 of NOx and lag4 of CO. An IQR increase of PM2.5 and PM10 was associated with a significant increase of 4% (95% CI: 0%; 9%) and 5% (95% CI: 1%; 9%) in OHCA events with 3 days lag, respectively. None of the other daily lags or other pollutants was significantly associated with OHCA events. Adjustment for O3 slightly increased the association between OHCA and PM2.5 and PM10. No susceptible groups were identified.

  16. Full recovery two months after therapeutic hypothermia following cardiopulmonary resuscitation in a patient with out-of-hospital cardiac arrest

    International Nuclear Information System (INIS)

    Neurologic impairments are very common among patients who get a recovery of spontaneous circulation after suffering from out-of-hospital cardiac arrest. Therapeutic hypothermia is established as a standardized therapeutic strategy for those patients in whom it decreases mortality rate and improves neurologic outcome. Herein, we report a case of patient who experienced out-of-hospital cardiac arrest with ischaemic heart disease and ventricular arrhythmia and got a full recovery without any neurologic impediments 2 months after being managed with therapeutic hypothermia. (author)

  17. Early clinical prediction of neurological outcome following out of hospital cardiac arrest managed with therapeutic hypothermia

    Directory of Open Access Journals (Sweden)

    Mohammed Ishaq Ruknuddeen

    2015-01-01

    Full Text Available Background: Therapeutic hypothermia (TH may improve neurological outcome in comatose patients following out of hospital cardiac arrest (OHCA. The reliability of clinical prediction of neurological outcome following TH remains unclear. In particular, there is very limited data on survival and predictors of neurological outcome following TH for OHCA from resource-constrained settings in general and South Asia in specific. Objective: The objective was to identify factors predicting unfavorable neurological outcome at hospital discharge in comatose survivors of OHCA treated with hypothermia. Design: Retrospective chart review. Setting: Urban 200-bed hospital in Chennai, India. Methods: Predictors of unfavorable neurological outcome (cerebral performance category score [3-5] at hospital discharge were evaluated among patients admitted between January 2006 and December 2012 following OHCA treated with TH. Hypothermia was induced with cold intravenous saline bolus, ice packs and cold-water spray with bedside fan. Predictors of unfavorable neurological outcome were examined through multivariate exact logistic regression analysis. Results: A total of 121 patients were included with 106/121 (87% experiencing the unfavorable neurological outcome. Independent predictors of unfavorable neurological outcome included: Status myoclonus <24 h (odds ratio [OR] 21.79, 95% confidence interval [CI] 2.89-Infinite, absent brainstem reflexes (OR 50.09, 6.55-Infinite, and motor response worse than flexion on day 3 (OR 99.41, 12.21-Infinite. All 3 variables had 100% specificity and positive predictive value. Conclusion: Status myoclonus within 24 h, absence of brainstem reflexes and motor response worse than flexion on day 3 reliably predict unfavorable neurological outcome in comatose patients with OHCA treated with TH.

  18. Helicopter emergency medical services (HEMS response to out-of-hospital cardiac arrest

    Directory of Open Access Journals (Sweden)

    Lyon Richard M

    2013-01-01

    Full Text Available Abstract Background Out-of-hospital cardiac arrest (OHCA is a common medical emergency with significant mortality and significant neurological morbidity. Helicopter emergency medical services (HEMS may be tasked to OHCA. We sought to assess the impact of tasking a HEMS service to OHCA and characterise the nature of these calls. Method Retrospective case review of all HEMS calls to Surrey and Sussex Air Ambulance, United Kingdom, over a 1-year period (1/9/2010-1/9/2011. All missions to cases of suspected OHCA, of presumed medical origin, were reviewed systematically. Results HEMS was activated 89 times to suspected OHCA. This represented 11% of the total HEMS missions. In 23 cases HEMS was stood-down en-route and in 2 cases the patient had not suffered an OHCA on arrival of HEMS. 25 patients achieved return-of-spontaneous circulation (ROSC, 13 (52% prior to HEMS arrival. The HEMS team were never first on-scene. The median time from first collapse to HEMS arrival was 31 minutes (IQR 22–40. The median time from HEMS activation to arrival on scene was 17 minutes (IQR 11.5-21. 19 patients underwent pre-hospital anaesthesia, 5 patients had electrical or chemical cardioversion and 19 patients had therapeutic hypothermia initiated by HEMS. Only 1 post-OHCA patient was transported to hospital by air. The survival to discharge rate was 6.3%. Conclusion OHCA represents a significant proportion of HEMS call outs. HEMS most commonly attend post-ROSC OHCA patients and interventions, including pre-hospital anaesthesia and therapeutic hypothermia should be targeted to this phase. HEMS are rarely first on-scene and should only be tasked as a first response to OHCA in remote locations. HEMS may be most appropriately utilised in OHCA by only attending the scene if a patient achieves ROSC.

  19. Safety of therapeutic hypothermia combined with primary percutaneous coronary intervention after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Chisholm, Gro E; Grejs, Anders

    2014-01-01

    BACKGROUND: The safety of therapeutic hypothermia combined with percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest has been challenged after reports of high risk of stent thrombosis. METHODS: We searched the Western Denmark Heart Registry to identify patients with an acute coronary angiography due to out-of-hospital cardiac arrest performed at our institution between September 2010 and September 2013. We identified 68 unconscious patients, who were resuscitated after out-of-hospital cardiac arrest and underwent acute PCI with stent implantation and immediate therapeutic hypothermia, and followed these for 30 days. Target temperature of 32-34°C was achieved by either an invasive or a non-invasive cooling system. RESULTS: All patients had elevated myocardial biomarkers and 37 patients had ST-segment elevation myocardial infarction. Bare metal stents were implanted in 14 and drug-eluting stents in 54 patients. All patients received antithrombotic treatment with a standard loading dose of 300 mg acetylsalicylic acid and 10,000 units heparin intravenously prior PCI. Clopidogrel or ticagrelor was administered orally through a gastric tube immediately after PCI. During the procedure abciximab or bivalirudin was administered in 44 patients. Electrocardiographic and clinical signs of stent thrombosis were found in one patient. CONCLUSIONS: We observed one stent thrombosis in this cohort of 68 consecutive patients with out-of-hospital cardiac arrest who were treated with PCI and therapeutic hypothermia. This suggests that PCI with stent implantation can be performed with acceptable safety in these patients.

  20. [Development of an embedded mobile terminal for real-time remote monitoring of out-of-hospital cardiac patients].

    Science.gov (United States)

    Xu, Zhi-min; Fang, Zu-Xiang; Lai, Da-Kun; Song, Hai-Lang

    2007-05-01

    A kind of real-time remote monitoring embedded terminal which is combined with mobile communication technology and GPS localization technology, has been developed. The results of preliminary experiments show that the terminal can transmit ECG signals and localization information in real time and continuously, supply a real-time monitoring of out-of-hospital cardiac patients and trace the patients. PMID:17672363

  1. Debriefing Bystanders of Out-of-hospital Cardiac Arrest is Valuable

    DEFF Research Database (Denmark)

    MØller, Thea Palsgaard; Hansen, Carolina Malta

    2014-01-01

    AIM OF THE STUDY: 1) To explore the concept of debriefing bystanders after participating in an out-of-hospital cardiac arrest resuscitation attempt including 1) bystanders' most commonly addressed reactions after participating in a resuscitation attempt when receiving debriefing from medical dispatchers; 2) their perception of effects of receiving debriefing and 3) bystanders' recommendations for a systematic debriefing concept. METHODS: Qualitative study based on telephone debriefing to bystanders and interviews with bystanders who received debriefing. Data was analyzed using the phenomenological approach. RESULTS: Six themes emerged from analysis of debriefing audio files: 1) identification of OHCA; 2) Emotional and perceptual experience with OHCA; 3) Collaboration with healthcare professionals; 4) Patients outcome; 5) Coping with the experience and 6) general reflections. When evaluating the concept, bystanders expressed positive short term effect of receiving debriefing and a retention of this effect after two months. Recommendations for a future debriefing concept were given. CONCLUSION: Debriefing by emergency medical dispatchers to OHCA bystanders stimulates reflection, positively influencing the ability to cope with the emotional reactions and the cognitive perception of own performance and motivates improvement of CPR skills. Importantly, it increases confidence to provide CPR in the future. Implementation of telephone debriefing to bystanders at Emergency Medical Dispatch Centres is a low complexity and a low cost intervention though the logistic challenges have to be considered.

  2. Debriefing bystanders of out-of-hospital cardiac arrest is valuable

    DEFF Research Database (Denmark)

    MØller, Thea Palsgaard; Hansen, Carolina Malta

    2014-01-01

    AIM OF THE STUDY: To explore the concept of debriefing bystanders after participating in an out-of-hospital cardiac arrest resuscitation attempt including (1) bystanders' most commonly addressed reactions after participating in a resuscitation attempt when receiving debriefing from medical dispatchers; (2) their perception of effects of receiving debriefing and (3) bystanders' recommendations for a systematic debriefing concept. METHODS: Qualitative study based on telephone debriefing to bystanders and interviews with bystanders who received debriefing. Data was analyzed using the phenomenological approach. RESULTS: Six themes emerged from analysis of debriefing audio files: (1) identification of OHCA; (2) emotional and perceptual experience with OHCA; (3) collaboration with healthcare professionals; (4) patients outcome; (5) coping with the experience and (6) general reflections. When evaluating the concept, bystanders expressed positive short term effect of receiving debriefing and a retention of this effect after two months. Recommendations for a future debriefing concept were given. CONCLUSION: Debriefing by emergency medical dispatchers to OHCA bystanders stimulates reflection, positively influencing the ability to cope with the emotional reactions and the cognitive perception of own performance and motivates improvement of CPR skills. Importantly, it increases confidence to provide CPR in the future. Implementation of telephone debriefing to bystanders at Emergency Medical Dispatch Centres is a low complexity and a low cost intervention though the logistic challenges have to be considered.

  3. Prehospital intranasal evaporative cooling for out-of-hospital cardiac arrest: a pilot, feasibility study.

    Science.gov (United States)

    Lyon, Richard M; Van Antwerp, Jerry; Henderson, Charles; Weaver, Anne; Davies, Gareth; Lockey, David

    2014-10-01

    Intranasal evaporative cooling presents a novel means of initiating therapeutic hypothermia after an out-of-hospital cardiac arrest (OHCA). Few studies have evaluated the use of intranasal therapeutic hypothermia using the Rhinochill device in the prehospital setting. We sought to evaluate the use of Rhinochill in the Physician Response Unit of London's Air Ambulance, aiming to describe the feasibility of employing it during prehospital resuscitation for OHCA. We prospectively evaluated the Rhinochill device over a 7-month period. Inclusion criteria for deployment included: age above 18 years, Physician Response Unit on-scene within maximum of 10 min after return-of-spontaneous circulation (ROSC), witnessed OHCA or unwitnessed downtime of less than 10 min, pregnancy not suspected, normal nasal anatomy, and likely ICU candidate if ROSC were to be achieved. Thirteen patients were included in the evaluation. The average time from the 999 call to initiation of cooling was 39.5 min (range 22-61 min). The average prehospital temperature change in patients who achieved ROSC was -1.9°C. Patients were cooled for an average of 38 min prehospital. In all cases, the doctor and paramedic involved with the resuscitation reported that the Rhinochill was easy to set up and use during resuscitation and that it did not interfere with standard resuscitation practice. Intranasal evaporative cooling using the Rhinochill system is feasible in an urban, prehospital, doctor/paramedic response unit. Cooling with Rhinochill was not found to interfere with prehospital resuscitation and resulted in significant core body temperature reduction. Further research on the potential benefit of intra-arrest and early initiation of intranasal evaporative cooling is warranted. PMID:24300245

  4. The Use of Pre-Hospital Mild Hypothermia after Resuscitation from Out-of-Hospital Cardiac Arrest

    OpenAIRE

    Kim, Francis; Olsufka, Michele; Nichol, Graham; Copass, Michael K.; Cobb, Leonard A.

    2009-01-01

    Hypothermia has emerged as a potent neuroprotective modality following resuscitation from cardiac arrest. Although delayed hospital cooling has been demonstrated to improve outcome after cardiac arrest, in-field cooling begun immediately following the return of spontaneous circulation may be more beneficial. Cooling in the field following resuscitation, however, presents new challenges, in that the cooling method has to be portable, safe, and effective. Rapid infusion of intravenous fluid at ...

  5. Early Outcomes of Out-of-Hospital Cardiac Arrest after Early Defibrillation: a 24 Months Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Paolo Terranova

    2006-10-01

    Full Text Available Introduction: Cardiovascular disease remains the most common cause of death in the United States and most other Western nations. Among these deaths, sudden, out-of-hospital cardiac arrest claims approximately 1000 lives each day in the United States alone. Most of these cardiac arrests are due to ventricular fibrillation. Though highly reversible with the rapid application of a defibrillator, ventricular fibrillation is otherwise fatal within minutes, even when cardiopulmonary resuscitation is provided immediately. The overall survival rate in the United States is estimated to be less than 5 percent. Recent developments in automated-external-defibrillator technology have provided a means of increasing the rate of prompt defibrillation after out-of-hospital cardiac arrest. After minimal training, nonmedical personnel (e.g., flight attendants and casino workers are also able to use defibrillators in the workplace, with lifesaving effects. Nonetheless, such programs have involved designated personnel whose job description includes assisting persons who have had sudden cardiac arrest. Data are still lacking on the success of programs in which automated external defibrillators have been installed in public places to be used by persons who have no specific training or duty to act. Materials and Methods: All patients who had an out-of-hospital cardiac arrest between January 2003 and December 2004 and who received early defibrillation for ventricular fibrillation were included. We conducted a 24 months retrospective population-based analysis of the outcome in our population. Results: Over a 24 month period, 446 people had non–traumatic cardiac arrest, and in all of them it was observed to be ventricular fibrillation. In a very few cases, the defibrillator operators were good Samaritans, acting voluntarily. Eighty-nine patients (about 19% with ventricular fibrillation were successfully resuscitated, including eighteen who regained consciousness before hospital admission. Conclusion: Automated external defibrillators deployed in readily accessible, well-marked areas, are really very effective in assisting patients with cardiac arrest. However, it's quite true that, in the cases of survivors, most of our users had good prior training in the use of these devices.

  6. Chest compressions before defibrillation for out-of-hospital cardiac arrest: A meta-analysis of randomized controlled clinical trials

    Directory of Open Access Journals (Sweden)

    Meier Pascal

    2010-09-01

    Full Text Available Abstract Background Current 2005 guidelines for advanced cardiac life support strongly recommend immediate defibrillation for out-of-hospital cardiac arrest. However, findings from experimental and clinical studies have indicated a potential advantage of pretreatment with chest compression-only cardiopulmonary resuscitation (CPR prior to defibrillation in improving outcomes. The aim of this meta-analysis is to evaluate the beneficial effect of chest compression-first versus defibrillation-first on survival in patients with out-of-hospital cardiac arrest. Methods Main outcome measures were survival to hospital discharge (primary endpoint, return of spontaneous circulation (ROSC, neurologic outcome and long-term survival. Randomized, controlled clinical trials that were published between January 1, 1950, and June 19, 2010, were identified by a computerized search using SCOPUS, MEDLINE, BIOS, EMBASE, the Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts database, and Web of Science and supplemented by conference proceedings. Random effects models were used to calculate pooled odds ratios (ORs. A subgroup analysis was conducted to explore the effects of response interval greater than 5 min on outcomes. Results A total of four trials enrolling 1503 subjects were integrated into this analysis. No difference was found between chest compression-first versus defibrillation-first in the rate of return of spontaneous circulation (OR 1.01 [0.82-1.26]; P = 0.979, survival to hospital discharge (OR 1.10 [0.70-1.70]; P = 0.686 or favorable neurologic outcomes (OR 1.02 [0.31-3.38]; P = 0.979. For 1-year survival, however, the OR point estimates favored chest compression first (OR 1.38 [0.95-2.02]; P = 0.092 but the 95% CI crossed 1.0, suggesting insufficient estimate precision. Similarly, for cases with prolonged response times (> 5 min point estimates pointed toward superiority of chest compression first (OR 1.45 [0.66-3.20]; P = 0.353, but the 95% CI again crossed 1.0. Conclusions Current evidence does not support the notion that chest compression first prior to defibrillation improves the outcome of patients in out-of-hospital cardiac arrest. It appears that both treatments are equivalent. However, subgroup analyses indicate that chest compression first may be beneficial for cardiac arrests with a prolonged response time.

  7. Prolonged closed cardiac massage using LUCAS device in out-of-hospital cardiac arrest with prolonged transport time

    Directory of Open Access Journals (Sweden)

    Edouard Matevossian

    2009-04-01

    Full Text Available Edouard Matevossian1, Dietrich Doll4, Jakob Säckl1, Inga Sinicina5, Jürgen Schneider2, Gerhard Simon3, Norbert Hüser11Department of Surgery, 2Department of Anesthesiology and Intensive-Care Medicine; 3Department of Radiology, Technische Universität of Munich, Germany; 4Department of Visceral, Vascular and Thoracic Surgery, Philips University of Marburg, Marburg, Germany; 5Institute of Clinical Forensic Medicine, Ludwig-Maximilian University of Munich, Munich, GermanyAbstract: Saving more human lives through more effective reanimation measures is the goal of the new international guidelines on cardiopulmonary resuscitation as the decisive aspect for survival after cardiovascular arrest is that basic resuscitation should start immediately. According to the updated guidelines, the greatest efficacy in cardiac massage is only achieved when the right compression point, an adequate compression depth, vertical pressure, the correct frequency, and equally long phases of compression and decompression are achieved. The very highest priority is placed on restoring continuous circulation. Against this background, standardized continuous chest compression with active decompression has contributed to a favorable outcome in this case. The hydraulically operated and variably adjustable automatic Lund University Cardiac Arrest System (LUCAS device (Jolife, Lund, Sweden undoubtedly meets these requirements. This case report describes a 44-year-old patient who – approximately 15 min after the onset of clinical death due to apparent ventricular fibrillation – received cardiopulmonary resuscitation, initially by laypersons and then by the emergency medical team (manual chest compressions followed by situation-adjusted LUCAS compressions. Sinus rhythm was restored after more than 90 min of continuous resuscitation, with seven defibrillations. Interventional diagnostic workup did not reveal a causal morphological correlate for the condition on coronary angiography. After a 16-day period of hospital convalescence, with preventive implantation of an implantable cardioverter defibrillator and several weeks of rehabilitation, the patient was able to return home with no evidence of health impairment.Keywords: resuscitation, cardiac arrest, cardiac massage, LUCAS

  8. Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?

    DEFF Research Database (Denmark)

    Salam, Idrees; Hassager, Christian

    2015-01-01

    BACKGROUND: Current guidelines recommend that comatose out-of-hospital cardiac arrest patients with ST-segment elevations (STEs) following return of spontaneous circulation (ROSC) should be referred for an acute coronary angiography. We sought to investigate the diagnostic value of the pre-hospital ROSC-ECG in predicting ST-elevation myocardial infarction (STEMI). METHOD: ROSC-ECGs of 145 comatose survivors of out-of-hospital cardiac arrest, randomly assigned in the Target Temperature Management trial, were classified according to the current STEMI ECG criteria (third universal definition of myocardial infarction). RESULTS: STEs were present in the pre-hospital ROSC-ECG of 78 (54%) patients. A final diagnosis revealed that 69 (48%) patients had STEMI, 31 (21%) patients had non-STEMI and 45 (31%) patients had no myocardial infarction. STE in ROSC-ECGs had a sensitivity of 74% (95% confidence interval (CI) 62-84), specificity of 65% (95% CI 53-75) and a positive and negative predictive value of 65% (95% CI 54-76) and 73% (95% CI 61-83) in predicting STEMI. Time to ROSC was significantly longer (24 minutes vs. 19 minutes, P=0.02) in STE compared with no STE patients. Percutaneous coronary intervention was successful in 68% versus 36% (P<0.001) of STE compared to no STE patients. No significant difference was found in 180-day mortality rates between STE and no STE patients (36% vs. 30%, Plogrank=0.37). CONCLUSION: The pre-hospital ROSC-ECG is a suboptimal diagnostic tool to predict STEMI and therefore not a sensitive tool for triage to cardiac centres. This supports the incentive of referring all comatose survivors of out-of-hospital cardiac arrest of suspected cardiac origin to a tertiary heart centre with the availability of acute coronary angiography, even in the absence of STEs.

  9. Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Lippert, Freddy K; Folke, Fredrik; Weeke, Peter; Hansen, Carolina Malta; Christensen, Erika Frischknecht; Jans, Henning; Hansen, Poul Anders; Lang-Jensen, Torsten; Olesen, Jonas Bjerring; Lindhardsen, Jesper; Fosbol, Emil L; Nielsen, Søren L; Gislason, Gunnar H; Kober, Lars; Torp-Pedersen, Christian

    2013-01-01

    IMPORTANCE Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many associated with improved survival. OBJECTIVE To examine temporal changes in bystander resuscitation attempts and survival during a 10-year period in which several national initiatives were taken to increase rates of bystander resuscitation and improve advanced...

  10. Advanced life support therapy and on out-of-hospital cardiac arrest patients: Applying signal processing and pattern recognition methods

    Directory of Open Access Journals (Sweden)

    Trygve Eftestøl

    2005-10-01

    Full Text Available In the US alone, several hundred thousands die of sudden cardiac arrests each year. Basic life support defined as chest compressions and ventilations and early defibrillation are the only factors proven to increase the survival of patients with out-of-hospital cardiac arrest, and are key elements in the chain of survival defined by the American Heart Association. The current cardiopulmonary resuscitation guidelines treat all patients the same, but studies show need for more individualiza- tion of treatment. This review will focus on ideas on how to strengthen the weak parts of the chain of survival including the ability to measure the effects of therapy, improve time efficiency, and optimize the sequence and quality of the various components of cardiopulmonary resuscitation.

  11. Antidepressant Use and Risk of Out-of-Hospital Cardiac Arrest : A Nationwide Case-Time-Control Study

    DEFF Research Database (Denmark)

    Weeke, P; Jensen, A

    2012-01-01

    Treatment with some types of antidepressants has been associated with sudden cardiac death. It is unknown whether the increased risk is due to a class effect or related to specific antidepressants within drug classes. All patients in Denmark with an out-of-hospital cardiac arrest (OHCA) were identified (2001-2007). Association between treatment with specific antidepressants and OHCA was examined by conditional logistic regression in case-time-control models. We identified 19,110 patients with an OHCA; 2,913 (15.2%) were receiving antidepressant treatment at the time of OHCA, with citalopram being the most frequently used type of antidepressant (50.8%). Tricyclic antidepressants (TCAs; odds ratio (OR) = 1.69, confidence interval (CI): 1.14-2.50) and selective serotonin reuptake inhibitors (SSRIs; OR = 1.21, CI: 1.00-1.47) were both associated with comparable increases in risk of OHCA, whereas no association was found for serotonin-norepinephrine reuptake inhibitors/noradrenergic and specific serotonergic antidepressants (SNRIs/NaSSAs; OR = 1.06, CI: 0.81-1.39). The increased risks were primarily driven by: citalopram (OR = 1.29, CI: 1.02-1.63) and nortriptyline (OR = 5.14, CI: 2.17-12.2). An association between cardiac arrest and antidepressant use could be documented in both the SSRI and TCA classes of drugs.

  12. Out-of hospital cardiac arrest in Okayama city (Japan: outcome report according to the "Utsutein Style".

    Directory of Open Access Journals (Sweden)

    Hayashi,Hoei

    2005-04-01

    Full Text Available

    The purpose of this study was to evaluate the outcomes for out-of-hospital cardiac arrest (OHCA and cardiopulmonary resuscitation (CPR in the city of Okayama, Japan, during a 1-year period after the reorganization of defibrillation by Emergency Life-Saving Technicians (ELSTs with standing orders of CPR. The data were collected prospectively according to an Utstein style between June 1, 2003 and May 31, 2004; OHCA was confirmed in 363 patients. Cardiac arrest of presumed cardiac etiology (179 was witnessed by a bystander in 62 (34.6% cases. Of this group, ventricular fibrillation (VF was documented in 20 cases (32.3%, and 1 patient (5% was discharged alive without severe neurological disability. This outcome is average in Japan, but it is quite low level compared with Western countries because there is less VF in Japan. The Utstein style revealed that we must try to detect VF before the rhythm changes and to provide defibrillation as soon as possible in order to improve outcomes. Further research will be required to accurately evaluate OHCA in Okayama city.

  13. Near-death experiences and electrocardiogram patterns in out-of-hospital cardiac arrest survivors: a prospective observational study

    Directory of Open Access Journals (Sweden)

    ZALIKA KLEMENC-KETIS

    2011-10-01

    Full Text Available Aim. To determine the effect of several factors, that are a part of cardiac arrest and resuscitation, on the incidence of neardeath experiences (NDEs. Methods. We conducted a prospective observational study in the three largest hospitals in Slovenia in a consecutive sample of patients after out-of-hospital primary cardiac arrest. The presence of NDE was assessed with the self-administered Greyson’s near-death experiences scale. The electrocardiogram pattern at the beginning of resuscitation was recorded. Main outcome measure was the presence of near-death experiences. Univariate analysis was used. Results. The study included 52 patients. There were 42 (80.8% males in the sample; median age ± standard deviation of the patients was 53.1 ± 14.5 years. Near-death experiences were reported by 11 (21.2% patients. Patients with ventricular fibrillation had significantly less NDEs than other patients (12.2% vs. 54.5%, P = 0.006. Patients with pulseless electrical activity had significantly more NDEs than others (60.0% vs. 11.9%, P = 0.003. Patients with asystole and pulseless electrical fibrillation had significantly more NDEs than patients who had ventricular fibrillation and ventricular tachycardia (60.0% vs. 11.9%, P = 0.003. Patients with at least one defibrillation attempt had significantly less near-death experiences than others (62.5% vs. 13.6%, P = 0.007. Conclusion. Our study found a possible correlation between electrocardiogram pattern in cardiac arrest patients and the incidence of near-death experiences. Further studies should address this problem in larger samples.

  14. Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    SØholm, Helle; Kjaergaard, Jesper

    2015-01-01

    BACKGROUND: Studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centers. The aim was to examine the level-of-care at tertiary centers compared with nontertiary hospitals and the association with outcome after out-of-hospital cardiac arrest. METHODS AND RESULTS: Consecutive out-of-hospital cardiac arrest patients (n=1078) without ST-segment-elevation myocardial infarction admitted to tertiary centers (54%) and nontertiary hospitals (46%) were included (2002-2011). Patient charts were reviewed focusing on level-of-care and comorbidity. Survival to discharge differed significantly with 45% versus 24% of patients discharged alive (P<0.001), and after adjustment for prognostic factors admissions to tertiary centers were still associated with lower 30-day mortality (hazard ratio, 0.78 [0.64-0.96; P=0.02]), independent of comorbidity. The adjusted odds of predefined markers of level-of-care were higher in tertiary centers: admission to intensive care unit (odds ratio [OR], 1.8 [95% confidence interval, 1.2-2.5]), temporary pacemaker (OR, 6.4 [2.2-19]), vasoactive agents (OR, 1.5 [1.1-2.1]), acute (<24 hours) and late coronary angiography (OR, 10 [5.3-22] and 3.8 [2.5-5.7]), neurophysiological examination (OR, 1.8 [1.3-2.6]), and brain computed tomography (OR, 1.9 [1.4-2.6]), whereas no difference in therapeutic hypothermia was noted. Patients at tertiary centers were more often consulted by a cardiologist (OR, 8.6 [5.0-15]), had an echocardiography (OR, 2.8 [2.1-3.7]), and survivors more often had implantable cardioverter defibrillator's implanted (OR, 2.1 [1.2-3.6]). CONCLUSION: Admissions to tertiary centers were associated with significantly higher survival after out-of-hospital cardiac arrest in patients without ST-segment-elevation myocardial infarction in the Copenhagen area even after adjustment for prognostic factors including comorbidity. Level-of-care seems higher in tertiary centers both in the early phase, during the intensive care unit admission, and in the workup before discharge. The varying level-of-care may contribute to the survival difference; however, differences in comorbidity do not seem to matter significantly.

  15. Return to Work in Out-of-Hospital Cardiac Arrest Survivors : A Nationwide Register-Based Follow-Up Study

    DEFF Research Database (Denmark)

    Kragholm, Kristian; Wissenberg, Mads

    2015-01-01

    BACKGROUND: -Data on long-term function of out-of-hospital cardiac arrest survivors are sparse. We examined return to work as proxy of preserved function without major neurological deficits in survivors. METHODS AND RESULTS: -In Denmark, out-of-hospital cardiac arrests are systematically reported to the Danish Cardiac Arrest Register since 2001. During 2001-2011, we identified 4,354 patients employed before arrest among 12,332 working age patients (18-65 years), of which 796 survived to day 30. Among 796 survivors (median age 53 years [Q1-Q3 46-59]; 81.5% men), 610 (76.6%) returned to work in a median time of 4 months [Q1-Q3 1-19] with a median time of 3 years spent back at work, of which 74.6% (N=455) remained employed without sick leaves during the first six months after return to work. This latter proportion of survivors returning to work increased over time (66.1% in 2001-2005 versus 78.1% in 2006-2011, P=0.002). In multivariable Cox regression analysis, factors associated with return to work with ?6 months of sustainable employment were 1] arrest during 2006-2011 versus 2001-2005, HR 1.38 (95% CI, 1.05-1.82); 2] male gender, HR 1.48 (CI 95%, 1.06-2.07); 3] age of 18-49 versus 50-65 years, HR 1.32 (95% CI, 1.02-1.68); 4] bystander-witnessed arrest, HR 1.79 (95% CI, 1.17-2.76); and 5] bystander cardiopulmonary resuscitation, HR 1.38 (95% CI, 1.02-1.87). CONCLUSIONS: -Of 30-day survivors employed before arrest, 76.6% returned to work. The percentage of survivors returning to work increased significantly along with improved survival during 2001-2011 suggesting an increase in proportions of survivors with preserved function over time.

  16. Five-Year Outcome after Coronary Artery Bypass Surgery in Survivors of Out-of-Hospital Cardiac Arrest

    Science.gov (United States)

    Mosorin, Matti-Aleksi; Lantos, Maté; Juvonen, Tatu; Biancari, Fausto

    2015-01-01

    Objective: The aim of this study was to evaluate the role of coronary artery bypass grafting (CABG) in patients with out-of-hospital cardiac arrest (OHCA). Methods: The immediate and 5-year outcome after CABG of a consecutive series of 48 patients who survived OHCA was compared with those of control patients having had a recent myocardial infarction without ventricular arrhythmias. Results: All OHCA patients were found to have suffered myocardial infarction-related cardiac arrest. The mean delay from OHCA to CABG was 10.3?±?13.0?days. Despite not statistically significant, the risk of 30-day postoperative mortality was higher among OHCA patients than control patients (6.3 vs. 0%, p?=?0.24, propensity score adjusted analysis: p?=?1.00). Cardioverter defibrillator was implanted in two patients who were alive 3.8 and 4.4?years after CABG, respectively. At 5-year, the overall survival rate was 80.7% in OHCA patients and 84.5% in control patients (p?=?0.98, propensity score adjusted analysis: p?=?0.87), and survival freedom from fatal cardiac event was 86.1% in OHCA patients and 86.5% in control patients (p?=?0.61; propensity score adjusted analysis: p?=?0.90). Conclusions: Early and 5-year survival rates after CABG in OHCA patients are excellent even when cardioverter defibrillator is very selectively implanted. The early and intermediate results CABG suggest a confident approach toward surgical revascularization in this critically ill patient population. PMID:25654081

  17. Out-of-hospital cardiac arrest and placement of automated external defibrillators in the community

    DEFF Research Database (Denmark)

    Folke, Fredrik

    2010-01-01

    INDLEDNING Chancen for at overleve et hjertestop udenfor hospital er i de første minutter efter kollaps afhængig af hjælpen fra nærmeste tilstedeværende. Dette har faciliteret strategier for placering af automatiske eksterne defibrillatorer (AED) i det offentlige rum og muliggjort hurtig defibrillering før ambulance ankomst. Sådanne strategier betegnes ’defibrillering med offentlig adgang’ (public access defibrillation (PAD)). Megen forskning har fokuseret på placering af og overlevelse med brug...

  18. Target Temperature Management after out-of-hospital cardiac arrest--a randomized, parallel-group, assessor-blinded clinical trial--rationale and design

    DEFF Research Database (Denmark)

    Nielsen, Niklas; Wetterslev, Jørn; al-Subaie, Nawaf; Andersson, Bertil; Bro-Jeppesen, John; Bishop, Gillian; Brunetti, Iole; Cranshaw, Julius; Cronberg, Tobias; Edqvist, Kristin; Erlinge, David; Gasche, Yvan; Glover, Guy; Hassager, Christian; Horn, Janneke; Hovdenes, Jan; Johnsson, Jesper; Kjaergaard, Jesper; Kuiper, Michael; Langørgen, Jørund; Macken, Lewis; Martinell, Louise; Martner, Patrik; Pellis, Thomas; Pelosi, Paolo; Petersen, Per Erik; Persson, Stefan; Rundgren, Malin; Saxena, Manoj; Svensson, Robert; Stammet, Pascal; Thorén, Anders; Undén, Johan; Walden, Andrew; Wallskog, Jesper; Wanscher, Michael; Wise, Matthew P; Wyon, Nicholas; Aneman, Anders; Friberg, Hans

    2012-01-01

    Experimental animal studies and previous randomized trials suggest an improvement in mortality and neurologic function with induced hypothermia after cardiac arrest. International guidelines advocate the use of a target temperature management of 32°C to 34°C for 12 to 24 hours after resuscitation from out-of-hospital cardiac arrest. A systematic review indicates that the evidence for recommending this intervention is inconclusive, and the GRADE level of evidence is low. Previous trials were smal...

  19. Targeted Temperature Management at 33°C Versus 36°C and Impact on Systemic Vascular Resistance and Myocardial Function After Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Hassager, Christian; Wanscher, Michael; Østergaard, Morten; Nielsen, Niklas; Erlinge, David; Friberg, Hans; Køber, Lars; Kjaergaard, Jesper

    2014-01-01

    BACKGROUND: Cardiovascular dysfunction is common after out-of-hospital cardiac arrest as part of the postcardiac arrest syndrome, and hypothermia may pose additional impact on hemodynamics. The aim was to investigate systemic vascular resistance index (SVRI), cardiac index, and myocardial performance at a targeted temperature management of 33°C (TTM33) versus 36°C (TTM36). METHODS AND RESULTS: Single-center substudy of 171 patients included in the Target Temperature Management Trial (TTM Trial) ...

  20. Out-of-hospital cardiac arrest and placement of automated external defibrillators in the community.

    DEFF Research Database (Denmark)

    Folke, Fredrik

    2010-01-01

    INDLEDNING Chancen for at overleve et hjertestop udenfor hospital er i de første minutter efter kollaps afhængig af hjælpen fra nærmeste tilstedeværende. Dette har faciliteret strategier for placering af automatiske eksterne defibrillatorer (AED) i det offentlige rum og muliggjort hurtig defibrillering før ambulance ankomst. Sådanne strategier betegnes ’defibrillering med offentlig adgang’ (public access defibrillation (PAD)). Megen forskning har fokuseret på placering af og overlevelse med brug af AED i udvalgte områder, hvorimod der er meget begrænset viden om hvor udbredt AED’er bør være i det offentlige rum. Tilsvarende er der begrænset viden om hvor AED’er strategisk bør opsættes uden for hospital, når forekomst af hjertestop i området er ukendt. I denne afhandling fokuseres på analyser af hjertestop i boligområder og offentligt rum og har følgende formål: 1) At undersøge hvordan forskellige AED placeringsstrategier påvirker PAD i boligområder og det offentligt rum; 2) at estimere risikoen for hjertestop afhængig af et områdes geografiske- og demografiske karakteristika, hvilket kan tjene som rettesnor for hvor AED bør placeres strategisk udenfor hospital; 3) at undersøge om der er forskelle i patientkarakteristika afhængigt af hvor hjertestoppet forekommer (boligområde versus offentligt rum); 4) at estimere omkostnings-effektiviteten for PAD programmer i boligområder og det offentligt rum afhængigt af valgte AED placeringsstrategi. METODE OG RESULTATER I perioden 1994-2005 blev alle personer med hjertestop udenfor hospital registreret af Akutlægebilen i København. Det Europæiske Kvadratnet, et defineret og harmoniseret kvadratnet for hele Europa med standardiseret størrelse og lokalisering af alle kvadratnetceller, blev benyttet til optælling af hjertestop forekommet i hver enkelt 100x100-meter celle i København. Antallet af hjertestop i hver enkelt celle blev analyseret i forhold til cellens underliggende geografiske og demografiske karakteristika. I alt blev 4828 hjertestop inkluderet i studieperioden; 3554 (74%) forekom i boligområder og 1274 (26%) i offentligt rum. Hvis anbefalingerne for AED placering fra det Europæiske Råd for Genoplivning fulgtes (1 hjertestop hvert 2. år), ville dette kræve AED opsætning svarende til 1% af det samlede areal for København og medføre dækning af 20% af alle hjertestop i offentligt rum. En større dækningsgrad kunne opnås ved at følge anbefalingerne fra den Amerikanske Hjerteforening (1 hjertestop hvert 5. år). Dette ville kræve AED opsætning svarende til 10% af Københavns areal og medføre dækning af næsten 70% af samtlige hjertestop i offentligt rum. Endvidere påvistes en paradoksal AED placering i offentligt rum, hvor hovedparten af opsatte AED’er skete i områder med lav hjertestop forekomst. Baseret på simple, demografiske karakteristika for beboede områder (befolkningstæthed, gennemsnitsalder, gennemsnitlig indkomst og andelen med kort uddannelse) var det muligt at identificere områder med høj forekomst af hjertestop. Disse områder udgjorde mindre end 3% af alle boligområder men inkluderede op mod 9% af alle hjertestop i boligområder. Personer med hjertestop i boligområder havde imidlertid øget forekomst af karakteristika forbundet med dårlig prognose, herunder højere alder, mandligt køn, oftere hjertestop om natten, længere responstid for ambulance og mindre sandsynlighed for at have stødbar hjerterytme sammenlignet med hjertestop i offentligt rum. KONKLUSION Denne afhandling viser, at en stor andel af hjertestop i offentligt rum kan dækkes ved strategisk opsætning af AED’er indenfor et begrænset geografisk område. Såfremt AED opsætning styres af tilfældige lokale eller politiske initiativer, fandtes en stor risiko for paradoksal AED placering, hvor opsætning primært forekom i områder med lav hjertestop forekomst. Ved at benytte simple, demografiske karakteristika for beboede områder i København, var det muligt at identificere boligområder med høj forekomst af hjertestop. Hj

  1. Systemic Inflammatory Response and Potential Prognostic Implications After Out-of-Hospital Cardiac Arrest: A Substudy of the Target Temperature Management Trial

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper

    2015-01-01

    OBJECTIVES: Whole-body ischemia during out-of-hospital cardiac arrest triggers immediate activation of inflammatory systems leading to a sepsis-like syndrome. The aim was to investigate the association between level of systemic inflammation and mortality in survivors after out-of-hospital cardiac arrest treated with targeted temperature management. DESIGN: Post hoc analysis. SETTING: Single-center study of a prospective multicenter randomized study. PATIENTS: One hundred sixty-nine patients (99%) with available blood samples out of 171 patients included in the Target -Temperature Management trial, randomly assigning patients to targeted temperature management at 33°C or 36°C. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: At baseline and 24, 48, and 72 hours after out-of-hospital cardiac arrest, blood samples were obtained and screened for a battery of inflammatory markers. Level of interleukin-1?, interleukin-2, interleukin-4, interleukin-5, interleukin-6, interleukin-9, interleukin-10, interleukin-12, interleukin-13, tumor necrosis factor-?, interferon-?, C-reactive protein, and procalcitonin were measured. Mortality at 30 days was evaluated by Cox analysis, and the predictive capability of inflammatory markers was evaluated by area under the curve. Level of all inflammatory markers changed significantly within 72 hours after out-of-hospital cardiac arrest (all p values < 0.001), but only procalcitonin levels showed overall differences between nonsurvivors and survivors (p = 0.0002). At baseline, interleukin-6 was independently associated with mortality, whereas both interleukin-6 levels (hazard ratio = 1.23 [1.01-1.49]; p = 0.04) and procalcitonin levels (hazard ratio = 1.20 [1.03-1.39]; p = 0.02) 24 hours after out-of-hospital cardiac arrest were associated with 30-day mortality with no interactions between targeted temperature management group and levels of interleukin-6 (p = 0.25) or procalcitonin (p = 0.85). None of the other inflammatory markers were independently associated with mortality. Area under the curve for procalcitonin and interleukin-6, 24 hours after out-of-hospital cardiac arrest, were 0.74 and 0.63, respectively. CONCLUSIONS: Level of inflammation, assessed by interleukin-6 and procalcitonin, was independently associated with increased mortality with the highest discriminative value obtained 24 hours after out-of-hospital cardiac arrest. Interventions aiming at decreasing level of inflammation as a way to improve outcome may be investigated in future studies.

  2. Acute coronary angiography in patients resuscitated from out-of-hospital cardiac arrest-A systematic review and meta-analysis

    DEFF Research Database (Denmark)

    Moesgaard, Jacob; Ravkilde, Jan

    2012-01-01

    INTRODUCTION: Out-of-hospital cardiac arrest has a poor prognosis. The main aetiology is ischaemic heart disease. AIM: To make a systematic review addressing the question: "In patients with return of spontaneous circulation following out-of-hospital cardiac arrest, does acute coronary angiography with coronary intervention improve survival compared to conventional treatment?" METHODS: Peer reviewed articles written in English with relevant prognostic data were included. Comparison studies on patients with and without acute coronary angiography were pooled in a meta-analysis. RESULTS: Thirty-two non-randomised studies were included of which 22 were case-series without patients with conservative treatment. Seven studies with specific efforts to control confounding had statistical evidence to support the use of acute coronary angiography following resuscitation from out-of-hospital cardiac arrest. The remaining 25 studies were considered neutral. Following acute coronary angiography, the survival to hospital discharge, 30 days or six months ranged from 23% to 86%. In patients without an obvious non-cardiac aetiology, the prevalence of significant coronary artery disease ranged from 59% to 71%. Electrocardiographic findings were unreliable for identifying angiographic findings of acute coronary syndrome. Ten comparison studies demonstrated a pooled unadjusted odds ratio for survival of 2.78 (1.89; 4.10) favouring acute coronary angiography. CONCLUSION: No randomised studies exist on acute coronary angiography following out-of-hospital cardiac arrest. An increasing number of observational studies support feasibility and a possible survival benefit of an early invasive approach. In patients without an obvious non-cardiac aetiology, acute coronary angiography should be strongly considered irrespective of electrocardiographic findings due to a high prevalence of coronary artery disease.

  3. Myocardial infarction is a frequent cause of exercise-related resuscitated out-of-hospital cardiac arrest in a general non-athletic population

    DEFF Research Database (Denmark)

    Søholm, Helle; Kjaergaard, Jesper; Thomsen, Jakob Hartvig; Bro-Jeppesen, John; Lippert, Freddy K; Køber, Lars; Wanscher, Michael; Hassager, Christian

    2014-01-01

    BACKGROUND: Performing exercise is shown to prevent cardiovascular disease, but the risk of an out-of-hospital cardiac arrest (OHCA) is temporarily increased during strenuous activity. We examined the etiology and outcome after successfully resuscitated OHCA during exercise in a general non-athletic population. METHODS: Consecutive patients with OHCA were admitted with return of spontaneous circulation (ROSC) or on-going resuscitation at hospital arrival (2002-2011). Patient charts were reviewed...

  4. Mortality and neurological outcome in the elderly after target temperature management for out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Winther-Jensen, Matilde; Pellis, Tommaso

    2015-01-01

    AIM: To assess older age as a prognostic factor in patients resuscitated from out-of-hospital-cardiac arrest (OHCA) and the interaction between age and level of target temperature management. Methods and results: 950 patients included in the Target Temperature Management (TTM) trial were randomly allocated to TTM at 33 or 36°C for 24hours. We assessed survival and cerebral outcome (Cerebral Performance Category (CPC) and modified Rankin Scale (mRS) using age as predictor, dividing patients into 5 age groups: ?65 (median), 66-70, 71-75, 76-80 and >80 years of age. Shockable rhythm decreased with higher age groups, p=0.001, the same was true for ST segment elevation on ECG at admission, p<0.01. Increasing age was associated with a higher mortality rate (HR=1.04 per year, 95% CI=1.03-1.06, p<0.001) after adjusting for confounders. Octogenarians had an increased mortality (HR=3.5, CI: 2.5-5.0, p <0.001) compared to patients ?65 years of age. Favorable vs. unfavorable outcome measured by CPC and mRS in survivors was different between age groups with adverse outcomes more prevalent in higher age groups (CPC: p=0.04, mRS: p=0.001). The interaction between age and target temperature allocation was not statistically significant for either mortality or neurological outcome. CONCLUSION: Increasing age is associated with significantly increased mortality after OHCA, but mortality rate is not influenced by level of target temperature. Risk of poor neurological outcome also increases with age, but is not modified by level of target temperature.

  5. Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction

    DEFF Research Database (Denmark)

    Ostenfeld, Sarah; Lindholm, Matias Greve

    2014-01-01

    OBJECTIVES: To compare outcome in patients with acute myocardial infarction (MI) and cardiogenic shock (CS) presenting with and without out-of-hospital cardiac arrest (OHCA). BACKGROUND: Despite general improvement in outcome after acute MI, CS remains a leading cause of death in acute MI patients with a high 30-day mortality rate. OHCA on top of cardiogenic shock may further increase mortality in these patients resulting in premature withdrawal of supportive therapy, but this is not known. METHODS AND RESULTS: In a retrospective study from 2008 to 2013, 248 consecutive patients admitted alive to a tertiary centre with the diagnosis of CS and acute MI were enrolled, 118 (48%) presented with OHCA and 130 (52%) without (non-OHCA patients). Mean lactate level at admission was significantly higher in OHCA patients compared with non-OCHA patients (9mmol/l (SD 6) vs. 6mmol/l (SD 4) p<0.0001). Co-morbidities were more prevalent in the non-OHCA group. By univariate analysis age (Hazard ratio (HR)=1.02 [CI 1.00-1.03], p=0.01) and lactate at admission (HR=1.06 [CI 1.03-1.09], p<0.001), but not OHCA (HR=1.1 [CI 0.8-1.4], p=NS) was associated with mortality. In multivariate analysis, only age (HR=1.02 [CI 1.01-1.04], p=0.003) and lactate level at admission (HR=1.06 [1.03-1.09], p<0.001) were independent predictors of mortality. One-week mortality was 63% in the OHCA group and 56% in the non-OHCA group, p=NS. CONCLUSION: OHCA is not an independent predictor of mortality in patients with acute MI complicated by cardiogenic shock. This should encourage active intensive treatment of CS patients regardless of OHCA.

  6. Target Temperature Management after out-of-hospital cardiac arrest--a randomized, parallel-group, assessor-blinded clinical trial--rationale and design

    DEFF Research Database (Denmark)

    Nielsen, Niklas; Wetterslev, JØrn

    2012-01-01

    Experimental animal studies and previous randomized trials suggest an improvement in mortality and neurologic function with induced hypothermia after cardiac arrest. International guidelines advocate the use of a target temperature management of 32°C to 34°C for 12 to 24 hours after resuscitation from out-of-hospital cardiac arrest. A systematic review indicates that the evidence for recommending this intervention is inconclusive, and the GRADE level of evidence is low. Previous trials were small, with high risk of bias, evaluated select populations, and did not treat hyperthermia in the control groups. The optimal target temperature management strategy is not known.

  7. Successful use of therapeutic hypothermia in an opiate induced out-of-hospital cardiac arrest complicated by severe hypoglycaemia and amphetamine intoxication: a case report

    Directory of Open Access Journals (Sweden)

    Søreide Eldar

    2010-01-01

    Full Text Available Abstract The survival to discharge rate after unwitnessed, non-cardiac out-of-hospital cardiac arrest (OHCA is dismal. We report the successful use of therapeutic hypothermia in a 26-year old woman with OHCA due to intentional poisoning with heroin, amphetamine and insulin. The cardiac arrest was not witnessed, no bystander CPR was initiated, the time interval from the call to ambulance arrival was 9 minutes and the initial cardiac rhythm was asystole. Eight minutes of advanced cardiac life support resulted in ROSC. Upon hospital admission, the patient's pupils were dilated. Her arterial lactate was 17 mmol/l, base excess -20, pH 6.9 and serum glucose 0.2 mmol/l. During the first 24 hours in the ICU, the patient developed maximally dilated pupils not reacting to light and became increasingly haemodynamically unstable, requiring both inotropic support and massive fluid resuscitation. After 1 week in the ICU, however, she made an uneventful recovery with a Cerebral Performance Category of 1 at hospital discharge and at a follow up examination at 6 months. Conclusion According to most prognostic factors, the patient had a statistical chance for survival of less than 1%, not taking into account her severe state of hypoglyaemia. We suggest that this case exemplifies the need for more studies on the use of TH in non-coronary causes of OHCA.

  8. Cognitive Function in Survivors of Out-of-Hospital Cardiac Arrest After Target Temperature Management at 33ºC Versus 36ºC

    DEFF Research Database (Denmark)

    Lilja, Gisela; Nielsen, Niklas

    2015-01-01

    BACKGROUND: -Target temperature management is recommended as a neuro-protective strategy after out-of-hospital cardiac arrest. Potential effects of different target temperatures on cognitive impairment commonly described in survivors are not sufficiently investigated. The primary aim of this study was to evaluate whether a target temperature of 33ºC compared to 36ºC was favourable for cognitive function, and secondary to describe cognitive impairment in cardiac arrest survivors in general. METHODS AND RESULTS: -Study-sites included 652 cardiac arrest survivors originally randomized and stratified for site to temperature control at 33ºC or 36ºC within the Target Temperature Management trial. Survival until 180 days after the arrest was 52% (33ºC n=178/328 36ºC n=164/324). Survivors were invited to a face-to-face follow-up and 287 cardiac arrest survivors (33ºC n=148/36ºC n=139) were assessed with tests for memory (Rivermead Behavioural Memory Test), executive functions (Frontal Assessment Battery) and attention/mental speed (Symbol Digit Modalities Test). A control-group of 119 matched patients hospitalized for acute ST-elevation myocardial infarction (STEMI) without cardiac arrest performed the same assessments. Half of the cardiac arrest survivors had cognitive impairment, which was mostly mild. Cognitive outcome did not differ (p >0.30) between the two temperature groups (33ºC/36ºC). Compared to STEMI-controls attention/mental speed was more affected among cardiac arrest patients, but results for memory and executive functioning were similar. CONCLUSIONS: -Cognitive function was comparable in survivors of out-of-hospital cardiac arrest when targeting a temperature of 33ºC and 36ºC. Cognitive impairment detected in cardiac arrest survivors was also common in matched STEMI-controls not having had a cardiac arrest. Clinical Trial Registration Information-ClinicalTrials.gov. Identifier: NCT01946932.

  9. Survival After Out-of-Hospital Cardiac Arrest in Relation to Age and Early Identification of Patients with Minimal Chance of Long-Term Survival

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Folke, Fredrik

    2015-01-01

    BACKGROUND: -Survival following out-of-hospital cardiac arrest (OHCA) has increased during the last decade in Denmark. We aimed to study the impact of age on changes in survival and whether it was possible to identify patients with minimal chance of 30-day survival. METHODS AND RESULTS: -Using data from the nationwide Danish Cardiac Arrest Registry (2001?2011), we identified 21,480 patients ?18 years old with a presumed cardiac-caused OHCA for which resuscitation was attempted. Patients were divided into three pre-selected age-groups: "working-age-patients" aged 18-65 years (33.7%); "early-senior-patients" aged 66-80 years (41.5%); and "late-senior-patients" aged >80 years (24.8%). Characteristics in working-age-patients, early-senior-patients, and late-senior-patients: witnessed arrest 53.8%, 51.1%, and 52.1%; bystander CPR 44.7%, 30.3%, and 23.4%; and pre-hospital shock from a defibrillator 54.7%, 45.0% and 33.8%, all p<0.05. Between 2001 and 2011, return of spontaneous circulation (ROSC) upon hospital arrival increased: working-age-patients from 12.1% to 34.6%; early-senior-patients 6.4% to 21.5%; and late-senior-patients 4.0% to 15.0%, all p<0.001. Furthermore, 30-day survival increased: working-age-patients 5.8% to 22.0%, p<0.001; and early-senior-patients 2.7% to 8.4%, p<0.001; while late-senior-patients only experienced a minor increase 1.5% to 2.0%, p=0.01. Overall, three out of 9499 patients, achieved 30-day survival if they met two criteria: had not achieved ROSC upon hospital arrival; and had not received a pre-hospital shock from a defibrillator. CONCLUSIONS: -All age groups experienced a large temporal increase in survival on hospital arrival, but the increase in 30-day survival was most prominent in the young. Using only two criteria, it was possible to identify patients with minimal chance of 30-day survival.

  10. Diurnal variations in incidence and outcome of out-of-hospital cardiac arrest including prior comorbidity and pharmacotherapy : A nationwide study in Denmark

    DEFF Research Database (Denmark)

    Karlsson, Lena I M; Wissenberg, Mads

    2014-01-01

    AIM: To investigate diurnal variations in incidence and outcomes following out-of-hospital cardiac arrest (OHCA). METHODS: OHCA of presumed cardiac etiology were identified through the nationwide Danish Cardiac Arrest Registry (2001-2010). Time of day was divided into three time periods: daytime 07.00-14.59; evening 15.00-22.59; and nighttime 23.00-06.59. RESULTS: We identified 18,929 OHCA patients, aged ?18 years. The median age was 72 years (IQR 62-80) and the majority were male (67.5%). OHCA occurrence varied across time periods, with 43.9%, 35.7% and 20.6% occurring during daytime, evening and nighttime, respectively. Nighttime patients were more likely to have: severe comorbidity (i.e. COPD), arrest in private home (87.2% vs. 69.0% and 73.0% daytime and evening, respectively), non-witnessed arrest (51.2% vs. 48.4% and 43.7%), no bystander CPR (75.9% vs. 68.4% and 66.1%), longer time interval from recognition of OHCA to rhythm analysis (12 min vs. 11 min and 11 min), and non-shockable heart rhythm (80.1% vs. 70.3% and 69.4%), all p<0.0001. Nighttime patients were less likely to achieve return of spontaneous circulation on arrival at the hospital (7.5% vs. 14.8% and 15.1%) and 1-year survival (2.8% vs. 7.2% and 7.1%), p<0.0001. Overall, the lower 1-year survival rate persisted after adjusting for patient-related and cardiac-arrest related characteristics mentioned above (OR 0.47, 95%CI 0.37-0.59; OR 0.51, 95%CI 0.40-0.65, compared to daytime and evening, respectively). CONCLUSIONS: We found nighttime patients to have a lower survival compared to daytime and evening that persisted when adjusting for patient-related and cardiac-arrest related characteristics including comorbidities.

  11. Detailed statistical analysis plan for the target temperature management after out-of-hospital cardiac arrest trial

    DEFF Research Database (Denmark)

    Nielsen, Niklas; Winkel, Per; Cronberg, Tobias; Erlinge, David; Friberg, Hans; Gasche, Yvan; Hassager, Christian; Horn, Janneke; Hovdenes, Jan; Kjaergaard, Jesper; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wanscher, Michael; Wise, Matt P; Aneman, Anders; Wetterslev, Jørn

    2013-01-01

    Animal experimental studies and previous randomized trials suggest an improvement in mortality and neurological function with temperature regulation to hypothermia after cardiac arrest. According to a systematic review, previous trials were small, had a risk of bias, evaluated select populations, and did not treat hyperthermia in the control groups. The optimal target temperature management (TTM) strategy is not known. To prevent outcome reporting bias, selective reporting and data-driven result...

  12. No fate but what we make: a case of full recovery after out-of-hospital cardiac arrest

    Directory of Open Access Journals (Sweden)

    Andrade Maria J

    2009-12-01

    Full Text Available Abstract An 80 years old man suffered a cardiac arrest shortly after arrival to his local health department. Basic Life Support was started promptly and nine minutes later, on evaluation by an Advanced Life Support team, the victim was defibrillated with a 200J shock. When orotracheal intubation was attempted, masseter muscle contraction was noticed: on revaluation, the victim had pulse and spontaneous breathing. Thirty minutes later, the patient had been transferred to an emergency department. As he complained of chest pain, the ECG showed a ST segment depression in leads V4 to V6 and laboratorial tests showed cardiac troponine I slightly elevated. A coronary angiography was performed urgently: significant left main plus three vessel coronary artery disease was disclosed. Eighteen hours after the cardiac arrest, a quadruple coronary artery bypass grafting operation was undertaken. During surgery, a fresh thrombus was removed from the middle left anterior descendent artery. Post-operative course was uneventful and the patient was discharged seven days after the procedure. Twenty four months later, he remains asymptomatic. In this case, the immediate call for the Advanced Life Support team, prompt basic life support and the successful defibrillation, altogether, contributed for the full recovery. Furthermore, the swiftness in the detection and treatment of the acute reversible cause (myocardial ischemia in this case was crucial for long-term prognosis.

  13. Detailed statistical analysis plan for the target temperature management after out-of-hospital cardiac arrest trial

    DEFF Research Database (Denmark)

    Nielsen, Niklas; Winkel, Per

    2013-01-01

    Animal experimental studies and previous randomized trials suggest an improvement in mortality and neurological function with temperature regulation to hypothermia after cardiac arrest. According to a systematic review, previous trials were small, had a risk of bias, evaluated select populations, and did not treat hyperthermia in the control groups. The optimal target temperature management (TTM) strategy is not known. To prevent outcome reporting bias, selective reporting and data-driven results, we present the a priori defined detailed statistical analysis plan as an update to the previously published outline of the design and rationale for the TTM trial.

  14. Prognostic value of reduced discrimination and oedema on cerebral computed tomography in a daily clinical cohort of out-of-hospital cardiac arrest patients

    DEFF Research Database (Denmark)

    Langkjær, Sandra; Hassager, Christian

    2015-01-01

    PURPOSE: Assessment of prognosis after out-of-hospital cardiac arrest (OHCA) is challenging. Cerebral computed tomography (cCT) scans are widely available, but the use in prognostication of comatose OHCA-patients is unclear. We evaluated the prognostic value of cCT in a clinical cohort of OHCA-patients. METHOD: A total of 1120 consecutive OHCA-patients with cardiac aetiology and successful or on-going resuscitation at hospital arrival were included (2002-2011). Utstein-criteria for registration of pre-hospital data and review of patient-charts for post-resuscitation care including cCT results were used. The primary endpoint was 30-day mortality analysed by log-rank and multivariate Cox-regression analyses. RESULTS: A cCT scan was performed in 341(30%) of the clinical OHCA-cohort, and an early CT (<24h) was performed in 188 patients. The early CT was found 'normal' in 163(89%) and with reduced discrimination in 7(4%) of patients, which was independently associated with higher 30-day mortality compared with OHCA-patients with an early cCT (HRadjusted=3.5 (95%CI: 1.0-11.5), p=0.04). A late CT (?24h) was performed in 153 patients in a median of 3 days (IQR: 2-5) and was 'normal' in 89(60%), 'cerebral bleeding' in 4(3%), 'new cerebral infarction' in 10(7%), and 'reduced discrimination between white and grey matter and/or oedema' in 45(30%) patients. 'Reduced discrimination and/or oedema' by late cCT was independently associated with higher 30-day mortality compared to patients with a normal late CT (HRadjusted=2.6 (95%CI: 1.4-4.8, p=0.002). CONCLUSION: Our observations suggest that a cCT may be useful as part of the neurological prognostication in patients with OHCA. 'Reduced discrimination between white and grey matter and/or oedema' on cCT was independently associated with a poor prognosis.

  15. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest before and after introduction of a mechanical chest compression device, LUCAS-2; a prospective, observational study

    DEFF Research Database (Denmark)

    Tranberg, Tinne; Lassen, Jens F

    2015-01-01

    BACKGROUND: Mechanical chest compressions have been proposed to provide high-quality cardiopulmonary resuscitation (CPR), but despite the growing use of mechanical chest compression devices, only few studies have addressed their impact on CPR quality. This study aims to evaluate mechanical chest compressions provided by LUCAS-2 (Lund University Cardiac Assist System) compared with manual chest compression in a cohort of out-of-hospital cardiac arrest (OHCA) cases. METHODS: In this prospective study conducted in the Central Denmark Region, Denmark, the emergency medical service attempted resuscitation and reported data on 696 non-traumatic OHCA patients between April 2011 and February 2013. Of these, 155 were treated with LUCAS CPR after an episode with manual CPR. The CPR quality was evaluated using transthoracic impedance measurements collected from the LIFEPAK 12 defibrillator, and the effect was assessed in terms of chest compression rate, no-flow time and no-flow fraction; the fraction of time during resuscitation in which the patient is without spontaneous circulation receiving no chest compression. RESULTS: The median total episode duration was 21 minutes, and the episode with LUCAS CPR was significantly longer than the manual CPR episode, 13 minutes vs. 5 minutes, p < 0.001. The no-flow fraction was significantly lower during LUCAS CPR (16%) than during manual CPR (35%); difference 19% (95% CI: 16% to 21%; p < 0.001). No differences were found in pre- and post-shock no-flow time throughout manual CPR and LUCAS CPR. Contrary to the manual CPR, the average compression rate during LUCAS CPR was in conformity with the current Guidelines for Resuscitation, 102/minute vs. 124/minute, p < 0.001. CONCLUSION: Mechanical chest compressions provided by the LUCAS device improve CPR quality by significantly reducing the NFF and by improving the quality of chest compression compared with manual CPR during OHCA resuscitation. However, data on end-tidal Co2 and chest compression depth surrogate parameters of CPR quality could not be reported.

  16. Tertiary centres have improved survival compared to other hospitals in the Copenhagen area after out-of-hospital cardiac arrest : 2013 og den har fået sidetal: vol 84(2):162-67

    DEFF Research Database (Denmark)

    SØholm, Helle; Wachtell, Kristian

    2013-01-01

    AIMS: Out-of-hospital cardiac arrest (OHCA) has been reported to carry very varying morbidity and mortality. However, it remains unclear whether this is caused by intrinsic factors of the OHCA or due to the level of in-hospital care. The aim of this study is to compare 30-day and long-term mortality after OHCA at tertiary heart centres and non-tertiary university hospitals. METHODS AND RESULTS: Data from the Copenhagen OHCA registry from June 2002 through December 2010 included a total of 1218 consecutive patients treated by the same mobile emergency care unit (MECU) with either return of spontaneous circulation (ROSC) or on-going resuscitation (n=53) at hospital arrival. The MECU transported patients to the nearest hospital unless an ECG on scene suggested ST-segment elevation myocardial infarction, in which case patients were transported to the nearest tertiary centre for acute coronary angiography. Therefore, patients with ST-elevation myocardial infarction (n=198) were excluded from the analysis. 30-day mortality was 56% vs. 76% and long term (up to 8years) mortality was 78% vs. 94% for tertiary and non-tertiary hospitals, respectively, both p

  17. Prognostic value of electroencephalography (EEG) after out-of-hospital cardiac arrest in successfully resuscitated patients used in daily clinical practice

    DEFF Research Database (Denmark)

    SØholm, Helle; Kjær, Troels Wesenberg

    2014-01-01

    BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis and predicting outcome is complex with neurophysiological testing and repeated clinical neurological examinations as key components of the assessment. In this study we examine the association between different electroencephalography (EEG) patterns and mortality in a clinical cohort of OHCA-patients. METHODS: From 2002-2011 consecutive patients were admitted to an intensive-care-unit after resuscitation from OHCA. Utstein-criteria for pre-hospital data and review of individual patients' charts for post-resuscitation care were used. EEG reports were analysed analysis according to the 2012 American Clinical Neurophysiology Society's guidelines. RESULTS: A total of 1076 patients were included, and EEG was performed in 20% (n=219) with a median of 3(IQR 2-4) days after OHCA. Rhythmic Delta Activity (RDA) was found in 71 patients (36%) and Periodic Discharges (PD) in 100 patients (45%). Background EEG frequency of Alpha+ or Theta was noted in 107 patients (49%), and change in cerebral EEG activity to stimulation (reactivity) was found in 38 patients (17%). Suppression (all activity <10?V) was found in 26 (12%) and burst-suppression in 17 (8%) patients. A favourable EEG pattern (reactivity, favourable background frequency and RDA) was independently associated with reduced mortality with hazard ratio (HR) 0.43 (95%CI: 0.24-0.76), p=0.004 (false positive rate: 31%) and a non-favourable EEG pattern (no reactivity, unfavourable background frequency, and PD, suppressed voltage or burst-suppression) was associated with higher mortality (HR=1.62(1.09-2.41), p=0.02) after adjustment for known prognostic factors (false positive rate: 9%). CONCLUSION: EEG may be useful in work-up in prognostication of patients with OHCA. Findings such as RDA (Rhythmic Delta Activity) seems to be associated with a better prognosis, whereas suppressed voltage and burst-suppression patterns were associated with poor prognosis.

  18. Impaired Fasting Plasma Glucose and Type 2 Diabetes Are Related to the Risk of Out-of-Hospital Sudden Cardiac Death and All-Cause Mortality

    Science.gov (United States)

    Laukkanen, Jari A.; Mäkikallio, Timo H.; Ronkainen, Kimmo; Karppi, Jouni; Kurl, Sudhir

    2013-01-01

    OBJECTIVE The aim of the study was to determine whether impaired fasting plasma glucose (FPG) and type 2 diabetes may be risk factors for sudden cardiac death (SCD). RESEARCH DESIGN AND METHODS This prospective study was based on 2,641 middle-aged men 42–60 years of age at baseline. Impaired FPG level (?5.6 mmol/L) among nondiabetic subjects (501 men) was defined according to the established guidelines, and the group with type 2 diabetes included subjects (159 men) who were treated with oral hypoglycemic agents, insulin therapy, and/or diet. RESULTS During the 19-year follow-up, a total of 190 SCDs occurred. The relative risk (RR) for SCD was 1.51-fold (95% CI 1.07–2.14, P = 0.020) for nondiabetic men with impaired FPG and 2.86-fold (1.87–4.38, P < 0.001) for men with type 2 diabetes as compared with men with normal FPG levels, after adjustment for age, BMI, systolic blood pressure, serum LDL cholesterol, smoking, prevalent coronary heart disease (CHD), and family history of CHD. The respective RRs for out-of-hospital SCDs (157 deaths) were 1.79-fold (1.24–2.58, P = 0.001) for nondiabetic men with impaired FPG and 2.26-fold (1.34–3.77, P < 0.001) for men with type 2 diabetes. Impaired FPG and type 2 diabetes were associated with the risk of all-cause death. As a continuous variable, a 1 mmol/L increment in FPG was related to an increase of 10% in the risk of SCD (1.10 [1.04–1.20], P = 0.001). CONCLUSIONS Impaired FPG and type 2 diabetes represent risk factors for SCD. PMID:23248190

  19. Challenges in out-of-hospital cardiac arrest-a study combining closed-circuit television (CCTV) and medical emergency calls

    DEFF Research Database (Denmark)

    Linderoth, Gitte; Hallas, Peter

    2015-01-01

    The aim of this study was to explore challenges in recognition and initial treatment of out-of-hospital cardiac arrest (OHCA) by using closed-circuit television (CCTV) recordings combined with audio recordings from emergency medical calls. METHOD: All OHCA captured by CCTV in the Capital Region of Denmark, 15 June 2013-14 June 2014, were included. Using a qualitative approach based on thematic analysis, we focused on the interval from the victim's collapse to the arrival of the ambulance. RESULTS: Based on the 21 CCTV recordings collected, the main challenges in OHCA seemed to be situation awareness, communication and attitude/approach. Situation awareness among bystanders and the emergency medical dispatchers (dispatcher) differed. CCTV showed that bystanders other than the caller, were often physically closer to the victim and initiated cardiopulmonary resuscitation (CPR). Hence, information from the dispatcher had to pass through the caller to the other bystanders. Many bystanders passed by or left, leaving the resuscitation to only a few. In addition, we observed that the callers did not delegate tasks that could have been performed more effectively by other bystanders, for example, receiving the ambulance or retrieving an Automated External Defibrillator (AED). CONCLUSION: CCTV combined with audio recordings from emergency calls can provide unique insights into the challenges of recognition and initial treatment of OHCA and can improve understanding of the situation. The main barriers to effective intervention were situation awareness, communication and attitude/approach. Potentially, some of these challenges could be minimized if the dispatcher was able to see the victim and the bystanders at the scene. A team approach, with the dispatcher responsible for the role as team leader of a remote resuscitation team of a caller and bystanders, may potentially improve treatment of OHCA.

  20. Reporting of data from out-of-hospital cardiac arrest has to involve emergency medical dispatching--taking the recommendations on reporting OHCA the Utstein style a step further

    DEFF Research Database (Denmark)

    Castrén, M; Bohm, K; Kvam, A M; Bovim, E; Christensen, Erika Frischknecht; Steen-Hansen, J-E; Karlsten, R

    2011-01-01

    OBJECTIVES: As a part of the chain of survival, the emergency medical communication centre (EMCC) and the emergency medical dispatcher (EMD) has an important role in early identification of out-of-hospital cardiac arrests (OHCA). The EMD may provide instructions to the caller and thereby initiate cardiopulmonary resuscitation in a substantial number of subjects and thus contribute to increased survival. The EMCC provides a response with first responders, ambulances, physician manned units and po...

  1. Neurologic Function and Health-Related Quality of Life in Patients Following Targeted Temperature Management at 33°C vs 36°C After Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Cronberg, Tobias; Lilja, Gisela; Horn, Janneke; Kjaergaard, Jesper; Wise, Matt P; Pellis, Tommaso; Hovdenes, Jan; Gasche, Yvan; Åneman, Anders; Stammet, Pascal; Erlinge, David; Friberg, Hans; Hassager, Christian; Kuiper, Michael; Wanscher, Michael; Bosch, Frank; Cranshaw, Julius; Kleger, Gian-Reto; Persson, Stefan; Undén, Johan; Walden, Andrew; Winkel, Per; Wetterslev, Jørn; Nielsen, Niklas

    2015-01-01

    Importance: Brain injury affects neurologic function and quality of life in survivors after cardiac arrest. Objective: To compare the effects of 2 target temperature regimens on long-term cognitive function and quality of life after cardiac arrest. Design, Setting, and Participants: In this multicenter, international, parallel group, assessor-masked randomized clinical trial performed from November 11, 2010, through January 10, 2013, we enrolled 950 unconscious adults with cardiac arrest of pres...

  2. Targeted Temperature Management at 33°C Versus 36°C and Impact on Systemic Vascular Resistance and Myocardial Function After Out-of-Hospital Cardiac Arrest : A Sub-Study of the Target Temperature Management Trial

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Hassager, Christian

    2014-01-01

    BACKGROUND: Cardiovascular dysfunction is common after out-of-hospital cardiac arrest as part of the postcardiac arrest syndrome, and hypothermia may pose additional impact on hemodynamics. The aim was to investigate systemic vascular resistance index (SVRI), cardiac index, and myocardial performance at a targeted temperature management of 33°C (TTM33) versus 36°C (TTM36). METHODS AND RESULTS: Single-center substudy of 171 patients included in the Target Temperature Management Trial (TTM Trial) randomly assigned to TTM33 or TTM36 for 24 hours after out-of-hospital cardiac arrest. Mean arterial pressure ?65 mm Hg and central venous pressure of 10 to 15 mm Hg were hemodynamic treatment goals. Hemodynamic evaluation was performed by serial right heart catheterization and transthoracic echocardiography. Primary end point was SVRI after 24 hours of cooling and secondary end points included mean SVRI, cardiac index, systolic function, and lactate levels. The TTM33 group had a significant increase in SVRI compared with TTM36 (2595; 95% confidence interval, 2422-2767) versus 1960 (95% confidence interval, 1787-2134) dynes m(2)/s per cm(5); P<0.0001, respectively) after 24 hours of cooling with an overall difference of 556 dynes m(2)/s per cm(5) (P(group) <0.0001). TTM33 was associated with decreased cardiac index (-0.4 L/min per m(2); P(group) <0.0001), decreased heart rate (P(group)=0.01), and stroke volume index (P(group)=0.004) compared with TTM36. Left ventricular ejection fraction (P=0.39) and peak systolic myocardial velocity (P=0.62) did not differ between TTM groups. Lactate levels were significantly higher in the TTM33 group (P=0.0008). CONCLUSIONS: Targeted temperature management at 33°C with target mean arterial pressure ?65 mm Hg is associated with increased SVRI and lower cardiac index because of lower heart rate with unaffected left ventricular systolic function compared with 36°C. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01020916.

  3. Targeted temperature management at 33°C versus 36°C and impact on systemic vascular resistance and myocardial function after out-of-hospital cardiac arrest : a sub-study of the Target Temperature Management Trial

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Hassager, Christian

    2014-01-01

    BACKGROUND: Cardiovascular dysfunction is common after out-of-hospital cardiac arrest as part of the postcardiac arrest syndrome, and hypothermia may pose additional impact on hemodynamics. The aim was to investigate systemic vascular resistance index (SVRI), cardiac index, and myocardial performance at a targeted temperature management of 33°C (TTM33) versus 36°C (TTM36). METHODS AND RESULTS: Single-center substudy of 171 patients included in the Target Temperature Management Trial (TTM Trial) randomly assigned to TTM33 or TTM36 for 24 hours after out-of-hospital cardiac arrest. Mean arterial pressure ?65 mm Hg and central venous pressure of 10 to 15 mm Hg were hemodynamic treatment goals. Hemodynamic evaluation was performed by serial right heart catheterization and transthoracic echocardiography. Primary end point was SVRI after 24 hours of cooling and secondary end points included mean SVRI, cardiac index, systolic function, and lactate levels. The TTM33 group had a significant increase in SVRI compared with TTM36 (2595; 95% confidence interval, 2422-2767) versus 1960 (95% confidence interval, 1787-2134) dynes m(2)/s per cm(5); P<0.0001, respectively) after 24 hours of cooling with an overall difference of 556 dynes m(2)/s per cm(5) (P(group) <0.0001). TTM33 was associated with decreased cardiac index (-0.4 L/min per m(2); P(group) <0.0001), decreased heart rate (P(group)=0.01), and stroke volume index (P(group)=0.004) compared with TTM36. Left ventricular ejection fraction (P=0.39) and peak systolic myocardial velocity (P=0.62) did not differ between TTM groups. Lactate levels were significantly higher in the TTM33 group (P=0.0008). CONCLUSIONS: Targeted temperature management at 33°C with target mean arterial pressure ?65 mm Hg is associated with increased SVRI and lower cardiac index because of lower heart rate with unaffected left ventricular systolic function compared with 36°C. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01020916.

  4. Out-of-Hospital therapeutic hypothermia. A Systematic Review

    Directory of Open Access Journals (Sweden)

    María Nélida Conejo Pérez

    2012-07-01

    Full Text Available Recent studies have demonstrated therapeutic mild hypothermia improves neurological outcome of patients after suffering an out-of-hospital cardiac arrest.Other studies in animals suggest that the sooner hypothermia is started after return of spontaneous circulation, the lower neurological symptoms are suffered by patients.The aim of this work is to know the efficiency of the therapeutic moderated hipotermia after the cardiopulmonar resuscitation realized extra hospitable.Methods: We made a literature search in Medline (Pubmed, Cinahl, Cuiden, Cochrane Library and the Joanna Briggs Institute, combining mesh and free terms; and searched in the journals Circulation, Resuscitation and Emergency Medicine Journal manually last year. We selected systematic reviews and randomized and nonrandomized clinical trials which had contrasted in-hospital and out-of-hospital TMH with over 18 years patients.Results: Only 5 articles met the inclusion criteria of the 35 selected: four randomized clinical trials and one nonrandomized. They were then subjected to a critical methodological evaluation (CASPe and statistic evaluation (IDIPaz.Conclusions: Pre hospital TMH is an effective and safe technique in comatose patients after being resuscitated from cardiac arrest, improving the neurological status at hospital discharge.

  5. Out-of-hospital resuscitation: have we gone too far?

    Science.gov (United States)

    Grudzen, Corita

    2006-01-01

    Americans are living longer and are more likely to be chronically or terminally ill at the time of death. Although surveys indicate that most people prefer to die at home, the majority of people in the United States die in acute care hospitals. Each year, approximately 400,000 persons suffer sudden cardiac arrest in the US, the majority occurring in the out-of-hospital setting. Mortality rates are high and reach almost 100% when prehospital care has failed to restore spontaneous circulation. Nonetheless, patients who receive little benefit or may wish to forgo life-sustaining treatment often are resuscitated. Risk versus harm of resuscitation efforts can be differentiated by various factors, including cardiac rhythm. Emergency medical services policy regarding resuscitation should consider its utility in various clinical scenarios. Patients, family members, emergency medical providers, and physicians all are important stakeholders to consider in decisions about out-of-hospital cardiac arrest. Ideally, future policy will place greater emphasis on patient preferences and quality of life by including all of these viewpoints. PMID:17334194

  6. Neuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C

    DEFF Research Database (Denmark)

    Stammet, Pascal; Collignon, Olivier

    2015-01-01

    BACKGROUND: Neuron-specific enolase (NSE) is a widely-used biomarker for prognostication of neurological outcome after cardiac arrest, but the relevance of recommended cutoff values has been questioned due to the lack of a standardized methodology and uncertainties over the influence of temperature management. OBJECTIVES: This study investigated the role of NSE as a prognostic marker of outcome after out-of-hospital cardiac arrest (OHCA) in a contemporary setting. METHODS: A total of 686 patients hospitalized after OHCA were randomized to targeted temperature management at either 33°C or 36°C. NSE levels were assessed in blood samples obtained 24, 48, and 72 h after return of spontaneous circulation. The primary outcome was neurological outcome at 6 months using the cerebral performance category score. RESULTS: NSE was a robust predictor of neurological outcome in a baseline variable-adjusted model, and target temperature did not significantly affect NSE values. Median NSE values were 18 ng/ml versus 35 ng/ml, 15 ng/ml versus 61 ng/ml, and 12 ng/ml versus 54 ng/ml for good versus poor outcome at 24, 48, and 72 h, respectively (p < 0.001). At 48 and 72 h, NSE predicted neurological outcome with areas under the receiver-operating curve of 0.85 and 0.86, respectively. High NSE cutoff values with false positive rates ?5% and tight 95% confidence intervals were able to reliably predict outcome. CONCLUSIONS: High, serial NSE values are strong predictors of poor outcome after OHCA. Targeted temperature management at 33°C or 36°C does not significantly affect NSE levels. (Target Temperature Management After Cardiac Arrest [TTM]; NCT01020916).

  7. The inflammatory response after out-of-hospital cardiac arrest is not modified by targeted temperature management at 33 °C or 36 °C

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper

    2014-01-01

    AIM: Survivors after cardiac arrest (CA) exhibits a systemic inflammatory response as part of post-cardiac arrest syndrome (PCAS). We investigated the association between systemic inflammation and severity of PCAS and whether level of targeted temperature management (TTM) modifies level of the inflammatory response. METHODS: We studied 169 patients included at a single center in the TTM-trial, randomly assigned to TTM at 33 °C or 36 °C for 24 h. Plasma samples were analyzed for inflammatory markers including interleukin (IL) IL-1?,IL-4,IL-6,IL-10, tumor necrosis factor-? (TNF-?), C-reactive protein (CRP) and procalcitonin (PCT) at randomization and 24, 48 and 72 h after CA. Severity of PCAS was assessed by Sequential Organ Failure Assessment (SOFA) score. RESULTS: Plasma levels of both IL-6 and IL-10 determined at randomization correlated with severity of PCAS at day 2 (r=0.36 and r=0.27, p<0.001) and day 3 (r=0.32 and r=0.22, p<0.001). IL-6 at randomization was an independent predictor of severity of PCAS at day 2 (p=0.003) and day 3 (p<0.0001) and was a significantly stronger predictor of severity of PCAS at day 3 compared to CRP (p=0.04) and PCT (p=0.03). Level of TTM did not modify level of the inflammatory markers IL-1?, IL-6, TNF-?, IL-4, IL-10, CRP and PCT, (p=NS for each inflammatory marker). CONCLUSIONS: Level of inflammatory response was associated with severity of PCAS with IL-6 being consistently and more strongly associated with severity of PCAS than the inflammatory markers CRP and PCT. The systemic inflammatory response after CA was not modified by TTM at 33 °C or 36 °C.

  8. Reporting of data from out-of-hospital cardiac arrest has to involve emergency medical dispatching--taking the recommendations on reporting OHCA the Utstein style a step further

    DEFF Research Database (Denmark)

    Castrén, M; Bohm, K

    2011-01-01

    OBJECTIVES: As a part of the chain of survival, the emergency medical communication centre (EMCC) and the emergency medical dispatcher (EMD) has an important role in early identification of out-of-hospital cardiac arrests (OHCA). The EMD may provide instructions to the caller and thereby initiate cardiopulmonary resuscitation in a substantial number of subjects and thus contribute to increased survival. The EMCC provides a response with first responders, ambulances, physician manned units and potentially other health care providers. EMCC in many cases initiates the communication with experts in the referral hospital and provide added value to the post resuscitation care by providing advanced transport, logistics and follow up. In research there is a growing focus on the EMCC/EMDs impact on survival in OHCA. The lack of standards in reporting results from medical dispatching is an obstacle for thorough evaluation of results in this area and comparison of data. The objective for this paper is to introduce a framework for uniform reporting of the dispatching process for quality improvement, collecting and reporting data and exchanging information regarding OHCA.

  9. Invasive coronary treatment strategies for out-of-hospital cardiac arrest : a consensus statement from the European Association for Percutaneous Cardiovascular Interventions (EAPCI)/Stent for Life (SFL) groups

    DEFF Research Database (Denmark)

    Noc, Marko; Fajadet, Jean

    2014-01-01

    Due to significant improvement in the pre-hospital treatment of patients with out-of-hospital cardiac arrest (OHCA), an increasing number of initially resuscitated patients are being admitted to hospitals. Because of the limited data available and lack of clear guideline recommendations, experts from the EAPCI and "Stent for Life" (SFL) groups reviewed existing literature and provided practical guidelines on selection of patients for immediate coronary angiography (CAG), PCI strategy, concomitant antiplatelet/anticoagulation treatment, haemodynamic support and use of therapeutic hypothermia. Conscious survivors of OHCA with suspected acute coronary syndrome (ACS) should be treated according to recommendations for ST-segment elevation myocardial infarction (STEMI) and high-risk non-ST-segment elevation -ACS (NSTE-ACS) without OHCA and should undergo immediate (if STEMI) or rapid (less than two hours if NSTE-ACS) coronary invasive strategy. Comatose survivors of OHCA with ECG criteria for STEMI on the post-resuscitation ECG should be admitted directly to the catheterisation laboratory. For patients without STEMI ECG criteria, a short "emergency department or intensive care unit stop" is advised to exclude non-coronary causes. In the absence of an obvious non-coronary cause, CAG should be performed as soon as possible (less than two hours), in particular in haemodynamically unstable patients. Immediate PCI should be mainly directed towards the culprit lesion if identified. Interventional cardiologists should become an essential part of the "survival chain" for patients with OHCA. There is a need to centralise the care of patients with OHCA to experienced centres.

  10. Target temperature management of 33°C and 36°C in patients with out-of-hospital cardiac arrest with initial non-shockable rhythm - A TTM sub-study

    DEFF Research Database (Denmark)

    Frydland, Martin; Kjaergaard, Jesper

    2015-01-01

    PURPOSE: Despite a lack of randomized trials in comatose survivors of out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm (NSR), guidelines recommend induced hypothermia to be considered in these patients. We assessed the effect on outcome of two levels of induced hypothermia in comatose patient resuscitated from NSR. METHODS: Hundred and seventy-eight patients out of 950 in the TTM trial with an initial NSR were randomly assigned to targeted temperature management at either 33°C (TTM33, n=96) or 36°C (TTM36, n=82). We assessed mortality, neurologic function (Cerebral Performance Score (CPC) and modified Rankin Scale (mRS)), and organ dysfunction (Sequential Organ Failure Assessment (SOFA) score). RESULTS: Patients with NSR were older, had longer time to ROSC, less frequently had bystander CPR and had higher lactate levels at admission compared to patients with shockable rhythm, p<0.001 for all. Mortality in patients with NSR was 84% in both temperature groups (unadjusted HR 0.92, adjusted HR 0.75; 95% CI 0.53-1.08, p=0.12). In the TTM33 group 3% survived with poor neurological outcome (CPC 3-4, mRS 4-5), compared to 2% in the TTM36 group (adjusted OR 0.67; 95% CI 0.08-4.73, p=0.69 for both). Thirteen percent in the TTM33 group and 15% in the TTM36 group had good neurologic outcome (CPC 1-2, mRS 0-3, OR 1.5, CI 0.21-12.5, p=0.69). The SOFA-score did not differ between temperature groups. CONCLUSION: Comatose patients after OHCA with initial NSR continue to have a poor prognosis. We found no effect of targeted temperature management at 33°C compared to 36°C in these patients.

  11. The association of targeted temperature management at 33 and 36 °C with outcome in patients with moderate shock on admission after out-of-hospital cardiac arrest : a post hoc analysis of the Target Temperature Management trial

    DEFF Research Database (Denmark)

    Annborn, Martin; Bro-Jeppesen, John

    2014-01-01

    PURPOSE: We hypothesized that a targeted temperature of 33 °C as compared to that of 36 °C would increase survival and reduce the severity of circulatory shock in patients with shock on admission after out-of-hospital cardiac arrest (OHCA). METHODS: The recently published Target Temperature Management trial (TTM-trial) randomized 939 OHCA patients with no difference in outcome between groups and no difference in mortality at the end of the trial in a predefined subgroup of patients with shock at admission. Shock was defined as a systolic blood pressure of 30 min or the need of supportive measures to maintain a blood pressure ?90 mmHg and/or clinical signs of end-organ hypoperfusion. In this post hoc analysis reported here, we further analyzed the 139 patients with shock at admission; all had been randomized to receive intervention at 33 °C (TTM33; n = 71) or 36 °C (TTM36; n = 68). Primary outcome was 180-day mortality. Secondary outcomes were intensive care unit (ICU) and 30-day mortality, severity of circulatory shock assessed by mean arterial pressure, serum lactate, fluid balance and the extended Sequential Organ Failure assessment (SOFA) score. RESULTS: There was no significance difference between targeted temperature management at 33 °C or 36 °C on 180-day mortality [log-rank test, p = 0.17, hazard ratio 1.33, 95 % confidence interval (CI) 0.88-1.98] or ICU mortality (61 vs. 44 %, p = 0.06; relative risk 1.37, 95 % CI 0.99-1.91). Serum lactate and the extended cardiovascular SOFA score were higher in the TTM33 group (p < 0.01). CONCLUSIONS: We found no benefit in survival or severity of circulatory shock with targeted temperature management at 33 °C as compared to 36 °C in patients with shock on admission after OHCA.

  12. The association of targeted temperature management at 33 and 36 °C with outcome in patients with moderate shock on admission after out-of-hospital cardiac arrest : a post hoc analysis of the Target Temperature Management trial

    DEFF Research Database (Denmark)

    Annborn, Martin; Bro-Jeppesen, John

    2014-01-01

    PURPOSE: We hypothesized that a targeted temperature of 33 °C as compared to that of 36 °C would increase survival and reduce the severity of circulatory shock in patients with shock on admission after out-of-hospital cardiac arrest (OHCA). METHODS: The recently published Target Temperature Management trial (TTM-trial) randomized 939 OHCA patients with no difference in outcome between groups and no difference in mortality at the end of the trial in a predefined subgroup of patients with shock at admission. Shock was defined as a systolic blood pressure of 30 min or the need of supportive measures to maintain a blood pressure ?90 mmHg and/or clinical signs of end-organ hypoperfusion. In this post hoc analysis reported here, we further analyzed the 139 patients with shock at admission; all had been randomized to receive intervention at 33 °C (TTM33; n = 71) or 36 °C (TTM36; n = 68). Primary outcome was 180-day mortality. Secondary outcomes were intensive care unit (ICU) and 30-day mortality, severity of circulatory shock assessed by mean arterial pressure, serum lactate, fluid balance and the extended Sequential Organ Failure assessment (SOFA) score. RESULTS: There was no significance difference between targeted temperature management at 33 °C or 36 °C on 180-day mortality [log-rank test, p = 0.17, hazard ratio 1.33, 95 % confidence interval (CI) 0.88-1.98] or ICU mortality (61 vs. 44 %, p = 0.06; relative risk 1.37, 95 % CI 0.99-1.91). Serum lactate and the extended cardiovascular SOFA score were higher in the TTM33 group (p < 0.01). CONCLUSIONS: We found no benefit in survival or severity of circulatory shock with targeted temperature management at 33 °C as compared to 36 °C in patients with shock on admission after OHCA.

  13. Nurses’ attitude in out-of-hospital cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Maria Meidani

    2008-10-01

    Full Text Available Sudden cardiac arrest is one of the leading causes of death in Europe. Bystanders’ early Cardio-Pulmonary Resuscitation (CPR may double or triple survival rates of out-of-hospital cardiac arrest victims.Aim: To investigate nurses’ attitude, in starting or not CPR and also the most frequent reasons that deter them from engaging in.Materials and Methods: The study had a sample of 177 nurses and assistant nurses that were working in nine hospitals of Athens. Nurses filled out the same, predetermined questionnaire, voluntarily and anonymously. The collected answers were analyzed with the help of the statistical program SPSS v.16, using x2 and Kendall’s Tau-B methods.Results: From 177 participants, 78% (137 were women and 22% (40 men with mean age 31 years (±7. According to their education, 16% (28 were Assistant Nurses, 79% (140 Registered Nurses (ATEI, AEI and 5% (9 Nurses had an MSc diploma. Nurses that had been recently trained in certified BLS courses felt more confident and were more willing to start CPR in a known victim (p=0.004 and in an unknown victim (p=0.02 comparing to nurses that had been trained a long time ago or never. Most frequent reasons nurses reported that deter them from starting CPR are the fear of a possible lawsuit (43%, the fear of harming instead of helping (30% and the fear of infectious transmission from victim to rescuer (15%. The fear of harming correlates considerably with lower ages (the younger the nurse the more is afraid, p=0.04 and also correlates substantially with the training in a certified CPR course (the more a nurse is trained, the less is afraid, p<0.001. Accordingly, the fear of infection diminishes as long as the CPR training is repeated (p=0.03.Conclusions: According to the results, there is a necessity of continuous education and re-education of nurses, in certified Basic Life Support programs. With frequent and specialized training, nurses will show more willingness to engage in an out-of-hospital arrest situation, in a familiar or unknown victim and, moreover, fears that deter them from starting CPR are remarkably reduced.

  14. Análisis de la inclusión de la policía en la respuesta de emergencias al paro cardiorrespiratorio extrahospitalario / Analysis of the inclussion of police personnel on the out of hospital cardiac arrest emergency response

    Scientific Electronic Library Online (English)

    Andrea, Aguilera-Campos; Enrique, Asensio-Lafuente; Juan Manuel, Fraga-Sastrías.

    2012-02-01

    Full Text Available OBJETIVO: El presente estudio busca analizar una alternativa al pronóstico de paro cardiorrespiratorio extrahospitalario (PCE) como problema de salud pública al involucrar a los cuerpos policiacos en la respuesta de emergencias. MATERIAL Y MÉTODOS: Se analizó retrospectivamente un registro de PCE in [...] iciado en junio de 2009. Se contrastó un modelo basado en un número limitado de ambulancias con primera respuesta por la policía. RESULTADOS: La mortalidad fue de 100%, tiempos de respuesta elevados y 10.8% recibió reanimación cardiopulmonar (RCP) por testigos presenciales. En 63.7% de los eventos la policía llegaba antes que la ambulancia y en 1.5% el policía dio RCP. El costo por vida salvada fue 5.8-60 millones de pesos en un modelo sólo con ambulancias vs. 0.5-5.5 millones de pesos en un modelo con primera respuesta policiaca. CONCLUSIONES: La intervención de la policía en la ciudad de Querétaro facilitaría la disminución de la mortalidad por PCE a un menor costo. Abstract in english OBJETIVE: Out-of-hospital cardiac arrest (OCHA) is a public health problem in which survival depends on community initial response among others. This study tries to analyze what's the proportional cost of enhancing such response by involving the police corps in it. MATERIALS AND METHODS: We analyzed [...] retrospectively an OCHA registry started on June 2009. We contrasted a model with limited number of ambulances and police based first response. RESULTS: Mortality was 100%, response times high and 10.8% of the victims were receiving cardiopulmonary resuscitation (CPR) by bystanders. In 63.7% of the events the police arrived before the ambulance, in 1.5% of these cases the police provided CPR. The cost for each saved life was of 5.8-60 million Mexican pesos per life with only ambulance model vs 0.5-5.5 million Mexican pesos on a police first response model with 12 ambulances. CONCLUSIONS: In Queretaro interventions can be performed taking advantage of the response capacity of the existing police focused on diminishing mortality from OCHA at a lesser cost than delegating this function only to ambulances.

  15. Análisis de la inclusión de la policía en la respuesta de emergencias al paro cardiorrespiratorio extrahospitalario Analysis of the inclussion of police personnel on the out of hospital cardiac arrest emergency response

    Directory of Open Access Journals (Sweden)

    Andrea Aguilera-Campos

    2012-02-01

    Full Text Available OBJETIVO: El presente estudio busca analizar una alternativa al pronóstico de paro cardiorrespiratorio extrahospitalario (PCE como problema de salud pública al involucrar a los cuerpos policiacos en la respuesta de emergencias. MATERIAL Y MÉTODOS: Se analizó retrospectivamente un registro de PCE iniciado en junio de 2009. Se contrastó un modelo basado en un número limitado de ambulancias con primera respuesta por la policía. RESULTADOS: La mortalidad fue de 100%, tiempos de respuesta elevados y 10.8% recibió reanimación cardiopulmonar (RCP por testigos presenciales. En 63.7% de los eventos la policía llegaba antes que la ambulancia y en 1.5% el policía dio RCP. El costo por vida salvada fue 5.8-60 millones de pesos en un modelo sólo con ambulancias vs. 0.5-5.5 millones de pesos en un modelo con primera respuesta policiaca. CONCLUSIONES: La intervención de la policía en la ciudad de Querétaro facilitaría la disminución de la mortalidad por PCE a un menor costo.OBJETIVE: Out-of-hospital cardiac arrest (OCHA is a public health problem in which survival depends on community initial response among others. This study tries to analyze what's the proportional cost of enhancing such response by involving the police corps in it. MATERIALS AND METHODS: We analyzed retrospectively an OCHA registry started on June 2009. We contrasted a model with limited number of ambulances and police based first response. RESULTS: Mortality was 100%, response times high and 10.8% of the victims were receiving cardiopulmonary resuscitation (CPR by bystanders. In 63.7% of the events the police arrived before the ambulance, in 1.5% of these cases the police provided CPR. The cost for each saved life was of 5.8-60 million Mexican pesos per life with only ambulance model vs 0.5-5.5 million Mexican pesos on a police first response model with 12 ambulances. CONCLUSIONS: In Queretaro interventions can be performed taking advantage of the response capacity of the existing police focused on diminishing mortality from OCHA at a lesser cost than delegating this function only to ambulances.

  16. Characteristics of in-hospital cardiac arrest and cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Josip Ivi?

    2009-02-01

    Full Text Available Aim We have studied epidemiology of in-hospital cardiac arrest, characteristics of organizing a reanimationand its,procedures as well as its documenting.Methods We analyzed all resuscitation procedure data where anesthesiology reanimation teams (RT providedcardiopulmonary resuscitation (CPR during one-year period. We included resuscitation attemptsthat were initiated outside the Department of Anesthesiology, excluding incidents in operation rooms andIntensive Care Unit (ICU. Data on every cardiac arrest and CPR were entered in a special form.Results During one-year period 87 CPR were performed. Victims of cardiac arrest were principallyelderly patients (age 60 – 80, mostly male (60%. Most frequent victims were neurological patients(42%, surgical patients (21% and neurosurgical patients (10%. The leading cause of cardiac arrestwas primary heart disease, following neurological diseases and respiration disorders of severe etiology.In over 90% cases CPR was initiated by medical personnel in their respective departments, RT arrivedwithin 5 minutes in 73,56% cases. Initially survival was 32%, but full recovery was accomplished in 4patients out of 87 (4,6%.Conclusion Victims of cardiac arrest are patients whose primary disease contributes to occurrence ofcardiorespiratory complications. High mortality and low percentage of full recovery can be explainedby characteristics of patients (old age, nature and seriousness of primary disease which significantly affectthe outcome of CPR. In some cases a question is raised whether to initiate the CPR at all. We wouldlike to point out that continous monitoring of potentially critical patients may prevent cardiorespiratoryincidents whereas the quality and success of CPR may be improved by training of staff and better technicalequipment on the relevant locations in the in the hospital where such incidents usually occur.

  17. Neurologic Function and Health-Related Quality of Life in Patients Following Targeted Temperature Management at 33°C vs 36°C After Out-of-Hospital Cardiac Arrest : A Randomized Clinical Trial

    DEFF Research Database (Denmark)

    Cronberg, Tobias; Lilja, Gisela

    2015-01-01

    Importance: Brain injury affects neurologic function and quality of life in survivors after cardiac arrest. Objective: To compare the effects of 2 target temperature regimens on long-term cognitive function and quality of life after cardiac arrest. Design, Setting, and Participants: In this multicenter, international, parallel group, assessor-masked randomized clinical trial performed from November 11, 2010, through January 10, 2013, we enrolled 950 unconscious adults with cardiac arrest of presumed cardiac cause from 36 intensive care units in Europe and Australia. Eleven patients were excluded from analysis for a total sample size of 939. Interventions: Targeted temperature management at 33°C vs 36°C. Main Outcomes and Measures: Cognitive function was measured by the Mini-Mental State Examination (MMSE) and assessed by observers through the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Patients reported their activities in daily life and mental recovery through Two Simple Questions and their quality of life through the Medical Outcomes Study 36-Item Short Form Health Survey, version 2. Results: In the modified intent-to-treat population, including nonsurvivors, the median MMSE score was 14 in the 33°C group (interquartile range [IQR], 0-28) vs 17 in the 36°C group (IQR, 0-29) (P?=?.77), and the IQCODE score was 115 (IQR, 79-130) vs 115 (IQR, 80-130) (P?=?.57) in the 33°C and 36°C groups, respectively. The median MMSE score for survivors was within the reference range and similar (33°C group median, 28; IQR, 26-30; vs 36°C group median, 28; IQR, 25-30; P?=?.61). The median IQCODE score was within the minor deficit range (33°C group median, 79.5; IQR, 78.0-85.9; vs 36°C group median, 80.7; IQR, 78.0-86.9; P?=?.04). A total of 18.8% vs 17.5% of survivors reported needing help with everyday activities (P?=?.71), and 66.5% in the 33°C group vs 61.8% in the 36°C group reported that they thought they had made a complete mental recovery (P?=?.32). The mean (SD) mental component summary score was 49.1 (12.5) vs 49.0 (12.2) (P?=?.79), and the mean (SD) physical component summary score was 46.8 (13.8) and 47.5 (13.8) (P?=?.45), comparable to the population norm. Conclusions and Relevance: Quality of life was good and similar in patients with cardiac arrest receiving targeted temperature management at 33°C or 36°C. Cognitive function was similar in both intervention groups, but many patients and observers reported impairment not detected previously by standard outcome scales. Trial Registration: ClinicalTrials.gov NCT01020916.

  18. Out-of-hospital noninvasive ventilation: epidemiology, technology and equipment

    Directory of Open Access Journals (Sweden)

    John Scott Baird

    2012-04-01

    Full Text Available Noninvasive ventilation has been utilized successfully in the pre- and out-of-hospital settings for a variety of disorders, including respiratory distress syndrome in neonates, neurologic and pulmonary diseases in infants and children, and heart failure as well as chronic obstructive pulmonary disease in adults. A variety of interfaces as well as mechanical positive pressure devices have been used: simple continuous positive airway pressure devices are available which do not require sophisticated equipment, while a broad spectrum of ventilators have been used to provide bilevel positive airway pressure. Extensive training of transport teams may be important, particularly when utilizing bilevel positive airway pressure in infants and children.

  19. Mechanical cardiopulmonary resuscitation in in-hospital cardiac arrest: a systematic review.

    Science.gov (United States)

    Lameijer, Heleen; Immink, Rosa S; Broekema, Josien J; Ter Maaten, Jan C

    2015-12-01

    With increasing rates of in-hospital cardiac arrest, improving resuscitation outcomes is essential. Mechanical chest compressors seem to be related to improved outcome in out-of hospital cardiac arrest; however, the literature on its use in in-hospital cardiac arrest is scarce. We used the Medline public database to systematically review patient outcomes considering mechanical cardiopulmonary resuscitation in in-hospital cardiac arrest. Fourteen studies were found, most cases (n=17), three cohort studies, a clinical pilot study and a registry study. The reported survival rate was high (35 out of 89 patients, 39%) and full neurological recovery was described in 91% of the survivors. Two studies did not report survival rates. Especially in patients with in-hospital cardiac arrest because of treatable causes, early start of mechanical chest compressions could improve future patient outcomes because of better (coronary and brain) perfusion during mechanical chest compressions compared with manual chest compressions. However, the current literature is probably influenced by publication bias and more high-quality research is needed. PMID:26237664

  20. Trends in Out-of-Hospital Births in the United States, 1990-2012

    Science.gov (United States)

    ... Briefs NCHS Data Brief Number 144, March, 2014 Trends in Out-of-Hospital Births in the United ... updates previous analyses ( 2 , 9 ) to examine recent trends and characteristics of out-of-hospital births, including ...

  1. Decision making in resuscitation from out of hospital cardiac arrest.

    OpenAIRE

    Brown, R.; Jones, E; Glucksman, E.

    1996-01-01

    OBJECTIVE--To determine which factors are perceived by senior house officers (SHOs), consultants, and medical registrars in accident and emergency (A&E) medicine as being important in decision making. METHODS--132 SHOs in A&E medicine, of 172 attending an induction course at the start of their job (77%), completed a questionnaire relating to 20 factors of possible importance in decision making; 73 completed the questionnaire at six weeks and 55 at six months. Ten medical registrars and 31 con...

  2. What accounting leaves out of hospital financial management.

    Science.gov (United States)

    Boles, K E; Glenn, J K

    1986-01-01

    As PPS and other fixed-price initiatives replace cost-based reimbursement in the hospital industry, the burden of assuming the risk for business success or failure shifts from the payor to the hospital. As a consequence, theories of risk to the business firm which have found application in other industries now deserve attention by hospital management. Incorporating such risk concepts into hospital strategies and actions requires a view of financial management that goes beyond the generally accepted accounting principles of managing and assigning costs for maximum revenue and profitability. This article examines the financial theory of risk in business firms, illustrates the various components of risk as they apply to a hospital business, and discusses how the hospital management strategies of cost-reduction, marketing, diversification, and multiorganizational affiliation can alter the risk characteristics of a hospital business. PMID:10275567

  3. Safety of Intranasal Fentanyl in the Out-of-Hospital Setting

    DEFF Research Database (Denmark)

    Karlsen, Anders P H; Pedersen, Danny M B; Trautner, Sven; Dahl, Jørgen B; Hansen, Morten S

    2014-01-01

    STUDY OBJECTIVE: Initial out-of-hospital analgesia is sometimes hampered by difficulties in achieving intravenous access or lack of skills in administering intravenous opioids. We study the safety profile and apparent analgesic effect of intranasal fentanyl in the out-of-hospital setting. METHODS: In this prospective observational study, we administered intranasal fentanyl in the out-of-hospital setting to adults and children older than 8 years with severe pain resulting from orthopedic conditio...

  4. Risky locations for out-of-hospital cardiopulmonary arrest in a typical urban city

    Directory of Open Access Journals (Sweden)

    Yoshihiro Moriwaki

    2014-01-01

    Full Text Available Background: The aim of this study is to clarify the circumstances including the locations where critical events resulting in out-of-hospital cardiopulmonary arrest (OHCPA occur. Materials and Methods: Subjects of this population-based observational case series study were the clinical records of patients with nontraumatic and nonneck-hanging OHCPA. Results: Of all 1546 cases, 10.3% occurred in a public place (shop, restaurant, workplace, stations, public house, sports venue, and bus, 8.3% on the street, 73.4% in a private location (victim?s home, the homes of the victims? relatives or friends or cheap bedrooms, where poor homeless people live, and 4.1% in residential institutions. In OHCPA occurring in private locations, the frequency of asystole was higher and the outcome was poorer than in other locations. A total of 181 OHCPA cases (11.7% took place in the lavatory and 166 (10.7% in the bathroom; of these, only 7 (3.9% of OHCPA in the lavatory and none in the bath room achieved good outcomes. The frequencies of shockable initial rhythm occurring in the lavatory and in bath room were 3.7% and 1.1% (lower than in other locations, P = 0.011 and 0.002, and cardiac etiology in OHCPA occurring in these locations were 46.7% and 78.4% (the latter higher than in other locations, P < 0.001. Conclusions: An unignorable population suffered from OHCPA in private locations, particularly in the lavatory and bathroom; their initial rhythm was usually asystole and their outcomes were poor, despite the high frequency of cardiac etiology in the bathroom. We should try to treat OHCPA victims and to prevent occurrence of OHCPA in these risky spaces by considering their specific conditions.

  5. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals 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); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

    Science.gov (United States)

    Perkins, Gavin D; Jacobs, Ian G; Nadkarni, Vinay M; Berg, Robert A; Bhanji, Farhan; Biarent, Dominique; Bossaert, Leo L; Brett, Stephen J; Chamberlain, Douglas; de Caen, Allan R; Deakin, Charles D; Finn, Judith C; Gräsner, Jan-Thorsten; Hazinski, Mary Fran; Iwami, Taku; Koster, Rudolph W; Lim, Swee Han; Ma, Matthew Huei-Ming; McNally, Bryan F; Morley, Peter T; Morrison, Laurie J; Monsieurs, Koenraad G; Montgomery, William; Nichol, Graham; Okada, Kazuo; Ong, Marcus Eng Hock; Travers, Andrew H; Nolan, Jerry P

    2015-11-01

    Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome. PMID:25438254

  6. Organisation of in-hospital cardiac arrest teams - A nationwide study

    DEFF Research Database (Denmark)

    Lauridsen, Kasper Glerup; Schmidt, Anders Sjørslev; Adelborg, Kasper; Løfgren, Bo

    2015-01-01

    BACKGROUND: In-hospital cardiac arrests are treated by a team of health care providers. Improving team performance may increase survival. Currently, no international standards for cardiac arrest teams exist in terms of member composition and allocation of tasks. AIM: To describe the composition of in-hospital cardiac arrest teams and review pre-arrest allocation of tasks. METHODS: A nationwide cross-sectional study was performed. Data on cardiac arrest teams and pre-arrest allocation of tasks we...

  7. Cardiocerebral resuscitation: advances in cardiac arrest resuscitation

    OpenAIRE

    Erwin Mulia; Siswanto, Bambang B.

    2011-01-01

    Cardiac arrest remains a leading cause of death in the world. Although advances in emergency cardiac care has been achieved, the survival rate of those non hospitalized hospital cardiac arrest remains low. Update in guidelines for CPR and emergency cardiovascular, their approach to out of hospital cardiac arrest is far from optimal. This provides an opportunity to advocate cardiocerebral resuscitation as an alternative to  traditional cardiopulmonary resuscitation for non hospitalized cardiac...

  8. Symptoms of anxiety and cardiac hospitalizations at 12 months in patients with heart failure

    DEFF Research Database (Denmark)

    Damen, Nikki L; Pelle, Aline J; Szabó, Balázs M; Pedersen, Susanne S.

    2012-01-01

    Heart failure (HF) is a leading cause of hospitalization. Clinical and socio-demographic factors have been associated with cardiac admissions, but little is known about the role of anxiety. We examined whether symptoms of anxiety were associated with cardiac hospitalizations at 12 months in HF patients.

  9. Imaging the heart: cardiac scintigraphy and echocardiography in US hospitals (1983)

    International Nuclear Information System (INIS)

    The rapid growth of cardiac catheterization has raised questions about the availability of less costly, noninvasive tests such as cardiac scintigraphy and echocardiography. To assess their availability and rates of use, we surveyed 3778 non-federal short-term US hospitals in June, 1983. Overall, 2605 hospitals (69%) offered 201Tl myocardial perfusion scans, 2580 (68%) 99mTc equilibrium gated blood pool scans, and 2483 (67%) cardiac shunt scans; 1679 hospitals (44%) offered M-mode and/or 2-dimensional echocardiography, and 768 (20%) pulsed Doppler echocardiography. Volumes of procedures varied enormously among hospitals capable of performing them. High volumes of both scintigraphy and echocardiography were performed in a small number of hospitals. Larger, voluntary, and teaching hospitals performed higher volumes of both procedures. Despite widespread availability of these noninvasive technologies, high volumes of both cardiac scintigraphy and echocardiography procedures are concentrated in a small number of US hospitals

  10. Safety of Intranasal Fentanyl in the Out-of-Hospital Setting : A Prospective Observational Study

    DEFF Research Database (Denmark)

    Karlsen, Anders P H; Pedersen, Danny M B

    2014-01-01

    STUDY OBJECTIVE: Initial out-of-hospital analgesia is sometimes hampered by difficulties in achieving intravenous access or lack of skills in administering intravenous opioids. We study the safety profile and apparent analgesic effect of intranasal fentanyl in the out-of-hospital setting. METHODS: In this prospective observational study, we administered intranasal fentanyl in the out-of-hospital setting to adults and children older than 8 years with severe pain resulting from orthopedic conditions, abdominal pain, or acute coronary syndrome refractory to nitroglycerin spray. Patients received 1 to 3 doses of either 50 or 100 ?g, and the ambulance crew recorded adverse effects and numeric rating scale (0 to 10) pain scores before and after treatment. RESULTS: Our 903 evaluable patients received a mean cumulative fentanyl dose of 114 ?g (range 50 to 300 ?g). There were no serious adverse effects and no use of naloxone. Thirty-six patients (4%) experienced mild adverse effects: mild hypotension, nausea, vomiting, vertigo, abdominal pain, rash, or decrease of Glasgow Coma Scale score to 14. The median reduction in pain score was 3 (interquartile range 2 to 5) after fentanyl administration. CONCLUSION: The out-of-hospital administration of intranasal fentanyl in doses of 50 to 100 ?g is safe and appears effective.

  11. Payment Reform Pilot In Beijing Hospitals Reduced Expenditures And Out-Of-Pocket Payments Per Admission.

    Science.gov (United States)

    Jian, Weiyan; Lu, Ming; Chan, Kit Yee; Poon, Adrienne N; Han, Wei; Hu, Mu; Yip, Winnie

    2015-10-01

    In 2009 China announced plans to reform provider payment methods at public hospitals by moving from fee-for-service (FFS) to prospective and aggregated payment methods that included the use of diagnosis-related groups (DRGs) to control health expenditures. In October 2011 health policy makers selected six Beijing hospitals to pioneer the first DRG payment system in China. We used hospital discharge data from the six pilot hospitals and eight other hospitals, which continued to use FFS and served as controls, from the period 2010-12 to evaluate the pilot's impact on cost containment through a difference-in-differences methods design. Our study found that DRG payment led to reductions of 6.2 percent and 10.5 percent, respectively, in health expenditures and out-of-pocket payments by patients per hospital admission. We did not find evidence of any increase in hospital readmission rates or cost shifting from cases eligible for DRG payment to ineligible cases. However, hospitals continued to use FFS payments for patients who were older and had more complications than other patients, which reduced the effectiveness of payment reform. Continuous evidence-based monitoring and evaluation linked with adequate management systems are necessary to enable China and other low- and middle-income countries to broadly implement DRGs and refine payment systems. PMID:26438752

  12. Short-stay, out-of-hospital, radiologically guided liver biopsy

    International Nuclear Information System (INIS)

    In order to evaluate the safety, the quality and adequacy of specimens obtained and the cost benefits associated with performing liver biopsy out of hospital, on a short-stay basis, using radiological guidance, a prospective study was undertaken over a three-year period, from March 1998 to March 2001, in a private radiology practice. 251 patients (159 men) with stable liver disease participated in this study. Coagulation studies were performed within a two-week period before biopsy, which was carried out under the guidance of ultrasound (143 patients) or computed tomography (108 patients). A disposable, spring-loaded gun with an 18-gauge biopsy needle was used in each case. A repeat ultrasound or CT scan was performed after the procedure to monitor for complications such as haemorrhage. Two hundred and twenty nine patients (91 2%) were discharged 60 minutes after the biopsy. The only post-biopsy complication was pain, either at the biopsy site or in the right shoulder. Pain was severe in three patients and, for one of these patients, a subcapsular hepatic haematoma was found on ultrasound eight days after the biopsy. Sufficient material for histopathological examination was obtained from all patients. The cost of out-of-hospital biopsies was substantially less than the cost of hospital-based, day-stay procedures. It was concluded that short-stay, out-of-hospital, radiologically guided liver biopsy is safe for patients who have stable chronic liver disease and acceptable coagulation profiles

  13. Cost control of out-of-hours laboratory services in district general hospitals.

    OpenAIRE

    Allen, K. D.

    1994-01-01

    AIMS--To survey methods for cost control of out-of-hours laboratory services in district general hospitals in England and Wales. METHODS--A questionnaire was distributed to 66 district general hospital laboratories in England and Wales. RESULTS--The response rate was 61%. Most laboratories for which budgetary information was provided had on-call costs ranging between 10-21% of staff costs. Ninety five per cent of respondents had attempted to reduce workload by the use of various strategies. S...

  14. Role of out-of-hours nurse co-ordinators in a children's hospital.

    Science.gov (United States)

    Hensman, Amy; Wright, Samantha; Nathan, Kerry

    2015-12-01

    In a hospital, a high proportion of working time occurs outside the traditional working day, affecting patient safety as staffing levels are at their lowest out of hours. A service evaluation audit was used to evaluate the effectiveness of a clinical out-of-hours nurse co-ordinator (COHNC) pilot role in a tertiary children's hospital. The COHNC role was trialled over a six-month period. During the pilot, the COHNC carried the junior paediatrician's 'bleep' and prioritised all phone calls and tasks. Following a patient assessment, the COHNC either performed the investigations and treatments within their scope of practice or escalated these to the appropriate multidisciplinary team member. A description of how the COHNC role has developed and its implications to nursing practice are presented in this article, along with an overview of the quantitative and qualitative data obtained during the audit. PMID:26654025

  15. Achieving better in-hospital and after-hospital care of patients with acute cardiac disease.

    Science.gov (United States)

    Scott, Ian A; Denaro, Charles P; Bennett, Cameron J; Hickey, Annabel C; Mudge, Alison M; Flores, Judy L; Sanders, Daniela C J; Thiele, Justine M; Wenck, Beres; Bennett, John W; Jones, Mark A

    2004-05-17

    In patients hospitalised with acute coronary syndromes (ACS) and congestive heart failure (CHF), evidence suggests opportunities for improving in-hospital and after-hospital care, patient self-care, and hospital-community integration. A multidisciplinary quality improvement program was designed and instigated in Brisbane in October 2000 involving 250 clinicians at three teaching hospitals, 1080 general practitioners (GPs) from five Divisions of General Practice, 1594 patients with ACS and 904 patients with CHF. Quality improvement interventions were implemented over 17 months after a 6-month baseline period and included: clinical decision support (clinical practice guidelines, reminders, checklists, clinical pathways); educational interventions (seminars, academic detailing); regular performance feedback; patient self-management strategies; and hospital-community integration (discharge referral summaries; community pharmacist liaison; patient prompts to attend GPs). Using a before-after study design to assess program impact, significantly more program patients compared with historical controls received: ACS: Angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering agents at discharge, aspirin and beta-blockers at 3 months after discharge, inpatient cardiac counselling, and referral to outpatient cardiac rehabilitation. CHF: Assessment for reversible precipitants, use of prophylaxis for deep-venous thrombosis, beta-blockers at discharge, ACE inhibitors at 6 months after discharge, imaging of left ventricular function, and optimal management of blood pressure levels. Risk-adjusted mortality rates at 6 and 12 months decreased, respectively, from 9.8% to 7.4% (P = 0.06) and from 13.4% to 10.1% (P = 0.06) for patients with ACS and from 22.8% to 15.2% (P < 0.001) and from 32.8% to 22.4% (P = 0.005) for patients with CHF. Quality improvement programs that feature multifaceted interventions across the continuum of care can change clinical culture, optimise care and improve clinical outcomes. PMID:15139843

  16. Moving out of the Laboratory: Deploying Pervasive Technologies in a Hospital

    DEFF Research Database (Denmark)

    Hansen, Thomas Riisgaard; Bardram, Jakob

    2006-01-01

    The authors deployed a distributed system containing a location-tracking system, a context-awareness system, wall-sized displays, and mobile phones in a Danish hospital's operating ward. This article presents the lessons they learned from deploying these pervasive computing technologies and a checklist of questions for researchers to consider relating to hardware, software, and organizational issues when moving pervasive systems out of the laboratory. This article is part of a special issue on Real-World Deployments.

  17. The changing interface between district hospital cardiology and the major cardiac centres

    OpenAIRE

    1997-01-01

    The national priority for reducing mortality and morbidity from cardiovascular disease, the resulting expansion in the number of consultant cardiologists, and the reforms of the National Health Service have produced significant changes in delivery of care for cardiac patients and in the relations between district general hospitals (DGH) and the old regional cardiac centres. 1.2 The British Cardiac Society, the Medical Royal Colleges of Physicians of London and Edinburgh, and the Royal C...

  18. Epidemiology of cardiac arrest outside and inside hospital - Experiences from registries in Sweden

    OpenAIRE

    JOHAN HERLITZ; SOLVEIG AUNE; ANDREAS CLAESSON; LEIF SVENSSON

    2010-01-01

    Cardiac arrest is a dramatic condition leading to sudden death if someone cannot perform two interventions, basic life support and early defibrillation, that have been proved to improve long-term survival. The ‘Utstein style', recently introduced, represents a standard of practice both inside and outside hospital with recommended guidelines for the uniform reporting of clinical data from the patient suffering cardiac arrest. In Sweden the vast majority of patients suffering from cardiac arres...

  19. Organisation of in-hospital cardiac arrest teams - A nationwide study

    DEFF Research Database (Denmark)

    Lauridsen, Kasper Glerup; Schmidt, Anders SjØrslev

    2015-01-01

    BACKGROUND: In-hospital cardiac arrests are treated by a team of health care providers. Improving team performance may increase survival. Currently, no international standards for cardiac arrest teams exist in terms of member composition and allocation of tasks. AIM: To describe the composition of in-hospital cardiac arrest teams and review pre-arrest allocation of tasks. METHODS: A nationwide cross-sectional study was performed. Data on cardiac arrest teams and pre-arrest allocation of tasks were collected from protocols on resuscitation required for hospital accreditation in Denmark. Additional data were collected through telephone interviews and email correspondence. Psychiatric hospitals and hospitals serving outpatients only were excluded. RESULTS: Data on the cardiac arrest team were available from 44 of 47 hospitals. The median team size was 5 (25th percentile; 75th percentile: 4; 6). Teams included a nurse anaesthetist (100%), a medical house officer (82%), an orderly (73%), an anaesthesiology house officer (64%) and a medical assistant (20%). Less likely to participate was a cardiology house officer (23%) or a cardiology specialist registrar (5%). Overall, a specialist registrar was represented on 20% of teams and 20% of cardiac arrest teams had a different team composition during nights and weekends. In total, 41% of teams did not define a team leader pre-arrest, and the majority of the teams did not define the tasks of the remaining team members. CONCLUSION: In Denmark, there are major differences among cardiac arrest teams. This includes team size, profession of team members, medical specialty and seniority of the physicians. Nearly half of the hospitals do not define a cardiac arrest team leader and the majority do not define the tasks of the remaining team members.

  20. Out-of-hospital births, U.S., 1978: birth weight and Apgar scores as measures of outcome.

    OpenAIRE

    Declercq, E R

    1984-01-01

    An examination of 1978 natality data for the United States disclosed that low birth weight was less common among 30,819 infants born out of hospital than among 3,294,101 infants born in hospital in that year. When controls were applied for birth attendant, infants' race, and mothers' education, age, nativity, and parity, the data revealed that white, well-educated women between 25 and 39 years of age, who were having their second babies and were attended by midwives out of hospital, were at l...

  1. Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation / Parada cardíaca extrahospitalaria: factores determinantes de la sobrevida inmediata después de maniobras de resucitación cardiopulmonar / Parada cardíaca extra-hospitalar: fatores determinantes da sobrevida imediata após manobras de ressuscitação cardiopulmonar

    Scientific Electronic Library Online (English)

    Daniela Aparecida, Morais; Daclé Vilma, Carvalho; Allana dos Reis, Correa.

    2014-07-01

    Full Text Available OBJETIVO: analisar fatores determinantes da sobrevida imediata de pessoas que receberam manobras de ressuscitação cardiopulmonar pelas equipes de suporte avançado do Serviço de Atendimento Móvel de Urgência, de Belo Horizonte. MÉTODO: trata-se de estudo epidemiológico, retrospectivo, no qual f [...] oram analisadas 1.165 fichas de atendimento, do período de 2008 a 2010. Os dados coletados seguiram o estilo Utstein, sendo submetidos à estatística descritiva e analítica com testes de nível de significância de 5%. RESULTADOS: a maioria era do sexo masculino, a mediana da idade foi de 64 anos e a do tempo de deslocamento, nove minutos. A sobrevida imediata foi observada em 239 pessoas. Verificou-se associação desse desfecho com a "parada cardiorrespiratória presenciada por pessoas treinadas em suporte básico de vida" (OR=3,49; p Abstract in spanish OBJETIVO: analizar factores determinantes de la sobrevida inmediata de personas que recibieron maniobras de resucitación cardiopulmonar por los equipos de soporte avanzado del Servicio de Atención Móvil de Urgencia de Belo Horizonte. MÉTODO: se trata de estudio epidemiológico, retrospectivo en [...] el cual fueron analizadas 1.165 fichas de atención, en el período de 2008 a 2010. Los datos recolectados siguieron el estilo Utstein, siendo sometidos a la estadística descriptiva y analítica con pruebas de nivel de significancia de 5%. RESULTADOS: la mayoría era del sexo masculino, la mediana de la edad fue de 64 años y el de tiempo de traslado, nueve minutos. La sobrevida inmediata fue observada en 239 personas. Se verificó asociación de ese resultado con la "parada cardiorrespiratoria presenciada por personas entrenadas en soporte básico de vida" (OR=3,49; p Abstract in english OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte. METHOD: this is a retrospective, epidemiological study which analyzed 1,1 [...] 65 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%. RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p

  2. Significance of the carboxyhemoglobin level for out-of-hospital cardiopulmonary arrest

    Directory of Open Access Journals (Sweden)

    Youichi Yanagawa

    2012-01-01

    Full Text Available Background: At low concentrations, carbon monoxide (CO can confer cyto and tissue-protective effects, such as endogenous Heme oxygenase 1 expression, which has antioxidative, anti-inflammatory, antiproliferative, and antiapoptotic effects. The level of carboxyhemoglobin in the blood is an indicator of the endogenous production of CO and inhaled CO. Aim of study: To investigate the significance of the value of carboxyhemoglobin for out-of-hospital (OH cardiopulmonary arrest (CPA. Materials and Methods: This study involved a medical chart review of cases treated from January to December 2005. The inclusion criteria included a patient who was transported to this department due to an OH CPA. The exclusion criteria included a patient who did not undergo blood gas analysis on arrival and who experienced CPA due to acute carbon monoxide intoxication. The subjects were divided into two groups based on their final outcome of either survival or non-survival. Results: There was no significant difference associated with the sex, age, frequency of witness collapse, bystander cardiopulmonary arrest, electrocardiogram at scene, cause of CPA, value of PCO 2 , HCO3 - , and methemoglobin. The frequency of OH return of spontaneous circulation and the value of pH, PO 2 , base excess, and carboxyhemoglobin in the survival group were greater than those values in the non-survival group. There were no subjects whose carboxyhemoglobin level was 0% on arrival in the survival groups. Conclusion: There appeared to be an association between higher carboxyhemoglobin levels and survival in comparison with non-survival patients.

  3. Long-term survival after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Holler, Nana G; Mantoni, Teit; Nielsen, Søren L; Lippert, Freddy; Rasmussen, Lars S

    2007-01-01

    OBJECTIVE: The purpose of this study was to assess the long-term survival after OHCA. METHODS: All OHCA-calls where the Copenhagen Mobile Emergency Care Unit (MECU) was involved from 1994 to1998 are included in this study. Data were collected prospectively. Data on long-term survival was obtained from the Danish Causes of Death Registry and the Danish Civil Registration System. We conducted a search to find out whether patients were still alive on 31 January 2005. RESULTS: Resuscitation was indi...

  4. beta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management.

    Science.gov (United States)

    Wax, Paul M; Erdman, Andrew R; Chyka, Peter A; Keyes, Daniel C; Caravati, E Martin; Booze, Lisa; Christianson, Gwenn; Woolf, Alan; Olson, Kent R; Manoguerra, Anthony S; Scharman, Elizabeth J; Troutman, William G

    2005-01-01

    In 2003, US poison centers were contacted regarding ingestion of beta-blockers by 15,350 patients including 3766 (25%) under 6 years of age; 7415 (48%) were evaluated in healthcare facilities and 33 died. An evidence-based expert consensus process was used to create this guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the primary author. The entire panel discussed and refined the guideline before its distribution to secondary reviewers for comment. The panel then made changes in response to comments received. The objective of this guideline is to assist US poison center personnel in the appropriate out-of-hospital triage and management of patients with suspected ingestions of beta-blockers by describing the process by which a beta-blocker ingestion might be managed, identifying the key decision elements in managing cases of beta-blocker ingestion, providing clear and practical recommendations that reflect the current state of knowledge, and identifying needs for research. This guideline applies to ingestion of beta-blockers alone and is based on an assessment of current scientific and clinical information. The panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and health professionals providing care, considering all of the circumstances involved. Recommendations are in chronological order of likely clinical use; the grade of recommendation is in parentheses. 1) Patients with stated or suspected self-harm or who are the victims of a potentially malicious administration of beta-blocker should be referred to an emergency department immediately. In general, this should occur regardless of the dose reported (Grade D). 2) Patients without evidence of self-harm should have further evaluation, including determination of the precise dose ingested, history of other medical conditions, and the presence of co-ingestants. Ingestion of either an amount that exceeds the usual maximum single therapeutic dose or an amount equal to or greater than the lowest reported toxic dose (whichever is lower) warrants consideration of referral to an emergency department. Ingestion of any excess dose of any beta-blocker in combination with a calcium channel blocker or the ingestion of any excess dose by an individual with serious underlying cardiovascular disease also warrants referral to an emergency department (Grade C). 3) Do not induce emesis. Consider the oral administration of activated charcoal if it is available and no contraindications are present but do not delay transportation to administer charcoal (Grade A). 4) Asymptomatic patients who ingest more than the referral dose should be sent to an emergency department if the ingestion occurred within 6 hours of contacting the poison center for an immediate-release product other than sotalol, within 8 hours of contacting the poison center for a sustained-release product, and 12 hours if they took sotalol (Grade C). 5) Ambulance transportation is recommended for patients who are referred to emergency departments because of the potential for life-threatening complications of beta-blocker overdose. Provide usual supportive care en route to the hospital, including intravenous fluids for hypotension (Grade D). 6) Follow-up calls should be made to determine outcome at appropriate intervals for up to 12-24 hours based on the judgment of the poison center staff (Grade D). 7) Asymptomatic patients who are referred to healthcare facilities should be monitored for at least 6 hours after ingestion if they took an immediate-release preparation other than sotalol, 8 hours if they took a sustained-release preparation, and 12 hours if they took sotalol. Routine 24-hour admission of an asymptomatic patient who has unintentionally ingested a sustained-release preparation is not warranted (Grade D). PMID:15906457

  5. Are hospitals also for relatives? A survey of hospitals' activities regarding relatives of cardiac patients

    DEFF Research Database (Denmark)

    Nissen, Nina Konstantin; Madsen, Mette; Kjøller, Mette; Waldorff, Susanne B; Olsen Zwisler, Ann-Dorthe

    2008-01-01

    AIM: Patients and their close relatives both feel the burden of cardiovascular disease. Relatives of heart patients experience lower quality of life and increased mortality than the general population and relatives of patients with other diseases. Nevertheless, knowledge on health services aimed at relatives of patients with cardiac diseases is sparse. This study aimed to survey the prevalence of health services for relatives of cardiac patients in Denmark. METHODS: We surveyed activities offere...

  6. Diphenhydramine and dimenhydrinate poisoning: an evidence-based consensus guideline for out-of-hospital management.

    Science.gov (United States)

    Scharman, Elizabeth J; Erdman, Andrew R; Wax, Paul M; Chyka, Peter A; Caravati, E Martin; Nelson, Lewis S; Manoguerra, Anthony S; Christianson, Gwenn; Olson, Kent R; Woolf, Alan D; Keyes, Daniel C; Booze, Lisa L; Troutman, William G

    2006-01-01

    In 2003, there were 28,092 human exposures to diphenhydramine reported to poison centers in the US. A related drug, dimenhydrinate, is a less frequent cause of poisonings. Between January 2000 and June 2004, there were 2,534 reported dimenhydrinate ingestions in children less than 6 years of age. An evidence-based expert consensus process was used to create this guideline. Relevant articles were abstracted by a trained physician researcher. The first draft was created by the primary author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial management of patients with a suspected ingestion of diphenhydramine or dimenhydrinate, or a dermal exposure to diphenhydramine. This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. The panel's recommendations for dermal or oral exposures to diphenhydramine or oral exposures to dimenhydrinate follow. The grade of recommendation is in parentheses: 1) All patients with suicidal intent, intentional abuse, or in cases in which a malicious intent is suspected (e.g., child abuse or neglect) should be referred to an emergency department (Grade D). 2) In patients without evidence of self-harm, abuse, or malicious intent, poison center personnel should elicit additional information including the time of the ingestion or dermal exposure, determination of the precise dose ingested, and the presence of co-ingestants (Grade D). 3) Patients experiencing any changes in behavior other than mild drowsiness or mild stimulation should be referred to an emergency department. Examples of moderate to severe symptoms that warrant referral include agitation, staring spells, inconsolable crying, hallucinations, abnormal muscle movements, loss of consciousness, seizures, or respiratory depression (Grade D). 4) For patients referred to the emergency department, transportation via ambulance should be considered based on several factors including the condition of the patient and the length of time it will take the patient to arrive at the emergency department (Grade D). 5) If the patient has no symptoms, and more than 4 hours have elapsed between the time of diphenhydramine ingestion and the call to the poison center, referral to an emergency department is not recommended. For dermal exposures to diphenhydramine, if the patient has no symptoms and it has been more than 8 hours since the diphenhydramine was thoroughly removed from the skin, referral to an emergency department is not recommended (Grade D). 6) Patients with acute ingestions of less than a toxic dose of diphenhydramine, or chronic exposures to diphenhydramine and no or mild symptoms, can be observed at home with instructions to call the poison center back if symptoms develop or worsen. The poison center should consider making a follow-up call at approximately 4 hours after ingestion (Grade D). 7) Children less than 6 years of age who ingest at least 7.5 mg/kg of diphenhydramine should be referred to an emergency department (Grade D). 8) Patients 6 years of age and older who ingest at least 7.5 mg/kg or 300 mg of diphenhydramine (whichever is less), should be referred to an emergency department (Grade D). 9) If the patient has no symptoms, and more than 6 hours have elapsed between the time of dimenhydrinate ingestion and the call to the poison center, referral to an emergency department is not recommended (Grade D). 10) Patients with acute ingestions of less than a toxic dose of dimenhydrinate, or chronic exposures to dimenhydrinate and no or mild symptoms, can be observed

  7. Dimensionality of the hospital anxiety and depression scale (HADS) in cardiac patients

    DEFF Research Database (Denmark)

    Emons, Wilco H M; Sijtsma, Klaas; Pedersen, Susanne S.

    2012-01-01

    The hospital anxiety and depression scale (HADS) measures anxiety and depressive symptoms and is widely used in clinical and nonclinical populations. However, there is some debate about the number of dimensions represented by the HADS. In a sample of 534 Dutch cardiac patients, this study examined (a) the dimensionality of the HADS using Mokken scale analysis and factor analysis and (b) the scale properties of the HADS. Mokken scale analysis and factor analysis suggested that three dimensions ad...

  8. Prevalence of hospital malnutrition among cardiac patients: results from six nutrition screening tools

    OpenAIRE

    Pathirana, Anidu K; Lokunarangoda, Niroshan; Ranathunga, Ishara; Santharaj, Wijeyasingam Samuel; Ekanayake, Ruwan; Jayawardena, Ranil

    2014-01-01

    Malnutrition is highly prevalent among hospitalized patients, ranging from 30% to 50% depending on the patient population and the criteria used for diagnosis. Identifying early those who are malnourished and at risk of malnutrition and intervening at an early stage will improve patients overall prognosis and will reduce the costs to the state. Even though cardiac patients are at risk of malnutrition, data on the prevalence of malnutrition among cardiology inpatients is limited. The aim of the...

  9. Participating in a world that is out of tune: shadowing an older hospital patient.

    Science.gov (United States)

    van der Meide, Hanneke; Olthuis, Gert; Leget, Carlo

    2015-11-01

    Hospitalization significantly impacts the lives of older people, both physically and psychosocially. There is lack of observation studies that may provide an embodied understanding of older patients' experiences in its context. The aim of this single case study was to reach a deeper understanding of one older patient's lived experiences of hospitalization. The study followed a phenomenological embodied enquiry design and the qualitative observation method of shadowing was used. In April 2011, one older patient was shadowed for 7 days, 5-7 h per day. To facilitate understanding in the reader the experiences are first presented in a story and subsequently analyzed by means of the lifeworld framework. The findings show that hospitalization is experienced as ambiguous safety, disconnected time, the feeling of being partially involved, and the struggle to re-attune to the body. PMID:25577239

  10. Cardiac disease in pregnancy: A 4-year audit at Pretoria Academic Hospital

    Scientific Electronic Library Online (English)

    P, Soma-Pillay; A P, Macdonald; T M, Mathivha; J L, Bakker; M O, Mackintosh.

    2008-07-01

    Full Text Available BACKGROUND: Pre-existing medical disease constitutes one of the five major causes of maternal death in South Africa. Increasing numbers of women with heart disease reach adulthood as a result of advances in diagnoses and treatment of heart disease in childhood. OBJECTIVE: To assess the profile of ca [...] rdiac disease and the maternal and fetal outcome of pregnant patients at Pretoria Academic Hospital (PAH). METHODS: A retrospective analysis was carried out on 189 pregnant cardiac patients who delivered at PAH between January 2002 and December 2005. RESULTS: Nearly 1% of all mothers who delivered at PAH had underlying cardiac disease. Most cardiac lesions were valvular disease secondary to childhood rheumatic heart disease. Pulmonary oedema was associated with the greatest morbidity and mortality. The severe morbidity rate was 11.6% and the case fatality rate 3.3%. The mean gestational age at delivery was 35 weeks; 18 (9.7%) babies were born before 34 weeks. CONCLUSION: Cardiac disease in pregnancy is associated with high morbidity and mortality rates for mothers and their babies. Multidisciplinary evaluation with discussion of risk factors, appropriate family planning and optimising of the cardiac state before conception is advised.

  11. Frequency of cardiac defects among children at echocardiography centre in a teaching hospital

    International Nuclear Information System (INIS)

    Objective: To assess frequency of cardiac defects among children from birth to 12 years of age on each Methodology: A cross sectional study was conducted at echocardiography centre in coronary care unit at Bahawal Victoria Hby Paediatric Transthoracic echo probe; 2-D colour Doppler, Acuson CV-70 and Niemo-30 echocardiography machines. Mothers of children with cardiac defects were interviewed at the echocardiography centre. Variables included were A- Muscular plus Vascular defects; B- Valvular defects; C-Pericardial effusion; D- Dextrocardia and E- Congestive cardiac failure. History of children for sore throat followed by joint pains; history of mothers for drug intake (antihypertensive, antipyretic, anti-emetic, hypoglycaemic) as well as chronic diseases (diabetes mellitus, hypertension, anaemia) during pregnancy were surveyed. Parity of mothers, their cousin marriages, and family socio-economic status was also inquired. The results were tabulated, analyzed and finally subjected to suitable test of significant (SR of proportion) to find out statistical significant if any. Results: It was found that out of 150 patients, 76 (50.66%) were suffering from Cardiac muscular and Vascular defects, 61 (40.66%) Valvular defects, 7 (4.66%) Pericardial effusion, 2 (1.33%) Dextrocardia and 4 (2.66%) from Congestive Cardiac Failure. According to age, 54 (36%) were from birth to 3 years of age and 51 (34%) from 10 to 12 years. There was history of Rheumatic fever among 45 (30%) children. There were 106 (70.6%) children from lower socio-economic class and 79 (52.6%) parents had history of cousin marriages. Conclusion: Frequency of cardiac defects was more in children of male sex, lower socio-economic group, from birth to three years age and children from primipara mothers in our specified locality. Rheumatic fever, cousin's marriage, and prescribed drugs intake during pregnancy (for metabolic and hormonal disorders) were other contributors to cardiac defects. (author)

  12. How Do Hospitals Respond to Market Entry? Evidence from a Deregulated Market for Cardiac Revascularization.

    Science.gov (United States)

    Li, Suhui; Dor, Avi

    2015-08-01

    Regulatory entry barriers to hospital service markets, namely Certificate of Need (CON) regulations, are enforced in many US states. Policy makers in other states are considering reinstating CON policies in tandem with service expansions mandated under the Affordable Care Act. Although previous studies examined the volume effects of CON, demand responses to actual entry into local hospital markets are not well understood. In this paper, we empirically examine the demand-augmenting, demand-redistribution, and risk-allocation effects of hospital entry by studying the cardiac revascularization markets in Pennsylvania, a state in which dynamic market entry occurred after repeal of CON in 1996. Results from interrupted time-series analyses indicate demand-augmenting effects for coronary artery bypass graft (CABG) and business-stealing effects for percutaneous coronary intervention (PCI) procedures: high entrant market share mitigated the declining incidence of CABG, but it had no significant effect on the rising trend in PCI use, among patients with coronary artery disease. We further find evidence that entry by new cardiac surgery centers tended to sort high-severity patients into the more invasive CABG procedure and low-severity patients into the less invasive PCI procedures. These findings underscore the importance of considering market-level strategic responses by hospitals when regulatory barriers are rescinded. PMID:24990327

  13. Continuous Infusion of Ketamine for Out-of-hospital Isolated Orthopedic Injuries Secondary to Trauma: A Randomized Controlled Trial.

    Science.gov (United States)

    Wiel, Eric; Zitouni, Djamel; Assez, Nathalie; Sebilleau, Quentin; Lys, Sébastien; Duval, Audrey; Mauriaucourt, Patrick; Hubert, Hervé

    2015-01-01

    Abstract Objective. Although ketamine has recently been demonstrated to provide a morphine-sparing effect, no previous study reports the effect of continuous infusion of ketamine for analgesia in out-of-hospital environments. The aim of this study was to compare the effect of a continuous infusion of ketamine (IK group) vs. a continuous infusion of saline (IS group) on morphine requirements in out-of-hospital trauma patients suffering from severe acute pain. Methods. In this prospective, multicenter, randomized, single-blind clinical study, patients suffering from isolated orthopedic injuries secondary to trauma with severe acute pain received a low-dose intravenous (IV) bolus of ketamine (0.2 mg·kg(-1)) combined with an IV bolus of morphine (0.1 mg·kg(-1)) and were randomized either in the IK group (IV continuous infusion of ketamine 0.2 mg·kg(-1)·h(-1)), or in the IS group (IV continuous infusion of saline at the same volume). The primary endpoint was morphine requirements in terms of total dose of morphine (excluding the baseline bolus) injected at the end of prehospital emergency care at hospital admission (final time, Tf). The secondary endpoint was evaluation of pain with visual analogic scale (VAS). Results. Sixty-six patients were enrolled. Total morphine dose was not significantly reduced with continuous infusion of ketamine (0.048 [0.000; 0.150] vs. 0.107 [0.052; 0.150] in IK and IS groups), with similar mean duration of care (median 35.0 min). Analgesia was as efficient without any significant difference in VAS at Tf between groups (3.1 ± 2.3 (IK group) vs. 3.7 ± 2.7 (IS group), p = 0.5). Conclusions. Continuous ketamine infusion did not reduce morphine requirements in severe acute pain trauma patients in the out-of-hospital emergency settings. PMID:24932670

  14. Hospital ownership and performance: evidence from stroke and cardiac treatment in Taiwan.

    Science.gov (United States)

    Lien, Hsien-Ming; Chou, Shin-Yi; Liu, Jin-Tan

    2008-09-01

    This paper compares program expenditure and treatment quality of stroke and cardiac patients between 1997 and 2000 across hospitals of various ownership types in Taiwan. Because Taiwan implemented national health insurance in 1995, the analysis is immune from problems arising from the complex setting of the U.S. health care market, such as segmentation of insurance status or multiple payers. Because patients may select admitted hospitals based on their observed and unobserved characteristics, we employ instrument variable (IV) estimation to account for the endogeneity of ownership status. Results of IV estimation find that patients admitted to non-profit hospitals receive better quality care, either measured by 1- or 12-month mortality rates. In terms of treatment expenditure, our results indicate no difference between non-profits and for-profits index admission expenditures, and at most 10% higher long-term expenditure for patients admitted to non-profits than to for-profits. PMID:18486978

  15. Hospital employees' theoretical knowledge on what to do in an in-hospital cardiac arrest

    Directory of Open Access Journals (Sweden)

    Herlitz Johan

    2010-08-01

    Full Text Available Abstract Background Guidelines recommend that all health care professionals should be able to perform cardiopulmonary resuscitation (CPR, including the use of an automated external defibrillator. Theoretical knowledge of CPR is then necessary. The aim of this study was to investigate how much theoretical knowledge in CPR would increase among all categories of health care professionals lacking training in CPR, in an intervention hospital, after a systematic standardised training. Their results were compared with the staff at a control hospital with an ongoing annual CPR training programme. Methods Health care professionals at two hospitals, with a total of 3144 employees, answered a multiple-choice questionnaire before and after training in CPR. Bootstrapped chi-square tests and Fisher's exact test were used for the statistical analyses. Results In the intervention hospital, physicians had the highest knowledge pre-test, but other health care professionals including nurses and assistant nurses reached a relatively high level post-test. Improvement was inversely related to the level of previous knowledge and was thus most marked among other health care professionals and least marked among physicians. The staff at the control hospital had a significantly higher level of knowledge pre-test than the intervention hospital, whereas the opposite was found post-test. Conclusions Overall theoretical knowledge increased after systematic standardised training in CPR. The increase was more pronounced for those without previous training and for those staff categories with the least medical education.

  16. Impact of respiratory infection in the results of cardiac surgery in a tertiary hospital in Brazil

    Science.gov (United States)

    Andrade, Isaac Newton Guimarães; de Araújo, Diego Torres Aladin; de Moraes, Fernando Ribeiro

    2015-01-01

    Objective To assess the impact of respiratory tract infection in the postoperative period of cardiac surgery in relation to mortality and to identify patients at higher risk of developing this complication. Methods Cross-sectional observational study conducted at the Recovery of Cardiothoracic Surgery, using information from a database consisting of a total of 900 patients operated on in this hospital during the period from 01/07/2008 to 1/07/2009. We included patients whose medical records contained all the information required and undergoing elective surgery, totaling 109 patients with two excluded. Patients were divided into two groups, WITH and WITHOUT respiratory tract infection, as the development or respiratory tract infection in hospital, with patients in the group without respiratory tract infection, the result of randomization, using for the pairing of the groups the type of surgery performed. The outcome variables assessed were mortality, length of hospital stay and length of stay in intensive care unit. The means of quantitative variables were compared using the Wilcoxon and student t-test. Results The groups were similar (average age P=0.17; sex P=0.94; surgery performed P=0.85-1.00) Mortality in the WITH respiratory tract infection group was significantly higher (P<0.0001). The times of hospitalization and intensive care unit were significantly higher in respiratory tract infection (P<0.0001). The presence of respiratory tract infection was associated with the development of other complications such as renal failure dialysis and stroke P<0.00001 and P=0.002 respectively. Conclusion The development of respiratory tract infection postoperative cardiac surgery is related to higher mortality, longer periods of hospitalization and intensive care unit stay. PMID:26313727

  17. Emergencias extrahospitalarias: el paciente suicida / Out-of-hospital emergencies: the suicidal patient

    Scientific Electronic Library Online (English)

    T., Pacheco Tabuenca; J.I., Robles Sánchez.

    2011-12-01

    Full Text Available Introducción: La conducta suicida ha existido desde que la humanidad existe, sin embargo, la concepción positiva o negativa del mismo ha cambiado a través de las diferentes culturas. En la actualidad, supone un grave problema de salud pública, y se estudia desde diferentes perspectivas y áreas de co [...] nocimiento, tratando de dar una visión global para poder entender este fenómeno tan interesante, apasionante y, en ciertos momentos desconcertante. Objetivo: Por tanto, el objetivo del presente estudio es analizar el perfil de las personas que cometen un acto suicida en la ciudad de Madrid y que son atendidos en el área de la emergencia extrahospitalaria. Método: Estudio observacional, descriptivo y retrospectivo, encuadrado en SAMUR-Protección Civil durante el año 2008, analizando todos los casos atendidos de ideación, tentativa y suicidio consumado donde han intervenido un Soporte Vital Avanzado y la Unidad de Asistencia Psicológica. Se ha analizado una muestra de 96 pacientes suicidas, donde el 48,4% fueron tentativas de suicidio, seguidos de un 44,2% de suicidios consumados y un 7,4% de ideación autolítica, atendidos principalmente en los meses de marzo y mayo, turno de mañana - tarde, y en el distrito de Puente de Vallecas, intervenciones demandadas desde Madrid 112 en su mayor porcentaje. Resultados: Se establece un perfil de paciente suicida como varón, de 25-35 años, español, soltero, con patología psiquiátrica en tratamiento, sin tentativas previas, que había verbalizado sus intenciones autolíticas, teniendo como factor desencadenante la propia enfermedad física o psíquica, que elige como método autolítico la defenestración sin presencia de otras personas, al cuál se le traslada al Hospital y presenta como diagnóstico principal TCE, trauma o politraumatismo. Conclusiones: El conocimientog del perfil del paciente suicida atendidos en diversas áreas permite conocer en mayor medida, los factores de riesgo de la conducta suicida, así como puede favorecer actuaciones preventivas futuras. Abstract in english Background: Suicidal behavior has existed since mankind exists, however, positive or negative view of it has changed through different cultures. At present, poses a significant public health problem, and studied from different perspectives and areas of expertise, trying to give an overview to unders [...] tand this phenomenon so interesting, exciting and at times bewildering. Therefore, the objective of this study is to analyze the profile of people who commit a suicide in the city of Madrid and are treated in the outpatient emergency area. Methods: Observational, descriptive and retrospective study, framed in SAMUR-Civil Protection in 2008, analyzing all cases seen ideation, suicide attempt, which have involved an Advanced Life Support and Counselling Unit. We analyzed a sample of 96 suicidal patients, where 48.4% were attempted suicide, followed by 44.2% of suicides and suicidal ideation 7.4%, seen mainly in the months of March and May, morning session-afternoon, and in the district of Puente de Vallecas, intervention from Madrid 112 defendants in the highest percentage. Results: Establishing a patient profile suicide as male, 25-35 years, Spanish, single, with psychiatric disorders in treatment, but previous attempts, he had verbalized his intentions autolytic, taking as a trigger for the physical or mental illness itself, which chooses defenestration as autolytic method without the presence of others, to which he was transferred to the Hospital and has a diagnosis of TBI, trauma or polytrauma. Conclusions: Knowledge of the profile of the suicidal patient treated in different areas allows better known, the risk factors of suicidal behavior and may facilitate future preventive actions.

  18. Hospital employees' theoretical knowledge on what to do in an in-hospital cardiac arrest

    OpenAIRE

    Herlitz Johan; Leppert Jerzy; Rosenblad Andreas; Källestedt Marie-Louise; Enlund Mats

    2010-01-01

    Abstract Background Guidelines recommend that all health care professionals should be able to perform cardiopulmonary resuscitation (CPR), including the use of an automated external defibrillator. Theoretical knowledge of CPR is then necessary. The aim of this study was to investigate how much theoretical knowledge in CPR would increase among all categories of health care professionals lacking training in CPR, in an intervention hospital, after a systematic standardised training. Their result...

  19. Postoperative cardiac arrest due to cardiac surgery complications

    International Nuclear Information System (INIS)

    To examine the role of anesthetists in the management of cardiac arrest occurring in association with cardiac anesthesia. In this retrospective study we studied the potential performances for each of the relevant incidents among 712 patients undergoing cardiac operations at Golestan and Naft Hospitals Ahwaz between November 2006 and July 2008. Out of total 712 patients undergoing cardiac surgery, cardiac arrest occurred in 28 cases (3.9%) due to different postoperative complications. This included massive bleeding (50% of cardiac arrest cases, 1.9% of patients); pulseless supra ventricular tachycardia (28.5% of cardiac arrest cases, 1.1% of patients); Heart Failure (7% of cardiac arrest cases, 0.2% of patients); Aorta Arc Rapture (3.5% of cardiac arrest cases, 0.1% of patients); Tamponade due to pericardial effusion (3.5% of cardiac arrest cases, 0.1% of total patients); Right Atrium Rupture (3.5% of cardiac arrest cases, 0.1% of patients) were detected after cardiac surgery. Out of 28 cases 7 deaths occurred (25% of cardiac arrest cases, 0.1% of patients). The most prevalent reason for cardiac arrest during post operative phase was massive bleeding (50%) followed by pulseless supra ventricular tachycardia (28.5%). Six patients had some morbidity and the remaining 15 patients recovered. There are often multiple contributing factors to a cardiac arrest under cardiac anesthesia, as much a complete systematic assessment of the patient, equipment, and drugs should be completed. We also found that the diagnosis and management of cardiac arrest in association with cardiac anesthesia differs considerably from that encountered elsewhere. (author)

  20. Relationship between quantitative cardiac neuronal imaging with {sup 123}I-meta-iodobenzylguanidine and hospitalization in patients with heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Parker, Matthew W.; Sood, Nitesh [University of Connecticut, School of Medicine Department of Medicine, Farmington, CT (United States); Hartford Hospital, Division of Cardiology, Hartford, CT (United States); Ahlberg, Alan W. [Hartford Hospital, Division of Cardiology, Hartford, CT (United States); Jacobson, Arnold F. [GE Healthcare, Princeton, NJ (United States); Heller, Gary V. [The Intersocietal Accreditation Commission, Ellicott City, MD (United States); Lundbye, Justin B. [University of Connecticut, School of Medicine Department of Medicine, Farmington, CT (United States); The Hospital of Central Connecticut, Division of Cardiology, New Britain, CT (United States)

    2014-09-15

    Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by {sup 123}I-meta-iodobenzylguanidine ({sup 123}I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between {sup 123}I-mIBG imaging findings and hospitalization. Source documents from the ADMIRE-HF trial were reviewed to identify hospitalization events in patients with systolic heart failure following cardiac neuronal imaging using {sup 123}I-mIBG. Time to hospitalization was analyzed with the Kaplan-Meier method and compared to the mIBG heart-to-mediastinum (H/M) ratio using multiple-failure Cox regression. During 1.4 years of median follow-up, 362 end-point hospitalizations occurred in 207 of 961 subjects, 79 % of whom had H/M ratio <1.6. Among subjects hospitalized for any cause, 88 % had H/M ratio <1.6 and subjects with H/M ratio <1.6 experienced hospitalization earlier than subjects with higher H/M ratios (log-rank p = 0.003). After adjusting for elevated brain natriuretic peptide (BNP) and time since heart failure diagnosis, a low mIBG H/M ratio was associated with cardiac-related hospitalization (HR 1.48, 95 % CI 1.05 - 2.0; p = 0.02). The mIBG H/M ratio may risk-stratify patients with heart failure for cardiac-related hospitalization, especially when used in conjunction with BNP. Further studies are warranted to examine these relationships. (orig.)

  1. Relationship between quantitative cardiac neuronal imaging with 123I-meta-iodobenzylguanidine and hospitalization in patients with heart failure

    International Nuclear Information System (INIS)

    Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by 123I-meta-iodobenzylguanidine (123I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between 123I-mIBG imaging findings and hospitalization. Source documents from the ADMIRE-HF trial were reviewed to identify hospitalization events in patients with systolic heart failure following cardiac neuronal imaging using 123I-mIBG. Time to hospitalization was analyzed with the Kaplan-Meier method and compared to the mIBG heart-to-mediastinum (H/M) ratio using multiple-failure Cox regression. During 1.4 years of median follow-up, 362 end-point hospitalizations occurred in 207 of 961 subjects, 79 % of whom had H/M ratio <1.6. Among subjects hospitalized for any cause, 88 % had H/M ratio <1.6 and subjects with H/M ratio <1.6 experienced hospitalization earlier than subjects with higher H/M ratios (log-rank p = 0.003). After adjusting for elevated brain natriuretic peptide (BNP) and time since heart failure diagnosis, a low mIBG H/M ratio was associated with cardiac-related hospitalization (HR 1.48, 95 % CI 1.05 - 2.0; p = 0.02). The mIBG H/M ratio may risk-stratify patients with heart failure for cardiac-related hospitalization, especially when used in conjunction with BNP. Further studies are warranted to examine these relationships. (orig.)

  2. RETROSPECTIVE ANALYSIS: TO ENHANCE PATIENT SAFETY BY MINIMIZING MEDICATION ERRORS IN TERTIARY CARE CARDIAC HOSPITAL

    Directory of Open Access Journals (Sweden)

    Lal Sukhbir

    2012-09-01

    Full Text Available To identify and measure the frequency of medication errors, to understand the causes for errors and best strategies to decrease medication errors rate in a cardiac hospital New Delhi. The Retrospective study of 137 case files, was undertaken to find out the medication errors in new drugs to be included in hospital formulary and to study policy compliances,for the period of a month, February 2010.We studied 137 patient files and Medication error related were reported most often at the stages of prescription- 32 cases(23.35%, 12 administration errors(8.75%, 9 documentation errors(6.56%, 7 transcription errors (5.1%. This study has demonstrated a whole range of different types of errors in different phases of medication use and documentation process. We have seen that handwritten prescriptions are associated with large number of errors. A combined effort is required by the physician’s, managerial staff, nursing staff and educational interventions to improve patient safety in hospital.KEY WORDS:

  3. Cognitive function, quality of life and mental health in survivors of our-of-hospital cardiac arrest: a review.

    Science.gov (United States)

    Green, C R; Botha, J A; Tiruvoipati, R

    2015-09-01

    There is growing interest in the long-term outcomes of patients surviving out-of-hospital cardiac arrest (OHCA). This paper aims to summarise the available literature on the long-term cognitive, health-related quality of life (QoL) and mental health outcomes of survivors of OHCA. Between 30% and 50% of survivors of OHCA experience cognitive deficits for up to several years post-discharge. Deficits of attention, declarative memory, executive function, visuospatial abilities and verbal fluency are commonly reported. Survivors of OHCA appear to report high rates of mental illness, with up to 61% experiencing anxiety, 45% experiencing depression and 27% experiencing post-traumatic stress. Fatigue appears to be a commonly reported long-term outcome for survivors of OHCA. Investigations of long-term QoL for these patients have produced mixed findings. Carers of survivors of OHCA report high rates of depression, anxiety and post-traumatic stress, with insufficient social and financial support. The heterogeneous range of instruments used to assess cognitive function and QoL prevent any clear conclusions being drawn from the available literature. The potential biases inherent in this patient population and the interaction between QoL, cognitive performance and mental health warrant further investigation, as does the role of post-discharge support services in improving long-term patient outcomes. PMID:26310406

  4. Dimensionality of the Hospital Anxiety and Depression Scale (HADS) in Cardiac Patients: Comparison of Mokken Scale Analysis and Factor Analysis

    Science.gov (United States)

    Emons, Wilco H. M.; Sijtsma, Klaas; Pedersen, Susanne S.

    2012-01-01

    The Hospital Anxiety and Depression Scale (HADS) measures anxiety and depressive symptoms and is widely used in clinical and nonclinical populations. However, there is some debate about the number of dimensions represented by the HADS. In a sample of 534 Dutch cardiac patients, this study examined (a) the dimensionality of the HADS using Mokken…

  5. Survival of patients with spinal cord injury after cardiac arrest in Department of Veterans Affairs hospital: Pilot study.

    Science.gov (United States)

    Caruso, Deborah; Carter, William E; Cifu, David X; Carne, William

    2014-01-01

    Survivability characteristics after cardiopulmonary resuscitation in the population with spinal cord injury (SCI) are unclear but may be useful for advanced care planning discussions with patients. Retrospective evaluation from records of all SCI patients over 10 yr at a Department of Veterans Affairs medical center who experienced in-hospital cardiac arrest was performed. Demographic data and other common measurements were recorded. Thirty-six male subjects were identified, and only two patients survived to discharge (5.5% survival rate), both of whom were admitted for nonacute issues and were asymptomatic shortly before the cardiac arrest. The mean age at the time of cardiopulmonary arrest was 62.4 yr, with a mean time from cardiac arrest to death of 3.02 d. No significant demographic parameters were identified. Overall, SCI likely portends worse outcome for acutely ill patients in the situation of a cardiac arrest. Conclusions are limited by sample size. PMID:25436984

  6. Cardiac surgery on Jehova's Witnesses at Instituto Cardiovascular-Hospital Pavia.

    Science.gov (United States)

    García Rinaldi, R; Pagán, J L; Meléndez, F J; Porro, R; Barceló, J; Rivera, M

    1992-01-01

    Jehovah's Witnesses (J.W.) can undergo successful cardiac operations. We have operated five J.W. patients. Of these patients, two had coronary artery bypass surgery and three had correction of congenital anomalies. These included an atrial septal defect with infundibular pulmonic stenosis, a tetralogy of Fallot and a patient with a ventricular septal defect. Our treatment protocol includes a meticulous surgery, the use of early heparinization to collect all shed blood into the pump oxygenator, observation in the operating room for early exploration if the patient bleeds and administration of iron preparations. Recombinant human erythropoietin, although available and in our treatment protocol, has not been used yet. All patients survived the operation and left the hospital with an excellent hemoglobin and hematocrit. The length of stay varied from 7 to 15 days. PMID:1295501

  7. Uso do desfibrilador automático externo no ambiente pré-hospitalar peruano: melhorando a resposta a emergências na América Latina / Use of automated external defibrillator in Peruvian out-of-hospital environment: improving emergency response in Latin America

    Scientific Electronic Library Online (English)

    Pablo, Lister; Christian Loret de, Mola; Elena, Arroyo; José, Solórzano; Raffo, Escalante-Kanashiro; Giuliana, Matos-Iberico.

    2009-08-01

    Full Text Available Este relato de caso reporta o atendimento pré-hospitalar de um paciente com fatores de risco atendido pelo serviço pré-hospitalar ao ser acometido por uma parada cardíaca e apresentar fibrilação ventricular. O paciente foi atendido seguindo os padrões de suporte básico de vida e suporte cardiovascul [...] ar avançado. Um desfibrilador automático externo (DAE) foi aplicado com resultados favoráveis e o paciente se recuperou do quadro de perigo de vida com sucesso. Este é o primeiro relato documentado com resultados favoráveis no Peru, na área de atendimento pré-hospitalar e enfatiza a necessidade de serem adotadas políticas de acesso público à desfibrilação precoce. Abstract in spanish El presente reporte de caso, relata la atencion prehospitalaria de un paciente con factores de riesgo atendido en el area prehospitalaria al sufrir arresto cardiaco y presentar fibrilacion ventricular. El paciente fue atendido bajo estandares de Soporte Basico Vital y Soporte Cardiovascular Avanzado [...] Vital, se aplico un Desfibrilador Automatizado Externo (DEA) con resultado favorable y exito al recuperar al paciente de su condicion de compromiso de vida. Este es el primer reporte documentado con resultado favorable en el pais, en el area prehospitalaria y refuerza la conveniencia de adoptar politicas de Acceso Publico a la Desfibrilacion Temprana. Abstract in english This case report relates out-of-hospital care to a patient with risk factors treated in the out-of-hospital services after cardiac arrest and ventricular fibrillation. The patient was treated according to the standards of basic life support and advanced cardiovascular life support; by applying an au [...] tomated external defibrillator (AED) with favorable outcome and successful recovery of the patient from his risk of life condition. This is the first documented report with a favorable outcome in Peru, in out-of-hospital services and stresses the desirability of adopting policies for public access to early defibrillation.

  8. Uso do desfibrilador automático externo no ambiente pré-hospitalar peruano: melhorando a resposta a emergências na América Latina Use of automated external defibrillator in Peruvian out-of-hospital environment: improving emergency response in Latin America

    Directory of Open Access Journals (Sweden)

    Pablo Lister

    2009-08-01

    Full Text Available Este relato de caso reporta o atendimento pré-hospitalar de um paciente com fatores de risco atendido pelo serviço pré-hospitalar ao ser acometido por uma parada cardíaca e apresentar fibrilação ventricular. O paciente foi atendido seguindo os padrões de suporte básico de vida e suporte cardiovascular avançado. Um desfibrilador automático externo (DAE foi aplicado com resultados favoráveis e o paciente se recuperou do quadro de perigo de vida com sucesso. Este é o primeiro relato documentado com resultados favoráveis no Peru, na área de atendimento pré-hospitalar e enfatiza a necessidade de serem adotadas políticas de acesso público à desfibrilação precoce.El presente reporte de caso, relata la atencion prehospitalaria de un paciente con factores de riesgo atendido en el area prehospitalaria al sufrir arresto cardiaco y presentar fibrilacion ventricular. El paciente fue atendido bajo estandares de Soporte Basico Vital y Soporte Cardiovascular Avanzado Vital, se aplico un Desfibrilador Automatizado Externo (DEA con resultado favorable y exito al recuperar al paciente de su condicion de compromiso de vida. Este es el primer reporte documentado con resultado favorable en el pais, en el area prehospitalaria y refuerza la conveniencia de adoptar politicas de Acceso Publico a la Desfibrilacion Temprana.This case report relates out-of-hospital care to a patient with risk factors treated in the out-of-hospital services after cardiac arrest and ventricular fibrillation. The patient was treated according to the standards of basic life support and advanced cardiovascular life support; by applying an automated external defibrillator (AED with favorable outcome and successful recovery of the patient from his risk of life condition. This is the first documented report with a favorable outcome in Peru, in out-of-hospital services and stresses the desirability of adopting policies for public access to early defibrillation.

  9. A process model to support automated measurement and detection of out-of-bounds events in a hospital laboratory process

    Scientific Electronic Library Online (English)

    Claire, Costello; Owen, Molloy.

    2009-08-01

    Full Text Available Business Activity Monitoring (BAM) allows organizations to capture enterprise events from their source systems and utilize these to detect non-compliant business situations. Similar concepts may be leveraged in the healthcare domain to improve the quality of patient care and the efficiency of clinic [...] al processes. This paper introduces a generic set of constructs for formally specifying threshold values relevant for cycle time and utilization calculations. It also describes a mechanism to capture information, including thresholds, about important business parameters for Six Sigma measurement. This full set of constructs are the basis for automated measurement and monitoring and are incorporated into the process model during the definition or capture phase thereby linking the definition and monitoring phases through a common underlying process model. Bespoke software is also described which uses the constructs contributed by this research to manage and monitor process models and enterprise events. A process performance module provides automated measurement and monitoring capabilities. At an aggregate level, this is achieved through the provision of process cycle time data for selected time periods on demand and the examination of business processes at frequent intervals with alerts generated for exceptional scenarios. At a more granular level, this solution uses a rules-based approach to evaluate individual events and generate alerts for out-of-bounds business parameters. This paper demonstrates the benefits of these capabilities for health informatics through application to a Laboratory Testing process observed at a local hospital. The paper also suggests recommendations for the extension of current modelling languages with respect to the constructs detailed herein.

  10. Efficacy of the EZ-IO® needle driver for out-of-hospital intraosseous access - a preliminary, observational, multicenter study

    Directory of Open Access Journals (Sweden)

    Latasch Leo

    2011-10-01

    Full Text Available Abstract Background Intraosseous (IO access represents a reliable alternative to intravenous vascular access and is explicitly recommended in the current guidelines of the European Resuscitation Council when intravenous access is difficult or impossible. We therefore aimed to study the efficacy of the intraosseous needle driver EZ-IO® in the prehospital setting. Methods During a 24-month period, all cases of prehospital IO access using the EZ-IO® needle driver within three operational areas of emergency medical services were prospectively recorded by a standardized questionnaire that needed to be filled out by the rescuer immediately after the mission and sent to the primary investigator. We determined the rate of successful insertion of the IO needle, the time required, immediate procedure-related complications, the level of previous experience with IO access, and operator's subjective satisfaction with the device. Results 77 IO needle insertions were performed in 69 adults and five infants and children by emergency physicians (n = 72 applications and paramedics (n = 5 applications. Needle placement was successful at the first attempt in all but 2 adults (one patient with unrecognized total knee arthroplasty, one case of needle obstruction after placement. The majority of users (92% were relative novices with less than five previous IO needle placements. Of 22 responsive patients, 18 reported pain upon fluid administration via the needle. The rescuers' subjective rating regarding handling of the device and ease of needle insertion, as described by means of an analogue scale (0 = entirely unsatisfied, 10 = most satisfied, provided a median score of 10 (range 1-10. Conclusions The EZ-IO® needle driver was an efficient alternative to establish immediate out-of-hospital vascular access. However, significant pain upon intramedullary infusion was observed in the majority of responsive patients.

  11. Sudden cardiac death and obesity.

    Science.gov (United States)

    Plourde, Benoit; Sarrazin, Jean-François; Nault, Isabelle; Poirier, Paul

    2014-09-01

    For individuals and the society as a whole, the increased risk of sudden cardiac death in obese patients is becoming a major challenge, especially since obesity prevalence has been increasing steadily around the globe. Traditional risk factors and obesity often coexist. Hypertension, diabetes, obstructive sleep apnea and metabolic syndrome are well-known risk factors for CV disease and are often present in the obese patient. Although the bulk of evidence is circumstantial, sudden cardiac death and obesity share common traditional CV risk factors. Structural, functional and metabolic factors modulate and influence the risk of sudden cardiac death in the obese population. Other risk factors such as left ventricular hypertrophy, increased number of premature ventricular complexes, altered QT interval and reduced heart rate variability are all documented in both obese and sudden cardiac death populations. The present review focuses on out-of-hospital sudden cardiac death and potential mechanisms leading to sudden cardiac death in this population. PMID:25160995

  12. Major depression and first-time hospitalization with ischemic heart disease, cardiac procedures and mortality in the general population

    DEFF Research Database (Denmark)

    Gasse, Christiane; Laursen, Thomas M; Baune, Bernhard T

    2014-01-01

    Objective: We investigated the association between unipolar depression and incident hospital admissions due to ischemic heart disease, invasive cardiac procedures and mortality independent of other medical illnesses.Methods: A population-based cohort of 4.6 million persons aged 15 years or older and born in Denmark was followed up from 1995-2009. Incidence rate ratio (IRR) and mortality rate ratio (MRR) were estimated by survival analysis, stratified by or adjusted for gender, age, severe chroni...

  13. Predictors of in-hospital mortality following non-cardiac surgery: Findings from an analysis of a South African hospital administrative database

    Scientific Electronic Library Online (English)

    Y, Moodley; B M, Biccard.

    2015-02-01

    Full Text Available BACKGROUND: Predictors of in-hospital mortality (IHM) following non-cardiac surgery in South African (SA) patients are not well described. OBJECTIVE: To determine the association between patient comorbidity and IHM in a cohort of SA non-cardiac surgery patients. METHODS: Data related to comorbidity [...] and IHM for 3 727 patients aged >45 years were obtained from a large administrative database at a tertiary SA hospital. Logistic regression analysis was used to determine independent predictors of IHM. In addition, population-attributable fractions (PAFs) were calculated for all clinical factors identified as independent predictors of IHM. RESULTS: Renal dysfunction, congestive heart failure, cerebrovascular disease, male gender and high-risk surgical specialties were independently associated with IHM (odds ratios (95% confidence intervals) 7.585 (5.480 - 10.50); 2.604 (1.119 - 6.060); 2.645 (1.414 - 4.950); 1.433 (1.107 -1.853); and 1.646 (1.213 - 2.233), respectively). Ischaemic heart disease, diabetes and hypertension were not identified as independent predictors of IHM in SA non-cardiac surgery patients. Renal dysfunction had the largest contribution to IHM in this study (PAF 0.34), followed by high-risk surgical specialties (PAF 0.15), male gender (PAF 0.08), cerebrovascular disease (PAF 0.03) and congestive heart failure (PAF 0.03). CONCLUSION: Renal dysfunction, congestive heart failure, cerebrovascular disease, male gender and high-risk surgical specialties were major contributors to increased IHM in SA non-cardiac surgery patients. Prospectively designed research is required to determine whether ischaemic heart disease, diabetes and hypertension contribute to IHM in these patients.

  14. [Assessment of functional food of general version of diet in cardiac hospital].

    Science.gov (United States)

    Nepovinnykh, N V; Lyamina, N P; Ptichkina, N M

    2015-01-01

    The efficacy of functional food was evaluated in general embodiment diet of cardiological hospital in patients receiving oxygen-containing products (oxygen smoothies) based on protein-carbohydrate raw materials (dairy whey) with dietary fiber. 60 patients were included in local open, prospective, parallel-group study; among them 36 men and 24 women aged 60-75 years, meeting the following criteria: patients with chronic heart failure I-IV functional class, are hospitalized in the cardiology department, have no contraindications to enteral oxygen therapy and sign an informed consent form. The main group comprised 30 patients, which along with standard therapy received enteral oxygen therapy. 30 patients from the control group received standard therapy and aerated non-oxygen mixture (placebo). Standard therapy included cardioprotective drugs, diuretics and concomitant therapy (enzyme preparations) depended upon the clinical status of the patient. Patients received 500 ml of a cocktail within 10-15 minutes daily for 10 days for 1-1,5 hours before the main meal. The studies revealed the most pronounced clinical effect of enteral oxygen therapy in relation to clinical symptoms and side effects caused by drug administrations. After 3-4 procedures patients with chronic heart failure treated with enteral oxygen therapy had a decrease in fatigue, increase physical performance, improve appetite, emotional lability. By the end the positive dynamics of oxygen therapy on the above grounds was detected in 90% of patients. Monitoring pulse oximetry showed a significant increase of oxygen saturation as a result of the course of enteral oxygen therapy: oxygen saturation increased from 98.13 ± 0.13 to 99.17 ± 0.13% (p < 0.001) while in the control group from 98.12 ± 0.20 to 98.19 ± 0.19% (p < 0.01). Physical activity increased from 318 ± 15 to 389 ± 13 m (p < 0.001), in the control group--from 331 ± 17 to 362 ± 15 m (p < 0.05) in the main group on the test results with the 6-minutes walk test. In the main group dyspnea Borg changed from 11 to 7 scores as compared to the control group--from 11 to 9 scores. Analysis of the results showed the advisability of incorporating developed oxygen-containing products in diet therapy of cardiac patients to reduce the severity of side effects from taking of drugs administration to normalize the process of digestion, to improve the overall health of patients. PMID:26402941

  15. Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management.

    Science.gov (United States)

    Nelson, Lewis S; Erdman, Andrew R; Booze, Lisa L; Cobaugh, Daniel J; Chyka, Peter A; Woolf, Alan D; Scharman, Elizabeth J; Wax, Paul M; Manoguerra, Anthony S; Christianson, Gwenn; Caravati, E Martin; Troutman, William G

    2007-05-01

    A review of US poison center data for 2004 showed over 48,000 exposures to selective serotonin reuptake inhibitors (SSRIs). A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial management of patients with a suspected ingestion of an SSRI by 1) describing the process by which an ingestion of an SSRI might be managed, 2) identifying the key decision elements in managing cases of SSRI ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to ingestion of immediate-release forms of SSRIs alone. Co-ingestion of additional substances might require different referral and management recommendations depending on their combined toxicities. This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) All patients with suicidal intent, intentional abuse, or in cases in which a malicious intent is suspected (e.g., child abuse or neglect) should be referred to an emergency department. This activity should be guided by local poison center procedures. In general, this should occur regardless of the dose reported (Grade D). 2) Any patient already experiencing any symptoms other than mild effects (mild effects include vomiting, somnolence [lightly sedated and arousable with speaking voice or light touch], mydriasis, or diaphoresis) should be transported to an emergency department. Transportation via ambulance should be considered based on the condition of the patient and the length of time it will take the patient to arrive at the emergency department (Grade D). 3) Asymptomatic patients or those with mild effects (defined above) following isolated unintentional acute SSRI ingestions of up to five times an initial adult therapeutic dose (i.e., citalopram 100 mg, escitalopram 50 mg, fluoxetine 100 mg, fluvoxamine 250 mg, paroxetine 100 mg, sertraline 250 mg) can be observed at home with instructions to call the poison center back if symptoms develop. For patients already on an SSRI, those with ingestion of up to five times their own single therapeutic dose can be observed at home with instructions to call the poison center back if symptoms develop (Grade D). 4) The poison center should consider making follow-up calls during the first 8 hours after ingestion, following its normal procedure. Consideration should be given to the time of day when home observation will take place. Observation during normal sleep hours might not reliably identify the onset of toxicity. Depending on local poison center policy, patients could be referred to an emergency department if the observation would take place during normal sleeping hours of the patient or caretaker (Grade D). 5) Do not induce emesis (Grade C). 6) The use of oral activated charcoal can be considered since the likelihood of SSRI-induced loss of consciousness or seizures is small. However, there are no data to suggest a specific c

  16. Hospital-level associations with 30-day patient mortality after cardiac surgery: a tutorial on the application and interpretation of marginal and multilevel logistic regression

    Directory of Open Access Journals (Sweden)

    Sanagou Masoumeh

    2012-03-01

    Full Text Available Abstract Background Marginal and multilevel logistic regression methods can estimate associations between hospital-level factors and patient-level 30-day mortality outcomes after cardiac surgery. However, it is not widely understood how the interpretation of hospital-level effects differs between these methods. Methods The Australasian Society of Cardiac and Thoracic Surgeons (ASCTS registry provided data on 32,354 patients undergoing cardiac surgery in 18 hospitals from 2001 to 2009. The logistic regression methods related 30-day mortality after surgery to hospital characteristics with concurrent adjustment for patient characteristics. Results Hospital-level mortality rates varied from 1.0% to 4.1% of patients. Ordinary, marginal and multilevel regression methods differed with regard to point estimates and conclusions on statistical significance for hospital-level risk factors; ordinary logistic regression giving inappropriately narrow confidence intervals. The median odds ratio, MOR, from the multilevel model was 1.2 whereas ORs for most patient-level characteristics were of greater magnitude suggesting that unexplained between-hospital variation was not as relevant as patient-level characteristics for understanding mortality rates. For hospital-level characteristics in the multilevel model, 80% interval ORs, IOR-80%, supplemented the usual ORs from the logistic regression. The IOR-80% was (0.8 to 1.8 for academic affiliation and (0.6 to 1.3 for the median annual number of cardiac surgery procedures. The width of these intervals reflected the unexplained variation between hospitals in mortality rates; the inclusion of one in each interval suggested an inability to add meaningfully to explaining variation in mortality rates. Conclusions Marginal and multilevel models take different approaches to account for correlation between patients within hospitals and they lead to different interpretations for hospital-level odds ratios.

  17. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest

    DEFF Research Database (Denmark)

    Nielsen, Niklas; Wetterslev, Jørn; Cronberg, Tobias; Erlinge, David; Gasche, Yvan; Hassager, Christian; Horn, Janneke; Hovdenes, Jan; Kjaergaard, Jesper; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wanscher, Michael; Wise, Matt P; Aneman, Anders; Al-Subaie, Nawaf; Boesgaard, Søren; Bro-Jeppesen, John; Brunetti, Iole; Bugge, Jan Frederik; Hingston, Christopher D; Juffermans, Nicole P; Koopmans, Matty; Køber, Lars; Langørgen, Jørund; Lilja, Gisela; Møller, Jacob Eifer; Rundgren, Malin; Rylander, Christian; Smid, Ondrej; Werer, Christophe; Winkel, Per; Friberg, Hans

    2013-01-01

    Background Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever. Methods In an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arr...

  18. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe Olsen; Soja, Anne Merete Boas; Rasmussen, Søren; Frederiksen, Marianne; Abadini, Sadollah; Appel, Jon; Rasmussen, Hanne; Gluud, Christian; Iversen, Lars; Sigurd, Bjarne; Madsen, Mette; Fischer-Hansen, Jørgen; Group, DANREHAB

    2008-01-01

    BACKGROUND: Current guidelines broadly recommend comprehensive cardiac rehabilitation (CCR), although evidence for this is still limited. We investigated the 12-month effect of hospital-based CCR versus usual care (UC) for a broadly defined group of cardiac patients within the modern therapeutic era of cardiology. METHODS: We conducted a centrally randomized single-center clinical trial with blinded assessment of the primary outcome: registry-based composite of total mortality, myocardial infarc...

  19. TORACOTOMÍA DE EMERGENCIA EN LESIONES CARDIACAS POR ARMA BLANCA EN EL HOSPITAL CLÍNICO FRANCISCO VIEDMA / Emergency toracothomy in cardiac injury in the Hospital Clinical Francisco Viedma

    Scientific Electronic Library Online (English)

    Ronald D., Quinteros Virreir; Marcelo E., Almanza Uribe; Monica, Abularach Heredia.

    Full Text Available Las lesiones cardiacas se han descrito con mucha claridad en el transcurso de la historia. Existen descripciones de heridas penetrantes de tórax en el papiro de Smith que data de 3000 a. C. y en la Ilíada, siglo XIX a. C, que contiene referencias específicas del desangramiento como causa de muerte y [...] de cuerpos extraños localizados dentro del corazón. Muchos de los pacientes con lesiones cardiacas mueren en el sitio de la agresión, durante el traslado o en la sala de emergencia y muchas de estas muertes se pueden prevenir con un transporte rápido asistido, realizando un diagnóstico y manejo hemodinámico precoz en sala de emergencia y realizando una TORACOTOMÍA INMEDIATA DE EMERGENCIA, ADECUADA, AMPLIA Y DE ABORDAJE RÁPIDO, con excelente exposición cardiaca y de sus grandes vasos. Presentamos tres casos de pacientes hospitalizados en el Hospital Clínico Viedma con lesiones penetrantes de corazón que fueron sometidos a Toracotomía de Emergencia, dos de los cuales simultáneamente presentaron traumas penetrantes de abdomen por arma blanca, el manejo a cargo de cirugía general de emergencia, los tres pacientes evolucionaron de manera favorable y fueron dados de alta en óptimas condiciones. Abstract in english Cardiac lesions have been described very clearly in the course of history. There are descriptions of penetrating chest wounds in the Smith papyrus dating from 3000 B C. and in the Iliad, XIX century B C, which contains specific refer-ences to the bleeding as the cause of death of foreign bodies loca [...] ted within the heart. Many patients with cardiac injuries die at the site of the attack, during transport or in the emergency room and many of these deaths can be prevented by rapid transport assisted by an early diagnosis and hemodynamic management in emergency room mak-ing immediate emergency thoracotomy, RIGHT, LARGE AND RAPID APPROACH, with excellent exposure heart and its large vessels. The cardiac lesions appear to be the biggest challenge of trauma surgery. Its handling requires immediate surgery, an experienced surgeon who has good technique, and the ability to offer better recovery and post-operative lifestyle for the patient. We present three patients hospitalized at Hospital Viedma with heart penetrating injuries who underwent emergency thoracotomy, two of which presented simultaneously penetrating abdominal trauma stab in charge of handling emergency general surgery, three patients evolved favorably and were discharged in optimal conditions.

  20. Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM): a randomised controlled trial

    OpenAIRE

    Jolly, K; Lip, G Y H; Sandercock, J.; Raferty, J.P.; Mant, J.W.F.

    2003-01-01

    Background: Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of homebased compared to hospital-based cardiac rehabilitation. Methods/design: A pragmatic randomised controll...

  1. Adjuvant Hypofractionated Versus Conventional Whole Breast Radiation Therapy for Early-Stage Breast Cancer: Long-Term Hospital-Related Morbidity From Cardiac Causes

    International Nuclear Information System (INIS)

    Purpose: The risk of cardiac injury with hypofractionated whole-breast/chest wall radiation therapy (HF-WBI) compared with conventional whole-breast/chest wall radiation therapy (CF-WBI) in women with left-sided breast cancer remains a concern. The purpose of this study was to determine if there is an increase in hospital-related morbidity from cardiac causes with HF-WBI relative to CF-WBI. Methods and Materials: Between 1990 and 1998, 5334 women ?80 years of age with early-stage breast cancer were treated with postoperative radiation therapy to the breast or chest wall alone. A population-based database recorded baseline patient, tumor, and treatment factors. Hospital administrative records identified baseline cardiac risk factors and other comorbidities. Factors between radiation therapy groups were balanced using a propensity-score model. The first event of a hospital admission for cardiac causes after radiation therapy was determined from hospitalization records. Ten- and 15-year cumulative hospital-related cardiac morbidity after radiation therapy was estimated for left- and right-sided cases using a competing risk approach. Results: The median follow-up was 13.2 years. For left-sided cases, 485 women were treated with CF-WBI, and 2221 women were treated with HF-WBI. Mastectomy was more common in the HF-WBI group, whereas boost was more common in the CF-WBI group. The CF-WBI group had a higher prevalence of diabetes. The 15-year cumulative hospital-related morbidity from cardiac causes (95% confidence interval) was not different between the 2 radiation therapy regimens after propensity-score adjustment: 21% (19-22) with HF-WBI and 21% (17-25) with CF-WBI (P=.93). For right-sided cases, the 15-year cumulative hospital-related morbidity from cardiac causes was also similar between the radiation therapy groups (P=.76). Conclusions: There is no difference in morbidity leading to hospitalization from cardiac causes among women with left-sided early-stage breast cancer treated with HF-WBI or CF-WBI at 15-year follow-up

  2. Major depression and first-time hospitalization with ischemic heart disease, cardiac procedures and mortality in the general population : A retrospective Danish population-based cohort study

    DEFF Research Database (Denmark)

    Gasse, Christiane; Laursen, Thomas M

    2014-01-01

    Objective: We investigated the association between unipolar depression and incident hospital admissions due to ischemic heart disease, invasive cardiac procedures and mortality independent of other medical illnesses.Methods: A population-based cohort of 4.6 million persons aged 15 years or older and born in Denmark was followed up from 1995-2009. Incidence rate ratio (IRR) and mortality rate ratio (MRR) were estimated by survival analysis, stratified by or adjusted for gender, age, severe chronic somatic comorbidity and calendar time.Results: Adjusted risks of cardiac hospital admissions and death were significantly increased by up to 15% and 68%, respectively, in persons with hospital admissions due to depression, and were most increased in 15-59 year old women (IRR: 1.64; MRR: 2.57) and men with depression (IRR: 1.39; MRR: 2.21), and during the first 180 days after being diagnosed with depression (women: IRR: 1.38; MRR: 2.35; men: IRR: 1.42; MRR: 2.67). One-year mortality after new ischemic heart disease was elevated by 34% in women and men. By contrast, overall rates of invasive cardiac procedures following cardiac hospitalizations were significantly decreased by 34% in persons with depression but were twofold increased in men recently diagnosed with depression.Conclusion: Clinical depression leading to hospitalization was a risk factor for new cardiac complications independent of somatic comorbidity in the magnitude of other cardiac risk factors, particularly in individuals between 15-59 years of age and during the first weeks following psychiatric admission. Our findings support recent cardiovascular disease prevention guidelines on assessing depression among other psychosocial factors in patients at increased cardiovascular disease (CVD) risk.

  3. Developing Indicators of Service Quality Provided for CardiovascularPatients Hospitalized in Cardiac Care Unit

    OpenAIRE

    AZAMI-AGHDASH, Saber; Ghaffari, Samad; Sadeghi-bazargani, Homayoun; Tabrizi, Jafar-Sadegh; Yagoubi, Alireza; NAGHAVI-BEHZAD, Mohammad

    2013-01-01

    Introduction:Cardiovascular diseases are among the most prevalent chronic diseases leading to high degrees of mortality and morbidity worldwide and in Iran. The aim of the current study was to determine and develop appropriate indicators for evaluating provided service quality for cardiovascular patients admitted to Cardiac Care Units (CCU) in Iran. Methods:In order to determine the indicators for evaluating provided service quality, a four-stage process including reviewing systematic revi...

  4. Impact of hospital infections on patients outcomes undergoing cardiac surgery at Santa Casa de Misericórdia de Marília

    Directory of Open Access Journals (Sweden)

    Lucieni Oliveira Conterno

    2014-04-01

    Full Text Available Objective: this study aimed to determine the incidence of nosocomial infections, the risk factors and the impact of these infections on mortality among patients undergoing to cardiac surgery. Methods: Retrospective cohort study of 2060 consecutive patients from 2006 to 2012 at the Santa Casa de Misericórdia de Marília. Results: 351 nosocomial infections were diagnosed (17%, 227 non-surgical infections and 124 surgical wound infections. Major infections were mediastinitis (2.0%, urinary tract infection (2.8%, pneumonia (2.3%, and bloodstream infection (1.7%. The in-hospital mortality was 6.4%. Independent variables associated with non-surgical infections were age > 60 years (OR 1.59, 95% CI 1.09 to 2.31, ICU stay > 2 days (OR 5, 49, 95% CI 2.98 to 10, 09, mechanical ventilation > 2 days (OR11, 93, 95% CI 6.1 to 23.08, use of urinary catheter > 3 days (OR 4.85 95% CI 2.95 -7.99. Non-surgical nosocomial infections were more frequent in patients with surgical wound infection (32.3% versus 7.2%, OR 6.1, 95% CI 4.03 to 9.24. Independent variables associated with mortality were age greater than 60 years (OR 2.0; 95% CI 1.4 to3.0, use of vasoactive drugs (OR 3.4, 95% CI 1.9 to 6, 0, insulin use (OR 1.8; 95% CI 1.2 to 2.8, surgical reintervention (OR 4.4; 95% CI 2.1 to 9.0 pneumonia (OR 4.3; 95% CI 2.1 to 8.9 and bloodstream infection (OR = 4.7, 95% CI 2.0 to 11.2. Conclusion: Non-surgical hospital infections are common in patients undergoing cardiac surgery; they increase the chance of surgical wound infection and mortality.

  5. 31P-NMR study of cardiac preservation: St. Thomas' Hospital cardioplegic solution versus UW preservation solution.

    Science.gov (United States)

    Minten, J; Van Hecke, P; Vanstapel, F; Flameng, W

    1991-06-01

    Ex vivo cardiac preservation was evaluated by measuring the catabolism of high-energy phosphate (ATP and creatine phosphate, CrP) using 31P-NMR spectroscopy. After cardioplegic arrest St. Thomas' Hospital cardioplegic solution (group A), and University of Wisconsin (UW) preservation solution (group B) were tested. The hearts were mounted in the 4.7 T horizontal bore magnet of the NMR spectrometer and were continuously perfused with the test solution under 25 cm H2O pressure for 6 h at 10 degrees C. Peak heights of the beta-phosphate of ATP and CrP were measured and expressed as percentages of the initial value. For both group A and group B. ATP declined less rapidly during preservation than CrP. In group A, ATP remained constant for 60 min while CrP decreased from the onset of preservation. After 6 h of preservation 28.3% of ATP and 24.5% of CrP remained (group A). On the other hand, in group B, levels of both ATP and CrP remained much more stable: CrP did not decrease during the first 3 h of preservation, while ATP started to decrease after 5 h. At the end of preservation 76.1% of ATP and 71.5% of CrP were still present. We conclude that UW solution is superior to St. Thomas' Hospital solution for the preservation of high-energy phosphates during 6 h cardiac preservation with continuous hypothermic low-flow perfusion. PMID:1910434

  6. Risk Stratification for Sudden Cardiac Death: Current Approaches and Predictive Value

    OpenAIRE

    Lopera, Gustavo; Curtis, Anne B.

    2009-01-01

    Sudden cardiac death (SCD) is a serious public health problem; the annual incidence of out-of-hospital cardiac arrest in North America is approximately 166,200. Identifying patients at risk is a difficult proposition. At the present time, left ventricular ejection fraction (LVEF) remains the single most important marker for risk stratification. According to current guidelines, most patients with LVEF

  7. Frequency and echocardiographic study of dilated cardiomyopathy in children presenting with cardiac failure

    International Nuclear Information System (INIS)

    Objective: To evaluate the role of echocardiography in diagnosis of dilated cardiomyopathy as a cause of cardiac failure in children. Design: This was descriptive study. Children presenting with cardiac failure from indoor patients were selected and echocardiography along with chest X- ray, ECG, cardiac enzymes and ASO titre was performed in all patients. Subject: Fifty hospitalized patients with congestive heart failure were selected consecutively from hospitalized patients. Main Outcome: Role of echocardiography in the diagnosis of dilated cardiomyopathy in children presenting with cardiac failure. Results: Out of fifty patients admitted with cardiac failure 27 (54%) cases were found to be dilated cardiomyopathy while congenital heart disease, myocarditis and rheumatic heart disease were found in 12 (24%), 8 (16%) and 3 (6%) cases respectively. Conclusion: Dilated cardiomyopathy is an important cause of cardiac failure in children and echocardiography is an important tool to diagnose and differentiate dilated cardiomyopathy from other causes of cardiac failure. (author)

  8. Gasto de hogares durante la hospitalización de menores derechohabientes, con diagnóstico de leucemia, en dos hospitales en México / Out-of-pocket expenditures during hospitalization of young leukemia patients with state medical insurance in two Mexican hospitals

    Scientific Electronic Library Online (English)

    Arnoldo, Rocha-García; Patricia, Hernández-Peña; Silvia, Ruiz-Velazco; Leticia, Avila-Burgos; Teresa, Marín-Palomares; Eduardo, Lazcano-Ponce.

    2003-08-01

    Full Text Available OBJETIVO: Estimar el gasto de los hogares durante la primera hospitalización en 51 menores de 15 años de edad con leucemia, atendidos en dos hospitales del Instituto Mexicano del Seguro Social, en México durante 1997. MATERIAL Y MÉTODOS: Estudio transversal hecho en 1997 en el Distrito Federal y en [...] León, Guanajuato. Se aplicó un cuestionario a los padres de 51 menores de 15 años de edad con diagnóstico de leucemia, hospitalizados por primera vez, en dos unidades del Instituto Mexicano del Seguro Social. Se capturó la información de los costos directos e indirectos enfrentados por los hogares durante esa primera hospitalización. Se aplicó el Indice de Precios al Consumidor (1997-2002) para expresar las estimaciones en precios de 2002. Se estimaron indicadores de gasto promedio y gastos catastróficos. Se establecieron los factores asociados, mediante un modelo de regresión lineal, utilizando el gasto total durante la hospitalización como variable dependiente. RESULTADOS: El costo promedio por paciente hospitalizado es de 7 318 pesos. El 86% corresponde a gastos asociados con la atención y 14% a costos indirectos. Para 14% de los hogares este gasto fue catastrófico. En 47% de los casos la erogación rebasó 100% de su ingreso disponible durante el periodo. Estos gastos se asociaron con lugar de residencia, nivel de ingreso y tipo de seguro. CONCLUSIONES: Ser derechohabiente de la seguridad social reduce los gastos de bolsillo por atención directa de los pacientes, pero no reduce los gastos complementarios, que pueden resultar onerosos para una elevada proporción de hogares. El costo de la primera hospitalización significó, en más de la mitad de los casos estudiados, el consumo de los ahorros, el endeudamiento o la venta de propiedades de los hogares, y dificultó la continuidad del tratamiento. Abstract in english OBJECTIVE: To estimate out-of-pocket expenditures for health care during the first hospitalization of children treated for leukemia in two hospitals of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social -IMSS-). MATERIAL AND METHODS: A cross-sectional study was conducted [...] in Mexico City and Leon, Guanajato, Mexico in 1997. The study population consisted of the parents of 51 children under 15 years of age diagnosed with leukemia, who were hospitalized for the first time in two IMSS hospitals. A questionnaire was applied to participants to obtain direct and indirect expenditures during that period. Consumer price indexes (1997-2002) were used to estimate expenditure prices for 2002. Average expenditures and catastrophic expenditures were estimated. Factors associated with expenditures were analyzed using a linear regression model in which the dependent variable was the total household expenditures during hospitalization. RESULTS: The average household cost per hospitalization was 7 318 pesos, 86% of which corresponded to medical care and 14% to indirect costs. Catastrophic expenditures occurred in 14% of households. In 47% of household expenditures exceeded 100% of the total household income during the hospitalization period. Expenditures during hospitalization were associated with place of residence, income level, and type of medical insurance. CONCLUSIONS: Being an IMSS policyholder decreased out-of-pocket expenditures, but not complementary expenditures, which may still be unaffordable for a large segment of the population. For more than a half of the households studied, continuity of care was compromised, as expenditures during the first hospitalization entailed using up savings, going into debt, and/or selling household property.

  9. The cardiac catheterization laboratory personnel TLD dosimetry in Dr. Faghihi Hospital in Shiraz

    International Nuclear Information System (INIS)

    In this study all of the personnel of Angiography of Dr.Faghihi hospital used TLD service During 2002-2003. This service was given by center for Radiation Protection and Application of the Shiraz University. These staff were divided in two group, one groups was technicians and the other group was the nurses. The result of this research shows that the maximum dose received to Technicians and nurses were 0.4mSv and 0.55mSV respectively. The average annual dose to technicians and nurses were 0.02 mSv and 0.19 mSv. This result shows that the nurses of this hospital receive more dose than the techniques

  10. Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM): a randomised controlled trial [ISRCTN72884263

    OpenAIRE

    Lane Deirdre; Taylor Rod; Mant Jonathan; Raftery James P; Greenfield Sheila M; Sandercock Josie; Lip Gregory YH; Jolly Kate; Lee Kaeng; Stevens AJ

    2003-01-01

    Abstract Background Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation. Methods/design A pragmatic randomised controlle...

  11. Feasibility and Acceptability of Utilizing a Smartphone Based Application to Monitor Outpatient Discharge Instruction Compliance in Cardiac Disease Patients around Discharge from Hospitalization

    OpenAIRE

    Layton, Aimee M.; Whitworth, James; Peacock, James; Bartels, Matthew N.; Jellen, Patricia A.; Thomashow, Byron M.

    2014-01-01

    The purpose of this study was to determine the feasibility and acceptability of utilizing a smartphone based application to monitor compliance in patients with cardiac disease around discharge. For 60 days after discharge, patients' medication compliance, physical activity, follow-up care, symptoms, and reading of education material were monitored daily with the application. 16 patients were enrolled in the study (12 males, 4 females, age 55 ± 18?years) during their hospital stay. Five partic...

  12. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease : 12-month results of a randomized clinical trial

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe Olsen; Soja, Anne Merete Boas

    2008-01-01

    Current guidelines broadly recommend comprehensive cardiac rehabilitation (CCR), although evidence for this is still limited. We investigated the 12-month effect of hospital-based CCR versus usual care (UC) for a broadly defined group of cardiac patients within the modern therapeutic era of cardiology.

  13. Complicações pulmonares em crianças submetidas à cirurgia cardíaca em um hospital universitário / Pulmonary complications in pediatric cardiac surgery at a university hospital

    Scientific Electronic Library Online (English)

    Daniel Lago, Borges; Lícia Raquel Teles, Sousa; Raquel Teixeira, Silva; Holga Cristina da Rocha, Gomes; Fernando Mauro Muniz, Ferreira; Willy Leite, Lima; Lívia Christina do Prado Lui, Borges.

    2010-06-01

    Full Text Available OBJETIVO: Identificar a prevalência de complicações pulmonares em crianças submetidas à cirurgia cardíaca, assim como características demográficas e clínicas da população estudada. MÉTODOS: A amostra foi composta por 37 crianças, de ambos os sexos, submetidas à cirurgia cardíaca no Hospital Universi [...] tário Presidente Dutra, São Luís (MA), durante o ano de 2007. Não foram incluídos pacientes que apresentaram doença pulmonar pré-cirúrgica, portadores de distúrbios neurológicos, óbito intra-operatório, além de falta de dados no prontuário. Os dados foram obtidos pela coleta nas evoluções médicas e de enfermagem dos respectivos prontuários. RESULTADOS: Quanto às características populacionais, houve predomínio de crianças do sexo feminino, provenientes do interior do estado e na faixa etária escolar. Patologias consideradas de baixo risco foram a maioria, destacando-se a persistência do canal arterial, comunicação interventricular e comunicação interatrial. Observou-se que a maior parcela das crianças fez uso de circulação extracorpórea por mais de 30 minutos, sendo a mediana igual a 80 minutos, sofreu esternotomia mediana, utilizou apenas dreno mediastinal e fez uso de ventilação mecânica pós-operatória, sendo a mediana aproximadamente de 6,6 horas. Somente três (8,1%) pacientes apresentaram complicações pulmonares, sendo que destes, dois foram a óbito. CONCLUSÃO: A maioria das crianças da amostra era do sexo feminino, na faixa etária escolar e proveniente do interior do estado. Os baixos tempos de circulação extracorpórea e ventilação mecânica, além de cardiopatias congênitas consideradas de baixo risco, podem ter sido fatores contribuintes para o pequeno índice de complicações pulmonares no pós-operatório. Abstract in english OBJECTIVE: To identify the prevalence of pulmonary complications in children undergone cardiac surgery, as well as demographic and clinical characteristics of this population. METHODS: The sample comprised 37 children of both genders, underwent cardiac surgery at the Hospital Universitário President [...] e Dutra, São Luis (MA) during the year of 2007. There were not included patients who had lung disease in pre-operative period, patients with neurological disorders, intra-operative death besides lack of data in medical records. The data were obtained from general medical and nursing staff of their medical records. RESULTS: The population of the study was predominantly composed by female children, from the countryside and at school age. Pathologies considered low risk were the majority, especially the patent ductus arteriosus, interventricular communication and interatrial communication. It was observed that the largest share of children made use of cardiopulmonary bypass for more than 30 minutes, with a median of 80 minutes, suffered a median sternotomy, using only the mediastinal drain and made use of mechanical ventilation after surgery, with the median about 6.6 hours. Only three (8.1%) patients developed pulmonary complications, and of these, two died. CONCLUSION: Most of the sample was female, school aged and from the countryside. The low time of cardiopulmonary bypass and mechanical ventilation, and congenital heart disease with low risk, may have been factors that contributed to the low rate of pulmonary complications postoperative.

  14. Grupo educativo de cirurgia cardíaca em um hospital universitário: impacto psicológico / Cardiac surgery educational group in a university hospital: psychological impact

    Scientific Electronic Library Online (English)

    Jeanny Joana Rodrigues Alves de, Santana; Luan Flávia Barufi, Fernandes; Carla Rodrigues, Zanin; Christiane Maia, Waeteman; Marcelo, Soares.

    2010-03-01

    Full Text Available Este estudo avaliou o impacto psicológico de um grupo educativo de cirurgia cardíaca em pacientes de um hospital universitário. Participaram 73 sujeitos, dos quais 62% eram homens. A média de idade foi 52 anos, desvio-padrão foi 16. Os pacientes foram submetidos a uma sessão multidisciplinar com exp [...] osição dialogada sobre cardiopatias, procedimento cirúrgico e sintomas psicológicos. Os resultados mostraram que, para poucos pacientes (36%), o grupo ajudou a esclarecer dúvidas sobre o tratamento, demonstrando a necessidade de ajustes nas estratégias didáticas para melhor compreensão dos conteúdos. A análise das emoções percebidas após participação no programa revelou que 70% responderam estar esperançosos. A contraposição entre "esperança" e "tranquilidade" foi uma resposta emocional esperada frente à vivência da cirurgia, avaliada como uma condição de ameaça ambiental. Conclui-se que o grupo educativo foi benéfico para o ajustamento psicossocial do paciente à cirurgia. Entretanto, maior eficácia será alcançada mediante aperfeiçoamento do método de atuação e inclusão de um programa interdisciplinar estruturado para controle do stress. Abstract in english This study assessed the psychological impact of an educational group for cardiac surgery patients in a university hospital. Seventy-three subjects took part in the study - 62% were men with an average age of 52 (standard deviation = 16), subjected to a multidisciplinary session including discussion [...] about heart disease, surgical procedures and psychological symptoms. The results showed that for a few patients (36%), the group helped to clarify questions about the treatment, demonstrating the need for adjustments in teaching strategies for a better understanding of the content. The analysis of emotions perceived after participation in the program showed that 70% were said to be hopeful. The contrast between "hope" and "tranquility" was an expected emotional response given the experience of surgery, evaluated as an environmental threat condition. It was concluded that the educational group was beneficial to the patients' psychosocial adjustment to surgery. However, greater effectiveness will be achieved by improving the performance method and the inclusion of an interdisciplinary program designed to control stress.

  15. Role of cardiac biomarkers (troponin I and CK-MB as predictors of quality of life and long-term outcome after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Bignami Elena

    2009-01-01

    Full Text Available Perioperative and postoperative morbidity and mortality associated with cardiac surgery affect both the outcome and quality of life. Markers such as troponin effectively predict short-term outcome. In a prospective cohort study in a University Hospital we assessed the role of cardiac biomarkers, also as predictors of long-term outcome and life quality after cardiac surgery with a three-year follow-up after conventional heart surgery. Patients were interviewed via phone calls with a structured questionnaire examining general health, functional status, activities of daily living, perception of life quality and need for hospital readmission. Descriptive statistics and multivariate analysis were performed. Out of 252 consecutive patients, 8 (3.2% died at the three years follow up: 7 for cardiac complications and 1 for cancer. Thirty-six patients (13.5% had hospital readmission for cardiac causes (mostly for atrial fibrillation or other arrhythmias (9.3%, but none needed cardiac surgical reintervention; 21 patients (7.9% were hospitalised for non-cardiac causes. No limitation in function activities of daily living was reported by most patients (94%, 92% perceived their general health as excellent, very good or good and none considered it insufficient; 80% were NYHA I, 17% NYHA II, 3% NYHA III and none NYHA IV. Multivariate analysis indicated preoperative treatment with digitalis or nitrates, and postoperative cardiac biomarkers release was independently associated to death. Elevated cardiac biomarker release and length of hospital stay were the only postoperative independent predictors of death in this study.

  16. Management of penetrating cardiac injuries in the Department of surgery, Mohamed Thahar Maamouri Hospital, Tunisia: report of 19 cases

    OpenAIRE

    Ezzine, Sonia Baccari; Bouassida, Mahdi; Benali, Mechaal; Ghannouchi, Mosaab; Chebbi, Fethi; Sassi, Sélim; Mighri, Mohamed Mongi; Touinsi, Hassen; Sassi, Sadok

    2012-01-01

    The goal of this paper is to discuss how to ameliorate the management of penetrating cardiac injuries in general surgery department. An algorithm for the initial assessment of penetrating injuries in cardiac box, based on our own experience, is presented. This was a retrospective study of 19 patients undergoing thoracotomy for penetrating cardiac injuries, managed in the department of general surgery of Nabeul-Tunisia, between 1994 and 2010. The mean age of patients was 25 years old. Sex rati...

  17. Complement Inhibition as a Proposed Neuroprotective Strategy following Cardiac Arrest

    OpenAIRE

    E. Sander Connolly; Andrew F. Ducruet; Grobelny, Bartosz T.; Peter A. DeRosa; Hickman, Zachary L.; Zacharia, Brad E

    2009-01-01

    Out-of-hospital cardiac arrest (OHCA) is a devastating disease process with neurological injury accounting for a disproportionate amount of the morbidity and mortality following return of spontaneous circulation. A dearth of effective treatment strategies exists for global cerebral ischemia-reperfusion (GCI/R) injury following ...

  18. Knowledge, attitude and practices on needle-stick and sharps injuries in tertiary care cardiac hospital: A survey

    Directory of Open Access Journals (Sweden)

    S Sharma

    2010-01-01

    Full Text Available Aims: One of the potential hazards for health care workers (HCWs is needle-stick and sharp injuries (NSSIs. The objective of the study was to assess the knowledge and attitude of health care workers about the NSSIs. Settings and Design: This was a cross-sectional survey conducted in the tertiary care cardiac center. The participants were health care workers including doctors, nurses, technicians, and housekeeping staff from the different areas of the hospital. Methods and Materials: This cross-sectional survey was conducted in the institute using a self-administered validated questionnaire. The participants consisted of a total of 190 HCWs namely doctors, nurses, technicians, and housekeeping staff. Statistical Analysis Used: Nil. Results: Results showed maximum participant were in the age group of 20-30 years. 94.7% were aware about standard precautions. 91.5% knew about the procedure for reporting of NSSIs. Only 50.2% HCWs gave correct answers regarding disease transmission through needle stick and sharp injury. The prevalence of NSSIs was highest among nurses (38.4%, and needle on the disposable syringe (76.9% was the most common source of NSSIs. Conclusions: The survey revealed few gaps in the knowledge amongst HCWs about NSSIs like risks associated with needle-stick injuries and use of preventive measures, disassembling of needles prior to disposal. These gaps can be addressed by extensive education. As nurses were the most affected victim for the NSSIs, more emphasis should be given towards them for reducing the NSSIs.

  19. Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM: a randomised controlled trial [ISRCTN72884263

    Directory of Open Access Journals (Sweden)

    Lane Deirdre

    2003-09-01

    Full Text Available Abstract Background Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation. Methods/design A pragmatic randomised controlled trial of home-based compared with hospital-based cardiac rehabilitation in four hospitals serving a multi-ethnic inner city population in the United Kingdom was designed. The home programme is nurse-facilitated, manual-based using the Heart Manual. The hospital programmes offer comprehensive cardiac rehabilitation in an out-patient setting. Patients We will randomise 650 adult, English or Punjabi-speaking patients of low-medium risk following myocardial infarction, coronary angioplasty or coronary artery bypass graft who have been referred for cardiac rehabilitation. Main outcome measures Serum cholesterol, smoking cessation, blood pressure, Hospital Anxiety and Depression Score, distance walked on Shuttle walk-test measured at 6, 12 and 24 months. Adherence to the programmes will be estimated using patient self-reports of activity. In-depth interviews with non-attendees and non-adherers will ascertain patient views and the acceptability of the programmes and provide insights about non-attendance and aims to generate a theory of attendance at cardiac rehabilitation. The economic analysis will measure National Health Service costs using resource inputs. Patient costs will be established from the qualitative research, in particular how they affect adherence. Discussion More data are needed on the role of home-based versus hospital-based cardiac rehabilitation for patients following myocardial infarction and revascularisation, which would be provided by the Birmingham Rehabilitation Uptake Maximisation Study (BRUM study and has implications for the clinical management of these patients. A novel feature of this study is the inclusion of non-English Punjabi speakers.

  20. Trauma penetrante cardíaco en la unidad de emergencia del Hospital Carlos Van Buren / Penetrating cardiac trauma. Review of 36 operated patients

    Scientific Electronic Library Online (English)

    GONZALO, GÓMEZ C; JOSÉ, HOLA B.

    2009-10-01

    Full Text Available El trauma penetrante cardíaco representa una de las mayores causas de muerte por motivo de violencia urbana y se clasifica en penetrante o contuso. La causa más común de trauma cardíaco penetrante es la herida por arma blanca o de fuego. La principal causa de trauma penetrante cardíaco en nuestra se [...] rie fue la lesión por arma blanca, siendo el ventrículo derecho la principal cámara cardíaca afectada. Los resultados quirúrgicos son comparables con otras series, con una mortalidad del 16,6% y una morbilidad de 22%. La mortalidad quirúrgica está relacionada con el retraso de la cirugía, o la lesión por arma de fuego, o la presencia de lesiones complejas. Aún sigue siendo fundamental el diagnóstico clínico y el manejo precoz. Abstract in english Background: The most common cause of cardiac penetrating trauma is wounds caused by knives or firearms. Aim: To review the operated cases of penetrating cardiac trauma in a public hospital emergency room. Material and Methods: Review of medical records of patients operated for penetrating cardiac tr [...] auma between 1986 and 2009. Results: We retrieved the records of 36 patients (33 males) with a median age of 30 years. Ninety four percent of lesions were cause by knife wounds. In 24 patients, the right ventncle was injured. Immediate surgical mortality was 17% and 22% of patients had complications. Conclusions: Surgical mortality in penetrating cardiac trauma is related to the delay of surgical correction, injury by firearms or the presence of complex lesions.

  1. Trauma penetrante cardíaco en la unidad de emergencia del Hospital Carlos Van Buren Penetrating cardiac trauma. Review of 36 operated patients

    Directory of Open Access Journals (Sweden)

    GONZALO GÓMEZ C

    2009-10-01

    Full Text Available El trauma penetrante cardíaco representa una de las mayores causas de muerte por motivo de violencia urbana y se clasifica en penetrante o contuso. La causa más común de trauma cardíaco penetrante es la herida por arma blanca o de fuego. La principal causa de trauma penetrante cardíaco en nuestra serie fue la lesión por arma blanca, siendo el ventrículo derecho la principal cámara cardíaca afectada. Los resultados quirúrgicos son comparables con otras series, con una mortalidad del 16,6% y una morbilidad de 22%. La mortalidad quirúrgica está relacionada con el retraso de la cirugía, o la lesión por arma de fuego, o la presencia de lesiones complejas. Aún sigue siendo fundamental el diagnóstico clínico y el manejo precoz.Background: The most common cause of cardiac penetrating trauma is wounds caused by knives or firearms. Aim: To review the operated cases of penetrating cardiac trauma in a public hospital emergency room. Material and Methods: Review of medical records of patients operated for penetrating cardiac trauma between 1986 and 2009. Results: We retrieved the records of 36 patients (33 males with a median age of 30 years. Ninety four percent of lesions were cause by knife wounds. In 24 patients, the right ventncle was injured. Immediate surgical mortality was 17% and 22% of patients had complications. Conclusions: Surgical mortality in penetrating cardiac trauma is related to the delay of surgical correction, injury by firearms or the presence of complex lesions.

  2. Analysis of steps adapted protocol in cardiac rehabilitation in the hospital phase / Análise do protocolo adaptado de steps na reabilitação cardíaca na fase hospitalar

    Scientific Electronic Library Online (English)

    Eliane Roseli, Winkelmann; Fernanda, Dallazen; Angela Beerbaum Steinke, Bronzatti; Juliara Cristina Werner, Lorenzoni; Pollyana, Windmöller.

    2015-02-01

    Full Text Available Objetivo: Analisar o protocolo adaptado de reabilitação cardíaca na fisioterapia durante a fase hospitalar pós-operatória de cirurgia cardíaca em um serviço de alta complexidade, nos aspectos complicações e prevalência de mortalidade e dias de internação. Métodos: Estudo observacional transversal, [...] retrospectivo, analítico. Realizado por meio da investigação de 99 prontuários de pacientes submetidos à cirurgia cardíaca de revascularização do miocárdio, troca de valva cardíaca ou associadas. Foi analisado um programa de step adaptado para reabilitação pós-operatória de cirurgia cardíaca executado pela equipe de Fisioterapia. Resultados: Em média, o paciente permanece dois dias na Unidade de Terapia Intensiva e de três a quatro dias no quarto, ficando, em média, seis dias internado no hospital. O óbito ocorreu em maior percentual no período hospitalar (5,1%) e até dois anos (8,6%) quando comparado ao período de 30 dias pós-alta hospitalar (1,1%). Dentre as complicações no pós-operatório, as hemodinâmicas (63,4%) e respiratórias (42,6%) foram as mais predominantes. De 36% a 42% das complicações ocorreram entre o pós-operatório imediato e o segundo dia pós-operatório. A alta hospitalar teve início a partir do quinto dia pós-operatório. Podemos observar que, com o passar dos dias, os pacientes vão evoluindo na realização dos steps, sendo que o mais utilizado durante a reabilitação na fase I foi o Step 3. Conclusão: Este programa de evolução por steps pode nortear a reabilitação fisioterapêutica nos pacientes no pós-operatório de cirurgia cardíaca na fase hospitalar. Abstract in english Objective: To analyze a cardiac rehabilitation adapted protocol in physical therapy during the postoperative hospital phase of cardiac surgery in a service of high complexity, in aspects regarded to complications and mortality prevalence and hospitalization days. Methods: This is an observational c [...] ross-sectional, retrospective and analytical study performed by investigating 99 patients who underwent cardiac surgery for coronary artery bypass graft, heart valve replacement or a combination of both. Step program adapted for rehabilitation after cardiac surgery was analyzed under the command of the physiotherapy professional team. Results: In average, a patient stays for two days in the Intensive Care Unit and three to four days in the hospital room, totalizing six days of hospitalization. Fatalities occurred in a higher percentage during hospitalization (5.1%) and up to two years period (8.6%) when compared to 30 days after hospital discharge (1.1%). Among the postoperative complications, the hemodynamic (63.4%) and respiratory (42.6%) were the most prevalent. 36-42% of complications occurred between the immediate postoperative period and the second postoperative day. The hospital discharge started from the fifth postoperative day. We can observe that in each following day, the patients are evolving in achieving the Steps, where Step 3 was the most used during the rehabilitation phase I. Conclusion: This evolution program by steps can to guide the physical rehabilitation at the hospital in patients after cardiac surgery.

  3. Repair of a Complex Congenital Cardiac Defect

    Medline Plus

    Full Text Available REPAIR OF A COMPLEX CONGENITAL CARDIAC DEFECT CHILDREN'S HOSPITAL BOSTON BOSTON, MASSACHUSETTS October 5, 2007 00:00:14 ANNOUNCER: Over the next hour, live from Children's Hospital Boston's cardiac OR, see ...

  4. Hospitals

    DEFF Research Database (Denmark)

    Mullins, Michael

    2013-01-01

    The challenge could be briefly seen in these terms: hospitals as places for treatment where there’s a technology focus and hospitals for healing where there’s a human focus. In the 60s - 70s wave of new hospital building, an emphasis on technology can be seen. It’s time to move from the technology focus. It is not enough to consider only the factors of function within architecture, hygiene, economy and logistics. We also need to look at aspects of aesthetics, bringing nature into the building, a...

  5. A CASE-CROSSOVER ANALYSIS OF PARTICULATE MATTER AIR POLLUTION AND OUT-OF-HOSPITAL PRIMARY CARDIAC ARREST. (R827355C001)

    Science.gov (United States)

    The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

  6. A randomized clinical trial of hospital-based, comprehensive cardiac rehabilitation versus usual care for patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease (the DANREHAB trial)--design, intervention, and population

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe Olsen; Soja, Anne Merete Boas; Brønnum-Hansen, Henrik; Gluud, Christian; Iversen, Lars; Sigurd, Bjarne; Madsen, Mette; Fischer-Hansen, Jørgen

    2005-01-01

    BACKGROUND: Current guidelines broadly recommend comprehensive cardiac rehabilitation (CR), although evidence for this is still limited. It is not known whether evidence from before 1995 is still valid. STUDY DESIGN: The DANish Cardiac ReHABilitation (DANREHAB) trial was designed as a centrally randomized clinical trial to clarify whether hospital-based comprehensive CR is superior to usual care for patients with congestive heart failure, ischemic heart disease, or high risk for ischemic heart d...

  7. A randomized clinical trial of hospital-based, comprehensive cardiac rehabilitation versus usual care for patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease (the DANREHAB trial) - design, intervention, and population

    DEFF Research Database (Denmark)

    Zwisler, A.D.O.; Schou, O.; Soja, A.M.B.; Bronnum-Hansen, H.; Gluud, C.; Iversen, L.; Sigurd, B.; Madsen, M.; Fischer-Hansen, J.; Danrehab, Grp

    2005-01-01

    Background Current guidelines broadly recommend comprehensive cardiac rehabilitation (CR), although evidence for this is still limited. It is not known whether evidence from before 1995 is still valid. Study Design The DANish Cardiac REHABilitation (DANREHAB) trial was designed as a centrally randomized clinical trial to clarify whether hospital-based comprehensive CR is superior to usual care for patients with congestive heart failure, ischemic heart disease, or high risk for ischemic heart dis...

  8. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe Olsen; Soja, Anne Merete Boas; Rasmussen, Søren; Frederiksen, Marianne; Abadini, Sadollah; Appel, Jon; Rasmussen, Hanne; Gluud, Christian; Iversen, Lars; Sigurd, Bjarne; Madsen, Mette; Fischer-Hansen, Jørgen

    2008-01-01

    BACKGROUND: Current guidelines broadly recommend comprehensive cardiac rehabilitation (CCR), although evidence for this is still limited. We investigated the 12-month effect of hospital-based CCR versus usual care (UC) for a broadly defined group of cardiac patients within the modern therapeutic era of cardiology. METHODS: We conducted a centrally randomized single-center clinical trial with blinded assessment of the primary outcome: registry-based composite of total mortality, myocardial infarc...

  9. Trauma penetrante cardiaco tratado en el Hospital Territorial Docente Pedro Betancourt Municipio Jovellanos. 2004. Reporte de un caso Penetrating cardiac trauma treated at the teaching Territorial Hospital Pedro Betancourt. Municipality of Jovellanos. 2004. Report of a case

    Directory of Open Access Journals (Sweden)

    Alfredo Sandelis Acosta

    2010-12-01

    Full Text Available Los traumas penetrantes cardiacos constituyen uno de los cuadros más dramáticos que pueden presentarse en la sala de urgencia por su alta letalidad, sólo un rápido traslado al centro asistencial, un diagnóstico precoz y una toracotomía de urgencia, puede aumentar la supervivencia. Se presentó un paciente operado en el Hospital Territorial Docente Pedro Betancourt, de Jovellanos, en mayo del 2004, de una herida ventricular izquierda, logrando su supervivencia.Penetrating cardiac trauma is one of the most dramatic features that could assist the urgency service because of its high lethality. Only a fast delivery of the patient to a health care institution, a precocious diagnostic and an urgent thoracotomy might increase survival. We present a patient operated in the Teaching Territorial Hospital Pedro Betancourt, Jovellanos, in May 2004, for a left ventricular injury, achieving his survival.

  10. Trauma penetrante cardiaco tratado en el Hospital Territorial Docente Pedro Betancourt Municipio Jovellanos. 2004. Reporte de un caso / Penetrating cardiac trauma treated at the teaching Territorial Hospital Pedro Betancourt. Municipality of Jovellanos. 2004. Report of a case

    Scientific Electronic Library Online (English)

    Alfredo, Sandelis Acosta; Juan A, Fariñas Correa; Ricardo, Souza Bello; Jorge E, Garchitorena González; Cándido, Lima Fernández.

    2010-12-01

    Full Text Available Los traumas penetrantes cardiacos constituyen uno de los cuadros más dramáticos que pueden presentarse en la sala de urgencia por su alta letalidad, sólo un rápido traslado al centro asistencial, un diagnóstico precoz y una toracotomía de urgencia, puede aumentar la supervivencia. Se presentó un pac [...] iente operado en el Hospital Territorial Docente Pedro Betancourt, de Jovellanos, en mayo del 2004, de una herida ventricular izquierda, logrando su supervivencia. Abstract in english Penetrating cardiac trauma is one of the most dramatic features that could assist the urgency service because of its high lethality. Only a fast delivery of the patient to a health care institution, a precocious diagnostic and an urgent thoracotomy might increase survival. We present a patient opera [...] ted in the Teaching Territorial Hospital Pedro Betancourt, Jovellanos, in May 2004, for a left ventricular injury, achieving his survival.

  11. Comparison of effective doses between computed tomography cardiac angiography and conventional angiography at Pantai Hospital, Kuala Lumpur

    Science.gov (United States)

    Mohamed, Faizal; Moin, F. H. A.

    2013-05-01

    This research studies two types of cardiac angiography procedures, namely Computed Tomography Cardiac Angiography (CTCA) and Conventional Angiography (CA). The following research was executed to estimate the difference of mean effective doses that the patients received through both procedures. The mean dose-length-product (DLP) from CTCA and mean dose-area-product (DAP) from CA were utilized in calculating the effective doses. The result shows that the mean effective dose for CTCA and CA are 1.71±0.59 mSv and 53.25±14.22 mSv respectively. This proves that the mean effective dose received by patients undergoing CA is higher than patients undergoing CTCA. According to t-test, both procedures differ significantly, with a difference amounting to p<0.0001. The increases of the effective dose that the patients received through CA procedure were influenced by exposure time, the coronary anatomical condition, the operator's experience, and the operation methods.

  12. Targeted temperature management at 33°C versus 36°C after cardiac arrest

    OpenAIRE

    Nielsen, Niklas; Wetterslev, Jørn; Cronberg, Tobias; Erlinge, David; Gasche, Yvan; Hassager, Christian; Horn, Janneke; Hovdenes, Jan; Kjaergaard, Jesper; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wanscher, Michael; Wise, Matt P; Åneman, Anders

    2013-01-01

    Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever.

  13. Temporal Influence of Heart Failure Hospitalizations Prior to Implantable Cardioverter Defibrillator or Cardiac Resynchronization Therapy With Defibrillator on Subsequent Outcome in Mild Heart Failure Patients (from MADIT-CRT)

    DEFF Research Database (Denmark)

    Lee, Andy Y; Moss, Arthur J

    2015-01-01

    The temporal effect of heart failure (HF) hospitalization occurring at different time periods before implantation has not yet been studied in detail. The aim of the present study was to investigate the potential association between time from last HF hospitalization to device implantation and effects on subsequent outcomes and benefit from cardiac resynchronization therapy with a defibrillator (CRT-D). Multivariate Cox models were used to determine the temporal influence of previous HF hospitalization on the end point of HF or death within all left bundle branch block implantable cardioverter-defibrillator (ICD) and CRT-D patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) trial (n = 1,250) and to evaluate the clinical benefit of CRT-D implantation, comparing CRT-D patients with ICD patients within each previous HF hospitalization group. The patients with previous HF hospitalization ?12 months before device implantation had the greatest incidence of HF or death during 4-year follow-up (31%), while those with previous HF hospitalization >12 months and those with no previous HF hospitalization had similar lower rates of HF or death (22% and 24%, respectively). All patients treated with CRT-D derived significant clinical benefit compared with their ICD counterparts, regardless of time of previous hospitalization (hazard ratios 0.38 [no previous hospitalization], 0.49 (?12 months), and 0.45 (>12 months); p for interaction = 0.67). In conclusion, in the present study of patients with mild HF with prolonged QRS intervals and LBBB, a previous HF hospitalization ?12 months was associated with increased risk for HF or death compared with >12 months and no previous HF hospitalizations. The clinical benefit of CRT-D was evident in all patients regardless of time from last HF hospitalization to implantation compared with ICD only.

  14. Resuscitation of patients suffering from sudden cardiac arrests in nursing homes is not futile

    DEFF Research Database (Denmark)

    Søholm, Helle; Bro-Jeppesen, John; Lippert, Freddy K; Køber, Lars; Wanscher, Michael; Kjaergaard, Jesper; Hassager, Christian

    2014-01-01

    BACKGROUND: Survival after out-of-hospital cardiac arrest (OHCA) has increased in recent years, and new data are therefore needed to avoid unsubstantiated statements when debating futility of resuscitation attempts following OHCA in nursing home (NH)-residents. We aimed to investigate the outcome and prognosis after OHCA in NH. METHODS: Consecutive Emergency Medical Service (EMS) attended OHCA-patients in Copenhagen during 2007-2011 were included. Utstein-criteria for pre-hospital data and revie...

  15. Impacto de la rehabilitación cardiaca intrahospitalaria en pacientes con I.M.A / Impact of cardiac intra-hospital rehabilitation in patients with Acute Myocardial Infarction

    Scientific Electronic Library Online (English)

    Liván, Cruz Benítez.

    2006-12-01

    Full Text Available Se realizó un estudio retrospectivo longitudinal y descriptivo sobre las ventajas de la aplicación de la fase 1 de la RC en el 100% de los pacientes con IMA de bajo riesgo atendidos en el periodo 2003-2004 en el Hospital General Docente ""Comandante Pinares"" en la provincia Pinar del Río. La invest [...] igación se basó en la toma de datos obtenidos en los expedientes clínicos de estos pacientes, que están archivados; donde las variables que se exploraron en las encuestas aplicadas incluyen anamnesis, examen físico, electrocardiograma, telecardiografía, aparición de complicaciones mayores y finalmente la clasificación funcional dada al alta hospitalaria. Todos los resultados demostraron las ventajas de la rehabilitación como parte esencial de la atención y terapéutica a la que deben tener acceso los pacientes con afecciones cardíacas de cualquier edad, para mejorar su calidad de vida. Abstract in english A retrospective, longitudinal and descriptive study was done on the advantages of applying the stage I of the RC in 100% of low-risk AMI patients assisted at Comandante Pinares General Teaching Hospital (HGCP) during 2003-2004 in Pinar del Río province. The research was based on data collected from [...] the clinical records of these patients, which are filed. The variables explored during the surveys include: anamnesis, physical examination, electrocardiogram, telecardiography, ocurrence of major complications and finally the functional classification done at hospital discharge. All results showed the rehabilitation advantages as essential part of the assistance and therapy which patients of any age and with cardiac disorders should have access to in order to improve their quality of life.

  16. Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper; Søholm, Helle; Wanscher, Michael; Lippert, Freddy K; Møller, Jacob E; Køber, Lars; Hassager, Christian

    2014-01-01

    AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopressor support and mortality. METHODS: In a 6-year period, 310 comatose OHCA patients treated with TH were included. Temperature, hemodynamic parameters and level of vasopressors were registered from admiss...

  17. Predictores de mortalidad intrahospitalaria y hospitalización prolongada en la insuficiencia cardíaca: resultados preliminares del registro nacional de insuficiencia cardíaca. Grupo ICARO Predictors of hospital death and prolonged hospitalization in patients with cardiac failure in Chilean hospitals

    Directory of Open Access Journals (Sweden)

    Pablo Castro G

    2006-09-01

    Full Text Available Background: Heart failure (HF is one of the most common causes for hospital admission. Aim: To evaluate clinical predictors of mortality and prolonged hospital stay among patients admitted for HF in Chilean hospitals. Patients and Methods: Prospective registry of 14 centers. Patients admitted for HF in functional class III and IV were included. Epidemiological, clinical data, functional class, decompensation cause, electrocardiogram, echocardiogram, treatment and evolution were registered. The endpoint was hospital death and hospital stay greater than 10 days. Results: Data from 646 patients (mean age 69±13 years, 56% men was collected. The main etiologies of HF were hypertensive in 29.6%, ischemic in 27.1% and valvular in 20%. Mean hospital stay was 10±9 days and mortality was 5.6%. Independent predictors of death and prolonged hospital stay were serum sodium <130 mEq/L at admission (odds ratio (OR 2.6, confidence interval (CI= 1.2-5.9, serum albumin <3 g/dL (OR 3.2, CI= 1.42-7.2 and a history of hypertension (OR 1.98, CI=1.1-3.85. The model predicted correctly the occurrence of the endpoint in 67% of cases. Conclusions: In patients admitted for worsening HF, low serum sodium, decreased serum albumin on admission and a history of hypertension increase the risk for in-hospital death and prolonged hospital stay

  18. Use of the hospital anxiety and depression scale (HADS) in a cardiac emergency room: chest pain unit

    OpenAIRE

    Soares-Filho, Gastão L. F.; Rafael C. Freire; Karla Biancha; Ticiana Pacheco; André Volschan; Valença, Alexandre M.; Nardi, Antonio E

    2009-01-01

    OBJECTIVE: To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. INTRODUCTION: Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. METHODOLOGY: Patients were assessed by the "Hospital Anxiety and Depression Scale" as a screening instrument wile following a systematized protocol to rule out the...

  19. Use of the hospital anxiety and depression scale (HADS) in a cardiac emergency room: chest pain unit

    Scientific Electronic Library Online (English)

    Gastão L. F., Soares-Filho; Rafael C., Freire; Karla, Biancha; Ticiana, Pacheco; André, Volschan; Alexandre M., Valença; Antonio E., Nardi.

    2009-03-01

    Full Text Available OBJECTIVE: To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. INTRODUCTION: Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may in [...] terfere in the patient prognosis. METHODOLOGY: Patients were assessed by the "Hospital Anxiety and Depression Scale" as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered "probable case" of anxiety or depression. RESULTS: According to the protocol, 59 (45.4%) of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6%) presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1%) had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression. CONCLUSION: The high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life.

  20. Predictors for outcome among cardiac arrest patients

    DEFF Research Database (Denmark)

    Wibrandt, Ida; Norsted, Kristine; Schmidt, Henrik; Schierbeck, Jens

    2015-01-01

    BackgroundIn the past decade, early treatment of cardiac arrest (CA) victims has been improved in several ways, leading to more optimistic over all prognoses. However, the global survival rate after out-of-hospital CA (OHCA) is still not more than 5-10%. With a better knowledge of the predictors for outcome among CA patients, we can improve the management of CA, in order to strengthen the leads in the chain of survival.MethodsA retrospective cohort study including 172 CA patients admitted to the...

  1. Características cardíacas e metabólicas de corredores de longa distância do ambulatório de cardiologia do esporte e exercício, de um hospital terciário / Cardiac and metabolic characteristics in long distance runners of sport and exercise cardiology outpatient facility of a tertiary hospital

    Scientific Electronic Library Online (English)

    Luciene Ferreira, Azevedo; Patrícia Chakur, Brum; Dudley, Rosemblatt; Patrícia de Sá, Perlingeiro; Antônio Carlos Pereira, Barretto; Carlos Eduardo, Negrão; Luciana Diniz Nagem Janot de, Matos.

    2007-01-01

    Full Text Available OBJETIVO: Caracterizar parâmetros cardíacos, eletrocardiográficos e funcionais, e respostas cardiopulmonares ao exercício em corredores de longa distância brasileiros, acompanhados no Ambulatório de Cardiologia do Esporte e Exercício de um hospital terciário. MÉTODOS: De uma população inicial de 443 [...] atletas, de ambos os sexos, de diferentes modalidades esportivas, foram avaliados 162 (37%) corredores de longa distância, do sexo masculino, com idade variando entre quatorze e 67 anos. Registros eletrocardiográficos (doze derivações) e ecocardiográficos (modos mono e bidimensional) foram realizados em repouso. Respostas cardiopulmonares foram avaliadas durante teste em esteira rolante, com protocolo em rampa. RESULTADOS: Alterações metabólicas e doenças cardiovasculares foram diagnosticadas em 17% e 9% dos corredores, respectivamente. Bradicardia sinusal e hipertrofia ventricular esquerda foram verificadas em 62% e 33% dos corredores, respectivamente. Alterações estruturais, como cavidade ventricular > 55mm, espessura relativa de parede > 0,44 e índice de massa ventricular > 134g/m2 foram encontradas em 15%, 11% e 7% dos corredores, respectivamente. Fração de ejeção Abstract in english OBJECTIVE: To characterize electrocardiographic and functional cardiac parameters and cardiopulmonary responses to exercise in long-distance Brazilian runners monitored at the Sport and Exercise Cardiology Outpatient Facility of a tertiary care hospital. METHODS: Of an initial population of 443 male [...] and female athletes of different sport modalities, we assessed 162 (37%) long-distance male runners, aged from 14 to 67. Electrocardiographic (12 leads) and echocardiographic (M-mode and two-dimensional) parameters were recorded at rest. Cardiopulmonary responses were evaluated on a treadmill with a ramp protocol. RESULTS: Metabolic alterations and cardiovascular diseases were diagnosed in 17% and 9% of the runners, respectively. Sinus bradycardia and left ventricular hypertrophy were observed in 62% and 33% of the runners, respectively. Structural alterations such as ventricular cavity > 55mm, relative wall thickness > 0.44, and ventricular mass index > 134g/m2 were found in 15%, 11% and 7% of the runners, respectively. Ejection fraction

  2. Ritmo circadiano y variaciones temporales en el paro cardiaco súbito extrahospitalario / Circadian rhythm and time variations in out-hospital sudden cardiac arrest

    Scientific Electronic Library Online (English)

    J.B., López-Messa; J.I., Alonso-Fernández; J.M., Andrés-de Llano; J.R., Garmendia-Leiza; J., Ardura-Fernández; F. de, Castro-Rodríguez; J.M., Gil-González.

    2012-09-01

    Full Text Available Objetivos: Analizar las características cronobiológicas y las variaciones temporales del paro cardiaco extrahospitalario (PCEH). Diseño: Estudio descriptivo retrospectivo. Pacientes: Todos los casos de PCEH de origen cardíaco registrados en la base de datos del servicio de emergencias médicas (SEM) [...] de la Comunidad Autónoma de Castilla y León (España) durante 18 meses. Variables de interés principales: Edad, sexo, recuperación de la circulación espontánea, primer ritmo monitorizado (desfibrilable /no desfibrilable), lugar de alerta [(hogar, lugar público, centro atención primaria (AP)], testigo (familiar, transeúnte, fuerzas de seguridad, personal AP), hora de alerta (0-8; 8-16; 16-24), hora de activación del equipo de emergencias, hora de atención y día de la semana. Análisis univariante mediante Chi², varianza y tests no paramétricos. Análisis cronobiológico mediante transformada rápida de Fourier y test Cosinor. Resultados: Se estudiaron 1.286 casos registrados entre enero 2007 y junio 2008. Se observaron diferencias estadísticas significativas en menor edad (p Abstract in english Objectives: To analyze the chronobiological and time variations of out- hospital cardiac arrest (OHCA). Design: A retrospective descriptive study was made. Patients: All cases of OHCA of cardiac origin registered over 18 months in the database of the emergency medical service (EMS) of the Autonomous [...] Community of Castilla y León (Spain) were evaluated. Variables analyzed: Age, sex, recovery of spontaneous circulation (ROSC), first monitored rhythm (amenable / not amenable to defibrillation), alert site [(home, public place, primary care (PC) center], alerting person (family, witness, law enforcement member, PC center staff), alert time (0-8; 8-16; 16-24), emergency team activation time, care time and day of the week. Univariate analysis (chi-squared), variance, and nonparametric tests comparing the variables in three periods of 8hours. Chronobiological analysis by fast Fourier transform and Cosinor testing. Results: We studied 1286 cases reported between January 2007 and June 2008. Statistically significant differences were observed in terms of younger age, higher incidence in the victim's home, and greater frequency of family-cohabiting persons as witnesses in the period between 0 and 8hours. Chronobiological analysis found daily rhythm (circadian) with acrophase at 11.16h (p

  3. Ritmo circadiano y variaciones temporales en el paro cardiaco súbito extrahospitalario Circadian rhythm and time variations in out-hospital sudden cardiac arrest

    Directory of Open Access Journals (Sweden)

    J.B. López-Messa

    2012-09-01

    Full Text Available Objetivos: Analizar las características cronobiológicas y las variaciones temporales del paro cardiaco extrahospitalario (PCEH. Diseño: Estudio descriptivo retrospectivo. Pacientes: Todos los casos de PCEH de origen cardíaco registrados en la base de datos del servicio de emergencias médicas (SEM de la Comunidad Autónoma de Castilla y León (España durante 18 meses. Variables de interés principales: Edad, sexo, recuperación de la circulación espontánea, primer ritmo monitorizado (desfibrilable /no desfibrilable, lugar de alerta [(hogar, lugar público, centro atención primaria (AP], testigo (familiar, transeúnte, fuerzas de seguridad, personal AP, hora de alerta (0-8; 8-16; 16-24, hora de activación del equipo de emergencias, hora de atención y día de la semana. Análisis univariante mediante Chi², varianza y tests no paramétricos. Análisis cronobiológico mediante transformada rápida de Fourier y test Cosinor. Resultados: Se estudiaron 1.286 casos registrados entre enero 2007 y junio 2008. Se observaron diferencias estadísticas significativas en menor edad (pObjectives: To analyze the chronobiological and time variations of out- hospital cardiac arrest (OHCA. Design: A retrospective descriptive study was made. Patients: All cases of OHCA of cardiac origin registered over 18 months in the database of the emergency medical service (EMS of the Autonomous Community of Castilla y León (Spain were evaluated. Variables analyzed: Age, sex, recovery of spontaneous circulation (ROSC, first monitored rhythm (amenable / not amenable to defibrillation, alert site [(home, public place, primary care (PC center], alerting person (family, witness, law enforcement member, PC center staff, alert time (0-8; 8-16; 16-24, emergency team activation time, care time and day of the week. Univariate analysis (chi-squared, variance, and nonparametric tests comparing the variables in three periods of 8hours. Chronobiological analysis by fast Fourier transform and Cosinor testing. Results: We studied 1286 cases reported between January 2007 and June 2008. Statistically significant differences were observed in terms of younger age, higher incidence in the victim's home, and greater frequency of family-cohabiting persons as witnesses in the period between 0 and 8hours. Chronobiological analysis found daily rhythm (circadian with acrophase at 11.16h (p<0.001 and weekly rhythm (circaseptan with acrophase on Wednesday (p<0.05. The median alert time-care time interval and emergency team activation time-care time were 11.7min and 8.0min, respectively, without differences between periods. Conclusions: We have demonstrated the presence of a daily rhythm of emergence of OHCA with a morning peak and a weekly rhythm with a peak on Wednesdays. These results can guide the planning of resources and improvements in response in certain time periods.

  4. Repair of a Complex Congenital Cardiac Defect

    Medline Plus

    Full Text Available REPAIR OF A COMPLEX CONGENITAL CARDIAC DEFECT CHILDREN'S HOSPITAL BOSTON BOSTON, MASSACHUSETTS October 5, 2007 00:00:14 ANNOUNCER: Over the next hour, live from Children's Hospital ...

  5. [Assessment of the prognosis in patients who remain comatose after resuscitation from cardiac arrest].

    Science.gov (United States)

    Ramberg, Emilie; Fedder, Anette Marianne; Dyrskog, Stig Eric; Degn, Niels Sanderhoff; Hassager, Christian; Jensen, Reinhold; Kirkegaard, Hans; Weber, Sven; Hoffmann-Petersen, Joachim Torp; Larsen, Niels Heden; Strange, Ditte Gry; Sonne, Morten; Lippert, Freddy K

    2014-06-30

    In Denmark there are around 3,500 unexpected cardiac arrests (CA) out of hospital each year. There is an unknown number of CA in hospitals. The survival rate after CA outside a hospital in Denmark is 10% after 30 days. There are varying data for the neurological outcome in this group of patients. The purpose of this work is to disseminate new knowledge and to help standardizing the treatment in the group of patients who remain comatose after being resuscitated from CA. Assessment of the prognosis for a patient in this group can be made after 72 hours and a multi-modal approach to the patient is required. PMID:25294674

  6. Outcomes in robotic cardiac surgery

    OpenAIRE

    Rodriguez, Evelio; Randolph Chitwood, W.

    2007-01-01

    The specialty of cardiac surgery has evolved substantially over the last 50 years, and surgical procedures that seemed impossible then are now commonly encountered in hospitals throughout the world. The latest development in this ever-evolving field is minimally invasive and robot-assisted procedures. In this article we will review the surgical outcomes reported for different series of procedures in cardiac surgery.

  7. ERC initiatives to reduce the burden of cardiac arrest: the European Cardiac Arrest Awareness Day.

    Science.gov (United States)

    Georgiou, Marios; Lockey, Andrew S

    2013-09-01

    The rate of survival from out-of-hospital cardiac arrest in Europe remains unacceptably low and could be increased by better bystander cardiopulmonary resuscitation (CPR) rates. The European Resuscitation Council has announced that there will be a European Cardiac Arrest Awareness Day every year on the 16th of October. This is to coincide with the goals of the Written Declaration passed by the European Parliament in June 2012 that emphasised the importance of equal access to CPR and automated external defibrillator (AED) training. The topic of this year's Awareness Day is 'Children Saving Lives' and it is hoped that all national resuscitation councils will promote awareness of the benefits of training all children in CPR and AED use and lobby for legislative change to ensure that all children receive this training. Children are not just the adults of tomorrow - they are the lifesavers of today and tomorrow. PMID:24054509

  8. Características cardíacas e metabólicas de corredores de longa distância do ambulatório de cardiologia do esporte e exercício, de um hospital terciário Cardiac and metabolic characteristics in long distance runners of sport and exercise cardiology outpatient facility of a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Luciene Ferreira Azevedo

    2007-01-01

    Full Text Available OBJETIVO: Caracterizar parâmetros cardíacos, eletrocardiográficos e funcionais, e respostas cardiopulmonares ao exercício em corredores de longa distância brasileiros, acompanhados no Ambulatório de Cardiologia do Esporte e Exercício de um hospital terciário. MÉTODOS: De uma população inicial de 443 atletas, de ambos os sexos, de diferentes modalidades esportivas, foram avaliados 162 (37% corredores de longa distância, do sexo masculino, com idade variando entre quatorze e 67 anos. Registros eletrocardiográficos (doze derivações e ecocardiográficos (modos mono e bidimensional foram realizados em repouso. Respostas cardiopulmonares foram avaliadas durante teste em esteira rolante, com protocolo em rampa. RESULTADOS: Alterações metabólicas e doenças cardiovasculares foram diagnosticadas em 17% e 9% dos corredores, respectivamente. Bradicardia sinusal e hipertrofia ventricular esquerda foram verificadas em 62% e 33% dos corredores, respectivamente. Alterações estruturais, como cavidade ventricular > 55mm, espessura relativa de parede > 0,44 e índice de massa ventricular > 134g/m2 foram encontradas em 15%, 11% e 7% dos corredores, respectivamente. Fração de ejeção OBJECTIVE: To characterize electrocardiographic and functional cardiac parameters and cardiopulmonary responses to exercise in long-distance Brazilian runners monitored at the Sport and Exercise Cardiology Outpatient Facility of a tertiary care hospital. METHODS: Of an initial population of 443 male and female athletes of different sport modalities, we assessed 162 (37% long-distance male runners, aged from 14 to 67. Electrocardiographic (12 leads and echocardiographic (M-mode and two-dimensional parameters were recorded at rest. Cardiopulmonary responses were evaluated on a treadmill with a ramp protocol. RESULTS: Metabolic alterations and cardiovascular diseases were diagnosed in 17% and 9% of the runners, respectively. Sinus bradycardia and left ventricular hypertrophy were observed in 62% and 33% of the runners, respectively. Structural alterations such as ventricular cavity > 55mm, relative wall thickness > 0.44, and ventricular mass index > 134g/m2 were found in 15%, 11% and 7% of the runners, respectively. Ejection fraction < 55% was observed in 4% of the runners. Peak oxygen uptake (VO2peak decreased as of the age of 41, although the anaerobic threshold relative to the VO2peak remained unchanged with age. CONCLUSION: Resting bradycardia and left ventricular hypertrophy are the most frequent cardiovascular adaptations in Brazilian long distance runners monitored by the Sport and Exercise Cardiology Outpatient Facility. Although VO2peak decreases after the age of 41, the relative oxygen uptake at the anaerobic threshold of these runners remained unchanged.

  9. The effect of therapeutic hypothermia after cardiac arrest

    Directory of Open Access Journals (Sweden)

    Georgia Mavrogianni

    2013-07-01

    Full Text Available Neurological impairment is common in survivors after cardiac arrest. Mild therapeutic hypothermia (32-34°C has been suggested to be useful in improving both survival rates and neurological outcome of these patients. Aim: The aim of the present study was to explore the relation between the method of mild therapeutic hypothermia, in ICU, with the traditional method (normothermia, for the treatment of out-of-hospital cardiac arrest survivals, after restoring spontaneous circulation. Material and method: As for the design, it was a retrospective study. The studied population consisted of 25 patients who suffered cardiac arrest, with initial cardiac rhythm ventricular fibrillation (VF or ventricular tachycardia (VT,who were successfully resuscitated and hospitalized after restoration of spontaneous circulation. During a 2-year period (2009-2011 these patients were treated with hypothermia (32-34°C with ice packs or an endovascular cooling device. Results: he systematic cooling of survivals, between 32-34°C for a 24-hour period, increased the probability of survival (p=0.17 and improved neurological outcomes (p= 0.06, compared to normothermia. Complications, such as arrhythmias, bleeding and infections were treated by rewarming. Conclusions: Although there is a number of complications associated with hypothermia such as arrhythmias, bleeding disorders and infection, none seems to relate to adverse patient outcomes.

  10. The impact of therapeutic hypothermia on neurological function and quality of life after cardiac arrest

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper; Horsted, Tina I; Wanscher, Michael C; Nielsen, Søren Louman; Rasmussen, Lars S; Hassager, Christian

    2008-01-01

    AIMS: To assess the impact of therapeutic hypothermia on cognitive function and quality of life in comatose survivors of out of Hospital Cardiac arrest (OHCA). METHODS: We prospectively studied comatose survivors of OHCA consecutively admitted in a 4-year period. Therapeutic hypothermia was implemented in the last 2-year period, intervention period (n=79), and this group was compared to patients admitted the 2 previous years, control period (n=77). We assessed Cerebral Performance Category (CPC)...

  11. Neurological prognostication after cardiac arrest and targeted temperature management 33°C versus 36°C

    DEFF Research Database (Denmark)

    Dragancea, Irina; Horn, Janneke; Kuiper, Michael; Friberg, Hans; Ullén, Susann; Wetterslev, Jørn; Cranshaw, Jules; Hassager, Christian; Nielsen, Niklas; Cronberg, Tobias

    2015-01-01

    BACKGROUND: The reliability of some methods of neurological prognostication after out-of-hospital cardiac arrest has been questioned since the introduction of induced hypothermia. The aim of this study was to determine whether different treatment temperatures after resuscitation affected the prognostic accuracy of clinical neurological findings and somatosensory evoked potentials (SSEP) in comatose patients. METHODS: We calculated sensitivity and false positive rate for Glasgow Coma Scale motor ...

  12. Continued breathing followed by gasping or apnea in a swine model of ventricular fibrillation cardiac arrest

    OpenAIRE

    Zuercher Mathias; Ewy Gordon A; Hilwig Ronald W; Sanders Arthur B; Otto Charles W; Berg Robert A; Kern Karl B

    2010-01-01

    Abstract Background Continued breathing following ventricular fibrillation has here-to-fore not been described. Methods We analyzed the spontaneous ventilatory activity during the first several minutes of ventricular fibrillation (VF) in our isoflurane anesthesized swine model of out-of-hospital cardiac arrest. The frequency and type of ventilatory activity was monitored by pneumotachometer and main stream infrared capnometer and analyzed in 61 swine during the first 3 to 6 minutes of untreat...

  13. Successful use of therapeutic hypothermia after cardiac arrest due to amitriptyline and venlafaxine intoxication.

    Science.gov (United States)

    Kontio, Terhi; Salo, Ari; Kantola, Teemu; Toivonen, Lauri; Skrifvars, Markus B

    2015-06-01

    The prognosis of out-of-hospital cardiac arrest (OHCA) due to intoxication is dismal. Tricyclic antidepressants (TCAs) are widely used in the treatment of depression, but possess significant cardiotoxicity, and are one of the most common medications used in suicide attempts worldwide. TCA poisoning can cause hypotension, seizures, and cardiac conduction disturbances, which can lead to life-threatening arrhythmia. Current guidelines recommend mild therapeutic hypothermia (TH) for unconscious survivors of OHCA, but hypothermia treatment itself can cause disturbances in cardiac conduction, which could aggravate the effect of TCAs on cardiac conduction. We report the successful use of TH in a 19-year-old woman who was resuscitated from ventricular tachycardia after intentional ingestion of amitriptyline and venlafaxine, a serotonin-norepinephrine reuptake inhibitor. The cardiac arrest was witnessed, but no bystander cardiopulmonary resuscitation (CPR) was performed. The initial rhythm was ventricular tachycardia with no detectable pulse. Three defibrillations, magnesium sulfate, and sodium bicarbonate were given and her trachea was intubated, after which return of spontaneous circulation (ROSC) was achieved in 26 minutes. After ROSC, she had seizures and was sedated with propofol. Out-of-hospital TH was initiated with 1500?mL of cold Ringer's acetate. An infusion of norepinephrine was initiated for low blood pressure. On arrival at the university hospital, she was unconscious and had dilated pupils. She was tachycardic with a body temperature of 33.5°C. She was transferred to the intensive care unit and TH was maintained with invasive cooling. During the TH treatment, she did not experience any serious cardiac arrhythmia, transthoracic echocardiogram was normal, and the electrocardiogram (ECG) returned to normal. The patient was extubated 45 hours after the cardiac arrest. After the extubation, she was alert and cooperative, but slightly delusional. She was transferred to a ward on the third day and discharged from hospital on the sixth day of admission. Ambulatory psychiatric follow-up was organized. Neuropsychological examinations were later performed and she was estimated to be able to work at her previous job. This case report suggests that mild TH is safe even in case of intoxication with a drug known to cause serious cardiac conduction disturbances and arrhythmia. PMID:25867296

  14. American Heart Association Response to the 2015 Institute of Medicine Report on Strategies to Improve Cardiac Arrest Survival.

    Science.gov (United States)

    Neumar, Robert W; Eigel, Brian; Callaway, Clifton W; Estes, N A Mark; Jollis, James G; Kleinman, Monica E; Morrison, Laurie J; Peberdy, Mary Ann; Rabinstein, Alejandro; Rea, Thomas D; Sendelbach, Sue

    2015-09-15

    The American Heart Association (AHA) commends the recently released Institute of Medicine (IOM) report, Strategies to Improve Cardiac Arrest Survival: A Time to Act (2015). The AHA recognizes the unique opportunity created by the report to meaningfully advance the objectives of improving outcomes for sudden cardiac arrest. For decades, the AHA has focused on the goal of reducing morbidity and mortality from cardiovascular disease though robust support of basic, translational, clinical, and population research. The AHA also has developed a rigorous process using the best available evidence to develop scientific, advisory, and guideline documents. These core activities of development and dissemination of scientific evidence have served as the foundation for a broad range of advocacy initiatives and programs that serve as a foundation for advancing the AHA and IOM goal of improving cardiac arrest outcomes. In response to the call to action in the IOM report, the AHA is announcing 4 new commitments to increase cardiac arrest survival: (1) The AHA will provide up to $5 million in funding over 5 years to incentivize resuscitation data interoperability; (2) the AHA will actively pursue philanthropic support for local and regional implementation opportunities to increase cardiac arrest survival by improving out-of-hospital and in-hospital systems of care; (3) the AHA will actively pursue philanthropic support to launch an AHA resuscitation research network; and (4) the AHA will cosponsor a National Cardiac Arrest Summit to facilitate the creation of a national cardiac arrest collaborative that will unify the field and identify common goals to improve survival. In addition to the AHA's historic and ongoing commitment to improving cardiac arrest care and outcomes, these new initiatives are responsive to each of the IOM recommendations and demonstrate the AHA's leadership in the field. However, successful implementation of the IOM recommendations will require a timely response by all stakeholders identified in the report and a coordinated approach to achieve our common goal of improved cardiac arrest outcomes. PMID:26130121

  15. The Effects of Cardiac Rehabilitation on Changes in the Lipid Profile of Iranian Male and Female with Coronary Artery Disease Refered to Emam Khomeini Hospital Complex

    Directory of Open Access Journals (Sweden)

    Shohreh Jalaei

    2010-12-01

    Full Text Available Background and aim: One of the most important part of management and modification of CAD risk factor is to control the level of plasma lipid profile. Application of comprehensive cardiac rehabilitation in patient with CAD could decrease the level of CHL, TG, LDL and increasing of HDL .There are a lot of studies that discuss the effect of rehabilitation on different people with different races and life style . Material and Methods: Thirty six patients with the age (40-75 who were referred by cardiologist participated in this study. Fast walking on treadmill, biking on stationary bicycle and cycling with upper body ergometer were chosen as aerobic exercises. For assessing the short term and long term effects of this protocol, blood sampling were taken at three stages; before exercise initiation, after 12 and 24 sessions of exercise. Results: Following the cardiac rehabilitation protocol, the level of CHL, LDL and the ratio of LDL/HDL and CHL/HDL decreased significantly. Conclusion: Cardiac rehabilitation could be used as means to improve lipid profile level in blood serum, prevention of cardiovascular disease and reducing mortality and morbidity rates.

  16. Causes and indications for reoperation in valve replacement and coronary artery bypass graft (CABG in 915 patients in cardiac surgery department in Imam Khomeini Hospital, 1374-77

    Directory of Open Access Journals (Sweden)

    Radmehr H

    2001-08-01

    Full Text Available Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female. The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A Valvular complications (female/male=3/1, B Non valvular complications (female/male=1/3. The most common nonvalvular complication was bleeding (66.6 percent. The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915 the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.

  17. A randomized clinical trial of hospital-based, comprehensive cardiac rehabilitation versus usual care for patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease (the DANREHAB trial) - design, intervention, and population

    DEFF Research Database (Denmark)

    Zwisler, A.D.O.; Schou, O.

    2005-01-01

    Background Current guidelines broadly recommend comprehensive cardiac rehabilitation (CR), although evidence for this is still limited. It is not known whether evidence from before 1995 is still valid. Study Design The DANish Cardiac REHABilitation (DANREHAB) trial was designed as a centrally randomized clinical trial to clarify whether hospital-based comprehensive CR is superior to usual care for patients with congestive heart failure, ischemic heart disease, or high risk for ischemic heart disease. A combined primary outcome measure included total mortality, myocardial infarction, or readmissions due to heart disease based on linkage to public registries. The CR was an individually tailored, multidisciplinary program (6 weeks of intensive CR and 12 months of follow-up) including patient education, exercise training, dietary counseling, smoking cessation, psychosocial support, risk factor management, and clinical assessment. Study Population Of 5060 discharged patients, 1614 (32%) were eligible for the trial and 770 patients were randomized (47% of those eligible). Participants were younger (P < .001) and had less comorbidity than nonparticipants (P < .03). Conclusion Our trial shows that a large-scale, centrally randomized clinical trial on comprehensive CR can be conducted among a broadly defined patient group, but reaching the stipulated number of 1800 patients was difficult. Although the study included relatively many women and older people, elderly patients and patients with high comorbidity were underrepresented, which may influence the external validity

  18. Akut koronarangiografi er indiceret ved ST-elevation efter hjertestop uden for hospital

    DEFF Research Database (Denmark)

    Kjærgaard, Jesper; Bro-Jeppesen, John

    2013-01-01

    Guidelines suggest that acute coronary angiography (CAG) is considered in patients resuscitated from out-of-hospital cardiac arrest with presumed cardiac aetiology. Since specialized post-resuscitation care, including therapeutic hypothermia, has proved beneficial in randomized studies, CAG should be offered to patients with a high likelihood of thrombotic coronary lesions, i.e. patients with ST-segment elevation in electrocardiogram (ECG) following resuscitation. This article suggests a triage and referral based on electronic transmission of ECG and teleconference with specialized centres in all patients.

  19. Cardiac metastases

    OpenAIRE

    BUSSANI, R; De?Giorgio, F; Abbate, A.; Silvestri, F.

    2007-01-01

    Tumours metastatic to the heart (cardiac metastases) are among the least known and highly debated issues in oncology, and few systematic studies are devoted to this topic. Although primary cardiac tumours are extremely uncommon (various postmortem studies report rates between 0.001% and 0.28%), secondary tumours are not, and at least in theory, the heart can be metastasised by any malignant neoplasm able to spread to distant sites. In general, cardiac metastases are considered to be rare; how...

  20. Cardiac surgery and acute kidney injury.

    OpenAIRE

    LAGNY, Marc-Gilbert; Blaffart, Francine; Koch, Jean-Noël; DEFRAIGNE, Jean; Donneau, Anne-Françoise; Roediger, Laurence; Krzesinski, Jean-Marie

    2013-01-01

    Lecture about Cardiac surgery and acute kidney injury. Presentations of results about a retrospective study performed in the University Hospital of Liège and presentations about the protocol of a prospective study on the same topic.

  1. Repair of a Complex Congenital Cardiac Defect

    Medline Plus

    Full Text Available ... CARDIAC DEFECT CHILDREN'S HOSPITAL BOSTON BOSTON, MASSACHUSETTS October 5, 2007 00:00:14 ANNOUNCER: Over the next ... and a restrictive atrial septum, which led to high left atrial pressures. He was born at 37 ...

  2. Perfil de recém-nascidos submetidos à cirurgia cardíaca em hospital privado do Município de São Paulo / Profile of newborns who underwent cardiac surgery in a private hospital in the city of São Paulo / Perfil de los recién nacidos sometidos a cirugía cardiaca en un Hospital privado del municipio de Sao Paulo

    Scientific Electronic Library Online (English)

    Mariana, Bueno; Amélia Fumiko, Kimura.

    2008-03-01

    Full Text Available Estudo transversal cujo objetivo foi descrever o perfil dos recém-nascidos submetidos à cirurgia cardíaca em um hospital privado, referência em cirurgia cardíaca neonatal, no município de São Paulo. Foram analisados prontuários de 30 pacientes internados entre julho de 2001 a dezembro de 2005. Foram [...] incluídos neonatos com idade > 35 semanas, com anomalias cardíacas. Excluíram-se os neonatos com óbito no 1. pós-operatório (OP) e com outras malformações sistêmicas. A maioria dos RNs nasceu a termo, com peso > a 2.500g e submetidos à cirurgia na primeira semana de vida. Foram identificados 24 diferentes diagnósticos de cardiopatias e 14 diferentes intervenções cirúrgicas. No 1. PO, todos os neonatos estavam com dispositivos para monitorar os parâmetros vitais ou como via de acesso para tratamento e suporte de vida, mostrando não só a complexidade do tratamento, como a necessidade de planejamento e organização do serviço na implementação da assistência a estes pacientes. Abstract in spanish El objetivo en este estudio transversal fue caracterizar a los recién nacidos sometidos a cirugía cardiaca en un hospital privado del municipio de Sao Paulo. Los dados fueron obtenidos de las historias clínicas de los recién nacidos sometidos a cirugía entre julio de 2001 y diciembre del 2005. Los r [...] ecién nacidos con 35 semanas o más de gestación fueron incluidos y excluidos los recién nacidos con óbito en el 1er dia de post-operatorio (PO) y con otras malformaciones sistémicas. La mayoría de los RNs nació a término, con peso a 2.500g e sometidos a la cirugía en la primera semana de vida. Fueron identificados 24 diferentes diagnósticos de cardiopatías y 14 diferentes intervenciones quirúrgicas. En el 1er dia de PO, todos los neonatos estaban con dispositivos para monitorear los parámetros vitales o como vía de acceso para el tratamiento y soporte de vida, mostrando no sólo la complejidad del tratamiento, sino también la necesidad de planificación y organización del servicio en la implementación de la asistencia a estos pacientes. Abstract in english The aim of this cross-sectional study was to characterize newborns that underwent cardiac surgery in a private hospital, a reference center in neonatal cardiac surgery, in the city of São Paulo. Data were collected from medical reports from July, 2001 to December, 2005. Newborns with gestational age [...] of more than 35 weeks were included in the study. Newborns that died on the first 48 postoperative hours and with other malformations were excluded. Most of the neonates were term, weighted 2,500 grams or more, and underwent surgery in the first week of life. There were 24 different diagnoses identified and 14 different types of surgery performed. In the first post-operative day, all newborns had invasive devices for vital signs monitoring or for treatment and life support, which shows not only the complexity of the treatment but the need for planning and organizing health services in order to provide adequate care for these patients.

  3. Perfil de recém-nascidos submetidos à cirurgia cardíaca em hospital privado do Município de São Paulo Perfil de los recién nacidos sometidos a cirugía cardiaca en un Hospital privado del municipio de Sao Paulo Profile of newborns who underwent cardiac surgery in a private hospital in the city of São Paulo

    Directory of Open Access Journals (Sweden)

    Mariana Bueno

    2008-03-01

    Full Text Available Estudo transversal cujo objetivo foi descrever o perfil dos recém-nascidos submetidos à cirurgia cardíaca em um hospital privado, referência em cirurgia cardíaca neonatal, no município de São Paulo. Foram analisados prontuários de 30 pacientes internados entre julho de 2001 a dezembro de 2005. Foram incluídos neonatos com idade > 35 semanas, com anomalias cardíacas. Excluíram-se os neonatos com óbito no 1. pós-operatório (OP e com outras malformações sistêmicas. A maioria dos RNs nasceu a termo, com peso > a 2.500g e submetidos à cirurgia na primeira semana de vida. Foram identificados 24 diferentes diagnósticos de cardiopatias e 14 diferentes intervenções cirúrgicas. No 1. PO, todos os neonatos estavam com dispositivos para monitorar os parâmetros vitais ou como via de acesso para tratamento e suporte de vida, mostrando não só a complexidade do tratamento, como a necessidade de planejamento e organização do serviço na implementação da assistência a estes pacientes.El objetivo en este estudio transversal fue caracterizar a los recién nacidos sometidos a cirugía cardiaca en un hospital privado del municipio de Sao Paulo. Los dados fueron obtenidos de las historias clínicas de los recién nacidos sometidos a cirugía entre julio de 2001 y diciembre del 2005. Los recién nacidos con 35 semanas o más de gestación fueron incluidos y excluidos los recién nacidos con óbito en el 1er dia de post-operatorio (PO y con otras malformaciones sistémicas. La mayoría de los RNs nació a término, con peso a 2.500g e sometidos a la cirugía en la primera semana de vida. Fueron identificados 24 diferentes diagnósticos de cardiopatías y 14 diferentes intervenciones quirúrgicas. En el 1er dia de PO, todos los neonatos estaban con dispositivos para monitorear los parámetros vitales o como vía de acceso para el tratamiento y soporte de vida, mostrando no sólo la complejidad del tratamiento, sino también la necesidad de planificación y organización del servicio en la implementación de la asistencia a estos pacientes.The aim of this cross-sectional study was to characterize newborns that underwent cardiac surgery in a private hospital, a reference center in neonatal cardiac surgery, in the city of São Paulo. Data were collected from medical reports from July, 2001 to December, 2005. Newborns with gestational age of more than 35 weeks were included in the study. Newborns that died on the first 48 postoperative hours and with other malformations were excluded. Most of the neonates were term, weighted 2,500 grams or more, and underwent surgery in the first week of life. There were 24 different diagnoses identified and 14 different types of surgery performed. In the first post-operative day, all newborns had invasive devices for vital signs monitoring or for treatment and life support, which shows not only the complexity of the treatment but the need for planning and organizing health services in order to provide adequate care for these patients.

  4. Hyponatremia Presenting as Cardiac Conduction Defect

    OpenAIRE

    Pawan Suri, Kaiser Habeeb, M S Alai, H A Rather, S Jalal

    2009-01-01

    Hyponatremia, the most common electrolyte disorder in hospitalized patients is usually asymptomatic.Clinical cardiac toxicity associated with hyponatremia has not been previously described, Although it isusually difficult to single out hyponatremia as the cause of conduction defects thus,we describe a case thatdeveloped reversible cardiac conduction defect temporally associated with hyponatremia.

  5. Initial lactate and lactate change in post-cardiac arrest : a multicenter validation study

    DEFF Research Database (Denmark)

    Donnino, Michael W; Wiuff Andersen, Lars

    2014-01-01

    OBJECTIVE: Rate of lactate change is associated with in-hospital mortality in post-cardiac arrest patients. This association has not been validated in a prospective multicenter study. The objective of the current study was to determine the association between percent lactate change and outcomes in post-cardiac arrest patients. DESIGN: Four-center prospective observational study conducted from June 2011 to March 2012. SETTING: The National Post-Arrest Research Consortium is a clinical research network conducting research in post-cardiac arrest care. The network consists of four urban tertiary care teaching hospitals. PATIENTS: Inclusion criteria consisted of adult out-of-hospital non-traumatic cardiac arrest patients who were comatose after return of spontaneous circulation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was survival to hospital discharge, and secondary outcome was good neurologic outcome. We compared the absolute lactate levels and the differences in the percent lactate change over 24 hours between survivors and nonsurvivors and between subjects with good and bad neurologic outcomes. One hundred patients were analyzed. The median age was 63 years (interquartile range, 50-75) and 40% were female. Ninety-seven percent received therapeutic hypothermia, and overall survival was 46%. Survivors and patients with good neurologic outcome had lower lactate levels at 0, 12, and 24 hours (p< 0.01). In adjusted models, percent lactate decrease at 12 hours was greater in survivors (odds ratio, 2.2; 95% CI, 1.1-6.2) and in those with good neurologic outcome (odds ratio, 2.2; 95% CI, 1.1-4.4). CONCLUSION: Lower lactate levels at 0, 12, and 24 hours and greater percent decrease in lactate over the first 12 hours post cardiac arrest are associated with survival and good neurologic outcome.

  6. Insuficiencia cardíaca en hospitales chilenos: resultados del Registro Nacional de Insuficiencia Cardíaca, Grupo ICARO / Cardiac failure in Chilean hospitals: results of the National Registry of Heart Failure, ICARO

    Scientific Electronic Library Online (English)

    Pablo, Castro G; José Luis, Vukasovic R; Eduardo, Garcés S; Luis, Sepúlveda M; Marcela, Ferrada K; Sergio, Alvarado O.

    2004-06-01

    Full Text Available [...] Abstract in english Background: Heart failure (HF) is a major public health problem. In Chile hospitalized patients due to HF have not been characterized. Aim: To evaluate clinical profile and outcome of patients hospitalized for heart failure in Chilean hospitals. Patients and Methods: Prospective registry of 14 cente [...] rs. Patients hospitalized for HF in functional class III and IV were included. Epidemiological and clinical data, functional class, type of presentation, decompensation cause, electrocardiogram, echocardiogram, treatment and evolution were registered. Results: Three hundred seventy two patients aged 69±13 years old, 59% men, were assessed. The main etiologies of HF were ischemic in 31.6%, hypertensive in 35.2%, valvular in 14.9% and idiopathic in 7.4%. There was a history of hypertension 69%, diabetes in 35%, myocardial infarction in 22%, atrial fibrillation (AF) in 28%. The presentation form of HF was chronic decompensated in 86%, acute in 12%, refractory in 2%. The causes of decompensation were non compliance with diet or medical prescriptions in 28%, infections in 22% and AF 17%. ECG showed AF in 36% and left bundle branch block in 16%. Echocardiography was performed in 52% of the patients, 69% had left ventricular ejection fraction

  7. Creativity out of difference

    DEFF Research Database (Denmark)

    Glaveanu, Vlad Petre; Gillespie, Alex

    2013-01-01

    Human creativity is ubiquitous, occurring in everyday actions and interactions. Accordingly, we suggest, it must be grounded in the most basic processes of human symbolic activity. This presentation seeks to identify the roots of human creativity in the most fundamental cultural psychological processes of semiotically mediated activity. Starting with the mediational pyramid of self-other-object-sign, we suggest that creativity arises out of two disjunctions, differences or ‘gaps.’ First there is...

  8. Pre-hospital treatment of STEMI patients. A scientific statement of the Working Group Acute Cardiac Care of the European Society of Cardiology

    DEFF Research Database (Denmark)

    Tubaro, M; Danchin, N; Goldstein, P; Filippatos, G; Hasin, Y; Heras, M; Jansky, P; Norekval, T M; Swahn, E; Thygesen, K; Vrints, C; Zahger, D; Arntz, H R; Bellou, A; De La Coussaye, J E; De Luca, L; Huber, K; Lambert, Y; Lettino, M; Lindahl, B; McLean, S; Nibbe, L; Peacock, W F; Price, S; Quinn, Thomas William; Spaulding, C; Tatu-Chitoiu, G; Van De Werf, F

    2011-01-01

    In ST-elevation myocardial infarction (STEMI) the pre-hospital phase is the most critical, as the administration of the most appropriate treatment in a timely manner is instrumental for mortality reduction. STEMI systems of care based on networks of medical institutions connected by an efficient emergency medical service are pivotal. The first steps are devoted to minimize the patient's delay in seeking care, rapidly dispatch a properly staffed and equipped ambulance to make the diagnosis on sce...

  9. Automated external defibrillators inaccessible to more than half of nearby cardiac arrests in public locations during evening, nighttime, and weekends : Circulation

    DEFF Research Database (Denmark)

    Hansen, Carolina Malta; Wissenberg, M.

    2013-01-01

    BACKGROUND: Despite wide dissemination, use of automated external defibrillators (AEDs) in community settings is limited. We assessed how AED accessibility affected coverage of cardiac arrests in public locations. METHODS AND RESULTS: We identified cardiac arrests in public locations (1994-2011) in terms of location and time and viewed them in relation to the location and accessibility of all AEDs linked to the emergency dispatch center as of December 31, 2011, in Copenhagen, Denmark. AED coverage of cardiac arrests was defined as cardiac arrests within 100 m (109.4 yd) of an AED and further categorized according to AED accessibility at the time of cardiac arrest. Daytime, evening, and nighttime were defined as 8 am to 3:59 pm, 4 to 11:59 pm, and midnight to 7:59 am, respectively. Of 1864 cardiac arrests in public locations, 61.8% (n=1152) occurred during the evening, nighttime, or weekends. Of 552 registered AEDs, 9.1% (n=50) were accessible at all hours, and 96.4% (n=532) were accessible during the daytime on all weekdays. Regardless of AED accessibility, 28.8% (537 of 1864) of all cardiac arrests were covered by an AED. Limited AED accessibility decreased coverage of cardiac arrests by 4.1% (9 of 217) during the daytime on weekdays and by 53.4% (171 of 320) during the evening, nighttime, and weekends. CONCLUSIONS: Limited AED accessibility at the time of cardiac arrest decreased AED coverage by 53.4% during the evening, nighttime, and weekends, which is when 61.8% of all cardiac arrests in public locations occurred. Thus, not only strategic placement but also uninterrupted AED accessibility warrant attention if public-access defibrillation is to improve survival after out-of-hospital cardiac arrest.

  10. August 2014 Tucson critical care journal club: bacteremia in cardiac arrest

    Directory of Open Access Journals (Sweden)

    Hypes C

    2014-10-01

    Full Text Available No abstract available. Article truncated at 150 words. Out-of-hospital cardiac arrest (OHCA is an uncommon, but important, condition encountered in the emergency department (ED. While cardiac arrest represents the final common pathway of multiple conditions, early evaluation often focuses on cardiac abnormalities. However, observed associations between infection, particularly pneumonia, and in-hospital cardiac arrest led Coba et al. (1 to investigate the incidence of bacteremia among OHCA patients. The study prospectively investigated 250 adult patients who presented to an academic ED with OHCA between 2007 and 2009. Two blood culture samples were drawn during resuscitation or shortly after return of spontaneous circulation through vascular devices placed for clinical purposes. Children, pregnant women, victims of trauma were excluded. To minimize false positive results, patients were classified as bacteremic if one sample was positive for a typical pathogen or both samples were positive for the same skin colonizing organism. Patients in whom only 1 sample was positive for suspected skin contaminant ...

  11. Cardiac Rehabilitation

    Science.gov (United States)

    Cardiac rehabilitation (rehab) is a medically supervised program to help people who have A heart attack Angioplasty or coronary artery bypass grafting for coronary heart disease A heart valve repair or replacement A ...

  12. Cardiac metastases

    OpenAIRE

    Al-Mamgani, A.; Baartman, L.; Baaijens, M.; Pree, I. de; Incrocci, L.; Levendag, P.C.

    2008-01-01

    We report a case of esophageal cancer with symptomatic metastases to the heart; the patient was treated with short-course radiotherapy with good symptomatic relief. We reviewed the current literature regarding the epidemiology, clinical presentation, diagnostic tools, treatment modalities, and the prognosis of cardiac metastases. In this report we summarize the most recent autopsy studies (published between 1975 and 2007), in which we found an autopsy incidence of cardiac metastases of 2.3% a...

  13. Gasometria arterial em dois diferentes métodos de transporte intra-hospitalar no pós-operatório imediato de cirurgia cardíaca / Arterial blood gas analysis in two different intra-hospital transport methods for postoperative cardiac surgery patients

    Scientific Electronic Library Online (English)

    Newton Almeida, Lima Junior; Silvia Correa, Bacelar; André Miguel, Japiassú; Samária Ali, Cader; Rosane Coelho Fernandes, Lima; Estélio Henrique Martin, Dantas; Alexandre Gomes, Sancho; Jefferson Braga, Caldeira.

    2012-06-01

    Full Text Available OBJETIVO: Avaliar as repercussões gasométricas de dois métodos de ventilação (ventilador de transporte e ressuscitador manual autoinflável) durante o transporte intra-hospitalar de pacientes submetidos à cirurgia cardíaca. MÉTODOS: Estudo observacional, longitudinal, prospectivo e randomizado. Foram [...] coletadas gasometrias arteriais ao final da cirurgia e ao final do transporte do paciente. RESULTADOS: Foram incluídos 23 pacientes: 13 no Grupo ventilador de transporte e 10 no ressuscitador manual autoinflável. As características dos pacientes entre os grupos foram semelhantes, exceto pela maior gravidade no Grupo ventilador de transporte. Observaram-se diferenças significativas nas comparações das variações percentuais dos dados gasométricos: pH (VT: + 4% vs RMA: - 5%, p=0,007), PaCO2 (VT: - 8% vs RMA: + 13%, p=0,006), PaO2 (VT: + 47% vs RMA: - 34%, p=0,01) e SatO2 (VT: + 0,6% vs RMA: - 1,7%, p=0,001). CONCLUSÃO: O uso de ventilador mecânico causa menor repercussão nos gases sanguíneos no transporte intra-hospitalar de pacientes após de cirurgia cardíaca. Abstract in english OBJECTIVE: To evaluate the effects on blood gases by two methods of ventilation (with transport ventilation or self-inflating manual resuscitator) during intra-hospital transport of patients after cardiac surgery. METHODS: Observational, longitudinal, prospective, randomized study. Two samples of ar [...] terial blood were collected at the end of the surgery and another at the end of patient transport. RESULTS: We included 23 patients: 13 in the Group with transport ventilation and 10 in the Group with self-inflating manual resuscitator. Baseline characteristics were similar between both groups, except for higher acute severity of illness in the Group with transport ventilation. We observed significant differences in comparisons of percentage variations of gasometric data: pH (transport ventilation + 4% x MR -5%, p=0.007), PaCO2 (-8% x +13%, p=0.006), PaO2 (+47% x -34%, p=0.01) and SatO2 (+0.6% x -1.7%, p=0.001). CONCLUSION: The use of mechanical ventilation results in fewer repercussions for blood gas analysis in the intra-hospital transport of cardiac surgery patients.

  14. Características cardíacas e metabólicas de corredores de longa distância do ambulatório de cardiologia do esporte e exercício, de um hospital terciário Cardiac and metabolic characteristics in long distance runners of sport and exercise cardiology outpatient facility of a tertiary hospital

    OpenAIRE

    Luciene Ferreira Azevedo; Patrícia Chakur Brum; Dudley Rosemblatt; Patrícia de Sá Perlingeiro; Antônio Carlos Pereira Barretto; Carlos Eduardo Negrão; Luciana Diniz Nagem Janot de Matos

    2007-01-01

    OBJETIVO: Caracterizar parâmetros cardíacos, eletrocardiográficos e funcionais, e respostas cardiopulmonares ao exercício em corredores de longa distância brasileiros, acompanhados no Ambulatório de Cardiologia do Esporte e Exercício de um hospital terciário. MÉTODOS: De uma população inicial de 443 atletas, de ambos os sexos, de diferentes modalidades esportivas, foram avaliados 162 (37%) corredores de longa distância, do sexo masculino, com idade variando entre quatorze e 67 anos. Registros...

  15. A collaborative chain out of phase

    Directory of Open Access Journals (Sweden)

    Bård Paulsen

    2013-03-01

    Full Text Available Introduction: The aim of this study is to explore the obstacles to collaborations between nurses in hospital and municipal care in the discharge of hospital patients who need continuing care.Methods: First, we conducted in-depth interviews of nurses in hospitals and nurses in municipal care. Second, we developed questionnaires and distributed them to a representative sample of Norwegian municipalities to study the representativeness of the most important findings from the interviews.Results: Municipal care nurses reported that the information they receive from hospital departments usually is insufficient for a complete understanding of a patient's needs. Formal discharge reports from hospital serve as a post factum formalization and authorization of information collected by municipal nurses in an ad hoc fashion and via oral communication.  Typically, formal information routines are out of phase with the information needed by municipal care professionals.Conclusions: Hospital information provided at discharge is neither sufficient nor timely with respect to the information needs of nurses in municipal care. Organizational efforts and the use of information technology might ease some obstacles, but several problems will remain because of differences in professional orientation and the contexts of care delivery.

  16. Fast tracking in adult cardiac surgery at Pakistan Institute of Medical Sciences

    International Nuclear Information System (INIS)

    Background: Early extubation after cardiac operation is an important aspect of fast-track cardiac anaesthesia. The length of stay in ICU limits utilisation of operation theatre in cardiac surgery. Increasing cost, limited resources, and newer surgical strategies have stimulated effectiveness of all routines in cardiac surgery, anaesthesia, and intensive care. Aim of this study was to determine the feasibility of fast-tracking in adult cardiac surgery and its effects on post operative recovery in our setup. Methods: This descriptive study was conducted over 14 months between Jul 16, 2007 to Sep 16, 2008. All the open heart cases were included unless absolute contraindications were there. We applied the rapid recovery protocol adopted from Oslo Hospital Norway in an attempt to achieve fast-tracking in our setup. Results: Two-hundred-seventy-four consecutive cases out of 400 operated cases were included in this study. Mean age was 47.69 +- 15.11 years, 27.7% were females, 5.8% were emergency cases, 5.1% were COPD, 11.1% were atrial fibrillation, and 6.9% were NYHA class-III cases. CABG was done in 66.1% cases and mean CPB-time was 75.92 +- 16.20 min. Mean Ventilation-time was 4.47+-4.48 hrs., 86% patients were fast-tracked to be extubated within 6 hours, and 85.4% patients remained free of post-op complications. Six (2.2%) re-intubatIions, 2.6% arrhythmias, 6.6% pleural effusions and 2.2% consolidation were observed post-operatively. Mean ICU stay was 2.49 +- 0.95 days and in-hospital mortality was 2.2%. Conclusion: Fast-tracking with extubation within 6 hours is feasible approach which minimises the post-operative complications significantly in adult cardiac surgical patients. (author)

  17. About Cardiac Arrest

    Science.gov (United States)

    ... High Blood Pressure Tools & Resources Stroke More About Cardiac Arrest Updated:Dec 10,2014 What is cardiac arrest? ... to heart disease and stroke. Start exploring today ! Cardiac Arrest • Home • About Cardiac Arrest • Understand Your Risk for ...

  18. Strategies for optimizing outcomes in the NSTE-ACS patient The CATH (cardiac catheterization and antithrombotic therapy in the hospital) Clinical Consensus Panel Report.

    Science.gov (United States)

    Cohen, Marc; Diez, Jose; Fry, Edward; Rao, Sunil V; Ferguson, James J; Zidar, James; Levine, Glenn; Shani, Jacob

    2006-12-01

    This paper provides a comprehensive up-to-date review of the medical and invasive management of patients with non- ST-segment elevation acute coronary syndromes (NSTE-ACS). The authors have summarized findings from key clinical trials published recent years that contribute to clinicians' understanding of how best to optimize therapy. The goals for the management of NSTE-ACS are rapid and accurate risk stratification, appropriate and institution-specific triage to interventional versus medical strategies and optimal pharmacologic therapy--all of which provide for a smooth and seamless transition of care between the emergency department and the cardiology service. High-risk features or absolute treatment trigger criteria that support more aggressive medical therapy (i.e., addition of small-molecule GP IIb/IIIa inhibitor to a core regimen of aspirin, enoxaparin, and in most cases, clopidogrel) and/or that would direct clinicians toward percutaneous, mechanical/interventional strategies as the preferred modality include, but are not limited to, the presence of one or more of the following: (1) elevated cardiac markers (troponin and/or CK-MB); (2) elevated levels of inflammatory markers (particularly CRP > 3 microg/dl); (3) age > 65 years; (4) presence of ST-T wave changes; (5) TIMI Risk Score greater than or equal to 4; (6) diabetes; and/or (7) clinical instability in the setting of suspected NSTE-ACS. Specific clinical, ECG and/or biochemical trigger points modulate the aggressiveness of both the medical therapy and the propensity to perform early angiography with or without subsequent revascularization in patients with NSTE-ACS. Although additional refinements and changes in ACS management are still to come, evidence-based strategies suggest that prompt mechanical revascularization is associated with the best possible clinical outcomes, particularly for patients with high-risk features and in whom benefits of adjunctive, pharmacoinvasive antithrombotic therapies can be consolidated. Patient transfer for cardiac catheterization/percutaneous coronary intervention (PCI) is strongly recommended in patients who manifest high-risk features and/or aggressive treatment trigger criteria, so that this high-risk subgroup may receive definitive, interventional and/or cardiology-directed specialty care at appropriate sites of care. When available, interventional management is preferred in these patients. The importance of safe and effective anticoagulation in the spectrum of management strategies has been confirmed, and the evidence in support of enoxaparin and other antithrombotic agents has been reviewed. Dosing recommendations for enoxaparin use in the setting of PCI have been issued by the CATH Panel and have been summarized in this consensus report. Similar recommendations have been presented for the use of oral antiplatelet agents and GP IIb/IIIa antagonists. The addition of statins, ACE-inhibitors and beta-blockers is also stressed as part of a comprehensive secondary cardioprotective strategy for patients with coronary heart disease. PMID:17197714

  19. A prospective study to determine the circumstances, incidence and outcome of cardiopulmonary resuscitation in a referral hospital in India, in relation to various factors

    Directory of Open Access Journals (Sweden)

    Muralidhar Joshi

    2015-01-01

    Full Text Available Background and Aims: Cardiac arrest has multifactorial aetiology and the outcome depends on timely and correct interventions. We decided to investigate the circumstances, incidence and outcome of cardiopulmonary resuscitation (CPR at a tertiary hospital in India, in relation to various factors, including extensive basic life support and advanced cardiac life support training programme for all nurses and doctors. Methods: It has been over a decade and a half with periodical updates and implementation of newer guidelines prepared by various societies across the world about CPR for both in-hospital and out-of hospital cardiac arrests (IHCA and OHCA. We conducted a prospective study wherein all cardiac arrests reported in the hospital consecutively for 12 months were registered for the study and followed their survival up to 1-year. Statistical analysis was performed by using Chi-square test for significant differences in proportions applied to various parameters of the study. Results: The main outcome measures were; (following CPR return of spontaneous circulation, survival for 24 h, survival from 24 h to 6 weeks or discharge, alive at 1-year. For survivors, an assessment was made about their cerebral performance and overall performance and accordingly graded. All these data were tabulated. Totally 419 arrests were reported in the hospital, out of which 413 were in-hospital arrests. Out of this 260 patients were considered for resuscitation, we had about 27 survivors at the end of 1-year follow-up (10.38%. Conclusion: We conclude by saying there are many factors involved in good clinical outcomes following IHCAs and these variable factors need to be researched further.

  20. CARDIAC MYXOMA

    Directory of Open Access Journals (Sweden)

    Yutina Himawan

    2013-03-01

    Full Text Available Myxoma is a benign primary tumor of the heart which is usually occurred in adult, which usually develop in the left atrium of the heart. In 1845, Cardiac Myxoma is first described by the expert. Myxoma, an endocrine neoplasm which usually begins from the endocardium of the heart it self. Generally, the shape of myxoma are round, oval with a smooth or lobulated surface. The clinical finding of myxoma is determined by it’s location, size, and mobility. Most of the patient comes with one or more from the triad of embolism, intracardiac obstruction, and associated symptoms. Until now, operation is the only treatment for cardiac myxoma.

  1. Clinically Significant Contrast Induced Acute Kidney Injury after Non-Emergent Cardiac Catheterization - Risk Factors and Impact on Length of Hospital Stay

    International Nuclear Information System (INIS)

    Objective: To evaluate the frequency and risk factors associated with clinically significant contrast-induced nephropathy (CIN) in patients undergoing non-emergent coronary angiography. Study Design: Descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2005 to December 2007. Methodology: Case records of patients who underwent coronary angiography with a serum creatinine of >= 1.5 mg/dl at the time of procedure were evaluated. Clinically significant contrast induced nephropathy (CSCIN) was defined as either doubling of serum creatinine from baseline value within a week following the procedure or need for emergency hemodialysis after the procedure. Results: One hundred and sixteen patients met the inclusion criteria. Mean age was 64.0 +- 11.5 years, 72% were males. Overall prevalence of CIN was 17% (rise of serum creatinine by A= 0.5 mg/dl) while that of clinically significant CIN (CSCIN) was 9.5% (11 patients). Patients with CSCIN had significantly lower left ventricular ejection fraction (p = 0.03, OR: 0.24; 95% CI = 0.06 A= 0.91) and higher prevalence of cerebrovascular disease (p < 0.001, OR: 14.66; 95% CI = 3.30 - 65.08). Mean baseline serum creatinine was significantly higher, 3.0 +- 1.5 vs. 2.0 +- 1.1 mg/dl (p = 0.03, OR: 1.47; 95% CI = 1.03 - 2.11) whereas mean GFR estimated by Cockcroft-Gault formula was significantly lower at 25 +- 7.4 vs. 41.0 +- 14.6 ml/minute (p = 0.001, OR = 0.89, 95% CI = 0.84 A= 0.95) at the time of procedure in patients with CSCIN. Mean length of hospital stay was significantly higher in this group compared to those without CIN, 9.0 +- 5.1 vs. 3.0 +- 3.2 days (p = 0.001, OR = 1.31, 95% CI = 1.12 - 1.54). Multivariate analysis revealed low GFR (p = 0.001, OR = 0.88; 95% CI = 0.82 - 0.95) and low ejection fraction (p = 0.03, OR = 0.20; 95% CI = 0.04 - 0.91) to be independent factors associated with CSCIN. No significant differences were noted between the two groups in patients with hypertension, diabetes and heart failure. Conclusion: CSCIN is a significant concern in high risk groups despite prophylaxis. Patients with lower EF, cerebrovascular disease and low GFR at the time of procedure are more likely to have CIN. (author)

  2. Cardiocerebral Resuscitation: An Approach to Improving Survival of Patients With Primary Cardiac Arrest.

    Science.gov (United States)

    Ewy, Gordon A; Bobrow, Bentley J

    2016-01-01

    Out-of-hospital cardiac arrest (OHCA) is a major public health problem. In the United States, OHCA accounts for more premature deaths than any other cause. For over a half-century, the national "Guidelines" for resuscitation have recommended the same initial treatment of primary and secondary cardiac arrests. Using this approach, the overall survival of patients with OHCA, while quite variable, was generally very poor. One reason is that the etiologies of cardiac arrests are not all the same. The vast majority of nontraumatic OHCA in adults are due to a "primary" cardiac arrest, rather than secondary to respiratory arrest. Decades of research and ongoing reviews of the literature led the University of Arizona Sarver Heart Center Resuscitation Research Group to conclude in 2003 that the national guidelines for patients with primary cardiac arrest were not optimal. Therefore, we instituted a new, nonguidelines approach to the therapy of primary cardiac arrest that dramatically improved survival. We called this approach cardiocerebral resuscitation (CCR), as it is the heart and the brain that are the most vulnerable and therefore need to be the focus of resuscitation efforts for these patients. In contrast, cardiopulmonary resuscitation should be reserved for respiratory arrests. Cardiocerebral resuscitation evolved into 3 components: the community, with emphasis for lay individuals to "Check, Call, Compress" and use an automated external defibrillator if available; the Emergency Medical Services, that emphasizes delayed intubation in favor of passive ventilation, urgent and near continuous chest compressions before and immediately after a single indicated shock, and the early administration of epinephrine; and the third component, added in 2007, the designations of hospitals in Arizona that request this designation and agree to receive patients with return of spontaneous circulation following OHCA and to institute state-of-the-art postresuscitation care that includes urgent therapeutic mild hypothermia and cardiac catheterization as a Cardiac Receiving Center. Each component of CCR is critical for optimal survival of patients with primary OHCA. In each city, county, and state where CCR was instituted, the result was a marked increase in survival of the subgroup of patients with OHCA most likely to survive, for example, those with a shockable rhythm. The purpose of this invited article on CCR is to review this alternative approach to resuscitation of patients with primary cardiac arrest and to encourage its adoption worldwide so that more lives can be saved. PMID:25077491

  3. Halogenated anaesthetics and cardiac protection in cardiac and non-cardiac anaesthesia

    Directory of Open Access Journals (Sweden)

    Landoni Giovanni

    2009-01-01

    Full Text Available Volatile anaesthetic agents have direct protective properties against ischemic myocardial damage. The implementation of these properties during clinical anaesthesia can provide an additional tool in the treatment or prevention, or both, of ischemic cardiac dysfunction in the perioperative period. A recent meta-analysis showed that desflurane and sevoflurane reduce postoperative mortality and incidence of myocardial infarction following cardiac surgery, with significant advantages in terms of postoperative cardiac troponin release, need for inotrope support, time on mechanical ventilation, intensive care unit and overall hospital stay. Multicentre, randomised clinical trials had previously demonstrated that the use of desflurane can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalisation following coronary artery bypass graft surgery either with and without cardiopulmonary bypass. The American College of Cardiology/American Heart Association Guidelines recommend volatile anaesthetic agents during non-cardiac surgery for the maintenance of general anaesthesia in patients at risk for myocardial infarction. Nonetheless, e vidence in non-coronary surgical settings is contradictory and will be reviewed in this paper together with the mechanisms of cardiac protection by volatile agents.

  4. Relação do teste de caminhada pós-operatório e função pulmonar com o tempo de internação da cirurgia cardíaca / Relationship on walk test and pulmonary function tests with the length of hospitalization in cardiac surgery patients

    Scientific Electronic Library Online (English)

    Elayne Kelen de, Oliveira; Vinicius Zacarias Maldaner da, Silva; Aída Luiza Ribeiro, Turquetto.

    2009-12-01

    Full Text Available OBJETIVO: A função pulmonar é apontada como preditora do tempo de hospitalização na cirurgia cardíaca. E o teste de caminhada de seis minutos (TC6') tem sido utilizado para caracterizar a capacidade funcional em pacientes cardiopatas, porém há poucos estudos que o correlacione com tempo de internaçã [...] o hospitalar. O objetivo desta pesquisa foi verificar se há correlação da função pulmonar pré e pós-operatória e da capacidade da deambulação pósoperatória com tempo de internação pós-operatória. MÉTODOS: Foi realizada uma coorte prospectiva com 18 pacientes, sendo 8 do gênero masculino e 10 do gênero feminino, com idade acima de 40 anos (média 64,89 ± 6,95 anos), internados para a submissão de cirurgias de revascularização do miocárdio e/ou troca valvar. Para caracterizar a função pulmonar, os pacientes foram submetidos a uma espirometria no pré-operatório e ao 5º dia pós-operatório. Neste último período também foi realizado um teste de caminhada de 6 minutos (TC6') para caracterizar a capacidade de deambulação. RESULTADO: Não houve correlação significativa da função pulmonar pré e pós-operatória com o tempo de internação pós-operatória. Somente a distância percorrida no TC6' apresentou correlação negativa significativa (rho=-0,62) com o tempo de internação pós-operatória. A distância no TC6' obteve correlação positiva significativa com a capacidade vital forçada (r=0,59) e volume expiratório forçado no 1º segundo (r=0,52). CONCLUSÃO: Esses resultados sugerem que os pacientes com maior capacidade de deambulação no pós-operatório apresentam menor tempo de internação e sugere-se também que a distância no TC6' pode representar melhor a capacidade funcional desses pacientes do que a função pulmonar isoladamente. Abstract in english OBJECTIVE: The lung function is identified as a predictor of time of hospitalization in heart surgery. Meanwhile sixminute walk test has been used to establish functional capacity of cardiac patients, however there are few studies that correlate it with the length of hospital stay. The aim of this r [...] esearch was to determine whether there is correlation of preoperative and postoperative lung function and the ability of walking during the hospital stay. METHODS: A prospective cohort with 18 patients was performed, being 8 males and 10 females, with age above 40 years (medium 64.89 ± 6.95 years). Patients where admitted for coronary artery bypass graft surgery and/or exchange valve. To characterize the pulmonary function, patients were submitted to spirometry in preoperative and the 5th postoperative day. In the latter period was also a test for 6 minutes walk (6MWT) to characterize the ability to walk. RESULTS: There was not significant correlation of preoperative and postoperative pulmonary function with length of hospital stay. Only the distance covered in 6MWT showed a significant negative correlation (rho= 0.62) with length of stay. The distance in 6MWT obtained a significant positive correlation with forced vital capacity (r=0.59) and first second of a maximal forced expiratory manoeuvre (r=0.52). CONCLUSION: These results suggest that patients with increased postoperative capacity to walk have a shorter time of hospitalization and it also suggest that the distance in the 6MWT can better represent the functional capacity of these patients than pulmonary function alone.

  5. Personal and environmental dosimetric measurements using TLD method in Cardiac Catheterization Laboratory (CathLab) at the Rzeszow's Regional Hospital No 2, Poland

    International Nuclear Information System (INIS)

    Complete test of publication follows. One of the basic problem in CathLab is the monitoring of ionizing radiation, calculations of doses for workers and finally to build a system to prevent workers from X-ray radiation. To measure doses from X-rays a passive method with thermoluminescent dosemeters (TLD) were applied. Experimental part was based on creating 3D grid of Tl environmental dosemeters with 2 high sensitive TL detectors based on MCP-N (LiF:Mg,Cu,P). Dosemeters were placed evenly (as far as staff's work conditions allowed such positioning) in operating room and a control room. Grid of about 100 dosemeters was designed to measure X-ray dose distribution present during interventional cardiology procedures. That part of the project was especially important for hospital's employee, because it has brought an information about most radiative dangerous areas of each room. Patient dosimetry measurements have been also made using TLD method just during the interventional cardiology procedures. Every patient got a few dosemeters dor different parts of body. Experimental part consists of measurements of absorbed dose equivalent, mean dose rate of absorbed dose equivalent, and mean dose of effective dose per each body part. That last measurements were accomplished by placing TLD's near patient's head, chest and gonads. Personal dosimetry for employees, has been made using TLD's during hemodynamics procedures. Every employee (medical doctors, nurses, technicians and charwoman) has received few dosemeters also based on high sensitive MCP-N detectors. The main dosimetry was done for whole body covered by led gown and additionally for unprotected parts: (hands, arm, eyes and protected by gown: chest, gonads). For individual dosimetry Hp(10) in mSv was calculated, while using environmental dosemeters KERMA in air in mGy. This work will present results obtained from ca. 100 environmental placed in CathLab room. Additionally personal doses for whole body and for parts of workers and patients will be shown.

  6. Risk Stratification for Sudden Cardiac Death: Current Approaches and Predictive Value

    Science.gov (United States)

    Lopera, Gustavo; Curtis, Anne B.

    2009-01-01

    Sudden cardiac death (SCD) is a serious public health problem; the annual incidence of out-of-hospital cardiac arrest in North America is approximately 166,200. Identifying patients at risk is a difficult proposition. At the present time, left ventricular ejection fraction (LVEF) remains the single most important marker for risk stratification. According to current guidelines, most patients with LVEF <35% could benefit from prophylactic ICD implantation, particularly in the setting of symptomatic heart failure. Current risk stratification strategies fail to identify patients at risk of SCD in larger population groups encompassing a greater number of potential SCD victims. However, the best approach to identifying patients and the value of various risk stratification tools is not entirely clear. The goal of this review is to discuss the problem of SCD and the value of the different risk stratification markers and their potential clinical use either alone or in combination with other risk stratification markers. PMID:20066150

  7. Depression and its treatment in cardiac patients.

    OpenAIRE

    Fernandez, F.

    1993-01-01

    In general medical-surgical hospital services, depression is the most common reason for seeking psychiatric consultation in behalf of patients with cardiovascular disease. The nontreatment of depression or the use of a psychotropic agent mismatched to a patient's particular cardiac condition or individual sensitivities has considerable negative impact. Therefore, a systematic approach should be used in the differential diagnosis of depression in cardiac patients, to eliminate other psychiatri...

  8. Impact of hospital infections on patients outcomes undergoing cardiac surgery at Santa Casa de Misericórdia de Marília / Impacto das infecções hospitalares na evolução de pacientes submetidos à cirurgia cardíaca na Santa Casa de Misericórdia de Marília

    Scientific Electronic Library Online (English)

    Lucieni Oliveira, Conterno; Silvana Martins Dias, Toni; Rubiana Gonçalves, Konkiewitz; Elaine Salla, Guedes; Rubens Tofano de, Barros; Marcos Gradim, Tiveron.

    2014-04-01

    Full Text Available Objetivo: O objetivo deste estudo foi determinar as taxas das infecções hospitalares, os fatores de risco associados e o impacto destas infecções na mortalidade dos pacientes submetidos à cirurgia cardíaca. Métodos: coorte retrospectivo que incluiu 2060 pacientes consecutivos, no período de 20 [...] 06 a 2012 na Santa Casa de Misericórdia de Marília. Resultados: Foram diagnosticadas 351 infecções hospitalares (17%), sendo 227 infecções não cirúrgicas e 124 infecções cirúrgicas. As principais infecções foram: mediastinite (2,0%), infecção urinária (2,8%), pneumonia (2,3%), infecção da corrente sanguínea (1,7%). A mortalidade global intra-hospitalar foi de 6,4%. As variáveis independentes associadas às infecções não cirúrgicas foram: idade > 60 anos (OR 1,59; IC95%1,09-2,31), internação em UTI > 2 dias (OR5,49; IC95% 2,98-10,09), ventilação mecânica > 2 dias (OR11,93; IC95% 6,1 - 23,08), uso de sonda vesical >3 dias (OR 4,85 IC95% 2,95 -7,99). Infecções hospitalares não cirúrgicas foram mais frequentes em pacientes com infecção cirúrgica (32,3% versus 7,2%; OR 6,1; IC95% 4,03- 9,24). As variáveis independentes associadas a mortalidade foram: idade >60 anos (OR= 2,0 ; IC 95% 1,4-3,0), uso de droga vasopressora (OR 3,4; IC95% 1,9-6,0), uso de insulina (OR=1,8; IC 95% 1,2-2,8), reintervenção cirúrgica (OR=4,4 IC95% 2,1-9,0) pneumonia (OR=4,3 IC95% 2,1-8,9) e infecção da corrente sanguíneas (OR=4,7; IC95% 2,0-11,2). Conclusão: infecções hospitalares não cirúrgicas são frequentes pós cirurgia cardíaca, e aumentam a chance de infecção cirúrgica e a mortalidade. Abstract in english Objective: this study aimed to determine the incidence of nosocomial infections, the risk factors and the impact of these infections on mortality among patients undergoing to cardiac surgery. Methods: Retrospective cohort study of 2060 consecutive patients from 2006 to 2012 at the Santa Casa d [...] e Misericórdia de Marília. Results: 351 nosocomial infections were diagnosed (17%), 227 non-surgical infections and 124 surgical wound infections. Major infections were mediastinitis (2.0%), urinary tract infection (2.8%), pneumonia (2.3%), and bloodstream infection (1.7%). The in-hospital mortality was 6.4%. Independent variables associated with non-surgical infections were age > 60 years (OR 1.59, 95% CI 1.09 to 2.31), ICU stay > 2 days (OR 5, 49, 95% CI 2.98 to 10, 09), mechanical ventilation > 2 days (OR11, 93, 95% CI 6.1 to 23.08), use of urinary catheter > 3 days (OR 4.85 95% CI 2.95 -7.99). Non-surgical nosocomial infections were more frequent in patients with surgical wound infection (32.3% versus 7.2%, OR 6.1, 95% CI 4.03 to 9.24). Independent variables associated with mortality were age greater than 60 years (OR 2.0; 95% CI 1.4 to3.0), use of vasoactive drugs (OR 3.4, 95% CI 1.9 to 6, 0), insulin use (OR 1.8; 95% CI 1.2 to 2.8), surgical reintervention (OR 4.4; 95% CI 2.1 to 9.0) pneumonia (OR 4.3; 95% CI 2.1 to 8.9) and bloodstream infection (OR = 4.7, 95% CI 2.0 to 11.2). Conclusion: Non-surgical hospital infections are common in patients undergoing cardiac surgery; they increase the chance of surgical wound infection and mortality.

  9. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest

    DEFF Research Database (Denmark)

    Nielsen, Niklas; Wetterslev, JØrn

    2013-01-01

    Background Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever. Methods In an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33°C or 36°C. The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or death at 180 days, as evaluated with the Cerebral Performance Category (CPC) scale and the modified Rankin scale. Results In total, 939 patients were included in the primary analysis. At the end of the trial, 50% of the patients in the 33°C group (235 of 473 patients) had died, as comparedwith 48% of the patients in the 36°C group (225 of 466 patients) (hazard ratio with a temperature of 33°C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P=0.51). At the 180-day follow-up, 54% of the patients in the 33°C group had died or had poor neurologic function according to the CPC, as compared with 52% of patients in the 36°C group (risk ratio, 1.02; 95% CI, 0.88 to 1.16; P=0.78). In the analysis using the modified Rankin scale, the comparable rate was 52% in both groups (risk ratio, 1.01; 95% CI, 0.89 to 1.14; P=0.87). The results of analyses adjusted for known prognostic factors were similar. Conclusions In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C. (Funded by the Swedish Heart-Lung Foundation and others; TTM ClinicalTrials.gov number, NCT01020916 .).

  10. Hypokalemia and sudden cardiac death

    DEFF Research Database (Denmark)

    Kjeldsen, Keld

    2010-01-01

    Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient reductions in plasma potassium concentration are of importance. Hypokalemia is present in 7% to 17% of patients with cardiovascular disease. Furthermore, up to 20% of hospitalized patients and up to 40% of pati...

  11. Menstrual bleeding after cardiac surgery

    DEFF Research Database (Denmark)

    Hjortdal, Vibeke Elisabeth; Larsen, Signe Holm; Wilkens, Helena; Jakobsen, Anja; Pedersen, Thais Almeida Lins

    2013-01-01

    OBJECTIVES: We investigated whether open-heart surgery with the use of extracorporeal circulation has an impact on menstrual bleeding. METHODS: The menstrual bleeding pattern was registered in fertile women undergoing open-heart surgery in 2010-12. Haematocrit and 24-h postoperative bleeding were compared with those of men undergoing cardiac surgery. RESULTS: Women (n = 22), with mean age of 36 (range 17-60) years, were operated on and hospitalized for 4-5 postoperative days. The mean preoperati...

  12. Hypokalemia and sudden cardiac death

    OpenAIRE

    Kjeldsen, Keld

    2010-01-01

    Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient reductions in plasma potassium concentration are of importance. Hypokalemia is present in 7% to 17% of patients with cardiovascular disease. Furthermore, up to 20% of hospitalized patients and up to 40% of p...

  13. Cardiac rhabdomyosarcoma

    OpenAIRE

    Chlumský, Jaromír; Holá, Dana; Hlavá?ek, Karel; Michal, Michal; Švec, Alexander; Špatenka, Jaroslav; Dušek, Jan

    2001-01-01

    Cardiac sarcoma is a very rare neoplasm and is difficult to diagnose. The case of a 51-year-old man with a left atrial tumour, locally recurrent three months after its surgical removal, is presented. Computed tomography showed metastatic spread to the lung parenchyma. On revised histology, the mass extirpated was a sarcoma. Because of the metastatic spread, further therapy was symptomatic only; the patient died 15 months after the first manifestation of his problems. Immunohistochemical stain...

  14. Frequency of causative factors for pleural effusions: a hospital based study

    International Nuclear Information System (INIS)

    To determine the frequency of various causative factors of pleural effusion in adults. Combined Military Hospital, Attock and PAF hospital Faisal Karachi. One hundred and fifty patients of clinical signs of pleural effusion, were selected and then, further classified in to transudative and exudative variety by carrying out pleural fluid routine testing and using Light's criteria . Later the final etiological diagnosis was made with the help of appropriate laboratory tests. Out of total 150 patients who were studied, 123 patients were found to have exudative effusions whereas 27 cases had transudative effusion. A total of five 5 patients (3.33%) were lost to follow up. Three patients were out of exudative variety and 02 were from transudative variety. Out of 120 patient of exudative pleural effusion, 70(58.2%) had tuberculosis, 28(23.2%) had malignancy, 12(10%) had pneumonia, 5(6%) were uraemic, 2(1.6%) had pulmonary embolism, and rheumatoid arthritis, Systemic lupus erythematosis and liver abscess were causative factors in 1(0.8%) each patient. Out of transudative effusions, 14(56%) had congestive cardiac failure, 5(20%) had cirrhosis liver, 4(16%) had nephrotic syndrome and 1(4%) each had cardiac tamponade and myxoedema. The most common cause of pleural effusion remains tuberculosis. (author)

  15. Cardiac troponin T and end stage renal disease.

    OpenAIRE

    Alaa-Eldin M. Gabr; Ibrahim, Ibrahim A; Shaza M. Aloulou; Al-Alfi, Mohamed A.; Khalid A. Al-Abdlrahim

    2004-01-01

    OBJECTIVES The aim of this study is to investigate the relationship between serum concentration of cardiac troponin T (cTnT) and other cardiac markers and ischemic heart disease (IHD) in end stage renal disease (ESRD) patients on chronic hemodialysis (HD). METHODS This study was carried out at King Fahd Specialist Hospital, Buraidah, Kingdom of Saudi Arabia from July 2002 to September 2003. Cardiac troponin T was measured using Elecsys 2020 immunoassay system, a method that is specif...

  16. Diesel Exhaust Inhalation Increases Cardiac Output, Bradyarrhythmias, and Parasympathetic Tone in Aged Heart Failure-Prone Rats

    Science.gov (United States)

    Acute air pollutant inhalation is linked to adverse cardiac events and death, and hospitalizations for heart failure. Diesel exhaust (DE) is a major air pollutant suspected to exacerbate preexisting cardiac conditions, in part, through autonomic and electrophysiologic disturbance...

  17. Acute Coronary Syndrome: Out-of-Hospital Evaluation and Management.

    Science.gov (United States)

    Veauthier, Brian; Sievers, Karlynn; Hornecker, Jaime R

    2015-10-01

    Identifying acute coronary syndrome (ACS) in family medicine settings can be challenging, partly because it is uncommon in office practice and partly because symptoms can be atypical. Initial evaluation includes review of the patient's symptoms, an assessment of risk factors, and an electrocardiogram (ECG). When symptoms are typical, such as chest pain and diaphoresis, patients should be transported rapidly by emergency medical services (EMS) to the nearest emergency department. If not contraindicated, aspirin and nitroglycerin should be administered before transport. Oxygen should be administered if hypoxemia is present. Patients with atypical symptoms and ECG results consistent with ACS also should be transported by EMS. When patients have atypical symptoms and nondiagnostic ECG results, consider risk factors for ACS. These include older age; female sex; nonwhite race; and history of heart failure, stroke, diabetes, or hypertension. If any of these risk factors is present and there is concern about ACS, the patient should be transported to an emergency department. Family practices in remote or rural areas are not always able to easily transport patients to emergency departments. These remote or rural practices should have ECG capabilities and consider acquiring the ability to obtain point-of-care troponin assays. PMID:26439393

  18. The Social and Emotional Impact of Cardiac Transplantation

    OpenAIRE

    Jones, B. M; Chang, V.P.; Baron, D. W.

    1986-01-01

    To date, there has been limited systematic research in the area of the emotional impact of cardiac transplantation. Since September 1984, a prospective study addressing this issue has been in progress at St. Vincent's Hospital, Sydney, Australia.

  19. Out of shadow / Peeter Linnap

    Index Scriptorium Estoniae

    Linnap, Peeter, 1960-

    2007-01-01

    "Out of shadow" oli näitus Baltimaade 1990. aastate kunstist Ameerika publikule - sõnumiks iseseisvumisjärgsete aastate materiaalse, sotsiaalse ning vaimuelu peegeldused/tõlgendused visuaalses kunstis

  20. Prediction of poor outcome using detector of epileptiform EEG in ICU patients resuscitated after cardiac arrest.

    Science.gov (United States)

    Ermes, Miikka; Särkelä, Mika; van Gils, Mark; Wennervirta, Johanna; Vakkuri, Anne; Salmi, Tapani

    2007-01-01

    Assessing the brain status of patients admitted to intensive care unit (ICU) after out-of-hospital cardiac arrest is challenging. We had earlier found wavelet subband entropy (WSE) to be a useful tool for quantifying the epileptiform content of EEG during anesthesia. In this paper, WSE was applied for EEG of ICU patients to study its prognostic value. During their stay in ICU, EEG was recorded from 20 patients resuscitated after out-of-hospital cardiac arrest. For the analysis, the patients were divided into subgroups of poor outcome (persistent vegetative state, N=4) and good outcome (regain of consciousness, N=16). WSE for each 5-sec segment of EEG was calculated and also the average of WSE for each hour. Also, similar results were calculated for EEG powers in the bands 16-32 Hz and 1-60 Hz to be used as references. The statistical analysis was made by comparing the medians of the distributions of average WSE of each hour between poor and good outcome groups. The median of WSE of poor outcome group was significantly lower than that of good outcome group. The reference indicators did not show significant differences between the groups. The results suggest that WSE can be a valuable prognostic indicator for detecting the patients with poor outcome. PMID:18002639

  1. Hypothermic cardiac arrest far away from the center providing rewarming with extracorporeal circulation

    OpenAIRE

    Mark, Eckhard; Jacobsen, Olaf; Kjerstad, Astrid Kristine; Næsheim, Torvind; Busund, Rolf; Bahar, Ramez; Jensen, Jon Kjetil; Skorpen, Per Kristian; Bjertnaes, Lars J

    2012-01-01

    A 41-year-old man suffered hypothermic cardiac arrest after water immersion and was transported to our university hospital by ambulance helicopter for rewarming on cardiopulmonary bypass. He resumed spontaneous cardiac activity 6 h 52 min after cardiac arrest and recovered completely.

  2. The CHARMS Study : cardiac patients' experiences of sexual problems following cardiac rehabilitation

    OpenAIRE

    Byrne, Molly; Doherty, Sally; Murphy, Andrew W; McGee, Hannah M; Jaarsma, Tiny

    2013-01-01

    Background:Sexual problems are common among cardiac patients. Further information is required on patients' experiences of sexuality and preferences for sexual counselling. Aim:To characterise sexual dysfunction and related factors among patients following cardiac rehabilitation and examine related treatment delivery. Methods:Telephone interviews with 382 patients (32% response rate) recruited from six hospital rehabilitation centres. Results:Seventy-nine per cent were male; average age was 64...

  3. FacilitiesHospitals_HOSPITAL

    Data.gov (United States)

    Vermont Center for Geographic Information — This data layer contains point locations of all major community, regional, comprehensive health, and healthcare provider hospitals in the state of Vermont. The...

  4. FacilitiesHospitals_HOSPITAL

    Data.gov (United States)

    Vermont Center for Geographic Information — This datalayer contains point locations of all major community, regional, comprehensive health, and healthcare provider hospitals in the state of Vermont. The...

  5. Repair of a Complex Congenital Cardiac Defect

    Medline Plus

    Full Text Available ... the answer to that question a little bit more, we would not be taking this child to the OR with a plan to replace ... of a complex congenital cardiac defect repair from Children's Hospital Boston. OR-Live makes it easy for you to learn more. Just click on the "request information" button on ...

  6. Barriers to Participation in Cardiac Rehabilitation

    Science.gov (United States)

    Dunlay, Shannon M.; Witt, Brandi J.; Allison, Thomas G.; Hayes, Sharonne N.; Weston, Susan A.; Koepsell, Ellen; Roger, Véronique L.

    2009-01-01

    Background Participation rates in cardiac rehabilitation following myocardial infarction (MI) remain low. Studies investigating the predictive value of psychosocial variables are sparse and often qualitative. We aimed to examine the demographic, clinical, and psychosocial predictors of participation in cardiac rehabilitation after MI in the community. Methods Olmsted County, Minnesota residents hospitalized with MI between June 2004 and May 2006 were prospectively recruited, and a 46-item questionnaire was administered prior to hospital dismissal. Associations between variables and cardiac rehabilitation participation were examined using logistic regression. Results Among 179 survey respondents (mean age 64.8 years, 65.9% male), 115 (64.2%) attended cardiac rehabilitation. The median (25th–75th percentile) number of sessions attended within 90 days of MI was 13 (5–20). Clinical characteristics associated with rehabilitation participation included younger age (odds ratio [OR] 0.95 per 1-year increase), male sex (OR 1.93), lack of diabetes (OR 2.50), ST elevation MI (OR 2.63), receipt of reperfusion therapy (OR 7.96), in-hospital cardiologist provider (OR 18.82), no prior MI (OR 4.17), no prior cardiac rehabilitation attendance (OR 3.85), and referral to rehabilitation in the hospital (OR 12.16). Psychosocial predictors of participation included placing a high importance on rehabilitation (OR 2.35), feeling that rehabilitation was necessary (OR 10.11), better perceived health prior to MI (excellent vs. poor OR 7.33), the ability to drive (OR 6.25), and post-secondary education (OR 3.32). Conclusions Several clinical and psychosocial factors are associated with decreased participation in cardiac rehabilitation programs after MI in the community. As many are modifiable, addressing them may improve participation and outcomes. PMID:19853708

  7. Characterization of Out of Lesson and Out Of School Physical

    Directory of Open Access Journals (Sweden)

    Krzysztof WARCHO?

    Full Text Available Principal purpose of the study is characteristics of out of lesson and out of school physical activities of children in selectedprimary schools in the Podkarpackie province. Inspiration for undertakings originate research was the opportunity to familiarizeoneself with the types of physical activity of students in their free time and the influence of formal and legal factors on theorganizational level of additional physical activities. The research was conducted in 60 primary schools in the Podkarpackieprovince. The basic condition in selecting the schools for the research owned a proper sport facility by the school. Research wasconducted in April and May, 2005. Empirical material was gathered by means of a diagnostic survey. Questionnaire of thesurvey included a set of closed questions. Students of physical education and headmasters of the schools were the respondents.The research indicates low level of physical activity of people of various ages. It should be assumed that this state of affairscorresponds to the state of physical education at schools. Therefore, in the search for optimal solutions, out of lesson and outof school activities should be included in the process of preparation of the young generation to physical activity in their adultlives. In conclusion, additional physical activity of children relies, to a large extent, on community service performed byteachers. Most of the times, out of lesson and out of school activities are occasional and incidental in nature and rarelyconstitute a part of an organized sequence of systematic events scheduled for specified points in time.

  8. Prevención primaria y secundaria de muerte súbita en un hospital de la Seguridad Social de Costa Rica: reporte del registro de pacientes con desfibrilador automático implantable, 2007-2011 / Primary and secondary prevention of sudden cardiac death in a hospital of the social security system in Costa Rica: report from the registry of patients with implantable cardioverter-defibrillators, 2007-2011

    Scientific Electronic Library Online (English)

    Hugo, Arguedas-Jiménez; Oswaldo, Gutiérrez-Sotelo.

    2013-03-01

    Full Text Available Justificación y objetivo: diversos estudios han demostrado la eficacia de los desfibriladores automáticos implantables en la prevención de la muerte súbita cardiaca. La aplicación de dicha evidencia debe ser evaluada mediante registros. El objetivo de este estudio fue describir las principales carac [...] terísticas epidemiológicas y clínicas y las complicaciones de los pacientes a quienes se les implanta un desfibrilador automático implantable en un hospital de tercer nivel en Costa Rica. Métodos: estudio observacional de cohorte, retrospectivo, que incluyó la totalidad de pacientes a quienes se les implantó un desfibrilador automático implantable en el hospital “Dr. Rafael Ángel Calderón Guardia” entre 2007 y 2011. Resultados: se incluyó 23 pacientes. La edad media fue de 55 ± 18 años. La cardiopatía isquémica fue la etiología más frecuente (10 pacientes). Veinte pacientes estaban en clase funcional I o II; la fracción de eyección media fue 0,38 ± 0,17. En los 18 pacientes el desfibrilador automático se implantó por prevención secundaria. Cinco pacientes presentaron una complicación temprana, todos ellos con dispositivos bicamerales: 2 hematomas menores, una disección del seno coronario, un desplazamiento del electrodo atrial derecho y un ictus cardioembólico. Hubo un total de 101 terapias (en 8 pacientes), de las cuales 94 fueron apropiadas (en 5 pacientes) y 7 inapropiadas (en 3 pacientes); dos de estos últimos habían tenido episodios previos de fibrilación atrial. Conclusión: este registro muestra que la mayoría de los implantes de desfibriladores automáticos se realizan por prevención secundaria, con una alta tasa de terapias adecuadas y una baja tasa de terapias inadecuadas y de complicaciones; además, permite evaluar las indicaciones y las complicaciones asociadas con esta terapia. Abstract in english Aim: Several studies have demonstrated the efficacy of implantable cardioverter-defibrillators in the prevention of sudden cardiac death. The validation of this evidence has to be assessed through various registries. The objective of this study was to describe the main epidemiological and clinical c [...] haracteristics of patients who were referred to a tertiary hospital in Costa Rica to be treated with a cardioverter-defibrillators implantable; as well as the associated problems and complications. Methods: A retrospective observational cohort study, which included all patients who were treated with a cardioverter-defibrillator implantable in the “Dr. Rafael A. Calderón Guardia” hospital between 2007 and 2011. Results: Twenty three patients were included. The mean age was 55 ± 18 years. Ischemic heart disease was the most frequent etiology (10 patients). Twenty patients had functional class I or II and the mean ejection fraction was 0.38 ± 0.17. In 18 patients, the cardioverter-defibrillator was implanted for secondary prevention. Five patients had an early complication; all of them had dual-chamber devices: 2 minor hematomas, 1 coronary sinus dissection, 1 right atrial lead displacement, and 1 cardio embolic stroke. From a total of 101 therapies (in 8 patients), 94 were appropriate (in 5 patients) and 7 were inappropriate (in 3 patients); 2 of the latter 3 patients had a history of atrial fibrillation episodes. Conclusion: This registry shows that the majority of implantable cardioverter-defibrillators implantations are performed as a secondary prevention, with a high rate of adequate therapies and a low rate of inadequate ones. The registry allowed an assessment of the indications and complications of this device therapy.

  9. Prevención primaria y secundaria de muerte súbita en un hospital de la Seguridad Social de Costa Rica: reporte del registro de pacientes con desfibrilador automático implantable, 2007-2011 Primary and secondary prevention of sudden cardiac death in a hospital of the social security system in Costa Rica: report from the registry of patients with implantable cardioverter-defibrillators, 2007-2011

    Directory of Open Access Journals (Sweden)

    Hugo Arguedas-Jiménez

    2013-03-01

    Full Text Available Justificación y objetivo: diversos estudios han demostrado la eficacia de los desfibriladores automáticos implantables en la prevención de la muerte súbita cardiaca. La aplicación de dicha evidencia debe ser evaluada mediante registros. El objetivo de este estudio fue describir las principales características epidemiológicas y clínicas y las complicaciones de los pacientes a quienes se les implanta un desfibrilador automático implantable en un hospital de tercer nivel en Costa Rica. Métodos: estudio observacional de cohorte, retrospectivo, que incluyó la totalidad de pacientes a quienes se les implantó un desfibrilador automático implantable en el hospital “Dr. Rafael Ángel Calderón Guardia” entre 2007 y 2011. Resultados: se incluyó 23 pacientes. La edad media fue de 55 ± 18 años. La cardiopatía isquémica fue la etiología más frecuente (10 pacientes. Veinte pacientes estaban en clase funcional I o II; la fracción de eyección media fue 0,38 ± 0,17. En los 18 pacientes el desfibrilador automático se implantó por prevención secundaria. Cinco pacientes presentaron una complicación temprana, todos ellos con dispositivos bicamerales: 2 hematomas menores, una disección del seno coronario, un desplazamiento del electrodo atrial derecho y un ictus cardioembólico. Hubo un total de 101 terapias (en 8 pacientes, de las cuales 94 fueron apropiadas (en 5 pacientes y 7 inapropiadas (en 3 pacientes; dos de estos últimos habían tenido episodios previos de fibrilación atrial. Conclusión: este registro muestra que la mayoría de los implantes de desfibriladores automáticos se realizan por prevención secundaria, con una alta tasa de terapias adecuadas y una baja tasa de terapias inadecuadas y de complicaciones; además, permite evaluar las indicaciones y las complicaciones asociadas con esta terapia.Aim: Several studies have demonstrated the efficacy of implantable cardioverter-defibrillators in the prevention of sudden cardiac death. The validation of this evidence has to be assessed through various registries. The objective of this study was to describe the main epidemiological and clinical characteristics of patients who were referred to a tertiary hospital in Costa Rica to be treated with a cardioverter-defibrillators implantable; as well as the associated problems and complications. Methods: A retrospective observational cohort study, which included all patients who were treated with a cardioverter-defibrillator implantable in the “Dr. Rafael A. Calderón Guardia” hospital between 2007 and 2011. Results: Twenty three patients were included. The mean age was 55 ± 18 years. Ischemic heart disease was the most frequent etiology (10 patients. Twenty patients had functional class I or II and the mean ejection fraction was 0.38 ± 0.17. In 18 patients, the cardioverter-defibrillator was implanted for secondary prevention. Five patients had an early complication; all of them had dual-chamber devices: 2 minor hematomas, 1 coronary sinus dissection, 1 right atrial lead displacement, and 1 cardio embolic stroke. From a total of 101 therapies (in 8 patients, 94 were appropriate (in 5 patients and 7 were inappropriate (in 3 patients; 2 of the latter 3 patients had a history of atrial fibrillation episodes. Conclusion: This registry shows that the majority of implantable cardioverter-defibrillators implantations are performed as a secondary prevention, with a high rate of adequate therapies and a low rate of inadequate ones. The registry allowed an assessment of the indications and complications of this device therapy.

  10. Critical appraisal of cardiac implantable electronic devices: complications and management

    Directory of Open Access Journals (Sweden)

    Padeletti L

    2011-09-01

    Full Text Available Luigi Padeletti1, Giosuè Mascioli2, Alessandro Paoletti Perini1, Gino Grifoni1, Laura Perrotta1, Procolo Marchese3, Luca Bontempi3, Antonio Curnis31Istituto di Clinica Medica e Cardiologia, Università degli Studi di Firenze, Italia; 2Elettrofisiologia, Istituto Humanitas Gavazzeni, Bergamo, Italia; 3Elettrofisiologia, Spedali Civili, Brescia, ItaliaAbstract: Population aging and broader indications for the implant of cardiac implantable electronic devices (CIEDs are the main reasons for the continuous increase in the use of pacemakers (PMs, implantable cardioverter-defibrillators (ICDs and devices for cardiac resynchronization therapy (CRT-P, CRT-D. The growing burden of comorbidities in CIED patients, the greater complexity of the devices, and the increased duration of procedures have led to an augmented risk of infections, which is out of proportion to the increase in implantation rate. CIED infections are an ominous condition, which often implies the necessity of hospitalization and carries an augmented risk of in-hospital death. Their clinical presentation may be either at pocket or at endocardial level, but they can also manifest themselves with lone bacteremia. The management of these infections requires the complete removal of the device and subsequent, specific, antibiotic therapy. CIED failures are monitored by competent public authorities, that require physicians to alert them to any failures, and that suggest the opportune strategies for their management. Although the replacement of all potentially affected devices is often suggested, common practice indicates the replacement of only a minority of devices, as close follow-up of the patients involved may be a safer strategy. Implantation of a PM or an ICD may cause problems in the patients' psychosocial adaptation and quality of life, and may contribute to the development of affective disorders. Clinicians are usually unaware of the psychosocial impact of implanted PMs and ICDs. The main difference between PM and ICD patients is the latter's dramatic experience of receiving a shock. Technological improvements and new clinical evidences may help reduce the total burden of shocks. A specific supporting team, providing psychosocial help, may contribute to improving patient quality of life.Keywords: pacemaker, cardiac cardioverter-defibrillator, cardiac implantable electronic devices, infection, recall, quality of life 

  11. Cardiac surgery in a fixed-reimbursement environment.

    Science.gov (United States)

    Scully, H E

    1996-02-01

    Hospital and physician services in Canada are funded by public (government) sources. This article will describe the practice of cardiac surgery in this setting. Federal legislation has prescribed the principles of accessibility, universality, comprehensiveness, portability, and public administration for essential healthcare services in Canada. Provincial and territorial governments are responsible for the provision of services, receiving federal tax and cash transfers that supplement provincial/territorial funds for hospital, physician, and community health services. Hospitals negotiate annually for global budgets. Physicians work as independent contractors in hospitals (and communities) and are usually paid as specified by fee-for-service contracts negotiated at intervals with governments. Cardiac surgical services have been planned conjointly with government. Forty-two centers in Canada serve a population of 28 million. All but three of these centers are located in tertiary teaching hospitals; all but one do more than 200 pumps annually. The rate of cardiac operations is 80 per 100,000 population. In Ontario, the Provincial Adult Cardiac Care Network makes recommendations to governments about the distribution of the 7,600 pumps annually (population, 11 million), rationalizing waiting lists based on an urgency rating scale. Patients requiring emergent/urgent operations are well served. The average waiting time for an elective cardiac operation is 10.5 weeks. The waiting list mortality is less than 0.5%. The Provincial Adult Cardiac Care Network also determines the placement of new programs and participates in creating hospital funding formulas developed from a combination of resource and acuity intensity weighting. Most surgeons hold full-time academic appointments but are funded largely by practice income. Surgical fees average $2,000 (Canada) per case. Overhead, including malpractice insurance, is approximately 45%. All Canadian patients enjoy reasonably timely access to good cardiac surgical care. Further constraints on physician compensation and (academic) hospital funding will compromise this balance. PMID:8572826

  12. Hospitals; hospitals13

    Data.gov (United States)

    University of Rhode Island Geospatial Extension Program — Hospital Facilities information was compiled from several various sources. Main source was the RI Department of Health Facilities Regulation database, License 2000....

  13. Incidência de parada cardíaca durante anestesia, em hospital universitário de atendimento terciário: estudo prospectivo entre 1996 e 2002 Incidencia de parada cardíaca durante anestesia, en hospital universitario de servicio terciario: estudio prospectivo entre 1996 y 2002 Cardiac arrest during anesthesia at a tertiary teaching hospital: prospective survey from 1996 to 2002

    OpenAIRE

    Leandro Gobbo Braz; José Reinaldo Cerqueira Braz; Norma Sueli Pinheiro Módolo; Paulo do Nascimento Júnior; Ana Paula Shuhama; Laís Helena Camacho Navarro

    2004-01-01

    JUSTIFICATIVA E OBJETIVOS: A incidência e causas de parada cardíaca (PC) durante a anestesia variam e são difíceis de comparar diante dos diversos métodos usados nos estudos. A pesquisa teve como objetivo estudar todas as PC ocorridas no intra e pós-operatório, durante um período de sete anos, de 1996 a 2002, em hospital de ensino de atendimento terciário para determinar incidência e causas da PC. MÉTODO: A incidência prospectiva de PC ocorrida durante a anestesia em 40.941 pacientes consecut...

  14. Pulmonary embolism as a cause of cardiac arrest: Hypothermia in post-resuscitation period (cooling therapy

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    Nikovi? Vuk

    2013-01-01

    Full Text Available Introduction. Pulmonary embolism as a possible cause of acute heart failure is a potentially fatal condition that can cause death in all age groups. Patients successfully resuscitated after cardiac arrest have a high risk of increased mortality and their poor long­term outcome is often associated with severe neurological complications. Case Outline. This is a case report of a 67­year­old man after a successful cardiopulmonary resuscitation (CPR which was followed by therapeutic hypothermia (TH. The patient visited the dermatological outpatients’ department with clinical presentation of pain and swelling of the right leg, shortness of breath and chest pain. During examination the patient lost consciousness, stopped breathing and had cardiac arrest. ECG was done which registered asystole. We began CPR. After 59 minutes of resuscitation return of heartbeat was achieved. The patient was transported to the Emergency Department. On admission, after computerized tomography (CT of the chest confirmed massive pulmonary embolism (PE, the patient was administered thrombolytic therapy with Metalyse (tenecteplase and anti­coagulation therapy (heparin. After stabilization, therapeutic hypothermia was applied. Combination of EMCOOLSpad on the chest and abdomen and cold Ringer lactate 500 ml at 4°C was flushed. Temperature was decreased to 33°C and kept stabile for 24 hours. After eight days the patient was conscious with a minimal neurological deficit. Conclusion. As shown in this case report, and according to the rich experience elsewhere, cooling therapy after out­of­hospital cardiac arrest and successful CRP may be useful in preventing neurological complications.

  15. Primera experiencia en el uso de Cardioplejia sanguínea: estudio prospectivo de 200 casos sometidos a Cirugía Cardíaca en el Hospital México, San José, Costa Rica

    Directory of Open Access Journals (Sweden)

    Edgar A. Méndez

    2002-12-01

    Full Text Available Introducción: Este estudio reporta la primera experiencia del uso de cardioplejia sanguínea durante la cirugía cardíaca en el hospital México y expone la importancia de su uso en cirugía cardíaca. Material y Métodos: Se estudiaron prospectivamente 200 pacientes consecutivos programados a varios procedimientos quirúrgicos cardíacos con el uso de cardioplejia sanguínea en un período comprendido entre setiembre de 1999 y febrero del 2002. Resultados: Estos 200 casos consistieron de 122 hombres y 78 mujeres con una edad promedio de 57.48 años ( rango, 26 a 28 años . 71 pacientes salieron del arresto cardíaco con ritmo espontáneo. Doce pacientes fallecieron y 30 casos presentaron complicaciones en el postoperatorio: 9 pacientes presentaron infarto agudo al miocardio perioperatorio, 6 casos presentaron para cardiorrespiratorio, 12 tuvieron arritmias cardíacas, 3 pacientes presentaron insuficiencia cardíaca congestivo. Conclusiones: En esta experiencia preliminar, el uso de la cardioplejia sanguínea parece proveer una protección miocárdica segura y confiable durante la cirugía cardíaca, siendo un método ideal en casos de cirugías de elevado riesgo quirúrgico.lntroduction: This study reports the first experience in the use of sanguineous cardioplegia during cardiac surgery in the Mexico Hospital and exposes the important role that this procedure plays in this type of surgery. Materials and Methods: A prospective study was carried out with 200 consecutive patients programmed for different cardiac surgical procedures with the use of sanguineous cardioplegia during the period of September 1999 to February 2002. Results: Of the 200 cases 122 were male and 78 females, all with average ages of 57.48 years. Seventy one patients carne out of cardiac arrest with spontaneous rhythm. Tweive patients died and 30 cases presentes post- surgícal complications: 9 patients presentes acute myocardium infarct, 6 cases presentes Respiratory cardiac arrest, 12 had cardiac arrhythmias and 3 patients presentes congestivo cardiac insufficiency. Conclusions: in this preliminary experience the use of sanguineous cardioplegia seems to provide a safe and refiable myocardium protection during cardiac surgery, making it an ideal method in high risk surgery.

  16. Neurological prognostication after cardiac arrest and targeted temperature management 33°C versus 36°C : Results from a randomised controlled clinical trial

    DEFF Research Database (Denmark)

    Dragancea, Irina; Horn, Janneke

    2015-01-01

    BACKGROUND: The reliability of some methods of neurological prognostication after out-of-hospital cardiac arrest has been questioned since the introduction of induced hypothermia. The aim of this study was to determine whether different treatment temperatures after resuscitation affected the prognostic accuracy of clinical neurological findings and somatosensory evoked potentials (SSEP) in comatose patients. METHODS: We calculated sensitivity and false positive rate for Glasgow Coma Scale motor score (GCS M), pupillary and corneal reflexes and SSEP to predict poor neurological outcome using prospective data from the Target Temperature Management after Out-of-Hospital Cardiac Arrest Trial which randomised 939 comatose survivors to treatment at either 33°C or 36°C. Poor outcome was defined as severe disability, vegetative state or death (Cerebral Performance Category scale 3-5) at six months. RESULTS: 313 patients (33%) were prognostically assessed; 168 in the 33°C, and 145 in the 36°C group. A GCS M ?2 had afalse positive rate of 19.1% to predict poor outcome due to nine false predictions. Bilaterally absent pupillary reflexes had a false positive rate of 2.1% and absent corneal reflexes had a false positive rate of 2.2% due to one false prediction in each group. The false positive rate for bilaterally absent SSEP N20-peaks was 2.6%. CONCLUSIONS: Bilaterally absent pupillary and corneal reflexes and absent SSEP N20-peaks were reliable markers of a poor prognosis after resuscitation from out-of-hospital cardiac arrest but low GCS M score was not. The reliability of the tests was not altered by the treatment temperature.

  17. La formación en urgencias extrahospitalarias y su adecuación al nuevo programa de la especialidad de Medicina Familiar y Comunitaria: ¿hemos avanzado? / Training in out-of-hospital emergency services and its adaptation to the new Family and Community Medicine speciality programme.: have we gone forward?

    Scientific Electronic Library Online (English)

    Magdalena, Canals Aracil; Alba, Riesgo García.

    2013-10-01

    Full Text Available Objetivo: Conocer la rotación en urgencias extrahospitalarias de los residentes de Medicina Familiar y Comunitaria (MFyC) y comparar su evolución durante el periodo 2005-2010. Diseño del estudio: Estudio observacional descriptivo longitudinal. Emplazamiento: Unidades Docentes (UU.DD.) de MFyC. Parti [...] cipantes: Responsables de UU.DD. de MFyC. Respondieron el 61,1% en 2005 y el 60,0% en 2010. Mediciones principales: Mediante cuestionario autoadministrado, comparando su evolución entre 2005 y 2010, se midió la proporción de residentes que realizan guardias en atención primaria, rotación por servicios de emergencias, grado de supervisión de éstas y evaluación de las mismas. Se describen las variables de estudio mediante cálculo de proporciones y medias e intervalos de confianza al 95%. Resultados: En el año 2010 la proporción de UU.DD. en las que los residentes de MFyC realizaron guardias en atención primaria fue del 87,7% (IC95% 78,3-97,1) y en 2005 del 74,5% (IC95% 62,1-87,0), supervisadas por tutores de medicina de familia en el 61,5% de los casos en 2010 (53,7% en 2005). La rotación por los servicios de emergencias se incrementó del 87,3% al 91,1%. En los SUAP/servicios de emergencias la tutorización de los residentes fue ejercida por tutores acreditados en el 53,1% en 2005 y en el 51,0% en 2010. Conclusiones: La rotación en urgencias extrahospitalarias ha mejorado al aplicarse el nuevo programa de la especialidad. Se ha de mejorar la tutorización y evaluación de esta rotación. Abstract in english Objective: To establish family and community medicine (FCM) resident rotation in out-of-hospital emergencies and compare its progress during the period 2005-2010. Design: Observational, descriptive and longitudinal study. Location: FCM teaching units. Participants: Those in charge of FCM teaching un [...] its. 61,1% responded in 2005 and 60,0% en 2010. Main Surveyed Data: By way of self-administrated questionnaire, comparing its progress between 2005 and 2010, the proportion of residents who carry out primary care duties, emergency services rotation, degree of their supervision and their assessment. Study variables are described by way of calculation of proportions and averages and 95% confidence intervals. Results: In the year 2010, the proportion of teaching units in which FCM residents carried out primary care duties was 87,7% (IC95% 78,3-97,1), and in 2005, 74,5% (IC95% 62,1-87,0), supervised by family medicine tutors in 61,5% of cases in 2010 (53,7% en 2005). Emergency service rotation was increased by 87,3% to 91,1%. In the SUAP/emergency services, the tutoring of residents was performed by authorized tutors in 53,1% in 2005 and in 51,0% in 2010. Conclusions: Rotation in out-of-hospital emergencies has improved by applying the new speciality programme. The tutoring and assessment of this rotation are in need of improvement.

  18. Cardiac Risk Assessment

    Science.gov (United States)

    ... limited. Home Visit Global Sites Search Help? Cardiac Risk Assessment Share this page: Was this page helpful? Formal ... Common Questions | Related Pages What is a cardiac risk assessment? This is a group of tests and health ...

  19. Catastrophic Cardiac Amyloidosis

    OpenAIRE

    Mohammed Mukhaini; Prashanth Panduranga

    2010-01-01

    We report a case of a 61-year-old patient presenting with cardiogenic shock. His echocardiogram suggested typical features of cardiac amyloidosis. This case demonstrates that cardiac amyloidosis can present acutely and may be catastrophic.

  20. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... use of a cardiac defibrillator in open heart surgery and what is the risk to the phrenic nerve? You don't use cardiac defibrillator in open heart surgery at the moment of the point of that ...

  1. Predictors for outcome among cardiac arrest patients : the importance of initial cardiac arrest rhythm versus time to return of spontaneous circulation, a retrospective cohort study

    DEFF Research Database (Denmark)

    Wibrandt, Ida; Norsted, Kristine

    2015-01-01

    BackgroundIn the past decade, early treatment of cardiac arrest (CA) victims has been improved in several ways, leading to more optimistic over all prognoses. However, the global survival rate after out-of-hospital CA (OHCA) is still not more than 5-10%. With a better knowledge of the predictors for outcome among CA patients, we can improve the management of CA, in order to strengthen the leads in the chain of survival.MethodsA retrospective cohort study including 172 CA patients admitted to the intensive care unit (ICU) in Odense University Hospital (OUH) in a three-year period was conducted. We determined the 90-day mortality and neurological outcome at discharge for CA patients treated with therapeutic hypothermia (TH), in regard to determine the importance of the predictors for mortality and neurological outcome, with emphasize on combining initial rhythm and time to return of spontaneous circulation (ROSC).ResultsThe overall mortality was 44% and a favorable neurological outcome was seen among 52%. Strong predictors for survival and favorable neurological outcome were ventricular tachycardia/ventricular fibrillation (VT/VF) as initial rhythm, cardiac etiology and time to ROSC¿<¿20 minutes. Age¿<¿60 years was a predictor for survival only. Patients with the combination of VT/VF and ROSC¿<¿20 minutes had undeniably the best chance of both survival and a favorable neurological outcome.ConclusionsWe found significant predictors for both survival and neurological outcome, in which an initial rhythm of VT/VF and a cardiac etiology were the strongest.

  2. Desigualdades entre pacientes hospitalizados por doenças cardíacas e vasculares-cerebrais em localidade do Estado de São Paulo (Brasil, 1986 Inequalities among patients hospitalized for cardiac and cerebral-vascular diseases in the City of the State of S. Paulo, Brazil, 1986

    Directory of Open Access Journals (Sweden)

    Juan Stuardo Yazlle Rocha

    1989-10-01

    Full Text Available Valendo-se de um sistema de informações sobre hospitalizações no Município de Ribeirão Preto, SP (Brasil foram estudadas as características clínico-epidemiológicas referidas dos pacientes internados, em 1986, por doenças cardíacas e vasculares-cerebrais (DCVC. De 43.499 hospitalizações ocorridas naquele ano, 4.673 foram ocasionadas por doenças cardíacas e vasculares-cerebrais. Utilizando a fonte de financiamento da internação como indicador do estrato social ao qual pertence o paciente, foram compostos 4 grupos de estudo: particulares, "outros", previdenciários e "não pagantes"; estes grupos apresentaram diferenças significativas quanto a coeficiente de internações por DCVC, média e mediana de idade na hospitalização, perfil ocupacional, duração da internação, freqüência dos sub-grupos diagnósticos, coeficientes de mortalidade e a idade média e mediana nos casos de óbitos. Estas diferenças foram atribuídas às disparidades sociais no nível de vida e condições de trabalho dos grupos estudados o que determina diferenças no adoecer, ser assistido e no morrer.The clinical and epidemiological characteristics of hospitalizations due to cardiac and cerebral-vascular diseases (CCVD - ICD 390 - 438, which occurred in 1986, were studied on the basis of data from an information system relating to medical care in the City of Ribeirão Preto, State of S. Paulo, Brazil. These causes accounted for 4,673 of the annual total of 43,449 hospital admissions. Using the sources of payment of the hospitalization as an indicator of the patients' social strata, the following four study groups were defined: private, social insurance, non-paying and "others". These groups showed significant differences in relation to the following variables: hospitalization rates due to CCVD, mean and median age at admission and time of death, occupation, average length of stay in the hospital, mortality rates and relative frequencies of specific sub-group diagnosis. These differences are attributed to inequalities in the standard of living and in the working conditions of the groups, which determine diverse patterns of disease, medical care and mortality.

  3. Mediastinitis after cardiac transplantation

    Directory of Open Access Journals (Sweden)

    Stolf Noedir A. G.

    2000-01-01

    Full Text Available OBJECTIVE: Assessment of incidence and behavior of mediastinitis after cardiac transplantation. METHODS: From 1985 to 1999, 214 cardiac transplantations were performed, 12 (5.6% of the transplanted patients developed confirmed mediastinitis. Patient's ages ranged from 42 to 66 years (mean of 52.3±10.0 years and 10 (83.3% patients were males. Seven (58.3% patients showed sternal stability on palpation, 4 (33.3% patients had pleural empyema, and 2 (16.7% patients did not show purulent secretion draining through the wound. RESULTS: Staphylococcus aureus was the infectious agent identified in the wound secretion or in the mediastinum, or both, in 8 (66.7% patients. Staphylococcus epidermidis was identified in 2 (16.7% patients, Enterococcus faecalis in 1 (8.3% patient, and the cause of mediastinitis could not be determined in 1 (8.3% patient. Surgical treatment was performed on an emergency basis, and the extension of the débridement varied with local conditions. In 2 (16.7% patients, we chose to leave the surgical wound open and performed daily dressings with granulated sugar. Total sternal resection was performed in only 1 (8.3% patient. Out of this series, 5 (41.7% patients died, and the causes of death were related to the infection. Autopsy revealed persistence of mediastinitis in 1 (8.3% patient. CONCLUSION: Promptness in diagnosing mediastinitis and precocious surgical drainage have changed the natural evolution of this disease. Nevertheless, observance of the basic precepts of prophylaxis of infection is still the best way to treat mediastinitis.

  4. Mediastinitis after cardiac transplantation

    Scientific Electronic Library Online (English)

    Noedir A. G., Stolf; Alfredo I., Fiorelli; Fernando, Bacal; Luiz F., Camargo; Edimar A., Bocchi; Andréa, Freitas; André, Nicoletti; Daniela, Meira.

    2000-05-01

    Full Text Available OBJECTIVE: Assessment of incidence and behavior of mediastinitis after cardiac transplantation. METHODS: From 1985 to 1999, 214 cardiac transplantations were performed, 12 (5.6%) of the transplanted patients developed confirmed mediastinitis. Patient's ages ranged from 42 to 66 years (mean of 52.3±1 [...] 0.0 years) and 10 (83.3%) patients were males. Seven (58.3%) patients showed sternal stability on palpation, 4 (33.3%) patients had pleural empyema, and 2 (16.7%) patients did not show purulent secretion draining through the wound. RESULTS: Staphylococcus aureus was the infectious agent identified in the wound secretion or in the mediastinum, or both, in 8 (66.7%) patients. Staphylococcus epidermidis was identified in 2 (16.7%) patients, Enterococcus faecalis in 1 (8.3%) patient, and the cause of mediastinitis could not be determined in 1 (8.3%) patient. Surgical treatment was performed on an emergency basis, and the extension of the débridement varied with local conditions. In 2 (16.7%) patients, we chose to leave the surgical wound open and performed daily dressings with granulated sugar. Total sternal resection was performed in only 1 (8.3%) patient. Out of this series, 5 (41.7%) patients died, and the causes of death were related to the infection. Autopsy revealed persistence of mediastinitis in 1 (8.3%) patient. CONCLUSION: Promptness in diagnosing mediastinitis and precocious surgical drainage have changed the natural evolution of this disease. Nevertheless, observance of the basic precepts of prophylaxis of infection is still the best way to treat mediastinitis.

  5. Understanding cardiac output

    OpenAIRE

    Vincent, Jean-Louis

    2008-01-01

    Cardiac output is the amount of blood the heart pumps in 1 minute, and it is dependent on the heart rate, contractility, preload, and afterload. Understanding of the applicability and practical relevance of each of these four components is important when interpreting cardiac output values. In the present article, we use a simple analogy comparing cardiac output with the speed of a bicycle to help appreciate better the effects of various disease processes and interventions on cardiac output an...

  6. Cardiac tamponade: atypical presentations after cardiac surgery.

    Science.gov (United States)

    Kirti, Ravi; Karadi, Rangaprasad

    2012-01-01

    We present two cases of cardiac tamponade presenting in the aftermath of cardiac surgery. We have briefly discussed the aetiology, presentation, diagnosis and management of the condition with emphasis on its atypical presentation in postoperative patients. A high index of suspicion and early access to echocardiography is necessary for prompt recognition and treatment of this life threatening emergency. PMID:22860267

  7. Considerable regional differences in visitation and initial handling of acute cardiac patients in Denmark

    DEFF Research Database (Denmark)

    Egholm, Gro; Mackenhauer, Julie

    2014-01-01

    Danish emergency departments (EDs) are undergoing a reorganisation in which the EDs are changed to serve as the single portal of entry for all acute patients. This survey-based study evaluates the entry to the Danish hospitals for acute cardiac patients. In 62% of the EDs there is not a cardiologist on call around the clock, thus compromising the availability of echocardiography and cardiac supervision. The handling of cardiac patients varies and the quality in the visitation and admission of these patients fluctuates. Pre-hospital findings should be used consequently to triage cardiac patients.

  8. Usefulness of 123I-metaiodobenzylguanidine myocardial scintigraphy in the prediction of cardiac events in patients with cardiomyopathy showing stabilization of symptoms or preserved cardiac function

    International Nuclear Information System (INIS)

    It is not rare for patients with cardiomyopathy to be asymptomatic for long periods or to show improved cardiac function following various medical interventions. Conversely, cardiac events sometimes occur in those patients, requiring close observation. We assessed the usefulness of 123I-metaiodobenzylguanidine myocardial scintigraphy (MIBG) to predict the occurrence of cardiac events in patients with stable cardiomyopathy. The subjects comprised 74 outpatients with stable cardiomyopathy. MIBG was performed calculate the extent score, severity score, washout rate (WR), and heart-to-mediastinum ratio. At about the same time, the left ventricular ejection fraction (LVEF) by echocardiography and the plasma brain natriuretic peptide were measured. The mean observation period extended for 741±437 days with an end point of cardiac events (cardiac death, heart failure requiring hospitalization, and arrhythmias requiring hospitalization). During the mean follow-up period, 15 cardiac events occurred. Results of multivariate analysis revealed that LVEF was the most powerful predictor of cardiac events (0.006, p<0.01). However, WR was the only significant predictor of hard events such as cardiac death (1.171, p<0.001) and cardiac events in the group of patients who preserved cardiac function with LVEF 0.4 or higher (1.079, p<0.05). Combined use of LVEF and WR is useful to predict the occurrence of cardiac events in patients with stable cardiomyopathy. (author)

  9. Hospital Compare

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find...

  10. HCAHPS - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital...

  11. Out of the healthcare crisis.

    Science.gov (United States)

    Siriwardena, A Niroshan

    2011-01-01

    W Edwards Deming's Out of the Crisis, was first published almost three decades ago.(1) It was a bestseller and remains a classic text written by one of the foremost quality improvement experts of the 20th century. It is a book which certainly warrants re-examination in light of today's challenges for health care. This discussion paper reviews what Deming can teach us about causes of failure in management, including health care, what can be done to remedy them and how to avert problems in future. PMID:21575335

  12. Cardiac chest pain in children

    Directory of Open Access Journals (Sweden)

    F. Ay?enur Paç

    2009-10-01

    Full Text Available Objective: Chest pain (CP is a common cause of referral to hospital, not always directly related with cardiac diseases (CD. We investigated the causes for cardiac CP in children.Methods: A hundred and twenty children, admitted consecutively to pediatric cardiology clinic with CP, were evaluated in two groups (5-12 and 13-16 age-group in a cross-sectional and a retrospective way. Chest X-ray, electrocardiography, and echocardiography were performed. In case of necessity, 24-hour Holter monitoring, exercise stress test, tilt-table test were performed, and hemogram, serum glucose, electrolytes were evaluated. Statistical analysis was performed using Chi-square test and risk ratio [(Odds-ratio (OR, (95% CI] in groups were evaluated. Results: Most children with CP were older. Cardiac diseases were established in 52 (42.5% patients. Cardiac diseases, which may cause CP (aortic stenosis, mitral valve prolapse, arrhythmias, etc. were found in 23.3% (n=28 of patients. Compared with the younger, the risk of structural CD was found to be 2.84 times higher (OR=2.84, 95%CI 1.24-6.48, p=0.011 and risk of arrhythmia was 3.53 times higher in the elder age group (OR=3.53, 95%CI 0.93-13.38, p=0.051. When all CD were evaluated, elder children were found to have 4.12 times more risk of having CD (OR=4.12, 95%CI 1.89-9.01, p<0.0001.Conclusion: Most children with CP were older than 12 years old. CDs were frequent and about half of them were thought to directly cause pain. So, further investigations according to standard algorithms are needed in the evaluation of children with CP. Other important result is the increased risk of CD found in elder children.

  13. Coping to Cardiac Surgery – preview note

    Directory of Open Access Journals (Sweden)

    Graciele Fernanda da Costa Linch

    2008-11-01

    Full Text Available It is a research project that has been developed at Santa Maria University Hospital (HUSM, aiming to identify the coping strategies that patients use when referred for Cardiac Surgery. The data will be collected in the cardiac pre-surgery period through a questionnaire, intending to characterize the participants; besides using the Coping Inventory instrument – Jalowiec – to identify the coping styles that the participants use against the stressors confront. From the coping process identification of the patients who were referred for cardiac surgery, it will be possible to analyze and base the professionals’ actions who deal with these patients, aiming to attend the emotional and physiological adaptation demands to the surgical process.

  14. Cardiac tumours in children

    Directory of Open Access Journals (Sweden)

    Parsons Jonathan M

    2007-03-01

    Full Text Available Abstract Cardiac tumours are benign or malignant neoplasms arising primarily in the inner lining, muscle layer, or the surrounding pericardium of the heart. They can be primary or metastatic. Primary cardiac tumours are rare in paediatric practice with a prevalence of 0.0017 to 0.28 in autopsy series. In contrast, the incidence of cardiac tumours during foetal life has been reported to be approximately 0.14%. The vast majority of primary cardiac tumours in children are benign, whilst approximately 10% are malignant. Secondary malignant tumours are 10–20 times more prevalent than primary malignant tumours. Rhabdomyoma is the most common cardiac tumour during foetal life and childhood. It accounts for more than 60% of all primary cardiac tumours. The frequency and type of cardiac tumours in adults differ from those in children with 75% being benign and 25% being malignant. Myxomas are the most common primary tumours in adults constituting 40% of benign tumours. Sarcomas make up 75% of malignant cardiac masses. Echocardiography, Computing Tomography (CT and Magnetic Resonance Imaging (MRI of the heart are the main non-invasive diagnostic tools. Cardiac catheterisation is seldom necessary. Tumour biopsy with histological assessment remains the gold standard for confirmation of the diagnosis. Surgical resection of primary cardiac tumours should be considered to relieve symptoms and mechanical obstruction to blood flow. The outcome of surgical resection in symptomatic, non-myxomatous benign cardiac tumours is favourable. Patients with primary cardiac malignancies may benefit from palliative surgery but this approach should not be recommended for patients with metastatic cardiac tumours. Surgery, chemotherapy and radiotherapy may prolong survival. The prognosis for malignant primary cardiac tumours is generally extremely poor.

  15. Initial lactate and lactate change in post-cardiac arrest

    DEFF Research Database (Denmark)

    Donnino, Michael W; Wiuff Andersen, Lars; Giberson, Tyler; Gaieski, David F; Abella, Benjamin S; Peberdy, Mary Anne; Rittenberger, Jon C; Callaway, Clifton W; Ornato, Joseph; Clore, John; Grossestreuer, Anne; Salciccioli, Justin; Cocchi, Michael N

    2014-01-01

    OBJECTIVE: Rate of lactate change is associated with in-hospital mortality in post-cardiac arrest patients. This association has not been validated in a prospective multicenter study. The objective of the current study was to determine the association between percent lactate change and outcomes in post-cardiac arrest patients. DESIGN: Four-center prospective observational study conducted from June 2011 to March 2012. SETTING: The National Post-Arrest Research Consortium is a clinical research ne...

  16. The role of psychological support in cardiac surgery: initial experience

    OpenAIRE

    Riccardo Casabona; Stefano del Ponte; Gian Luca Bardi; Giuseppe Punta; Francesco Parisi; Pier Giuseppe Forsennati; Guglielmo Mario Actis Dato; Edoardo Zingarelli; Roberto Flocco; Erika Bellini; Sabrina Ghersi; Fabrizio Sansone

    2011-01-01

    The scientific literature has pointed out several predictors of negative outcome after surgery such as pain and depression, negatively affecting the postoperative outcome in cardiac surgery. From January 2009 until June 2010, 15 patients scheduled for cardiac surgery were enrolled. The patients were assessed by psychological evaluation either in the hospital stay either in the rehabilitation period with the aim of identifying their emotional condition (sentiments about the onset of the diseas...

  17. A case of thyroid storm with cardiac arrest

    Directory of Open Access Journals (Sweden)

    Nakashima Y

    2014-05-01

    Full Text Available Yutaka Nakashima,1 Tsuneaki Kenzaka,2 Masanobu Okayama,3 Eiji Kajii31Department for Support of Rural Medicine, Yamaguchi Grand Medical Center, 2Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan; 3Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, JapanAbstract: A 23-year-old man became unconscious while jogging. He immediately received basic life support from a bystander and was transported to our hospital. On arrival, his spontaneous circulation had returned from a state of ventricular fibrillation and pulseless electrical activity. Following admission, hyperthyroidism led to a suspicion of thyroid storm, which was then diagnosed as a possible cause of the cardiac arrest. Although hyperthyroidism-induced cardiac arrest including ventricular fibrillation is rare, it should be considered when diagnosing the cause of treatable cardiac arrest.Keywords: hyperthyroidism, ventricular fibrillation, treatable cardiac arrest, cardiac arrest, cardiopulmonary arrest

  18. Cardiac regeneration: different cells same goal

    OpenAIRE

    Barnett, Phil; van den Hoff, Maurice J. B.

    2011-01-01

    Cardiovascular diseases are the leading cause of mortality, morbidity, hospitalization and impaired quality of life. In most, if not all, pathologic cardiac ischemia ensues triggering a succession of events leading to massive death of cardiomyocytes, fibroblast and extracellular matrix accumulation, cardiomyocyte hypertrophy which culminates in heart failure and eventually death. Though current pharmacological treatment is able to delay the succession of events and as a consequence the develo...

  19. Primary cardiac osteosarcoma in a 42-year-old woman

    Directory of Open Access Journals (Sweden)

    Zou Jianyong

    2010-11-01

    Full Text Available Abstract We describe here a 42-year-old woman who was admitted to hospital with a pedunculated mass in her left atrium. She was diagnosed with a primary cardiac osteosarcoma with special immunohistochemical characteristics. Echocardiography and computed tomography can be used to differentiate cardiac osteosarcomas from routine intracardiac tumors. The patient was treated by surgical removal of the mass. Two years later, she has shown no evidence of disease recurrence. We discuss primary osteosarcomas in the cardiac cavity and their management.

  20. Occupational stress and mental health of cardiac and noncardiac patients

    Directory of Open Access Journals (Sweden)

    S Subramanian

    2009-01-01

    Full Text Available Background: Much of the research studies have shown that occupational stress is one of the strong determinant factors of coronary heart diseases among people in general. However, exploring the extent to which the type or nature of ailments and its subsequent risk factors have an effect on the onset of mental health will help evolve suitable preventive measures. The present study attempts to explore the status of mental health and occupational stress with respect to 2 categories of patients: Those who are suffering from cardiac problems and those suffering from noncardiac health problems. Materials and Methods: Occupational Stress Questionnaire and Mental Health Questionnaire were administered to both cardiac and noncardiac patients. The cardiac group consisted of 40 patients who were being treated at the cardiology department of a reputed hospital, and noncardiac group (40 patients consisted of outpatients of the same hospital being treated for noncardiac problems like knee pain, headache, etc. Responses to these self-reported questionnaires were subjected to statistical analysis to find out the difference between cardiac and noncardiac groups. Results: The results revealed that cardiac patients tend to have lower levels of mental health than noncardiac patients. Similarly, cardiac patients were reported to have higher levels of stress due to role ambiguity, powerlessness, intrinsic impoverishment and unprofitability. Conclusions: The implications of the study were implementation of interventions to improve the internal strength of cardiac patients to overcome various aspects of occupational stress.

  1. Redução do período de internação e de despesas no atendimento de portadores de cardiopatias congênitas submetidos à intervenção cirúrgica cardíaca no protocolo da via rápida The reduction in hospital stay and costs in the care of patients with congenital heart diseases undergoing fast-track cardiac surgery

    Directory of Open Access Journals (Sweden)

    Alfredo Manoel da Silva Fernandes

    2004-07-01

    Full Text Available OBJETIVO: Avaliar o atendimento de cardiopatas congênitos e cardiopatas isquêmicos submetidos à cirurgia cardíaca no protocolo de atendimento na via rápida (fast-track recovery em relação ao convencional. MÉTODOS: Avaliada a movimentação de 175 pacientes, 107 (61% homens e 68 (39% mulheres, idades entre 0,3-81 anos nas diferentes unidades hospitalares. RESULTADOS: A taxa de alta das diferentes unidades hospitalares por unidade de tempo, dos cardiopatas congênitos atendidos no protocolo da via rápida em relação ao convencional foi: a 11,3 vezes a taxa de alta quando assistidos no protocolo da via convencional, quanto ao tempo de permanência no centro cirúrgico; b 6,3 vezes quanto à duração da intervenção cirúrgica; c 6,8 vezes quanto à duração da anestesia; d 1,5 vezes quanto à duração da perfusão; e 2,8 vezes quanto à permanência na unidade de recuperação pós-operatória I; f 6,7 vezes quanto à permanência no hospital (período de tempo entre a data da internação e a data da alta; g 2,8 vezes quanto à permanência na unidade de internação pré-operatória; h 2,1 vezes quanto à permanência na unidade de internação após a alta da recuperação pós-operatória; i associada com redução de despesas pré e pós-operatórias. A diferença não foi significativa nos portadores de cardiopatia isquêmica. CONCLUSÃO: Verificou-se redução do período de internação e de despesas no atendimento dos pacientes submetidos à intervenção cirúrgica cardíaca no protocolo da via rápida.OBJECTIVE: To assess the care provided to patients with congenital heart diseases and ischemic heart diseases undergoing cardiac surgery according to the fast-track recovery protocol compared with those undergoing the conventional procedure. METHODS: The transfer of patients from one hospital unit to another was assessed for 175 patients, 107 (61% men and 68 (39% women, with ages ranging from 0.3 to 81 years. RESULTS: The discharge rate from the different hospital units per unit of time of the patients with congenital heart diseases treated according to the fast-track recovery protocol compared with that of patients conventionally treated was as follows: a 11.3 times faster than the discharge rate of patients treated according to the conventional protocol, in regard to the time spent in the operating room; b 6.3 times faster in regard to the duration of the surgical intervention; c 6.8 times faster in regard to the duration of anesthesia; d 1.5 times faster in regard to the duration of perfusion; e 2.8 times faster in regard to the stay in the postoperative recovery I unit; f 6.7 times faster in regard to hospital stay (time period between hospital admission and hospital discharge; g 2.8 times faster in regard to the stay in the preoperative unit; h 2.1 times faster in regard to the stay in the admission unit after discharge from postoperative recovery; i associated with reduced costs. The difference was not significant for patients with ischemic heart disease. CONCLUSION: A reduction in the length of hospital stay and costs for the care of patients undergoing cardiac surgery according to the fast-track protocol was observed.

  2. Redução do período de internação e de despesas no atendimento de portadores de cardiopatias congênitas submetidos à intervenção cirúrgica cardíaca no protocolo da via rápida / The reduction in hospital stay and costs in the care of patients with congenital heart diseases undergoing fast-track cardiac surgery

    Scientific Electronic Library Online (English)

    Alfredo Manoel da Silva, Fernandes; Alfredo José, Mansur; Luis Fernando, Canêo; Domingos Dias, Lourenço; Marilde Albuquerque, Piccioni; Sonia Mieken, Franchi; Cristina Machado C., Afiune; Jorge Wiliam, Gadioli; Sérgio de Almeida, Oliveira; José Antonio Franchini, Ramires.

    2004-07-01

    Full Text Available OBJETIVO: Avaliar o atendimento de cardiopatas congênitos e cardiopatas isquêmicos submetidos à cirurgia cardíaca no protocolo de atendimento na via rápida (fast-track recovery) em relação ao convencional. MÉTODOS: Avaliada a movimentação de 175 pacientes, 107 (61%) homens e 68 (39%) mulheres, idade [...] s entre 0,3-81 anos nas diferentes unidades hospitalares. RESULTADOS: A taxa de alta das diferentes unidades hospitalares por unidade de tempo, dos cardiopatas congênitos atendidos no protocolo da via rápida em relação ao convencional foi: a) 11,3 vezes a taxa de alta quando assistidos no protocolo da via convencional, quanto ao tempo de permanência no centro cirúrgico; b) 6,3 vezes quanto à duração da intervenção cirúrgica; c) 6,8 vezes quanto à duração da anestesia; d) 1,5 vezes quanto à duração da perfusão; e) 2,8 vezes quanto à permanência na unidade de recuperação pós-operatória I; f) 6,7 vezes quanto à permanência no hospital (período de tempo entre a data da internação e a data da alta); g) 2,8 vezes quanto à permanência na unidade de internação pré-operatória; h) 2,1 vezes quanto à permanência na unidade de internação após a alta da recuperação pós-operatória; i) associada com redução de despesas pré e pós-operatórias. A diferença não foi significativa nos portadores de cardiopatia isquêmica. CONCLUSÃO: Verificou-se redução do período de internação e de despesas no atendimento dos pacientes submetidos à intervenção cirúrgica cardíaca no protocolo da via rápida. Abstract in english OBJECTIVE: To assess the care provided to patients with congenital heart diseases and ischemic heart diseases undergoing cardiac surgery according to the fast-track recovery protocol compared with those undergoing the conventional procedure. METHODS: The transfer of patients from one hospital unit t [...] o another was assessed for 175 patients, 107 (61%) men and 68 (39%) women, with ages ranging from 0.3 to 81 years. RESULTS: The discharge rate from the different hospital units per unit of time of the patients with congenital heart diseases treated according to the fast-track recovery protocol compared with that of patients conventionally treated was as follows: a) 11.3 times faster than the discharge rate of patients treated according to the conventional protocol, in regard to the time spent in the operating room; b) 6.3 times faster in regard to the duration of the surgical intervention; c) 6.8 times faster in regard to the duration of anesthesia; d) 1.5 times faster in regard to the duration of perfusion; e) 2.8 times faster in regard to the stay in the postoperative recovery I unit; f) 6.7 times faster in regard to hospital stay (time period between hospital admission and hospital discharge); g) 2.8 times faster in regard to the stay in the preoperative unit; h) 2.1 times faster in regard to the stay in the admission unit after discharge from postoperative recovery; i) associated with reduced costs. The difference was not significant for patients with ischemic heart disease. CONCLUSION: A reduction in the length of hospital stay and costs for the care of patients undergoing cardiac surgery according to the fast-track protocol was observed.

  3. Survey of Staphylococcus isolates among hospital personnel, environment and their antibiogram with special emphasis on methicillin resistance

    Directory of Open Access Journals (Sweden)

    Shobha K

    2005-01-01

    Full Text Available The objective of this study was to find the prevalence of Staphylococcus spp. carriage among hospital personnel and hospital environment and their antibiogram with special emphasis on methicillin resistance. A total of 205 samples from hospital personnel and environment were collected from casualty, oncology and multidisciplinary cardiac unit ward of Kasturba Medical College Hospital, Manipal. Samples were collected using sterile cotton wool swabs and inoculated into brain heart infusion broth. Subcultures were done onto blood agar and MacConkey?s agar. Isolates were identified by standard methods up to species level. Antimicrobial susceptibility test was performed according to standardized disc diffusion Kirby-Bauer method. Each of the isolates was screened for methicillin resistance using oxacillin disc on Mueller Hinton agar plate followed by MIC for methicillin and cefoxitin susceptibility test by disc diffusion method. Sixty five out of 205 strains (31.7% were Staphylococcus spp. and all of them were coagulase negative. Most of the strains belonged to S.epidermidis 49.23%(32/65 followed by S. saprophyticus 26.15%(17/65. Maximum isolates of S.epidermidis were from anterior nares 28.12%(9/32 strains of S.epidermidis . Highest number of methicillin resistant coagulase negative strains (3/9, 33.33% were isolated from stethoscope of multidisciplinary cardiac unit ward followed by carriers in the anterior nares (2/9, 22.22%. Methicillin resistant coagulase negative staphylococci are prevalent in anterior nares of hospital personnel and in the hospital environment thereby providing a definite source for hospital acquired infection. All isolates were sensitive to vancomycin, ciprofloxacin and amikacin.

  4. Autologous Transfusion in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Radmehr H

    2003-11-01

    Full Text Available Preoperative autologous blood donation is commonly used to reduce exposure to homologous blood transfusions among patients undergoing elective cardiac surgery. The aim of this study was to evaluate the effect of autologous transfusion on patients' hematocryte value, intra and postoperative blood loss, hospitalization time, the development of infective complications and other factors. Materials and Methods: Between June 2001 to April 2002, 208 patients were underwent cardiac surgery in cardiac surgery ward in Imam Khomeini Medical Center. One or more blood units donate from 104 Patients before cardiopulmonary bypass and heparin injection, and transfused to them after CPB and Protamin injection (autologous Group, group 1. 104 patients underwent cardiac surgery routinely (control group, group 2."nResults: Mean of age was 55.9±8.6 in group 1 and 56.6±9.3 in group 2 (P=NS. 73 male and 31 females were in group 1 and 79 males and 25 females were in group 2 (P=NS. Smoking, familial history, hyperlipidemia, diabetes mellitus, renal failure, hypertension, stroke, and history of myocardial infarction was similar in two groups."nSeverity of angina, urgency operation, number vessels disease, duration of cardiopulmonary bypass, duration of aortic cross clamp time, use of internal thoracic artery graft, and number of grafts was similar in both groups. Mean of bleeding post operation was 548 cc in group 1 and 803 cc in-group 2 (P=0.003. Bleeding that need to operation was 1.8% in group 1 and 8.6% in group 2 (P=0.002. Wound infection, mediastinitis, renal failure, ventilatory prolonged, stroke, need to Intra-aortic Balloon Pump (IABP, intraoperative bleeding, and hospital stay was similar in both groups. Mean of extubationt time was 10.2 hours in group 1 and 14.8 hours in group 2 (P=0.001."nConclusion: Preoperative and intra-operative donations are safe and continue to contribute uniquely to blood conservation, providing important options in comprehensive blood conservation programs in current pediatric open-heart surgery."n"n"n"n"n"n"n 

  5. Physiotherapy-supervised mobilization and exercise following cardiac surgery: a national questionnaire survey in Sweden

    OpenAIRE

    Westerdahl Elisabeth; Möller Margareta

    2010-01-01

    Abstract Background Limited published data are available on how patients are mobilized and exercised during the postoperative hospital stay following cardiac surgery. The aim of this survey was to determine current practice of physiotherapy-supervised mobilization and exercise following cardiac surgery in Sweden. Methods A prospective survey was carried out among physiotherapists treating adult cardiac surgery patients. A total population sample was identified and postal questionnaires were s...

  6. Cardiac developmental toxicity

    Science.gov (United States)

    Mahler, Gretchen J.; Butcher, Jonathan T.

    2013-01-01

    Congenital heart disease is a highly prevalent problem with mostly unknown origins. Many cases of CHD likely involve an environmental exposure coupled with genetic susceptibility, but practical and ethical considerations make nongenetic causes of CHD difficult to assess in humans. The development of the heart is highly conserved across all vertebrate species, making animal models an excellent option for screening potential cardiac teratogens. This review will discuss exposures known to cause cardiac defects, stages of heart development that are most sensitive to teratogen exposure, benefits and limitations of animal models of cardiac development, and future considerations for cardiac developmental toxicity research. PMID:22271678

  7. Vigilância de infecção de sítio cirúrgico no pós-alta hospitalar de cirurgia cardíaca reconstrutora / Surgical site infection surveillance in post-hospital discharge after cardiac reconstructive surgery / Vigilancia de la infección de sitio quirúrgico después del alta hospitalaria de cirugía cardíaca reconstructiva

    Scientific Electronic Library Online (English)

    Vanessa Damiana Menis, Sasaki; Adilson Edson, Romanzini; Ana Paula Marcielo de, Jesus; Edevã de, Carvalho; João Junior, Gomes; Valquiria Barco, Damiano.

    2011-06-01

    Full Text Available A incidência de doenças cardiovasculares vem aumentando a cada ano e, na maioria das vezes, a cirurgia de revascularização do miocárdio se faz necessária, sendo a infecção de sítio cirúrgico, uma das principais complicações. Este estudo teve por objetivo identificar sinais e sintomas de infecção de [...] sítio cirúrgico no pós-alta hospitalar de cirurgia cardíaca reconstrutora. Trata-se de um estudo quantitativo descritivo de caráter prospectivo. A coleta de dados foi realizada na residência de 20 pacientes maiores de 18 anos, submetidos à cirurgia cardíaca reconstrutora, em um hospital filantrópico de nível quaternário, situado em São José do Rio Preto-SP, Brasil. Quatro pacientes apresentavam exsudato seroso ou purulento e hiperemia na incisão cirúrgica. Evidenciou-se uma taxa de 20% de infecção de sítio cirúrgico no pós-alta hospitalar. Ressalta-se a necessidade de implementar um método de vigilância no período cirúrgico focalizado no pós-alta hospitalar que possibilite uma real notificação das infecções de sítio cirúrgico, já que estas podem ser subnotificadas ocasionando uma alta taxa de morbi-mortalidade. Abstract in spanish Cada año la incidencia de las enfermedades cardiovasculares ha ido en aumento, y en la mayoría de los casos, la cirugía de revascularización miocárdica se hace necesaria, siendo la infección de sitio quirúrgico una de las principales complicaciones. Este estudio tuvo como objetivo identificar señale [...] s y síntomas de infección de sitio quirúrgico después del alta hospitalaria de cirugía cardíaca reconstructiva. Este es un estudio cuantitativo descriptivo de carácter prospectivo. La recolección de datos se realizó en la residencia de 20 pacientes mayores de 18 años, sometidos a cirugía cardíaca reconstructiva en un hospital filantrópico cuaternario, de São José de Rio Preto-SP, Brazil. Cuatro pacientes presentaban exudado seroso o purulento e hiperemia en la incisión quirúrgica. Se encontró una tasa de 20% de infección de sitio quirúrgico después del alta hospitalaria. Destacamos la necesidad de aplicar un método de vigilancia en el período posterior al alta hospitalaria para permitir una información real de las infecciones del sitio quirúrgico, ya que estas pueden no ser reportadas, causando una alta tasa de morbilidad y mortalidad. Abstract in english The incidence of cardiovascular disease has been increasing annually in recent years, and in the majority of cases Myocardial Revascularization surgery becomes necessary. One of the principle complications of this procedure is post-surgical infection of the surgical site. This study aimed to identif [...] y signs and symptoms of infection of surgical site in the post-hospital discharge following cardiac reconstructive surgery. This is a descriptive quantitative study of a prospective character. Data was collected in the respective houses of 20 patients older than 18 years old who were submitted to cardiac reconstructive surgery in a quaternary philanthropic hospital located in São José do Rio Preto, SP, Brazil. Four patients presented serous exudate or festering and hyperemia in the surgical incision. An infection rate of the surgical site of 20% was found in post-hospital discharges studied. We highlight the need to implement a surveillance method in the period following post-hospital discharge to enable a real notification of surgical site infections, as these may be underreported and cause a high mortality rate.

  8. INCIDENCE OF SUDDEN CARDIAC DEATH IN ZIVINICE MUNICIPALITY, BOSNIA AND HERZEGOVINA, DURING THE YEAR 2007

    Directory of Open Access Journals (Sweden)

    Mirsad Bijelic

    2009-11-01

    Full Text Available

    Introduction: sudden cardiac death (SCD is an unexpected natural death due to cardiac causes in a short time period in a person with or without preexisting heart disease. Incidence of SCD in general population is 1/1000 inhabitants.

    Aims: to determine the incidence of SCD at a territory of Zivinice municipality.

    Patients and methods: this study is a prospective examination of SCD by using the data from death certificates, data received from interviews with competent physicians, witnesses and family members. Definition and criteria of SCD by European Society of Cardiologist and American Heart Association from 2001 and use of International Classification of Diseases, version 10, were applied to determine the number of SCD.

    Results: sudden cardiac death is the single most frequent cause of death in inhabitants of the Živinice municipality. The incidence of SCD at the municipal Živinice was 1 .4 cases per 1000 inhabitants per year. Mean age was 66.3 (±12,6 years; in average, men were 7.2 years younger than women. The risk for SCD was 1.24-fold higher in men than in women. Correlation between the age and numbers of SCD was high (r=0.89; p<0.005. The most frequent risk factors were age, family history of SCD and/or cardiovascular disease and inadequate physical activity; leading conventional risk factor was hypertension. Witnesses of sudden cardiac death were present in 58.0% cases. None of the persons with out-of-hospital SCD received adequate first aid from bystanders.

    Conclusion: Sudden cardiac death is the single most frequent cause of death among inhabitants of Zivinice municipality; proportion of SCD within all other causes of death was 22.3%. Incidence of SCD however, is not significantly higher when compared to industrialized countries. A risk for sudden cardiac death is significantly higher and directly depends on the presence and number of risk factors.

  9. Relationship between Awareness of Disease and Adherence to Therapeutic Regimen among Cardiac Patients

    OpenAIRE

    Heydari, Abbas; Ziaee, Elaheh Sadat; Gazrani, Akram

    2015-01-01

    Background: Adherence to prescribed therapeutic regimen is an important element of self-care behaviors in cardiac patients. Awareness of disease may play an important role in patient adherence. Thus, this study was conducted to examine the relationship between awareness of the disease and adherence to therapeutic regimen among cardiac patients admitted to selected hospitals in Mashhad, Iran.

  10. Hard spheres out of equilibrium

    Science.gov (United States)

    Hermes, M.

    2010-05-01

    In this thesis, experiments and simulations are combined to investigate the nonequilibrium behaviour of hard spheres. In the first chapters we use Molecular Dynamics simulations to investigate the dynamic glass transition of polydisperse hard spheres. We show that this dynamic transition is accompanied by a thermodynamic signature. The higher-order derivatives of the pressure change abruptly at the dynamic glass transition. If a system is compressed beyond this dynamic transition, the pressure increases until it diverges when the system is completely jammed. The density at which the pressure diverges depends on the compression speed. We proceed with experiments on colloidal polymethylmethacrylate (PMMA) particles which closely resemble hard spheres. We investigate the effect of compression using gravity and electric field gradients on the nucleation and on the glass transition. The transition from glass to crystal is gradual and is strongly effected by gravity. We go back to computer simulations to investigate two different techniques to calculate the rate at which a hard-sphere system nucleates. We find that the two techniques yield similar results for the nucleation rate as well as the critical nucleus shape. From this we conclude that the simulation techniques are valid. A combination of simulations and experiments is used to study the nucleation of hard spheres on seed structures. We initiate the nucleation with a seed of particles kept in place by optical tweezers. We show that whereas the nucleation itself can be well described as an equilibrium process, the growth after nucleation can not. We demonstrate that defects play an important role in the growth of the crystal. Colloidal hard spheres can also be driven out of equilibrium using shear. We perform experiments on an equilibrium fluid phase below the coexistence density of the fluid. We show that we can induce order in an equilibrium fluid using oscillatory shear. We find five different phases for varying frequency and amplitude: four known phases and one new phase. The formation of all phases occurs via nucleation and growth and the melting, when the shear is stopped, starts on the edges and near the defects of the crystal phases. In the final chapter, we investigate the interactions between rough colloidal particles in the presence of polymers. We investigate whether surface roughness can be used to reduce the depletion attraction. We find that when the polymer is smaller than the surface roughness the attraction can be reduced significantly compared to smooth colloids.

  11. High Thoracic Epidural Analgesia in Cardiac Surgery : Part 1-High Thoracic Epidural Analgesia Improves Cardiac Performance in Cardiac Surgery Patients

    DEFF Research Database (Denmark)

    Jakobsen, Carl-Johan; Bhavsar, Rajesh

    2012-01-01

    OBJECTIVE: The purpose of this study was to evaluate the perioperative cardioprotective effect of high thoracic epidural analgesia (HTEA), primarily expressed as an effect on cardiac performance and hemodynamics in patients undergoing cardiac surgery. DESIGN: A randomized, prospective study. PARTICIPANTS: Sixty low-to-moderate risk patients between the ages of 65 and 80 years scheduled for elective coronary artery bypass graft surgery with or without aortic valve replacement. SETTING: A university hospital. INTERVENTION: Patients randomized to receive HTEA as a supplement to general anesthesia. MEASUREMENTS AND MAIN RESULTS: Perioperative hemodynamic measurements, perioperative fluid balance, and postoperative release of cardiac enzymes were collected. The end-diastolic volume index (EDVI), the stroke volume index (overall 38 v 32 mL), the cardiac index (overall 2.35 v. 2.18 L/minute/m(2)), the central venous pressure, and central venous oxygenation were higher in the HTEA group. The mean arterial blood pressure was marginally lower in the HTEA group, whereas no difference was noted in the heart rate or peripheral saturation between the groups. No differences were found in the postoperative levels of troponin T and CK-MB between groups. NT-proBNP changed over time (p <0.001) and was lower in the HTEA group (p = 0.013), with maximal values of 291 ± 265 versus 326 ± 274. CONCLUSIONS: The findings of a higher stroke volume index and central venous oxygenation without an increase in heart rate or mean arterial pressure suggest that HTEA improves cardiac performance in elderly cardiac surgery patients.

  12. Surgical treatment of cardiac pheochromocytomas

    International Nuclear Information System (INIS)

    The development at our institution of the radiopharmaceutical 131-I-metaiodobenzylguanidine has permitted for the first time scintigraphic localization of pheochromocytomas. By the use of this scan in combination with contrast-enhanced computed tomography, intrapericardial pheochromocytomas have been demonstrated in eight patients at our hospital during the past 2 years. Four of these patients have been operated upon by us, and each was found to have a pheochromocytoma arising from the heart (left atrium in three and interventricular groove at the aortic root in one). While in one patient it was possible to shell the tumor away from the left atrial wall without cardiopulmonary bypass, in the remaining patients, bypass and cardioplegia were required to resect the pheochromocytomas without inducing life-threatening intraoperative hypertension and cardiac arrhythmias. One patient required coronary artery reconstruction and two, excision of the posterior left atrial wall with pericardial replacement. One of these latter two patients died intraoperatively of uncontrollable hemorrhage. The three remaining patients are well and normotensive after more than 1 year of follow-up. Cardiac pheochromocytomas should not be approached as typical posterior mediastinal tumors, or as they are in the abdomen, with the expectation that they will shell away from contiguous structures. Cardiopulmonary bypass should be available, and resection of involved myocardium may be necessary for complete removal

  13. [Cardiac involvement in polymyositis].

    Science.gov (United States)

    Romdhane, M B; Mahdhaoui, A; Khelifa, M B; Lagren, A; Hajri, S E; Bouraoui, H; Trimeche, B; Ghannouchi, N; Jeridi, G; Bahri, F

    2012-08-01

    Cardiovascular involvement in polymyositis constitutes a major cause of death. However, the cardiac location is rarely symptomatic and does not usually represent the principle clinical feature at the time of the initial presentation. We present here an unusual case of polymyositis with severe and polymorph cardiac disturbances that predominant the muscular signs. PMID:20709312

  14. Hypokalemia and sudden cardiac death

    DEFF Research Database (Denmark)

    Kjeldsen, Keld

    2010-01-01

    Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient reductions in plasma potassium concentration are of importance. Hypokalemia is present in 7% to 17% of patients with cardiovascular disease. Furthermore, up to 20% of hospitalized patients and up to 40% of patients on diuretics suffer from hypokalemia. Importantly, inadequate management of hypokalemia was found in 24% of hospitalized patients. Hypokalemia is associated with increased risk of arrhythmia in patients with cardiovascular disease, as well as increased all-cause mortality, cardiovascular mortality and heart failure mortality by up to 10-fold. Long-term potassium homeostasis depends on renal potassium excretion. However, skeletal muscles play an important role in short-term potassium homeostasis, primarily because skeletal muscles contain the largest single pool of potassium in the body. Moreover, due to the large number of Na(+)/K(+) pumps and K(+) channels, the skeletal muscles possess a huge capacity for potassium exchange. In cardiovascular patients, hypokalemia is often caused by nonpotassium-sparing diuretics, insufficient potassium intake and a shift of potassium into stores by increased potassium uptake stimulated by catecholamines, beta-adrenoceptor agonists and insulin. Interestingly, drugs with a proven significant positive effect on mortality and morbidity rates in heart failure patients all increase plasma potassium concentration. Thus, it may prove beneficial to pay more attention to hypokalemia and to maintain plasma potassium levels in the upper normal range. The more at risk of fatal arrhythmia and sudden cardiac death a patient is, the more attention should be given to the potassium homeostasis.

  15. Hypokalemia and sudden cardiac death

    Science.gov (United States)

    Kjeldsen, Keld

    2010-01-01

    Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient reductions in plasma potassium concentration are of importance. Hypokalemia is present in 7% to 17% of patients with cardiovascular disease. Furthermore, up to 20% of hospitalized patients and up to 40% of patients on diuretics suffer from hypokalemia. Importantly, inadequate management of hypokalemia was found in 24% of hospitalized patients. Hypokalemia is associated with increased risk of arrhythmia in patients with cardiovascular disease, as well as increased all-cause mortality, cardiovascular mortality and heart failure mortality by up to 10-fold. Long-term potassium homeostasis depends on renal potassium excretion. However, skeletal muscles play an important role in short-term potassium homeostasis, primarily because skeletal muscles contain the largest single pool of potassium in the body. Moreover, due to the large number of Na+/K+ pumps and K+ channels, the skeletal muscles possess a huge capacity for potassium exchange. In cardiovascular patients, hypokalemia is often caused by nonpotassium-sparing diuretics, insufficient potassium intake and a shift of potassium into stores by increased potassium uptake stimulated by catecholamines, beta-adrenoceptor agonists and insulin. Interestingly, drugs with a proven significant positive effect on mortality and morbidity rates in heart failure patients all increase plasma potassium concentration. Thus, it may prove beneficial to pay more attention to hypokalemia and to maintain plasma potassium levels in the upper normal range. The more at risk of fatal arrhythmia and sudden cardiac death a patient is, the more attention should be given to the potassium homeostasis. PMID:21264075

  16. Mathematical cardiac electrophysiology

    CERN Document Server

    Colli Franzone, Piero; Scacchi, Simone

    2014-01-01

    This book covers the main mathematical and numerical models in computational electrocardiology, ranging from microscopic membrane models of cardiac ionic channels to macroscopic bidomain, monodomain, eikonal models and cardiac source representations. These advanced multiscale and nonlinear models describe the cardiac bioelectrical activity from the cell level to the body surface and are employed in both the direct and inverse problems of electrocardiology. The book also covers advanced numerical techniques needed to efficiently carry out large-scale cardiac simulations, including time and space discretizations, decoupling and operator splitting techniques, parallel finite element solvers. These techniques are employed in 3D cardiac simulations illustrating the excitation mechanisms, the anisotropic effects on excitation and repolarization wavefronts, the morphology of electrograms in normal and pathological tissue and some reentry phenomena. The overall aim of the book is to present rigorously the mathematica...

  17. Biomaterials for cardiac regeneration

    CERN Document Server

    Ruel, Marc

    2015-01-01

    This book offers readers a comprehensive biomaterials-based approach to achieving clinically successful, functionally integrated vasculogenesis and myogenesis in the heart. Coverage is multidisciplinary, including the role of extracellular matrices in cardiac development, whole-heart tissue engineering, imaging the mechanisms and effects of biomaterial-based cardiac regeneration, and autologous bioengineered heart valves. Bringing current knowledge together into a single volume, this book provides a compendium to students and new researchers in the field and constitutes a platform to allow for future developments and collaborative approaches in biomaterials-based regenerative medicine, even beyond cardiac applications. This book also: Provides a valuable overview of the engineering of biomaterials for cardiac regeneration, including coverage of combined biomaterials and stem cells, as well as extracellular matrices Presents readers with multidisciplinary coverage of biomaterials for cardiac repair, including ...

  18. Cardiac Conduction Disturbance Due To Prallethrin (Pyrethroid) Poisoning

    OpenAIRE

    Bhaskar, Emmanuel M.; Moorthy, Swathy; Ganeshwala, Gaurav; Abraham, Georgi

    2010-01-01

    Pyrethroids are common household insecticides. Even though they are less toxic to humans, reports of accidental and suicidal poisoning are not uncommon. Cardiotoxicity due to pyrethroid poisoning is rare. We report a case of cardiac conduction disturbance due to a pyrethroid, prallethrin. A 28-year-old female presented after a suicidal consumption of prallethrin. Her clinical and laboratory parameters were normal during the first 24 h of hospital stay. On the second hospital day, she develope...

  19. The cardiac patient during Ramadan and Hajj.

    Science.gov (United States)

    Chamsi-Pasha, Hassan; Ahmed, Waqar H; Al-Shaibi, Khaled F

    2014-10-01

    The holy month of Ramadan is one of the five pillars of Islam. During this month, fasting Muslims refrain from eating, drinking, smoking, and sex from dawn until sunset. Although the Quran exempts sick people from the duty of fasting, it is not uncommon for many heart disease patients to fast during Ramadan. Despite the fact that more than a billion Muslims worldwide fast during Ramadan, there is no clear consensus on its effects on cardiac disease. Some studies have shown that the effects of fasting on stable patients with cardiac disease are minimal and the majority of patients with stable cardiac illness can endure Ramadan fasting with no clinical deterioration. Fasting during Ramadan does not seem to increase hospitalizations for congestive heart failure. However, patients with decompensated heart failure or those requiring large doses of diuretics are strongly advised not to fast, particularly when Ramadan falls in summer. Patients with controlled hypertension can safely fast. However, patients with resistant hypertension should be advised not to fast until their blood pressure is reasonably controlled. Patients with recent myocardial infarction, unstable angina, recent cardiac intervention or cardiac surgery should avoid fasting. Physician advice should be individualized and patients are encouraged to seek medical advice before fasting in order to adjust their medications, if required. The performance of the Hajj pilgrimage is another pillar of Islam and is obligatory once in the lifetime for all adult Muslims who are in good health and can afford to undertake the journey. Hajj is a physically, mentally, emotionally, and spiritually demanding experience. Medical checkups one or two months before leaving for Hajj is warranted, especially for those with chronic illnesses such as cardiovascular disease. Patients with heart failure, uncontrolled hypertension, serious arrhythmias, unstable angina, recent myocardial infarction, or cardiac surgery should be considered unfit for undertaking the Hajj pilgrimage. PMID:25278723

  20. One-year follow-up of neurological status of patients after cardiac arrest seen at the emergency room of a teaching hospital / Um ano de seguimento da condição neurológica de pacientes pós-parada cardiorrespiratória atendidos no pronto-socorro de um hospital universitário

    Scientific Electronic Library Online (English)

    Cássia Regina, Vancini-Campanharo; Rodrigo Luiz, Vancini; Claudio Andre Barbosa de, Lira; Maria Carolina Barbosa Teixeira, Lopes; Meiry Fernanda Pinto, Okuno; Ruth Ester Assayag, Batista; Álvaro Nagib, Atallah; Aécio Flávio Teixeira de, Góis.

    2015-06-01

    Full Text Available RESUMO Objetivo: Identificar a condição neurológica e os fatores associados de sobreviventes pós-parada cardiorrespiratória na alta hospitalar, após 6 e 12 meses de seguimento. Métodos: Estudo de coorte, prospectivo e descritivo, realizado em um pronto-socorro. Foram incluídos pacientes em parada ca [...] rdiorrespiratória que sobreviveram à alta. A amostra foi consecutiva por um ano, sendo composta por 285 pacientes, e os sobreviventes (n=16) foram acompanhados por um ano após alta. O estado neurológico foi avaliado pela Categoria de Performance Cerebral antes da parada, na alta, 6 e 12 meses após alta. Foram investigados os seguintes fatores: comorbidades, presença de consciência na admissão, parada cardiorrespiratória prévia, parada cardiorrespiratória testemunhada, local, causa e ritmo inicial da parada, número de paradas, intervalo entre colapso e início da ressuscitação cardiopulmonar, e entre colapso e término da ressuscitação, e duração da ressuscitação. Resultados: Dos pacientes atendidos, 4,5% (n=13) sobreviveram após 6 e 12 meses de seguimento. Na alta, 50% dos pacientes permaneceram com Categoria de Performance Cerebral prévia à parada, e 50% tiveram piora da mesma. Após 6 meses, 53,8% permaneceram com mesma Categoria de Performance Cerebral, e 46,2% tiveram melhora em relação à alta. Após 12 meses, a totalidade dos pacientes permaneceu com mesma Categoria de Performance Cerebral em relação aos 6 meses anteriores. Não houve associação estatisticamente significativa entre evolução neurológica durante o seguimento e variáveis de interesse. Conclusão: Observou-se piora neurológica na alta, mas houve melhora ou estabilização no decorrer de 1 ano. Não foi encontrada associação entre Categoria de Performance Cerebral e variáveis de interesse. Abstract in english ABSTRACT Objective: To describe neurological status and associated factors of survivors after cardiac arrest, upon discharge, and at 6 and 12 month follow-up. Methods: A cohort, prospective, descriptive study conducted in an emergency room. Patients who suffered cardiac arrest and survived were incl [...] uded. A one-year consecutive sample, comprising 285 patients and survivors (n=16) followed up for one year after discharge. Neurological status was assessed by the Cerebral Performance Category before the cardiac arrest, upon discharge, and at 6 and 12 months after discharge. The following factors were investigated: comorbidities, presence of consciousness upon admission, previous cardiac arrest, witnessed cardiac arrest, location, cause and initial rhythm of cardiac arrest, number of cardiac arrests, interval between collapse and start of cardiopulmonary resuscitation, and between collapse and end of cardiopulmonary resuscitation, and duration of cardiopulmonary resuscitation. Results: Of the patients treated, 4.5% (n=13) survived after 6 and 12 months follow-up. Upon discharge, 50% of patients remained with previous Cerebral Performance Category of the cardiac arrest and 50% had worsening of Cerebral Performance Category. After 6 months, 53.8% remained in the same Cerebral Performance Category and 46.2% improved as compared to discharge. After 12 months, all patients remained in the same Cerebral Performance Category of the previous 6 months. There was no statistically significant association between neurological outcome during follow-up and the variables assessed. Conclusion: There was neurological worsening at discharge but improvement or stabilization in the course of a year. There was no association between Cerebral Performance Category and the variables assessed.

  1. Fast tracking in paediatric cardiac anaesthesia : an update.

    Directory of Open Access Journals (Sweden)

    Lake Carol

    2002-01-01

    Full Text Available A care plan in which cardiac surgical patients progress quickly through the perioperative course to hospital discharge is often referred to as a Fast Track. Such care plans have been used extensively in adult cardiac patients but are also applicable to paediatric patients. Although no randomised controlled trials are available to document a reduction in hospital costs and avoidance of iatrogenic complications with paediatric fast tracks, many healthcare administrators encourage their use. Fast Track clinical guidelines usually include same day surgery, use of short- acting anaesthetic drugs, early extubation, effective pain management, and reduced intensive care unit stays. These protocols are certainly appropriate for simple procedures such as repair of atrial or ventricular septal defects or ligation of a patent ductus arteriosus. However, many paediatric cardiac anaesthesiologists consider that all paediatric patients without significant pulmonary or residual cardiac pathology can be managed using expedited postoperative protocols. Essential components in a "fast track" protocol include use of minimally invasive surgical techniques, modified ultrafiltration during cardiopulmonary bypass, transoesophageal echocardiography to evaluate the cardiac repair, and postoperative pain control. Using such techniques, 80-90% of paediatric patients can be extubated in the operating room or within 2-4 hours postoperatively. Despite the opinions of recognised experts, an appropriately sized and powered multicentre, controlled, randomised, prospective study is still needed to conclusively document the efficiency and effectiveness of the Fast Track in paediatric cardiac patients.

  2. Patient dose in cardiac multislice computed tomography

    International Nuclear Information System (INIS)

    Cardiac Multislice Computed Tomography (MSCT) is mainly used for the quantification of coronary artery calcification and for minimally invasive coronary angiography. Many physicians are not aware of the radiation doses delivered to the patient in these exams. The aim of this study is to evaluate and compare the radiation doses that are delivered to the patient during specific cardiac MSCT examinations in two different hospitals in Madrid. The volume computed tomographic dose index (CTDI vol), the dose length product (DLP), and the effective dose (E) are the most useful parameters to describe and compare radiation doses received from cardiac MSCT examinations. To calculate effective doses the spreadsheet developed by ImPACT was used. Computed tomography dose index (CTDIn) in air was measured with an ionization chamber model 20x5-2CT and dose-length product (DLP) values were obtained from the scanner consol for each examination. Results and conclusions: Effective dose values of 18,2 mSv and 24 mSv for coronary angiography were found in the two hospitals. The difference in dose is mainly due to the different mode of acquisition in the applied protocols rather than to the type of scanner used. (Author)

  3. Nationwide study of sudden cardiac death in persons aged 1-35 years

    DEFF Research Database (Denmark)

    Winkel, Bo Gregers; Holst, Anders Gaarsdal

    2011-01-01

    Aims The aim of this investigation was to study the incidence of sudden cardiac death (SCD) in persons aged 1-35 years in a nationwide setting (5.38 million people) by systematic evaluation of all deaths. Methods and results All deaths in persons aged 1-35 years in Denmark in 2000-06 were included. Death certificates were read independently by two physicians. The National Patient Registry was used to retrieve information on prior medical history. All autopsy reports were read and the cause of death was revised based on autopsy findings. We identified 625 cases of sudden unexpected death (10% of all deaths), of which 156 (25%) were not autopsied. Of the 469 autopsied cases, 314 (67%) were SCD. The most common cardiac cause of death was ischaemic heart disease (13%); 29% of autopsied sudden unexpected death cases were unexplained. In 45% of SCD cases, the death was witnessed; 34% died during sleep; 89% were out-of-hospital deaths. Highest possible incidence rate of SCD in the young was 2.8 per 100 000 person-years including non-autopsied cases of sudden unexpected death. Excluding those, the incidence rate declined to 1.9 per 100 000 person-years. Conclusions A total of 7% of all deaths in the young can be attributed to SCD, when including non-autopsied cases (autopsy ratio 75%). The incidence rate of SCD in the young of 2.8 per 100 000 person-years is higher than previously reported.

  4. Predictors of low cardiac output in decompensated severe heart failure

    Scientific Electronic Library Online (English)

    Marcelo Eidi, Ochiai; Juliano Novaes, Cardoso; Kelly Regina Novaes, Vieira; Marcelo Villaça, Lima; Euler Cristovan Ochiai, Brancalhao; Antonio Carlos Pereira, Barretto.

    Full Text Available OBJECTIVE: To identify predictors of low cardiac output and mortality in decompensated heart failure. INTRODUCTION: Introduction: Patients with decompensated heart failure have a high mortality rate, especially those patients with low cardiac output. However, this clinical presentation is uncommon, [...] and its management is controversial. METHODS: We studied a cohort of 452 patients hospitalized with decompensated heart failure with an ejection fraction of 60 years, and 64.6% were men. Low cardiac output was present in 281 (63%) patients on admission. Chagas disease was the cause of heart failure in 92 (20.4%) patients who had higher B type natriuretic peptide levels (1,978.38 vs. 1,697.64 pg/mL; P = 0.015). Predictors of low cardiac output were Chagas disease (RR: 3.655, P

  5. Cardiac involvement mimicking acute coronary syndrome in idiopathic hypereosinophilic syndrome.

    Science.gov (United States)

    Fredy, Felix C; Iskandar, William J; Yung Jih, Felix Keng

    2013-10-01

    Hypereosinophilic syndrome (HES) is defined as a persistent eosinophilia lasting longer than 6 months of unknown origin and related to organ involvement. Cardiac involvement, usually leading to morbidity and mortality of HES patients, often mimics other diseases such as acute coronary syndrome. We report a 46-year-old female who came to hospital with atypical chest pains and a known history of eosinophilia. After excluding other possible causes of eosinophilia, she underwent further cardiac investigations. She had normal cardiac size on echocardiography and no thrombus or mass, with only global hypokinesia with systolic and diastolic dysfunction noted. These findings were different from other studies. This patient was then treated as HES with cardiac involvement. PMID:24448335

  6. Trombosis venosa mayor asociada a catéter de hipotermia terapéutica en un paciente con paro cardiorrespiratorio recuperado: comunicación de un caso y revisión de la literatura Venous thrombosis secondary to catheter insertion for hypothermia after cardiac arrest: Report of one case

    Directory of Open Access Journals (Sweden)

    Jaime Retamal

    2011-09-01

    Full Text Available To improve survival and reduce neurological injury, the use of mild hypothermia following cardiac arrest has been recommended. We report a 65 years old woman who presented an out-of-hospital ventricular fibrillation and cardiac arrest. The patient was comatose following initial resuscitation and was admitted into the ICU, where cooling was initiated using an intravascular catheter. After 48 hours, rewarming was initiated. Although no neurological impairment was observed, physical examination of the right inguinal area and echo-Doppler examination revealed an extensive catheter-related thrombophlebitis with right ileocaval vein occlusion., with high risk of masive and life threatening pulmonary embolism. We report a clinical case and review the literature to point out the need for a high index of diagnostic suspicion of deep venous thrombosis in these specific setting.

  7. Economic and biological costs of cardiac imaging

    Directory of Open Access Journals (Sweden)

    Picano Eugenio

    2005-05-01

    Full Text Available Abstract Medical imaging market consists of several billion tests per year worldwide. Out of these, at least one third are cardiovascular procedures. Keeping in mind that each test represents a cost, often a risk, and a diagnostic hypothesis, we can agree that every unnecessary and unjustifiable test is one test too many. Small individual costs, risks, and wastes multiplied by billions of examinations per year represent an important population, society and environmental burden. Unfortunately, the appropriateness of cardiac imaging is extra-ordinarily low and there is little awareness in patients and physicians of differential costs, radiological doses, and long term risks of different imaging modalities. For a resting cardiac imaging test, being the average cost (not charges of an echocardiogram equal to 1 (as a cost comparator, the cost of a CT is 3.1x, of a SPECT 3.27x, of a Cardiovascular Magnetic Resonance imaging 5.51x, of a PET 14.03x, and of a right and left heart catheterization 19.96x. For stress cardiac imaging, compared with the treadmill exercise test equal to 1 (as a cost comparator, the cost of stress echocardiography is 2.1x and of a stress SPECT scintigraphy is 5.7x. Biohazards and downstream long-term costs linked to radiation-induced oncogenesis should also be considered. The radiation exposure is absent in echo and magnetic resonance, and corresponds to 500 chest x rays for a sestamibi cardiac stress scan and to 1150 chest x rays for a thallium scan. The corresponding extra-risk in a lifetime of fatal cancer is 1 in 2000 exposed patients for a sestamibi stress and 1 in 1000 for a thallium scan. Increased awareness of economic, biologic, and environmental costs of cardiac imaging will hopefully lead to greater appropriateness, wisdom and prudence from both the prescriber and the practitioner. In this way, the sustainability of cardiac imaging will eventually improve.

  8. [Minimal invasive cardiac surgery].

    Science.gov (United States)

    Sierra, J; Lahlaidi Sierra, N; Bednarkiewicz, M; Montessuit, M

    2015-03-01

    With the advent of cardiopulmonary bypass in 1953, complex intracardiac procedures were developed and a full sternotomy was established as the standard approach for these. With this technique, cardiac surgery achieved excellent immediate and long-term results that became the gold standard in a variety of cardiac pathologies, both congenital and acquired. By the late 90's, new techniques were developed, associated with less surgical trauma, decreased postoperative pain and faster functional recovery. Today, in specialized centres, minimally invasive cardiac surgery has been shown to achieve comparable and even better results than conventional surgery. It is rapidly becoming a new standard for valvular heart surgery. PMID:25924248

  9. Cardiac Arrest Resuscitation.

    Science.gov (United States)

    Guyette, Francis X; Reynolds, Joshua C; Frisch, Adam

    2015-08-01

    Cardiac arrest is a dynamic disease that tests the multitasking and leadership abilities of emergency physicians. Providers must simultaneously manage the logistics of resuscitation while searching for the cause of cardiac arrest. The astute clinician will also realize that he or she is orchestrating only one portion of a larger series of events, each of which directly affects patient outcomes. Resuscitation science is rapidly evolving, and emergency providers must be familiar with the latest evidence and controversies surrounding resuscitative techniques. This article reviews evidence, discusses controversies, and offers strategies to provide quality cardiac arrest resuscitation. PMID:26226873

  10. Minimally invasive paediatric cardiac surgery.

    Science.gov (United States)

    Bacha, Emile; Kalfa, David

    2014-01-01

    The concept of minimally invasive surgery for congenital heart disease in paediatric patients is broad, and has the aim of reducing the trauma of the operation at each stage of management. Firstly, in the operating room using minimally invasive incisions, video-assisted thoracoscopic and robotically assisted surgery, hybrid procedures, image-guided intracardiac surgery, and minimally invasive cardiopulmonary bypass strategies. Secondly, in the intensive-care unit with neuroprotection and 'fast-tracking' strategies that involve early extubation, early hospital discharge, and less exposure to transfused blood products. Thirdly, during postoperative mid-term and long-term follow-up by providing the children and their families with adequate support after hospital discharge. Improvement of these strategies relies on the development of new devices, real-time multimodality imaging, aids to instrument navigation, miniaturized and specialized instrumentation, robotic technology, and computer-assisted modelling of flow dynamics and tissue mechanics. In addition, dedicated multidisciplinary co-ordinated teams involving congenital cardiac surgeons, perfusionists, intensivists, anaesthesiologists, cardiologists, nurses, psychologists, and counsellors are needed before, during, and after surgery to go beyond apparent technological and medical limitations with the goal to 'treat more while hurting less'. PMID:24189403

  11. Follow-Up After Cardiac Surgery Should be Extended to at Least 120 Days When Benchmarking Cardiac Surgery Centers

    DEFF Research Database (Denmark)

    Hansen, Laura S; Sloth, Erik

    2015-01-01

    OBJECTIVE: Short-term (30 days) mortality frequently is used as an outcome measure after cardiac surgery, although it has been proposed that the follow-up period should be extended to 120 days to allow for more accurate benchmarking. The authors aimed to evaluate whether mortality rates 120 days after surgery were comparable to general mortality and to compare causes of death between the cohort and the general population. DESIGN: A multicenter descriptive cohort study using prospectively entered registry data. SETTING: University hospital. The cohort was obtained from the Western Denmark Heart Registry and matched to the Danish National Hospital Register as well as the Danish Register of Causes of Death. A weighted, age-matched general population consisting of all Danish patients who died within the study period was identified through the central authority on Danish statistics. PARTICIPANTS: A total of 11,988 patients (>15 years) who underwent cardiac-surgery at Aarhus, Aalborg and Odense University Hospitals from April 1, 2006 to December 31, 2012 were included. INTERVENTIONS: Coronary artery bypass grafting, valve surgery and combinations. MEASUREMENTS AND MAIN RESULTS: Mortality after cardiac surgery matches with mortality in the general population after 140 days. Mortality curves run almost parallel from this point onwards, regardless of The European system for cardiac operative risk evaluation (EuroSCORE) and intervention. The causes of death in the cohort differed statistically significantly from the background population (p<0.0001; one-sample t-test) throughout the first postoperative year. The leading cause of death in the cohort was cardiac (38%); 53% of which was categorized as heart failure. A total of 54% of these patients were assessed preoperatively as having normal or mildly impaired heart function (EuroSCORE). CONCLUSIONS: This study supported an extended follow-up period after cardiac surgery when benchmarking cardiac surgery centers. Regardless of preoperative heart function, heart failurewas the consistent leading cause of death.

  12. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... Implantable Cardiac Defibrillator February 19, 2009 Halifax Health Medical Center, Daytona Beach, FL Welcome to Halifax Health ... Webcast screen, and open the door to informed medical care. Welcome and thank you for joining us ...

  13. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available Automatic Implantable Cardiac Defibrillator February 19, 2009 Halifax Health Medical Center, Daytona Beach, FL Welcome to Halifax Health Daytona Beach, Florida. Over the next hour you' ...

  14. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... current state of cardiac disease here in the United States. So where are we right now, Dr. ... disease. We got over 360,000 people in United State with going to die with heart disease ...

  15. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available Automatic Implantable Cardiac Defibrillator February 19, 2009 Halifax Health Medical Center, Daytona Beach, FL Welcome to Halifax ... it and cause it to contract and have control over it. No way, man. I don't ...

  16. Perioperative Cardiac Arrests

    Directory of Open Access Journals (Sweden)

    JURAJ SPRUNG

    2008-10-01

    Full Text Available Perioperative cardiac arrests represent the most serious complication of anesthesia and surgery. It is believed that the incidence and mortality of cardiac arrest has declined, however, a more recent review questioned whether these rates have changed over the last 5 decades. It is difficult to compare the reports from different epochs, because medical practice has advanced, surgical acuity increased, and patients in extremes of age undergo surgery today. In the present article we review the information regarding the incidence of perioperative cardiac arrests and predictors of survival covering the period since the first comprehensive report by Beecher and Todd in 1954. We focus on our publications that report perioperative cardiac arrest at Mayo Clinic for adult noncardiac surgery, during regional anesthesia, and arrests in our pediatric surgical practice.

  17. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... hour you'll see the implantation of an automated implantable cardiac defibrillator. The surgery will be performed ... on a cruise on a boat. There’s a drill at the beginning. They give you a life ...

  18. Sudden cardiac death

    Directory of Open Access Journals (Sweden)

    Aran?elovi? Aleksandra ?.

    2004-01-01

    Full Text Available Sudden cardiac death in an athlete is rare and tragic event. An athlete's death draws high public attention given that athletes are considered the healthiest category of society. The vast majority of sudden cardiac death in young athletes is due to congenital cardiac malformations such as hypertrophie cardiomyopathy and various coronary artery anomalies. In athletes over age 35, the usual cause of sudden cardiac death is coronary artery disease. With each tragic death of a young athlete, there is a question why this tragedy has not been prevented. The American College of Sports Medicine and the American Heart Association recommend that a pre-participation exam should include a complete cardiovascular history and physical examination.

  19. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... Dr. Stoner about the current state of cardiac disease here in the United States. So where are we right now, Dr. Stoner, with heart disease? Well, Matt, we're going to see tonight ...

  20. How one trust made its way out of special measures.

    Science.gov (United States)

    Pratt, Pauleen

    2015-11-25

    United Lincolnshire Hospitals NHS Trust (ULHT) was placed into special measures by the Care Quality Commission in 2013 after problems were identified with its governance, patient and medicines safety, management and complaints handling. The author was appointed acting chief nurse six months later and has helped to identify and implement a package of improvements at the trust. As a result, ULHT was taken out of special measures in March 2015. This article describes the changes that were introduced and the processes involved that made this happen. PMID:26602485

  1. Sudden cardiac death

    DEFF Research Database (Denmark)

    Hougen, H P; Valenzuela, Antonio Jesus Sanchez; Lachica, E; Villanueva, E

    1992-01-01

    The study deals with the comparison of morphological, histochemical and biochemical methods applied to the detection of myocardial infarction in 150 medico-legal autopsies performed at the Institute of Forensic Pathology in Copenhagen. The study also included an NBT (formazan) test of cardiac cross-sections, and light microscopy and fluorescence microscopy of acridine orange-stained specimens from four different sites of the cardiac musculature. Specimens of myocardium from the same four sites a...

  2. Awareness in cardiac anesthesia.

    LENUS (Irish Health Repository)

    Serfontein, Leon

    2010-02-01

    Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it.

  3. Rehabilitating elderly cardiac patients.

    OpenAIRE

    Anderson, J M

    1991-01-01

    The aging cardiovascular system undergoes many anatomic and physiologic changes. Increased vascular resistance, myocardial "stiffness," abnormalities of rhythmicity of the sinoatrial node, irregular cardiac rhythms, and alterations in heart rate and blood pressure responses are all seen more frequently in older patients. These changes are likely to impair these patients' ability to make the rapid adjustments necessary to maintain cardiac output during exercise and activity. When cardiovascula...

  4. Human cardiac stem cells

    OpenAIRE

    Bearzi, Claudia; Rota, Marcello; Hosoda, Toru; Tillmanns, Jochen; Nascimbene, Angelo; De Angelis, Antonella; Yasuzawa-Amano, Saori; Trofimova, Irina; Siggins, Robert W.; LeCapitaine, Nicole; Cascapera, Stefano; Beltrami, Antonio P; D'Alessandro, David A.; Zias, Elias; Quaini, Federico

    2007-01-01

    The identification of cardiac progenitor cells in mammals raises the possibility that the human heart contains a population of stem cells capable of generating cardiomyocytes and coronary vessels. The characterization of human cardiac stem cells (hCSCs) would have important clinical implications for the management of the failing heart. We have established the conditions for the isolation and expansion of c-kit-positive hCSCs from small samples of myocardium. Additionally, we have tested wheth...

  5. Increasing cardiac interventions among the aged.

    LENUS (Irish Health Repository)

    Groarke, J D

    2010-11-01

    Ireland\\'s over 65 year population is growing. As incidence of coronary events rises with age, there is a growing population of elderly patients with cardiac disease. The changing age profile of patients treated by a tertiary hospital\\'s Cardiology service was quantified using Hospital Inpatient Enquiry data. 53% of CCU admissions were aged > or = 65 years, with admissions aged > or = 85 years in 2008 four times greater than in 2002. Percentages of patients undergoing diagnostic coronary angiography and percutaneous coronary interventions in 1997 aged > or = 70 years were 19% and 18% respectively. By 2007, these percentages had risen to 31% and 34% respectively--greatest increases were in the very elderly age categories. The proportion of ICD recipients aged > 70 years increased from 8% in 2003 to 25% by 2008. The proportion of elderly patients receiving advanced cardiac care is increasing. This trend will continue and has clear resource implications. Outcomes of interventions in the very old need further investigation, since the \\'old old\\' are under-represented in clinical trials.

  6. Cardiac Image Registration

    Directory of Open Access Journals (Sweden)

    2008-09-01

    Full Text Available Long procedure time and somewhat suboptimal results hinder the widespread use of catheter ablation of complex arrhythmias such as atrial fibrillation (AF. Due to lack of contrast differentiation between the area of interest and surrounding structures in a moving organ like heart, there is a lack of proper intraprocedural guidance using current imaging techniques for ablation. Cardiac image registration is currently under investigation and is in clinical use for AF ablation. Cardiac image registration, which involves integration of two images in the context of left atrium (LA, is intermodal, with the acquired image and the real-time reference image residing in different image spaces, and involves optimization, where one image space is transformed into the other. Unlike rigid body registration, cardiac image registration is unique and challenging due to cardiac motion during the cardiac cycle and due to respiration. This review addresses the basic principles of the emerging technique of registration and the inherent limitations as they relate to cardiac imaging and registration.

  7. Pharmacoinvasive management of acute coronary syndrome: incorporating the 2007 ACC/AHA guidelines: the CATH (cardiac catheterization and antithrombotic therapy in the hospital) Clinical Consensus Panel Report--III.

    Science.gov (United States)

    Cohen, Marc; Diez, Jos E; Levine, Glenn N; Ferguson, James J; Morrow, David A; Rao, Sunil V; Zidar, James P

    2007-12-01

    This paper provides a comprehensive up-to-date review of the medical and invasive management of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), and ST-elevation myocardial infarction (STEMI), as supported by recent updates to the ACC/AHA Guidelines. The authors have summarized findings from key clinical trials published in recent years that contribute to clinician's understanding of how best to optimize therapy. The goals for the management of NSTE-ACS and STEMI are rapid and accurate risk stratification, appropriate and institution-specific triage to interventional versus medical strategies and optimal pharmacologic therapy - all of which provide for a smooth and seamless transition of care between the emergency department and the cardiology service. High-risk features or absolute treatment trigger criteria that support more aggressive medical therapy (i.e., addition of a small molecule gylcoprotein [GP] IIb/IIIa inhibitor to a core regimen of aspirin, enoxaparin or other anticoagulants, and in most cases, clopidogrel) and/or that would direct clinicians toward percutaneous interventional strategies as the preferred modality include, but are not limited to the presence of one or more of the following: 1) elevatedcardiac markers (troponin and/or CK-MB); 2) age older than 65 years; 3) presence of ST-T-wave changes; 4) TIMI Risk Score >/= 5; 5) clinical instability in the setting of suspected NSTE-ACS. Although additional refinements and changes in ACS management are still to come, evidence-based strategies suggest that prompt mechanical revascularization is associated with the best possible clinical outcomes, particularly for patients with high-risk features and in whom benefits of adjunctive, pharmacoinvasive antithrombotic therapies can be consolidated. Transfer for cardiac catheterization/percutaneous coronary intervention (PCI) is strongly recommended in patients who manifest high-risk features and/or aggressive treatment trigger criteria, so that this high-risk subgroup may receive definitive, interventional and/or cardiology-directed specialty care at appropriate sites of care. When available, interventional management is preferred in these patients. The importance of safe and effective anticoagulation in the spectrum of management strategies has been confirmed, and the evidence in support of enoxaparin and other antithrombotic agents has been reviewed. Dosing recommendations for enoxaparin use in the setting of PCI have been issued by the CATH Panel and have been summarized in this consensus report. Similar recommendations have been presented for the use of oral antiplatelet agents and GP IIb/IIIa antagonists. The addition of statins, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers is also stressed as part of a comprehensive secondary cardioprotective strategy for patients with coronary heart disease. PMID:18180524

  8. A morte no contexto hospitalar: as equipes de reanimação cardíaca La muerte en el contexto hospitalario: los equipos de reanimación cardiaca Death in the hospital context: the teams of cardiac reviving

    Directory of Open Access Journals (Sweden)

    Nájela Hassan Saloum

    1999-12-01

    Full Text Available A autora investigou o significado do trabalho cotidiano com a morte sob a perspectiva dos profissionais que integram uma equipe de reanimação cárdio-pulmonar de um Hospital Universitário. Pertencer a esta equipe implica em uma forma de lidar com a morte com a intenção explícita de revertê-la. A literatura vem evidenciando a preocupação de diferentes autores com o cotidiano profissional dessa natureza, dada sua tendência ao desgaste das pessoas. O estudo foi conduzido segundo a metodologia de investigação fenomenológica; foram realizadas entrevistas com todos os integrantes da referida equipe, utilizando a gravação. Os dados analisados evidenciam que os profissionais percebem o trabalho sob uma perspectiva funcionalista, onde o tempo se revela como fator determinante na luta contra a morte; é um trabalho permeado pelo sucesso/insucesso e por dificuldades; gera uma postura de onipotência/impotência e requer um enfrentamento. Evidenciam também desgaste, sentimentos de impotência e fracasso quando a reanimação não é possível. Referendam ainda o alerta mundial de se atentar para cotidianos de trabalho desgastantes e de que as escolas e instituições de saúde implementem canais para elaboração dessa forma de desgaste e para o redimensionamento do papel do profissional de saúde.La autora investigó el significado del trabajo cotidiano con la muerte sobre la perspectiva de los profesionales que integran un equipo de reanimación cardiopulmonar de un hospital universitario. Pertenecer a este equipo implica de alguna manera, convivir con la muerte con una intensión explícita de revertirla. La literatura viene evidenciando la preocupación de diferentes autores con el cotidiano profesional de esta naturaleza, dada su tendencia al desgaste de las personas. El estudio fue conducido según la metodología de investigación fenomenológica y fueron realizadas entrevistas con todos los integrantes del equipo referido, utilizando la grabación. Los datos analizados permiten evidenciar que los profesionales perciben el trabajo sobre una perspectiva funcionalista, donde el tiempo se revela como factor determinante en la lucha contra la muerte; es un trabajo permeado por el éxito/fracaso y por dificultades; genera una postura de omnipotencia/impotencia y requiere un enfrentamiento. Evidencian también desgaste, sentimientos de impotencia y de fracaso cuando la reanimación no es posible. Refuerzan aún la alerta mundial en relación con trabajos cotidianos desgastantes y el hecho de que las escuelas e instituciones de salud desarrollen canales para la valoración de esa forma de desgaste y para la redimensión del papel del profesional de salud.The author investigated the meaning of the daily work with the death on the perspective of the professionals that integrate a team of heart and lung revival from a university hospital. To belong to this team implies somehow, to live together with the death with an explicit objective of reverting it. The literature evidences the concern of several authors with these professionals, considering their tendency of wearines. The study was developed according to the methodology of phenomenological investigation and was carried out through recorded interviews with all members of the referred team. The analyzed data allowed authors to evidence that the professionals perceive the work on a functionalist perspective, where the time is revealed as a decisive factor against death; it is a work permeated by the success/failure and difficulties; it generates a posture of omnipotence/ impotence and requires a confrontation. They also evidenced waste, feelings of impotence and of failure when the reanimation is not possible. They still reinforce the concern about daily exhausting work and the advise for schools and institutions of health to develop channels for the evaluation of weariness and for the new valuation of the health professionals role.

  9. A morte no contexto hospitalar: as equipes de reanimação cardíaca / Death in the hospital context: the teams of cardiac reviving / La muerte en el contexto hospitalario: los equipos de reanimación cardiaca

    Scientific Electronic Library Online (English)

    Nájela Hassan, Saloum; Magali Roseira, Boemer.

    1999-12-01

    Full Text Available A autora investigou o significado do trabalho cotidiano com a morte sob a perspectiva dos profissionais que integram uma equipe de reanimação cárdio-pulmonar de um Hospital Universitário. Pertencer a esta equipe implica em uma forma de lidar com a morte com a intenção explícita de revertê-la. A lite [...] ratura vem evidenciando a preocupação de diferentes autores com o cotidiano profissional dessa natureza, dada sua tendência ao desgaste das pessoas. O estudo foi conduzido segundo a metodologia de investigação fenomenológica; foram realizadas entrevistas com todos os integrantes da referida equipe, utilizando a gravação. Os dados analisados evidenciam que os profissionais percebem o trabalho sob uma perspectiva funcionalista, onde o tempo se revela como fator determinante na luta contra a morte; é um trabalho permeado pelo sucesso/insucesso e por dificuldades; gera uma postura de onipotência/impotência e requer um enfrentamento. Evidenciam também desgaste, sentimentos de impotência e fracasso quando a reanimação não é possível. Referendam ainda o alerta mundial de se atentar para cotidianos de trabalho desgastantes e de que as escolas e instituições de saúde implementem canais para elaboração dessa forma de desgaste e para o redimensionamento do papel do profissional de saúde. Abstract in spanish La autora investigó el significado del trabajo cotidiano con la muerte sobre la perspectiva de los profesionales que integran un equipo de reanimación cardiopulmonar de un hospital universitario. Pertenecer a este equipo implica de alguna manera, convivir con la muerte con una intensión explícita de [...] revertirla. La literatura viene evidenciando la preocupación de diferentes autores con el cotidiano profesional de esta naturaleza, dada su tendencia al desgaste de las personas. El estudio fue conducido según la metodología de investigación fenomenológica y fueron realizadas entrevistas con todos los integrantes del equipo referido, utilizando la grabación. Los datos analizados permiten evidenciar que los profesionales perciben el trabajo sobre una perspectiva funcionalista, donde el tiempo se revela como factor determinante en la lucha contra la muerte; es un trabajo permeado por el éxito/fracaso y por dificultades; genera una postura de omnipotencia/impotencia y requiere un enfrentamiento. Evidencian también desgaste, sentimientos de impotencia y de fracaso cuando la reanimación no es posible. Refuerzan aún la alerta mundial en relación con trabajos cotidianos desgastantes y el hecho de que las escuelas e instituciones de salud desarrollen canales para la valoración de esa forma de desgaste y para la redimensión del papel del profesional de salud. Abstract in english The author investigated the meaning of the daily work with the death on the perspective of the professionals that integrate a team of heart and lung revival from a university hospital. To belong to this team implies somehow, to live together with the death with an explicit objective of reverting it. [...] The literature evidences the concern of several authors with these professionals, considering their tendency of wearines. The study was developed according to the methodology of phenomenological investigation and was carried out through recorded interviews with all members of the referred team. The analyzed data allowed authors to evidence that the professionals perceive the work on a functionalist perspective, where the time is revealed as a decisive factor against death; it is a work permeated by the success/failure and difficulties; it generates a posture of omnipotence/ impotence and requires a confrontation. They also evidenced waste, feelings of impotence and of failure when the reanimation is not possible. They still reinforce the concern about daily exhausting work and the advise for schools and institutions of health to develop channels for the evaluation of weariness and for the new valuation of the health professionals role.

  10. Diesel Exhaust Inhalation Increases Cardiac Output, Bradyarrhythmias, and Parasympathetic Tone in Aged Heart Failure–Prone Rats

    OpenAIRE

    Carll, Alex P.; LUST, ROBERT M.; Hazari, Mehdi S.; Perez, Christina M.; Krantz, Quentin Todd; King, Charly J.; Winsett, Darrell W.; Cascio, Wayne E.; Costa, Daniel L; Farraj, Aimen K.

    2012-01-01

    Acute air pollutant inhalation is linked to adverse cardiac events and death, and hospitalizations for heart failure. Diesel engine exhaust (DE) is a major air pollutant suspected to exacerbate preexisting cardiac conditions, in part, through autonomic and electrophysiologic disturbance of normal cardiac function. To explore this putative mechanism, we examined cardiophysiologic responses to DE inhalation in a model of aged heart failure–prone rats without signs or symptoms of overt heart fai...

  11. Pediatric cardiac emergencies.

    Science.gov (United States)

    Lee, C; Mason, L J

    2001-06-01

    Successful management of pediatric cardiac emergencies requires an accurate diagnosis to institute an appropriate plan of therapy. The diagnosis, however, is not always straightforward, as evidenced by the nonspecific clinical picture that can be presented by congenital heart defects. Entertaining the possibility of a cardiac problem in neonates with pulmonary symptoms unresponsive to standard therapies is crucial for successful management of patients with congenital heart disease. In addition to ventilatory support, prostaglandin E1 infusions or emergency interventional cardiac catheterization is often a life-saving initial measure in patients with acutely decompensated congenital cardiac lesions that require a patent ductus arteriosus for survival. Pericardial tamponade is associated with various acquired and iatrogenic causes. Emergent pericardiocentesis is mandatory when cardiovascular compromise occurs. The goal of anesthetic management is to maintain cardiac output. With the increasing use of central venous catheters in neonatal ICUs and the high mortality rate for central venous catheter-related cardiac tamponade, the diagnosis must be considered in any patient with a central venous catheter in situ who acutely develops unexplained hypotension, bradycardia, and diminished pulses. Arrhythmias also can cause hemodynamic instability in infants and children. Supraventricular tachycardia is by far the most common emergently presenting arrhythmia in the pediatric population. Unstable patients require immediate intravenous adenosine or synchronized cardioversion. Complete heart block is rare, but it can lead to congestive heart failure and occasionally to cardiovascular collapse and sudden death. Emergency treatment of complete heart block includes pharmacologic support and temporary or permanent pacemaker placement as indicated. In infants, congestive heart failure usually is related to congenital heart disease, whereas in older children, it tends to be secondary to an acquired cause. Supportive measures, fluid restriction, and inotropic support are the principles of initial treatment. Prompt recognition and initiation of appropriate therapy in pediatric cardiac emergencies are essential for favorable outcomes. PMID:11469066

  12. Pattern of cardiovascular diseases in pilgrims admitted in Al-Noor hospital Makkah during hajj 1429 H

    International Nuclear Information System (INIS)

    The number of Hajj pilgrims is increasing every year, and has crossed the huge figure of 2 million. During Hajj period of 1428H (2007G), cardiac problems have been reported as one of the commonest causes of admissions in hospitals. However, the data regarding their Nationalities, age and gender is not available in the literature. This study was carried out to identify the cardiovascular diseases in Hajj pilgrims for the year 1429 H (2008G) classified on geographical, age and gender basis, and to suggest pre-Hajj measures for their home countries and their handling by concerned Ministry during Hajj. Methods: On retrospective basis, data of all patients belonging to different Nationalities of various regions of the world, their age and gender, was analysed, who were admitted in the Coronary Care Unit (CCU) and cardiology wards at Al- Noor Specialist Hospital Makkah, over a period of 15 days in Hajj season 1429H (2008G). Results: Out of 203 patients hospitalised, the majority (94%) were older, i.e., >45 years. The patients suffering from various cardiac diseases were in the following order: heart failure cases 67%; ischemic heart disease 21.7%; and valvular heart disease 11.3%. As an outcome of total admissions (hospitalisation), 84% patients were discharged in stable condition, 9% were discharged against medical advice, 4.5% were unable to perform Hajj and 2.5% patients died. Most common cardiac diseases were found in hospitalized patients for Hajj 1429 H, which belongs to different countries over the globe. It indicate loop holes in the health services of their home countries not verifying the physical fitness of their pilgrims before allowing them to proceed for Hajj. This study will also serve as a helping tool for the Ministry of Hajj in Saudi Arabia to take appropriate measures for demanding strictness for the physical fitness of Hajj pilgrims and anticipated health services for them. (author)

  13. Rheumatic fever and rheumatic heart disease among children presenting to two referral hospitals in Harare, Zimbabwe

    Scientific Electronic Library Online (English)

    P, Gapu; M, Bwakura-Dangarembizi; G, Kandawasvika; D, Kao; C, Bannerman; J, Hakim; J A, Matenga.

    2015-05-01

    Full Text Available BACKGROUND: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain significant causes of morbidity and mortality in resource-limited settings. In Zimbabwe ARF/RHD characteristics have not been systematically documented OBJECTIVES: To document cases of ARF/RHD among children presenting [...] at referral hospitals in Harare, Zimbabwe, determine their clinical and echocardiographic characteristics, and identify opportunities for improving care METHODS: A cross-sectional survey was carried out in which consecutive children aged 1 - 12 years presenting with ARF/RHD according to the 2002/3 World Health Organization modified Jones criteria were enrolled RESULTS: Out of 2 601 admissions and 1 026 outpatient visits over 10 months, 50 children were recruited, including 31 inpatients with ARF/RHD and 19 outpatients with chronic RHD. Among inpatients, 9 had ARF only, 7 recurrent ARF with RHD, and 15 RHD only. The commonest valve lesions were mitral regurgitation (26/31) and aortic regurgitation (11/31). The commonest reason for admission was cardiac failure (22/31). The proportion of ARF/RHD cases among inpatients aged 1 - 12 years was 11.9/1 000. Of the 22 with RHD, 14 (63.6%) presented de novo and 1 had bacterial endocarditis. Among the outpatients, 15 had cardiac failure while echocardiographic findings included mitral regurgitation (18/19) and aortic regurgitation (5/19). At presentation, 18/26 known cases were on oral penicillin prophylaxis and 7 on injectable penicillin. Of those on secondary prophylaxis, 68.0% reported taking it regularly CONCLUSION: ARF/RHD remains a major problem and cause of hospital admissions in Harare, Zimbabwe. Children often present late with established RHD and cardiac failure. With the majority on oral penicillin, secondary prophylaxis was suboptimal in a resource-limited setting unable to offer valve replacement surgery

  14. Blunt Cardiac Injury in the Severely Injured – A Retrospective Multicentre Study

    Science.gov (United States)

    Hanschen, Marc; Kanz, Karl-Georg; Kirchhoff, Chlodwig; Khalil, Philipe N.; Wierer, Matthias; van Griensven, Martijn; Laugwitz, Karl-Ludwig; Biberthaler, Peter; Lefering, Rolf; Huber-Wagner, Stefan

    2015-01-01

    Background Blunt cardiac injury is a rare trauma entity. Here, we sought to evaluate the relevance and prognostic significance of blunt cardiac injury in severely injured patients. Methods In a retrospective multicentre study, using data collected from 47,580 patients enrolled to TraumaRegister DGU (1993-2009), characteristics of trauma, prehospital / hospital trauma management, and outcome analysis were correlated to the severity of blunt cardiac injury. The severity of cardiac injury was assessed according to the abbreviated injury score (AIS score 1-6), the revised injury severity score (RISC) allowed comparison of expected outcome with injury severity-dependent outcome. N = 1.090 had blunt cardiac trauma (AIS 1-6) (2.3% of patients). Results Predictors of blunt cardiac injury could be identified. Sternal fractures indicate a high risk of the presence of blunt cardiac injury (AIS 0 [control]: 3.0%; AIS 1: 19.3%; AIS 2-6: 19.1%). The overall mortality rate was 13.9%, minor cardiac injury (AIS 1) and severe cardiac injury (AIS 2-6) are associated with higher rates. Severe blunt cardiac injury (AIS 4 and AIS 5-6) is associated with a higher mortality (OR 2.79 and 4.89, respectively) as compared to the predicted average mortality (OR 2.49) of the study collective. Conclusion Multiple injured patients with blunt cardiac trauma are at high risk to be underestimated. Careful evaluation of trauma patients is able to predict the presence of blunt cardiac injury. The severity of blunt cardiac injury needs to be stratified according to the AIS score, as the patients’ outcome is dependent on the severity of cardiac injury. PMID:26136126

  15. Cardiac applications of PET.

    Science.gov (United States)

    Sarikaya, Ismet

    2015-10-01

    Routine use of cardiac positron emission tomography (PET) applications has been increasing but has not replaced cardiac single-photon emission computerized tomography (SPECT) studies yet. The majority of cardiac PET tracers, with the exception of fluorine-18 fluorodeoxyglucose (18F-FDG), are not widely available, as they require either an onsite cyclotron or a costly generator for their production. 18F-FDG PET imaging has high sensitivity for the detection of hibernating/viable myocardium and has replaced Tl-201 SPECT imaging in centers equipped with a PET/CT camera. PET myocardial perfusion imaging with various tracers such as Rb-82, N-13 ammonia, and O-15 H2O has higher sensitivity and specificity than myocardial perfusion SPECT for the detection of coronary artery disease (CAD). In particular, quantitative PET measurements of myocardial perfusion help identify subclinical coronary stenosis, better define the extent and severity of CAD, and detect ischemia when there is balanced reduction in myocardial perfusion due to three-vessel or main stem CAD. Fusion images of PET perfusion and CT coronary artery calcium scoring or CT coronary angiography provide additional complementary information and improve the detection of CAD. PET studies with novel 18F-labeled perfusion tracers such as 18F-flurpiridaz and 18F-FBnTP have yielded high sensitivity and specificity in the diagnosis of CAD. These tracers are still being tested in humans, and, if approved for clinical use, they will be commercially and widely available. In addition to viability studies, 18F-FDG PET can also be utilized to detect inflammation/infection in various conditions such as endocarditis, sarcoidosis, and atherosclerosis. Some recent series have obtained encouraging results for the detection of endocarditis in patients with intracardiac devices and prosthetic valves. PET tracers for cardiac neuronal imaging, such as C-11 HED, help assess the severity of heart failure and post-transplant cardiac reinnervation, and understand the pathogenesis of arrhytmias. The other uncommon applications of cardiac PET include NaF imaging to identify calcium deposition in atherosclerotic plaques and ?-amyloid imaging to diagnose cardiac amyloid involvement. 18F-FDG imaging with a novel PET/MR camera has been reported to be very sensitive and specific for the differentiation between malignant and nonmalignant cardiac masses. The other potential applications of PET/MR are cardiac infectious/inflammatory conditions such as endocarditis. PMID:26035516

  16. Preoperative Anxiety as a Predictor of Mortality and Major Morbidity in Patients >70 Years of Age Undergoing Cardiac Surgery

    OpenAIRE

    Williams, Judson B.; Alexander, Karen P.; Morin, Jean-François; Langlois, Yves; Noiseux, Nicolas; Perrault, Louis P.; Smolderen, Kim; Arnold, Suzanne V; Eisenberg, Mark J.; Pilote, Louise; Monette, Johanne; Bergman, Howard; Smith, Peter K.; Afilalo, Jonathan

    2013-01-01

    This study examined the association between patient-reported anxiety and post-cardiac surgery mortality and major morbidity. Frailty ABC'S was a prospective multicenter cohort study of elderly patients undergoing cardiac surgery (coronary artery bypass surgery and/or valve repair or replacement) at 4 tertiary care hospitals between 2008 and 2009. Patients were evaluated a mean of 2 days preoperatively with the Hospital Anxiety and Depression Scale (HADS), a validated questionnaire assessing d...

  17. Hospital Inspections

    Data.gov (United States)

    U.S. Department of Health & Human Services — Welcome to hospitalinspections.org, a website run by the Association of Health Care Journalists (AHCJ) that aims to make federal hospital inspection reports easier...

  18. Hospital Hints

    Science.gov (United States)

    ... home. The hospital is not responsible for your cell phone, laptop, tablet, CD player, or other electronics. Admission ... people. Often, the strange routine and lack of sleep can cause confusion . Family and caregivers may be ...

  19. Hospitals - Chicago

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospitals in Chicago. To view or use these files, compression software, like WinZip, and special GIS software, such as ESRI ArcGIS, is required. The .dbf file may...

  20. Preventable Hospitalizations

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Governor's strategic goal on preventable hospitalizations is to drive down the rate by 10 percent by the end of 2015. 2011 cost data are in 2011 dollars. 2010...

  1. Cardiac arrest due to lymphocytic colitis : a case report

    DEFF Research Database (Denmark)

    Groth, Kristian; Kelsen, Jens

    2012-01-01

    ABSTRACT: INTRODUCTION: We present a case of cardiac arrest due to hypokalemia caused by lymphocytic colitis. CASE PRESENTATION: A 69-year-old Caucasian man presented four months prior to a cardiac arrest with watery diarrhea and was diagnosed with lymphocytic colitis. Our patient experienced a witnessed cardiac arrest at his general practitioner's surgery. Two physicians and the emergency medical services resuscitated our patient for one hour and four minutes before arriving at our university hospital. Our patient was defibrillated 16 times due to the recurrence of ventricular tachyarrhythmias. An arterial blood sample revealed a potassium level of 2.0mmol/L (reference range: 3.5 to 4.6mmol/L) and pH 6.86 (reference range: pH 7.37 to 7.45). As the potassium level was corrected, the propensity for ventricular tachyarrhythmias ceased. Our patient recovered from his cardiac arrest without any neurological deficit. Further tests and examinations revealed no other reason for the cardiac arrest. CONCLUSION: Diarrhea can cause life-threatening situations due to the excretion of potassium, ultimately causing cardiac arrest due to hypokalemia. Physicians treating patients with severe diarrhea should consider monitoring their electrolyte levels.

  2. 8. Maternal cardiac complications in women with cardiac disease in pregnancy

    Directory of Open Access Journals (Sweden)

    C.N. Sheela

    2011-12-01

    Full Text Available The aim of the present work is to identify the risk factors for maternal cardiac complications and for adverse neonatal outcome in women with heart disease in pregnancy. Prospective observational study was carried out at a tertiary referral hospital in South India. Data was collected from 144 women going through 146 pregnancies and delivered after 24 weeks of gestation, over a period of 7 years. Logistic regression analysis was done to identify the risk factors for maternal and the neonatal complications. Principal etiology of the lesion was Rheumatic in 67%, Congenital in 26% and peripartum cardiomyopathy in 5%. Maternal mortality was 2% (3 women and maternal cardiac complications occurred in 27%. NYHA class III/IV at booking, pulmonary arterial hypertension and myocardial dysfunction were the risk factors for maternal cardiac complications during pregnancy. NYHA class III/IV, gestational age >20 weeks at booking and associated hypertension during present pregnancy were the risk factors for adverse neonatal outcome. RHD remains an important cause for maternal as well as perinatal mortality and morbidity in developing countries. NYHA class III/IV, myocardial dysfunction and pulmonary arterial hypertension are the risk factors for maternal cardiac complications.

  3. Perioperative management of cardiac disease.

    Science.gov (United States)

    Aresti, N A; Malik, A A; Ihsan, K M; Aftab, S M E; Khan, W S

    2014-01-01

    Pre-existing cardiac disease contributes significantly to morbidity and mortality amongst patients undergoing non cardiac surgery. Patients with pre-existing cardiac disease or with risk factors for it, have as much as a 3.9% risk of suffering a major perioperative cardiac event (Lee et al 1999, Devereaux 2005). Furthermore, the incidence of perioperative myocardial infarction (MI) is increased 10 to 50 fold in patients with previous coronary events (Jassal 2008). PMID:24516966

  4. Survey of junior hospital doctors' attitudes to cardiopulmonary resuscitation

    OpenAIRE

    Morgan, R; Westmoreland, C

    2002-01-01

    Most cardiac arrest teams are made up of junior doctors. The stressful effect of cardiopulmonary resuscitation (CPR) on doctors has not previously been established. A questionnaire was sent to all 52 junior doctors who participated in the cardiac arrest team at a district general hospital. Forty one questionnaires were returned by 22 junior house officers, 12 senior house officers, and seven specialist registrars. The questionnaire was anonymous so non-responders could not be recontacted. Sev...

  5. Cardiac Syndrome X: Update.

    Science.gov (United States)

    Agrawal, Shilpa; Mehta, Puja K; Bairey Merz, C Noel

    2016-01-01

    Cardiac Syndrome X (CSX), characterized by angina-like chest discomfort, ST segment depression during exercise, and normal epicardial coronary arteries at angiography, is highly prevalent in women. CSX is not benign, and linked to adverse cardiovascular outcomes and a poor quality of life. Coronary microvascular and endothelial dysfunction and abnormal cardiac nociception have been implicated in the pathogenesis of CSX. Treatment includes life-style modification, anti-anginal, anti-atherosclerotic, and anti-ischemic medications. Non-pharmacological options include cognitive behavioral therapy, enhanced external counterpulsation, neurostimulation, and stellate ganglionectomy. Studies have shown the efficacy of individual treatments but guidelines outlining the best course of therapy are lacking. PMID:26567981

  6. Endogenous cardiac stem cells.

    Science.gov (United States)

    Barile, Lucio; Messina, Elisa; Giacomello, Alessandro; Marbán, Eduardo

    2007-01-01

    In the past few years it has been established that the heart contains a reservoir of stem and progenitor cells. These cells are positive for various stem/progenitor cell markers (Kit, Sca-1, Isl-1, and Side Population (SP) properties). The relationship between the various cardiac stem cells (CSC) and progenitor cells described awaits clarification. Furthermore, they may open a new therapeutic strategies of cardiac repair based on the regeneration potential of cardiac stem cells. Currently, cellular cardiomyoplasty is actively explored as means of regenerating damaged myocardium using several different cell types. CSCs seem a logical cell source to exploit for cardiac regeneration therapy. Their presence into the heart, the frequent co-expression of early cardiac progenitor transcription factors, and the capability for ex vivo and in vivo differentiation toward the cardiac lineages offer promise of enhanced cardiogenicity compared to other cell sources. CSCs, when isolated from various animal models by selection based on c-Kit, Sca-1, and/or MDR1, have shown cardiac regeneration potential in vivo following injection in the infracted myocardium. Recently, we have successfully isolated CSCs from small biopsies of human myocardium and expanded them ex vivo by many folds without losing differentiation potential into cardiomyocytes and vascular cells, bringing autologous transplantation of CSCs closer to clinical evaluation. These cells are spontaneously shed from human surgical specimens and murine heart samples in primary culture. This heterogeneous population of cells forms multi-cellular clusters, dubbed cardiospheres (CSs), in suspension culture. CSs are composed of clonally-derived cells, consist of proliferating c-Kit positive cells primarily in their core and differentiating cells expressing cardiac and endothelial cell markers on their periphery. Although the intracardiac origin of adult myocytes has been unequivocally documented, the potential of an extracardiac source of cells, able to repopulate the lost CSCs in pathological conditions (infarct) cannot be excluded and will be discussed in this review. The delivery of human CSs or of CSs-derived cells into the injured heart of the SCID mouse resulted in engraftment, migration, myocardial regeneration and improvement of left ventricular function. Our method for ex vivo expansion of resident CSCs for subsequent autologous transplantation back into the heart, may give these cell populations, the resident and the transplanted one, the combined ability to mediate myocardial regeneration to an appreciable degree, and may change the way in which cardiovascular disease will be approached in the future. PMID:17631436

  7. Reoperation for bleeding in cardiac surgery

    DEFF Research Database (Denmark)

    Kristensen, Katrine Lawaetz; Rauer, Line Juul

    2012-01-01

    At Odense University Hospital (OUH), 5-9% of all unselected cardiac surgical patients undergo reoperation due to excessive bleeding. The reoperated patients have an approximately three times greater mortality than non-reoperated. To reduce the rate of reoperations and mortality due to postoperative bleeding, we aim to identify risk factors that predict reoperation. A total of 1452 consecutive patients undergoing cardiac surgery using extracorporeal circulation (ECC) between November 2005 and December 2008 at OUH were analysed. Statistical tests were used to identify risk factors for reoperation. We performed a case-note review on propensity-matched patients to assess the outcome of reoperation for bleeding regarding morbidity and mortality. In total, 101 patients (7.0%) underwent surgical re-exploration due to excessive postoperative bleeding. Significant risk factors for reoperation for bleeding after cardiac surgery was low ejection fraction, high EuroSCORE, procedures other than isolated CABG, elongated time on ECC, low body mass index, diabetes mellitus and preoperatively elevated s-creatinine. Reoperated patients significantly had a greater increase in postoperative s-creatinine and higher mortality. Surviving reoperated patients significantly had a lower EuroSCORE and a shorter time on ECC compared with non-survivors. The average time to re-exploration was 155 min longer for non-survivors when compared with survivors.

  8. Two approaches for repeat cardiac surgery

    Directory of Open Access Journals (Sweden)

    Chung Jin

    2012-10-01

    Full Text Available Abstract Background With recent advances in post-operative care and surgical methods, the number of cardiovascular re-operations is increasing. We analyzed our institutional experience to evaluate the safety and efficacy of the approach methods for cardiac re-operations. Methods Between September 2007 and December 2010, we performed 208 cardiac re-operations, defined as surgery which was not performed within a month from the previous operation or during the same hospitalization for the same disease and reviewed retrospectively. According to the surgical approach, we divided patients into two groups: median sternotomy group (S-group, n?=?146, and thoracotomy group (T-group, n?=?62. Results There were no differences in sex or mean interval from the first surgery to re-operation between the two groups. Mean cardiopulmonary bypass, adhesion dissection time, bleeding control time, and operation time were significantly shorter in the T-group. The need for transfusion (p?=?0.001 during adhesion dissection and the chest tube drainage (p? Conclusions Two approaches for repeated cardiac surgery were safe and effective in terms of mortality, wound infection, bleeding, operation time, adhesion dissecting time, and bleeding control time. We were able to obtain a good visual field and perform safe surgery by applying the thoracotomy method in selective patients for cardiovascular re-operation.

  9. Cardiac magnetic resonance imaging in clinical practice

    Scientific Electronic Library Online (English)

    Adriana Dias, Barranhas; Alair Augusto S. M. D. dos, Santos; Otavio R., Coelho-Filho; Edson, Marchiori; Carlos Eduardo, Rochitte; Marcelo Souto, Nacif.

    2014-01-01

    Full Text Available Objective To evaluate and describe indications, mainly diagnoses and cardiac magnetic resonance imaging findings observed in clinical practice. Materials and Methods Retrospective and descriptive study of cardiac magnetic resonance performed at a private hospital and clinic in the city of Niterói [...] , RJ, Brazil, in the period from May 2007 to April 2011. Results The sample included a total of 1000 studies performed in patients with a mean age of 53.7 ± 16.2 years and predominance for male gender (57.2%). The majority of indications were related to assessment of myocardial perfusion at rest and under pharmacological stress (507/1000; 51%), with positive results in 36.2% of them. Suspected myocarditis was the second most frequent indication (140/1000; 14%), with positive results in 63.4% of cases. These two indications were followed by study of arrhythmias (116/1000; 12%), myocardial viability (69/1000; 7%) and evaluation of cardiomyopathies (47/1000; 5%). In a subanalysis, it was possible to identify that most patients were assessed on an outpatient basis (58.42%). Conclusion Cardiac magnetic resonance has been routinely performed in clinical practice, either on an outpatient or emergency/inpatient basis, and myocardial ischemia represented the main indication, followed by investigation of myocarditis, arrhythmogenic right ventricular dysplasia and myocardial viability.

  10. Reoperation for bleeding in cardiac surgery

    Science.gov (United States)

    Kristensen, Katrine Lawaetz; Rauer, Line Juul; Mortensen, Poul Erik; Kjeldsen, Bo Juel

    2012-01-01

    At Odense University Hospital (OUH), 5–9% of all unselected cardiac surgical patients undergo reoperation due to excessive bleeding. The reoperated patients have an approximately three times greater mortality than non-reoperated. To reduce the rate of reoperations and mortality due to postoperative bleeding, we aim to identify risk factors that predict reoperation. A total of 1452 consecutive patients undergoing cardiac surgery using extracorporeal circulation (ECC) between November 2005 and December 2008 at OUH were analysed. Statistical tests were used to identify risk factors for reoperation. We performed a case-note review on propensity-matched patients to assess the outcome of reoperation for bleeding regarding morbidity and mortality. In total, 101 patients (7.0%) underwent surgical re-exploration due to excessive postoperative bleeding. Significant risk factors for reoperation for bleeding after cardiac surgery was low ejection fraction, high EuroSCORE, procedures other than isolated CABG, elongated time on ECC, low body mass index, diabetes mellitus and preoperatively elevated s-creatinine. Reoperated patients significantly had a greater increase in postoperative s-creatinine and higher mortality. Surviving reoperated patients significantly had a lower EuroSCORE and a shorter time on ECC compared with non-survivors. The average time to re-exploration was 155 min longer for non-survivors when compared with survivors. PMID:22368106

  11. Radiography in cardiology [cardiac disorders, cardiac insufficiency

    International Nuclear Information System (INIS)

    The diagnostic procedure in cardiology nearly always requires an X-ray examination of the thorax. This examination is very informative when it is correctly performed and interpreted. The radiographs need to be read precisely and comprehensively: this includes the evaluation of the silhouette of the heart (size, form and position) as well as the examination of extra-cardiac thoracic structures allowing among other things to search for signs of cardiac insufficiency. The conclusion of the X-ray examination can be drawn after having brought together information concerning the case history, the clinical examination and the study of the radiographs. The radiologist finds himself in one of three situations: (1) the information provided by the X-ray pictures is characteristic of a disease and permits a diagnosis, (2) the X-ray pictures indicate a group of hypotheses; further complementary tests could be useful and (3) the X-ray pictures provide ambiguous even contradictory information; it is necessary to complete the radiological examination by other techniques such as an ultrasonographic study of the heart

  12. Out of the e-Box programme

    OpenAIRE

    Groenewald, M.E.; Groenewald, Hettie; De Waal, Martha; Steyn, Christelle

    2012-01-01

    Programme including speakers profiles of the 'Out of the e-Box' Symposium, as part of the e-Strategy Marketing & Training Event, held by the University of Pretoria Library Services, 19-20 September 2012.

  13. Keep Listeria Out of Your Kitchen

    Science.gov (United States)

    ... For Consumers Home For Consumers Consumer Updates Keep Listeria Out of Your Kitchen Share Tweet Linkedin Pin ... Updates by E-mail Consumer Updates RSS Feed Listeria Podcast Download PDF (236 K) En Español On ...

  14. A survey of attitudes and factors associated with successful cardiopulmonary resuscitation (CPR knowledge transfer in an older population most likely to witness cardiac arrest: design and methodology

    Directory of Open Access Journals (Sweden)

    Brehaut Jamie C

    2008-11-01

    Full Text Available Abstract Background Overall survival rates for out-of-hospital cardiac arrest rarely exceed 5%. While bystander cardiopulmonary resuscitation (CPR can increase survival for cardiac arrest victims by up to four times, bystander CPR rates remain low in Canada (15%. Most cardiac arrest victims are men in their sixties, they usually collapse in their own home (85% and the event is witnessed 50% of the time. These statistics would appear to support a strategy of targeted CPR training for an older population that is most likely to witness a cardiac arrest event. However, interest in CPR training appears to decrease with advancing age. Behaviour surrounding CPR training and performance has never been studied using well validated behavioural theories. Methods/Design The overall goal of this study is to conduct a survey to better understand the behavioural factors influencing CPR training and performance in men and women 55 years of age and older. The study will proceed in three phases. In phase one, semi-structured qualitative interviews will be conducted and recorded to identify common categories and themes regarding seeking CPR training and providing CPR to a cardiac arrest victim. The themes identified in the first phase will be used in phase two to develop, pilot-test, and refine a survey instrument based upon the Theory of Planned Behaviour. In the third phase of the project, the final survey will be administered to a sample of the study population over the telephone. Analyses will include measures of sampling bias, reliability of the measures, construct validity, as well as multiple regression analyses to identify constructs and beliefs most salient to seniors' decisions about whether to attend CPR classes or perform CPR on a cardiac arrest victim. Discussion The results of this survey will provide valuable insight into factors influencing the interest in CPR training and performance among a targeted group of individuals most susceptible to witnessing a victim in cardiac arrest. The findings can then be applied to the design of trials of various interventions designed to promote attendance at CPR classes and improve CPR performance. Trial registration ClinicalTrials.gov NCT00665288

  15. Cardiac Physiology of Pregnancy.

    Science.gov (United States)

    May, Linda

    2015-07-01

    Although the physiology of the heart and vascular system has not changed, there are many things we have learned and are still learning today. Research related to heart adaptations during pregnancy has been performed since the 1930s. Since the mid-1950s, researchers began to look at changes in the maternal cardiovascular system during exercise while pregnant. Research related to exercise during pregnancy and offspring heart development began and has continued since the 1970s. We will review the normal female cardiovascular system adaptations to pregnancy in general. Additionally, topics related to maternal cardiac adaptations to pregnancy during acute exercise, as well as the chronic conditioning response from exercise training will be explored. Since physical activity during pregnancy influences fetal development, the fetal cardiac development will be discussed in regards to acute and chronic maternal exercise. Similarly, the influence of various types of maternal exercise on acute and chronic fetal heart responses will be described. Briefly, the topics related to how and if there is maternal-fetal synchrony will be explained. Lastly, the developmental changes of the fetal cardiovascular system that persist after birth will be explored. Overall, the article will discuss maternal cardiac physiology related to changes with normal pregnancy, and exercise during pregnancy, as well as fetal cardiac physiology related to changes with normal development, and exercise during pregnancy as well as developmental changes in offspring after birth. PMID:26140720

  16. Nonexercise cardiac stress testing

    International Nuclear Information System (INIS)

    Many patients who require evaluation for coronary artery disease are unable to undergo exercise stress testing because of physiologic or psychological limitations. Drs Vacek and Baldwin describe three alternative methods for assessment of cardiac function in these patients, all of which have high levels of diagnostic sensitivity and specificity. 23 references

  17. Trauma cardíaco: estudo de necropsias Cardiac trauma: autopsy findings

    Directory of Open Access Journals (Sweden)

    Gustavo Pereira Fraga

    2004-12-01

    Full Text Available RESUMO OBJETIVO: Pacientes vítimas de trauma cardíaco morrem, na maioria das vezes, antes de receberem atendimento médico. Porém, são poucos os estudos epidemiológicos deste tipo de lesão descrevendo a porcentagem de pacientes que chegam a ser tratados. O objetivo do presente trabalho é avaliar as características das vítimas de trauma cardíaco através da interpretação de laudos de necropsia. MÉTODO: Foram revisados 1.976 casos de óbito por causas externas submetidos a necropsia no Instituto Médico Legal de Campinas, num período de dois anos. Os casos foram divididos em dois grupos: I, trauma penetrante; e II, trauma fechado. RESULTADOS: Houve predomínio dos traumas penetrantes (1.294 casos - 65,5%. Trauma cardíaco foi identificado em 359 laudos (18,2%, sendo 296 do grupo I e 63 do grupo II. No grupo I, 73,6% dos óbitos ocorreram no local do trauma e apenas 18 pacientes (6% foram atendidos em hospital e submetidos a toracotomia. No grupo II o tratamento cirúrgico foi indicado em dois dos 14 traumatizados (3,2% dos traumas fechados admitidos com presença de sinais vitais. A câmara cardíaca mais acometida no grupo I foi o ventrículo esquerdo (lesão isolada em 24,6% dos casos e no grupo II o ventrículo direito (25%. CONCLUSÕES: Conclui-se que as lesões cardíacas são eminentemente fatais e apenas 5,6% destes traumatizados que morreram chegaram a receber tratamento efetivo.ABSTRACT BACKGROUND: The vast majority of cardiac trauma victims die before receiving medical care. However, epidemiological studies are few about this injury, describing the patients whom treatment is provided. The objective of this study is to evaluate cardiac injuries victims' profile through the autopsy findings. METHODS: We have reviewed 1.976 external causes death cases, which were autopsied in the Campinas Medical Legal Institute, over a two-year period. The cases were assigned for two groups: I, penetrating trauma, and II, blunt trauma. RESULTS: Penetrating trauma was predominant (1.294 cases - 65.5%. Heart trauma was identified in 359 cases (18.2%, out of 296 in Group I and 63 in Group II. In Group I, 73.6% of the victims died at the scene and only 18 patients (6% were admitted at hospital and submitted to thoracotomy. In Group II, surgical care was offered for two out of 14 patients (3.2% of blunt trauma who were admitted with vital signs. The most affected heart chamber in Group I was the left ventricle (isolated injury in 24.6% and in Group II the was the right ventricle (25%. CONCLUSION: We conclude that heart injuries are eminently fatal and only 5.6% of this victims who died received effective medical care.

  18. Comparison of Benefits from Cardiac Resynchronization Therapy between Patients with Ischemic Cardiomyopathy and Patients with Idiopathic Dilated Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Talia Alenabi

    2009-06-01

    Full Text Available Background: Cardiac resynchronization therapy (CRT is an effective treatment for patients with moderate to severe heart failure. However, 20-30% of patients remain non-responders to CRT. We sought to identify which patients benefit the most from CRT in regard to the etiology of heart failure. Methods: Eighty-three consecutive patients (62 men who had a biventricular pacemaker inserted at Tehran Heart Center between May 2004 and March 2007 were evaluated retrospectively. The inclusion criteria were comprised of New York Heart Association (NYHA class III or IV, left ventricular ejection fraction120ms. After 6 months, response was defined as being alive, no hospitalization for cardiac decompensation, and an improvement in NYHA class>1 grade. Results: After 6 months, 60 patients out of the 83 patients were responders. Amongst the 83 patients, 48 had ischemic cardiomyopathy and 35 had non-ischemic cardiomyopathy. A cross-tabulation of response versus etiology showed no significant difference between ischemic versus non-ischemic cardiomyopathy with regard to response to CRT (P=0.322. Conclusion: According to our study, there was no difference in response to CRT between ischemic versus non-ischemic cardiomyopathy at six months’ follow-up.

  19. Myocardial imaging and radionuclide angiography in survivors of sudden cardiac death due to ventricular fibrillation: preliminary report

    International Nuclear Information System (INIS)

    Twenty-one long-term survivors of out of hospital sudden cardiac death due to ventricular fibrillation underwent radionuclide angiography and myocardial imaging with thallium-201. In 13 patients images were obtained at rest and after maximal treadmill exercise; 11 of these 13 (85 percent) had an image defect in one or both studies. Eleven of the 21 patients (52 percent) had a defect in the image obtained at rest. The magnitude of myocardial image defects was typically great; some patients had an image abnormality without other clinical evidencee (angina, S-T depression) of ischemia. The mean ejection fraction, assessed in 16 patients with radionuclide angiography, was 0.41 +- 0.15 (standard deviation); in 5 of the 16 ejection fraction was normal (more than 0.50) and in 3 it was severely abnormal (less than 0.25). Thus, noninvasive radionuclide studies defined a broad spectrum of ischemic and ventriculographic abnormalities in survivors of sudden cardiac death. Further application of these noninvasive studies may identify those at high risk

  20. Moore's law, Dabbawalas, and pediatric cardiac care in Sri Lanka.

    Science.gov (United States)

    Samarasinghe, Duminda

    2015-01-01

    Sri Lanka is an island nation in Indian Ocean that provides free healthcare to all citizens through government healthcare system. It has commendable health indices in the region. Pediatric cardiac services have rapidly progressed over past few years helping to further bring down infant and under-five mortality rates. Lady Ridgeway Hospital for Children (LRH) is the only tertiary care referral center for children with heart disease in the country. Currently it performs approximately 1,000 cardiac catheterizations and 1,000 cardiac surgeries every year. Target is to double the surgical output to treat all children with heart diseases in a timely and appropriate manner. Being a middle-income country, this is not an easy task. Technology used in diagnosis and treatment of congenital heart diseases is rapidly advancing with its price tag. In such a setting, it is challenging to proceed to achieve this target in a resource-limited environment. PMID:26085764

  1. Hydrogels for Cardiac Tissue Engineering

    Directory of Open Access Journals (Sweden)

    Jianjun Guan

    2011-04-01

    Full Text Available Cardiac tissue regeneration is an integrated process involving both cells and supporting matrix. Cardiomyocytes and stem cells are utilized to regenerate cardiac tissue. Hydrogels, because of their tissue-like properties, have been used as supporting matrices to deliver cells into infarcted cardiac muscle. Bioactive and biocompatible hydrogels mimicking biochemical and biomechanical microenvironments in native tissue are needed for successful cardiac tissue regeneration. These hydrogels not only retain cells in the infarcted area, but also provide support for restoring myocardial wall stress and cell survival and functioning. Many hydrogels, including natural polymer hydrogels, synthetic polymer hydrogels, and natural/synthetic hybrid hydrogels are employed for cardiac tissue engineering. In this review, types of hydrogels used for cardiac tissue engineering are briefly introduced. Their advantages and disadvantages are discussed. Furthermore, strategies for cardiac regeneration using hydrogels are reviewed.

  2. Virtual reality in a children's hospital.

    Science.gov (United States)

    Nihei, K; Shirakawa, K; Isshiki, N; Hirose, M; Iwata, H; Kobayashi, N

    1999-01-01

    We used virtual reality technology to improve the quality of life and amenity of in-patients in a children's hospital. Children in the hospital could enjoy a zoo, amusement park, and aquarium, in virtual. They played soccer, skiing and horse riding in virtual. They could communicate with persons who were out of the hospital and attend the school which they had gone to before entering hospital. They played music with children who had been admitted to other children's hospitals. By using this virtual technology, the quality of life of children who suffered from psychological and physiological stress in the hospital greatly improved. It is not only useful for their QOL but also for the healing of illness. However, these methods are very rare. Our systemic in our children's hospital is the first to be reported in Japan both software and hardware of virtual reality technology to increase the QOL of sick children need further development. PMID:10770078

  3. Cardiac amyloidosis detection with pyrophosphate-99mTc scintigraphy

    International Nuclear Information System (INIS)

    Full text: Introduction: Amyloidosis is a rare disease, characterized by extracellular deposition of insoluble amyloid fibrils in organs and tissues. It may affect virtually any system, preferably heart, kidneys and liver. The cardiac involvement produces a spectrum of clinical features, usually with progressive dysfunction. Early diagnosis is important for institution of appropriate therapy. Case report: Male patient, 75 years old, with diagnosed congestive heart failure functional class III and Mobitz II second-degree atrial-ventricular block, was hospitalized for implantation of definitive cardiac pacemaker. Patient mentioned history of worsening effort dyspnoea over a one-month period, progressing to minimum effort, orthopnea, paroxysmal nocturnal dyspnoea and paroxysms of dry cough, and swelling of lower limbs. Echocardiography showed diffuse hypertrophy of left ventricle (LV), with systolic dysfunction due to diffuse hypokinesia and hyperrefringent aspect in the septum. It was questioned a cardiac infiltrating process. Cardiac amyloidosis was considered as a diagnostic hypothesis. The patient underwent a pyrophosphate-99mTc scintigraphy, which showed abnormal tracer uptake in the heart projection, with diffuse pattern on the left ventricle walls, compatible with the clinical suspicion cardiac amyloidosis, which was later confirmed by endomyocardial biopsy. Discussion: In this case report, the patient had clinical and other auxiliary examinations, such as electrocardiography and Doppler echocardiography, compatible with cardiac amyloidosis, which led to implementation with pyrophosphate-99mTc scintigraphy and later endomyocardial biopsy. Cardiac amyloidosis occurs in about half the cases of primary amyloidosis (AL) and is rare in secondary amyloidosis (AA). Its clinical presentation is polymorphic and it can be classified into four distinctive types: restrictive cardiomyopathy, systolic dysfunction, postural hypotension and conduction disorders. Cardiac amyloidosis is often under diagnosed due to unspecific and varied signs and symptoms. The diagnosis is confirmed by endomyocardial biopsy, an invasive procedure with inherent risks to this technique. Pyrophosphate-99mTc scintigraphy is a simple, non-invasive, low cost, with good sensitivity method for detection of cardiac amyloidosis. The scintigraphy pattern observed in cardiac amyloidosis cases is abnormal diffuse tracer uptake in both heart ventricles. Planar and/or tomographic imaging may be performed. It is considered a highly sensitive test, with low rates of false-negative results despite the existing little literature. Therefore the scintigraphy can be useful to select patients for biopsy. Conclusion: Scintigraphy can be of great assistance in cardiac amyloidosis, despite its low specificity. Due to its high sensibility, it can be a useful test to early discriminate patients who should undergo biopsy, allowing treatment optimization.

  4. Cardiac amyloidosis detection with pyrophosphate-99mTc scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Souza, D.S.F.; Ichiki, W.A.; Coura Filho, G.B.; Izaki, M.; Giorgi, M.C.P.; Soares Junior, J; Meneghetti, J.C. [Universidade de Sao Paulo (FM/USP), SP (Brazil). Fac. de Medicina. Instituto do Coracao. Servico de Medicina Nuclear e Imagem Molecular

    2008-07-01

    Full text: Introduction: Amyloidosis is a rare disease, characterized by extracellular deposition of insoluble amyloid fibrils in organs and tissues. It may affect virtually any system, preferably heart, kidneys and liver. The cardiac involvement produces a spectrum of clinical features, usually with progressive dysfunction. Early diagnosis is important for institution of appropriate therapy. Case report: Male patient, 75 years old, with diagnosed congestive heart failure functional class III and Mobitz II second-degree atrial-ventricular block, was hospitalized for implantation of definitive cardiac pacemaker. Patient mentioned history of worsening effort dyspnoea over a one-month period, progressing to minimum effort, orthopnea, paroxysmal nocturnal dyspnoea and paroxysms of dry cough, and swelling of lower limbs. Echocardiography showed diffuse hypertrophy of left ventricle (LV), with systolic dysfunction due to diffuse hypokinesia and hyperrefringent aspect in the septum. It was questioned a cardiac infiltrating process. Cardiac amyloidosis was considered as a diagnostic hypothesis. The patient underwent a pyrophosphate-{sup 99m}Tc scintigraphy, which showed abnormal tracer uptake in the heart projection, with diffuse pattern on the left ventricle walls, compatible with the clinical suspicion cardiac amyloidosis, which was later confirmed by endomyocardial biopsy. Discussion: In this case report, the patient had clinical and other auxiliary examinations, such as electrocardiography and Doppler echocardiography, compatible with cardiac amyloidosis, which led to implementation with pyrophosphate-{sup 99m}Tc scintigraphy and later endomyocardial biopsy. Cardiac amyloidosis occurs in about half the cases of primary amyloidosis (AL) and is rare in secondary amyloidosis (AA). Its clinical presentation is polymorphic and it can be classified into four distinctive types: restrictive cardiomyopathy, systolic dysfunction, postural hypotension and conduction disorders. Cardiac amyloidosis is often under diagnosed due to unspecific and varied signs and symptoms. The diagnosis is confirmed by endomyocardial biopsy, an invasive procedure with inherent risks to this technique. Pyrophosphate-{sup 99m}Tc scintigraphy is a simple, non-invasive, low cost, with good sensitivity method for detection of cardiac amyloidosis. The scintigraphy pattern observed in cardiac amyloidosis cases is abnormal diffuse tracer uptake in both heart ventricles. Planar and/or tomographic imaging may be performed. It is considered a highly sensitive test, with low rates of false-negative results despite the existing little literature. Therefore the scintigraphy can be useful to select patients for biopsy. Conclusion: Scintigraphy can be of great assistance in cardiac amyloidosis, despite its low specificity. Due to its high sensibility, it can be a useful test to early discriminate patients who should undergo biopsy, allowing treatment optimization. (author)

  5. Cardiac fusion and complex congenital cardiac defects in thoracopagus twins: diagnostic value of cardiac CT

    International Nuclear Information System (INIS)

    Most thoracopagus twins present with cardiac fusion and associated congenital cardiac defects, and assessment of this anatomy is of critical importance in determining patient care and outcome. Cardiac CT with electrocardiographic triggering provides an accurate and quick morphological assessment of both intracardiac and extracardiac structures in newborns, making it the best imaging modality to assess thoracopagus twins during the neonatal period. In this case report, we highlight the diagnostic value of cardiac CT in thoracopagus twins with an interatrial channel and complex congenital cardiac defects. (orig.)

  6. Cardiac fusion and complex congenital cardiac defects in thoracopagus twins: diagnostic value of cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of); Park, Jeong-Jun [University of Ulsan College of Medicine, Asan Medical Center, Department of Pediatric Cardiac Surgery, Seoul (Korea, Republic of); Kim, Ellen Ai-Rhan [University of Ulsan College of Medicine, Asan Medical Center, Division of Neonatology, Department of Pediatrics, Seoul (Korea, Republic of); Won, Hye-Sung [University of Ulsan College of Medicine, Asan Medical Center, Department of Obstetrics and Gynecology, Seoul (Korea, Republic of)

    2014-09-15

    Most thoracopagus twins present with cardiac fusion and associated congenital cardiac defects, and assessment of this anatomy is of critical importance in determining patient care and outcome. Cardiac CT with electrocardiographic triggering provides an accurate and quick morphological assessment of both intracardiac and extracardiac structures in newborns, making it the best imaging modality to assess thoracopagus twins during the neonatal period. In this case report, we highlight the diagnostic value of cardiac CT in thoracopagus twins with an interatrial channel and complex congenital cardiac defects. (orig.)

  7. The therapeutic use of music as experienced by cardiac surgery patients of an intensive care unit

    OpenAIRE

    Varshika M. Bhana; Annali D.H. Botha

    2014-01-01

    Patients perceive the intensive care unit (ICU) as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expo...

  8. Acute Kidney Injury and Long-term Risk of Cardiovascular Events After Cardiac Surgery

    DEFF Research Database (Denmark)

    Hansen, Malene Kærslund; Gammelager, Henrik; Jacobsen, Carl-Johan; Hjortdal, Vibeke Elisabeth; Layton, J Bradley; Rasmussen, Bodil Steen; Andreasen, Jan Jesper; Johnsen, Søren Paaske; Christiansen, Christian Fynbo

    2015-01-01

    OBJECTIVE: To examine the impact of postoperative acute kidney injury (AKI) on the long-term risk of myocardial infarction, heart failure, stroke, and all-cause mortality after elective cardiac surgery. The authors investigated whether time of onset of AKI altered the association between AKI and the adverse events. DESIGN: Population-based cohort study in 2006-2011. SETTING: Two university hospitals. PARTICIPANTS: Adult elective cardiac surgical patients. INTERVENTIONS: None. MEASUREMENTS AND MA...

  9. Longitudinal Changes of Cardiac Structure and Function in CKD (CASCADE Study)

    OpenAIRE

    Cai, Qi-Zhe; Lu, Xiu-Zhang; Lu, Ye; Wang, Angela Yee-Moon

    2014-01-01

    Little is known regarding the natural longitudinal changes in cardiac structure and function in CKD. We hypothesized that baseline CKD stage is associated with progressive worsening in cardiac structure and function. We conducted a prospective longitudinal study, recruiting 300 patients with stages 3–5 CKD from a major regional tertiary center and university teaching hospital in Hong Kong. Baseline CKD stages were studied in relation to natural longitudinal changes in echocardiographic and ti...

  10. Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database

    DEFF Research Database (Denmark)

    Andersen, Peter Oluf; Maaløe, Rikke; Andersen, Henning Boje

    2010-01-01

    Background Critical incident reports can identify areas for improvement in resuscitation practice. The Danish Patient Safety Database is a mandatory reporting system and receives critical incident reports submitted by hospital personnel. The aim of this study is to identify, analyse and categorize critical incidents related to cardiac arrests reported to the Danish Patient Safety Database. Methods The search terms “cardiac arrest” and “resuscitation” were used to identify reports in the Danish P...

  11. Angiotensin converting enzyme inhibitors and magnesium conservation in patients with congestive cardiac failure.

    OpenAIRE

    Stevenson, R N; Keywood, C; Amadi, A A; Davies, J. R.; Patterson, D L

    1991-01-01

    OBJECTIVE--To investigate whether angiotensin converting enzyme inhibitors reduce diuretic induced magnesium excretion in patients in congestive cardiac failure. DESIGN--Cohort analytic study. SETTING--A London district general hospital. SUBJECTS--Thirty four patients with chronic congestive cardiac failure caused by ischaemic heart disease or cardiomyopathy selected consecutively from inpatients under the care of two consultant cardiologists. Nineteen patients (group 1) on diuretics alone we...

  12. Psychometric properties of the cardiac depression scale in patients with coronary heart disease

    OpenAIRE

    Kiropoulos Litza A; Meredith Ian; Tonkin Andrew; Clarke David; Antonis Paul; Plunkett Julie

    2012-01-01

    Abstract Background This study examined the psychometric properties of the Cardiac Depression Scale (CDS) in a sample of coronary heart disease (CHD) patients. Methods A total of 152 patients were diagnosed with coronary heart disease and were administered the CDS along with the Beck Depression Inventory- 2 (BDI-2) and the State Trait Anxiety Inventory (STAI) 3.5-months after cardiac hospitalization. Results The CDS’s factorial composition in the current sample was similar to that observed in...

  13. Physical conditioning and mental stress reduction - a randomised trial in patients undergoing cardiac surgery

    OpenAIRE

    van der Merwe Juliana; Bailey Michael; Shepherd Judy; Bradley Scott; Spitzer Ondine; Braun Lesley; Rosenfeldt Franklin; Leong Jee; Esmore Donald

    2011-01-01

    Abstract Background Preoperative anxiety and physical unfitness have been shown to have adverse effects on recovery from cardiac surgery. This study involving cardiac surgery patients was primarily aimed at assessing the feasibility of delivering physical conditioning and stress reduction programs within the public hospital setting. Secondary aims were to evaluate the effect of these programs on quality of life (QOL), rates of postoperative atrial fibrillation (AF) and length of stay (LOS) in...

  14. Acute Kidney Injury after Using Contrast during Cardiac Catheterization in Children with Heart Disease

    OpenAIRE

    Hwang, Young Ju; Hyun, Myung Chul; Choi, Bong Seok; Chun, So Young; Cho, Min Hyun

    2014-01-01

    Acute kidney injury (AKI) is closely associated with the mortality of hospitalized patients and long-term development of chronic kidney disease, especially in children. The purpose of our study was to assess the evidence of contrast-induced AKI after cardiac catheterization in children with heart disease and evaluate the clinical usefulness of candidate biomarkers in AKI. A total of 26 children undergoing cardiac catheterization due to various heart diseases were selected and urine and blood ...

  15. Pattern of sudden death at Ladoke Akintola University of Technology Teaching Hospital, Osogbo, South West Nigeria

    Directory of Open Access Journals (Sweden)

    Akinwusi PO

    2013-06-01

    Full Text Available Patience Olayinka Akinwusi,1,2 Akinwumi Oluwole Komolafe,3 Olanrewaju Olayinka Olayemi,2 Adeleye Abiodun Adeomi41Department of Medicine, College of Health Sciences, Osun State University, 2Department of Medicine, LAUTECH Teaching Hospital, Osogbo, 3Department of Morbid Anatomy, Obafemi Awolowo University Teaching, Hospitals Complex, Ile-Ife, Osun State, 4Department of Community Medicine, LAUTECH Teaching Hospital, Ogbomoso, Oyo State, NigeriaBackground: The purpose of this study was to determine the etiology and epidemiologic characteristics of sudden death at Ladoke Akintola University of Technology (LAUTECH Teaching Hospital, South West Nigeria.Methods: This was a retrospective descriptive study of all cases of natural unexpected death, either occurring out of hospital or less than 24 hours after admission to LAUTECH Teaching Hospital, over a nine-year period from January 2003 to December 2011. Data were generated from information in the case notes and autopsy reports for these cases.Results: Sudden death accounted for 29 (4.0% of 718 adult medical deaths and 1.0% of all adult medical admissions. Out-of-hospital deaths occurred in 72.4% of cases. The mean age of the patients was 46.8 ± 11.5 (range 25–74 years. The male to female ratio was 6.25:1. Cardiovascular disease were the most common cause of death (51.7%, followed by respiratory disease (20.7%, pulmonary thromboembolism (10.4%, central nervous system disease (13.8%, gastrointestinal disorders (13.8%, severe chemical/drug poisoning (13.8%, and combined cardiovascular and central nervous system disease (13.8%. Hypertension-related causes were responsible for 14/29 (48.3% of the sudden deaths. Hypertensive heart disease accounted for 86.7% of the cardiovascular deaths, hypertensive heart failure accounted for 73.3%, whilst all heart failure cases accounted for 80.0%. Left ventricular hypertrophy was present in 69.2% of the patients with hypertensive heart disease. Moderate to severe atheromatous changes occurred in the aorta in 38.5% of patients aged ?50 years. No case of myocardial infarction was found.Conclusion: Hypertensive heart disease and hypertension-related disorders are the most common causes of sudden death in South West Nigeria, so effective public health strategies should be channeled towards prevention, detection, and treatment of hypertension.Keywords: sudden cardiac death, hypertensive heart disease, hypertensive heart failure, left ventricular hypertrophy, atheromatous changes

  16. Do out-of-hours co-operatives improve general practitioners' health?

    OpenAIRE

    Fletcher, J.; Pickard, D.; De Rose, J; Stewart-Brown, S.; Wilkinson, E.; Brogan, C.; Lawrence, D.

    2000-01-01

    General practitioners (GPs) have been found to have a higher level of anxiety and depression then hospital managers and consultants. In 1995 and 1998, we surveyed GPs in Buckinghamshire. We found that the development of out-of-hours co-operatives was an important factor in the improvement in GPs' health status.

  17. Cardiac Implantable Electronic Device Infection: From an Infection Prevention Perspective

    Science.gov (United States)

    Sastry, Sangeeta; Rahman, Riaz; Yassin, Mohamed H.

    2015-01-01

    A cardiac implantable electronic device (CIED) is indicated for patients with severely reduced ejection fraction or with life-threatening cardiac arrhythmias. Infection related to a CIED is one of the most feared complications of this life-saving device. The rate of CIED infection has been estimated to be between 2 and 25; though evidence shows that this rate continues to rise with increasing expenditure to the patient as well as healthcare systems. Multiple risk factors have been attributed to the increased rates of CIED infection and host comorbidities as well as procedure related risks. Infection prevention efforts are being developed as defined bundles in numerous hospitals around the country given the increased morbidity and mortality from CIED related infections. This paper aims at reviewing the various infection prevention measures employed at hospitals and also highlights the areas that have relatively less established evidence for efficacy.

  18. Increased survival after EMS witnessed cardiac arrest. Observations from the Resuscitation Outcomes Consortium (ROC) Epistry - Cardiac Arrest

    Science.gov (United States)

    Hostler, David; Thomas, Elizabeth G; Emerson, Scott S; Christenson, James; Stiell, Ian G; Rittenberger, Jon C; Gorman, Kyle R; Bigham, Blair L; Callaway, Clifton W; Vilke, Gary M; Beaudoin, Tammy; Cheskes, Sheldon; Craig, Alan; Davis, Daniel P; Reed, Andrew; Idris, Ahamed; Nichol, Graham

    2010-01-01

    Summary Background Out of hospital cardiac arrest (OHCA) is common and lethal. It has been suggested that OHCA witnessed by EMS providers is a predictor of survival because advanced help is immediately available. We examined EMS witnessed OHCA from the Resuscitation Outcomes Consortium (ROC) to determine the effect of EMS witnessed vs. bystander witnessed and unwitnessed OHCA. Methods Data were analyzed from a prospective, population-based cohort study in 10 U.S. and Canadian ROC sites. Individuals with non-traumatic OHCA treated 04/01/06 – 03/31/07 by EMS providers with defibrillation or chest compressions were included. Cases were grouped into EMS-witnessed, bystander witnessed, and unwitnessed and further stratified for bystander CPR. Multiple logistic regressions evaluated the odds ratio (OR) for survival to discharge relative to the EMS-witnessed group after adjusting for age, sex, public/private location of collapse, ROC site, and initial ECG rhythm. Of 9,991 OHCA, 1022 (10.2%) of EMS-witnessed, 3,369 (33.7%) bystander witnessed, and 5,600 (56.1%) unwitnessed. Results The most common initial rhythm in the EMS-witnessed group was PEA which was higher than in the bystander- and unwitnessed groups (p<0.001). The adjusted OR (95% CI) of survival compared to the EMS-witnessed group was 0.41, (0.36, 0.46) in bystander witnessed with bystander CPR, 0.37, (0.33, 0.43) in bystander witnessed without bystander CPR, 0.17 (0.14, 0.20) in unwitnessed with bystander CPR and 0.21 (0.18, 0.24) in unwitnessed cases without bystander CPR. Conclusions Immediate application of prehospital care for OHCA may improve survival. Efforts should be made to educate patients to access 9-1-1 for prodromal symptoms. PMID:20403656

  19. Spatiotemporal representation of cardiac vectorcardiogram (VCG signals

    Directory of Open Access Journals (Sweden)

    Yang Hui

    2012-03-01

    Full Text Available Abstract Background Vectorcardiogram (VCG signals monitor both spatial and temporal cardiac electrical activities along three orthogonal planes of the body. However, the absence of spatiotemporal resolution in conventional VCG representations is a major impediment for medical interpretation and clinical usage of VCG. This is especially so because time-domain features of 12-lead ECG, instead of both spatial and temporal characteristics of VCG, are widely used for the automatic assessment of cardiac pathological patterns. Materials and methods We present a novel representation approach that captures critical spatiotemporal heart dynamics by displaying the real time motion of VCG cardiac vectors in a 3D space. Such a dynamic display can also be realized with only one lead ECG signal (e.g., ambulatory ECG through an alternative lag-reconstructed ECG representation from nonlinear dynamics principles. Furthermore, the trajectories are color coded with additional dynamical properties of space-time VCG signals, e.g., the curvature, speed, octant and phase angles to enhance the information visibility. Results In this investigation, spatiotemporal VCG signal representation is used to characterize various spatiotemporal pathological patterns for healthy control (HC, myocardial infarction (MI, atrial fibrillation (AF and bundle branch block (BBB. The proposed color coding scheme revealed that the spatial locations of the peak of T waves are in the Octant 6 for the majority (i.e., 74 out of 80 of healthy recordings in the PhysioNet PTB database. In contrast, the peak of T waves from 31.79% (117/368 of MI subjects are found to remain in Octant 6 and the rest (68.21% spread over all other octants. The spatiotemporal VCG signal representation is shown to capture the same important heart characteristics as the 12-lead ECG plots and more. Conclusions Spatiotemporal VCG signal representation is shown to facilitate the characterization of space-time cardiac pathological patterns and enhance the automatic assessment of cardiovascular diseases.

  20. Prehospital cardiac arrest in Leicestershire: targeting areas for improvement.

    OpenAIRE

    Hassan, T B; Hickey, F G; Goodacre, S; Bodiwala, G G

    1996-01-01

    OBJECTIVE: To identify the impact of advanced life support skills on outcome for prehospital cardiac arrest in a defined population and to assess the value of certain physiological variables in predicting the outcome in those successfully resuscitated in the accident and emergency (A&E) department; to identify areas for improvement in the outcome of such patients. DESIGN: Prospective 12 month study. SETTING: Leicestershire, United Kingdom. MAIN OUTCOME MEASURE: Survival to hospital discharge ...

  1. Reality TV positions heart center as cardiac care leader.

    Science.gov (United States)

    Rees, T

    2001-01-01

    Saint Thomas Heart Institute, Nashville, Tenn., has a long history of successful cardiac care. More than 200,000 patients have been treated at Saint Thomas. Earlier this year the hospital launched a new branding campaign that features former patients who have bonded with the institution. These former patients were provided MiniDV video cameras to record their stories. The campaign has attracted considerable attention, including newspaper and TV news coverage. PMID:11374127

  2. Electrolyte disturbances and cardiac failure with hypomagnesaemia in anorexia nervosa.

    OpenAIRE

    Fonseca, V.; Havard, C. W.

    1985-01-01

    A 32 year old woman with anorexia nervosa was admitted to hospital with severe hypocalcaemia and hypokalaemia that was refractory to replacement treatment but that responded immediately to an infusion of magnesium. She also had congestive cardiac failure that responded to magnesium replacement. The mild hypomagnesaemia found in this patient was responsible for the refractory hypocalcaemia. Minor deficiencies of magnesium may cause severe hypocalcaemia and hypokalaemia that are refractory to r...

  3. Moore's law, Dabbawalas, and pediatric cardiac care in Sri Lanka

    OpenAIRE

    Samarasinghe, Duminda

    2015-01-01

    Sri Lanka is an island nation in Indian Ocean that provides free healthcare to all citizens through government healthcare system. It has commendable health indices in the region. Pediatric cardiac services have rapidly progressed over past few years helping to further bring down infant and under-five mortality rates. Lady Ridgeway Hospital for Children (LRH) is the only tertiary care referral center for children with heart disease in the country. Currently it performs approximately 1,000 card...

  4. Anxiety, Depression and Psychosocial Stress in Patients with Cardiac Events

    OpenAIRE

    Michael, Anne John; Krishnaswamy, Saroja; Muthusamy, Tamil Selvan; Yusuf, Khalid; Mohamed, Jamaludin

    2005-01-01

    Stress tends to worsen the prognosis of patients with coronary heart disease. The aim of the study is to determine the relationship between stress related psychosocial factors like anxiety, depression and life events and temporally cardiac events specified as acute myocardial infarction and unstable angina 65 subjects with confirmed myocardial infarction or unstable angina were interviewed using 2 sets of questionnaire, the Hospital Anxiety and Depression Scale (HADS) and Life Changes Stress ...

  5. Right-sided hepatic hernia of normal left lobe resembling cardiac tumor.

    Science.gov (United States)

    Ono, Hiroshi; Nagamine, Hiroki; Toyoda, Akifumi; Shimizu, Nobutaka; Katori, Tatsuo; Sugiyama, Masahiko

    2015-08-01

    A 3-year-old boy was referred for cardiac tumor diagnosed on transthoracic echocardiography (TTE) at another hospital. The tumor appeared to be in the right atrium and obstructed inferior vena cava flow. TTE, enhanced computed tomography (CT) and angiography were done to confirm diagnosis. Subsequently, cardiac tumor was ruled out and he was diagnosed with a very rare condition of hepatic hernia containing a normal left lobe. When cardiac tumor is suspected in the right atrium on the basis of TTE, enhanced CT or magnetic resonance imaging should be done for definitive diagnosis. PMID:25919892

  6. Menstrual bleeding after cardiac surgery

    DEFF Research Database (Denmark)

    Hjortdal, Vibeke Elisabeth; Larsen, Signe Holm

    2013-01-01

    OBJECTIVES: We investigated whether open-heart surgery with the use of extracorporeal circulation has an impact on menstrual bleeding. METHODS: The menstrual bleeding pattern was registered in fertile women undergoing open-heart surgery in 2010-12. Haematocrit and 24-h postoperative bleeding were compared with those of men undergoing cardiac surgery. RESULTS: Women (n = 22), with mean age of 36 (range 17-60) years, were operated on and hospitalized for 4-5 postoperative days. The mean preoperative haematocrit was 40% (range 32-60%), and mean haematocrit at discharge was 32% (range 26-37%). Mean postoperative bleeding in the first 24 h was 312 (range 50-1442) ml. They underwent surgery for atrial septal defect (n = 5), composite graft/David procedure (n = 4), pulmonary or aortic valve replacement (n = 6), myxoma (n = 2), mitral valvuloplasty (n = 2), ascending aortic aneurysm (n = 1), aortic coarctation (n = 1) and total cavopulmonary connection (n = 1). Unplanned menstrual bleeding (lasting 2-5 days) was detected in 13 (60%) patients. Of them, 4 were 1-7 days early, 4 were 8-14 days early, 3 were 1-7 days late and 2 had menstruation despite having had menstrual bleeding within the last 2 weeks. None had unusually large or long-lasting menstrual bleeding. Ten women took oral contraceptives, 8 of whom had unexpected menstrual bleeding during admission. Men (n = 22), with a mean age of 35 (range 17-54) years, had mean bleeding of 331 (range 160-796) ml postoperatively, which was not statistically significantly different from the women's. The mean preoperative haematocrit was 40% (range 29-49%) among men, while haematocrit at discharge was 32% (28-41), not significantly different from that seen in the female subgroup. CONCLUSIONS: Menstrual bleeding patterns are disturbed by open-heart surgery in the majority of fertile women. Nevertheless, the unexpected menstrual bleeding is neither particularly long-lasting nor of large quantity, and the postoperative surgical bleeding is unaffected. We recommend that information about menstrual cycle disturbances related to cardiac surgery be provided, but no special precautions be taken, when operating on women of fertile age.

  7. Clinicians ignore best practice guidelines: Prospective audit of cardiac injury marker ordering in patients with chest pain

    Scientific Electronic Library Online (English)

    U, Bellbhudder; J C, Stanfliet.

    2014-04-01

    Full Text Available BACKGROUND: Chest pain is a frequent presenting symptom and is a diagnostic challenge. Recent recommendations state that high-sensitivity cardiac troponin assays are the only biochemical test required in the diagnosis of acute coronary syndrome (ACS) and that other biomarkers such as myoglobin or cr [...] eatine kinase (CK)-MB isoform are not indicated. OBJECTIVE: To establish whether clinician ordering in the setting of suspected ACS was in keeping with recent recommendations. METHODS: A prospective audit was undertaken of all requests for cardiac troponin I (cTnI) and CK-MB received at a large tertiary hospital in Durban, South Africa, during a 20-day period in December 2012. RESULTS: A total of 193 cardiac marker requests were received: 12 (6.2%) requests were for cTnI alone; 8 (4.1%) were for CK-MB alone; and the remaining 173 (89.7%) were for both cTnI and CK-MB. Therefore, a total of 181 (93.8%) incorrect requests were received during this period. A total of 103 (53.4%) patients had values below the cut-off point of 40 ng/l for cTnI, i.e. ACS was ruled out. Of these, 15 had CK-MB values above the reference interval. A total of 12 (6.2%) patients had cTnI values >500 ng/l, i.e. ACS was ruled in; 33.3% of this group had normal CK-MB values. CONCLUSION: Ordering patterns in the setting of ACS did not reflect current recommendations and were wasteful and potentially dangerous.

  8. Participation in Cardiac Rehabilitation, Readmissions and Death After Acute Myocardial Infarction

    Science.gov (United States)

    Dunlay, Shannon M.; Pack, Quinn R.; Thomas, Randal J.; Killian, Jill M.; Roger, Véronique L.

    2014-01-01

    Background Participation in cardiac rehabilitation has been shown to decardiac rehabilitationease mortality following acute myocardial infarction, but its impact on readmissions requires examination. Methods We conducted a population-based surveillance study of residents discharged from the hospital following their first-ever myocardial infarction in Olmsted County, Minnesota from January 1, 1987 to September 30, 2010. Patients were followed up through December 31, 2010. Participation in cardiac rehabilitation following myocardial infarction was determined using billing data. We used a landmark analysis approach (cardiac rehabilitation participant vs. not determined by attendance in at least one session of cardiac rehabilitation at 90 days post-myocardial infarction discharge) to compare readmission and mortality risk between cardiac rehabilitation participants and non-participants accounting for propensity to participate using inverse probability treatment weighting. Results Of 2991 patients with incident MI, 1569 (52.5%) participated in cardiac rehabilitation following hospital discharge. The cardiac rehabilitation participation rate did not change during the study period, but increased in the elderly, and decreased in men and younger patients. After adjustment, Cardiac rehabilitation participants had lower all-cause readmission (HR 0.75, 95% CI 0.65-0.87, p<0.001), cardiovascular readmission (HR 0.80, 95% CI 0.65-0.99, p=0.037), non-cardiovascular readmission (HR 0.72, 95% CI 0.61-0.85, p<0.001), and mortality (HR 0.58, 95% CI 0.49-0.68, p<0.001) risk. Conclusions Cardiac rehabilitation participation is associated with a markedly reduced risk of readmission and death after incident myocardial infarction. Improving cardiac rehabilitation participation rates may have a large impact on post-myocardial infarction healthcare resource use and outcomes. PMID:24556195

  9. Scenes from Out-of-Balance Schooling

    Science.gov (United States)

    Berliner, David C.

    2008-01-01

    A recent incident prompted this author to think that the life of an educator is terribly out of balance, and to demand that they find another way of living. Beginning with a description of that incident, the author goes on to recount several painful scenarios involving educators, substituting his narratives with the visuals of an appropriate…

  10. UK pulls out of plans for ILC

    CERN Multimedia

    Durrani, Matin

    2007-01-01

    "A funding crisis at one of the UK's leading research councils has forced the country to pull out of plans for the International Linear Collider (ILC). The science and Technology Facilities Council (STFC) says in a report published today that it does not see "a practicable path towards the realization of this facility as currently conceived on a reasonable timescale". (1 page)

  11. Efficacy of a Rapid Response Team on Reducing the Incidence and Mortality of Unexpected Cardiac Arrests

    Science.gov (United States)

    Sabahi, Majid; Fanaei, Seyed Ahmad; Ziaee, Seyed Ali; Falsafi, Farokh Sadat

    2012-01-01

    Background Rapid Response Teams (RRTs) assess patients during early phases of deterioration to reduce patient morbidity and mortality. Objectives This study aimed to evaluate the ability of earlier medical intervention by a RRT prompted by clinical instability in patients to reduce the incidence of and mortality from unexpected cardiac arrest at our hospital. Patients and Methods A nonrandomized, population-based study before 2008 and after 2010 introduction of the Rapid Response Teams in a 300 bed private hospital. All patients were admitted to the hospital in 2008 (n = 25348) and 2010 (n = 28024). RRT (One doctor, one senior intensive care nurse and one staff nurse) attended to clinically unstable patients immediately with resuscitation drugs, fluid, and equipment. Response was activated by the bedside nurse or doctor according to predefined criteria. Main outcome measures were incidence and outcome of unexpected cardiac arrest. Results The incidence of unexpected cardiac arrest was 17 per 1000 hospital admissions (431 cases) in 2008 (before RRT intervention) and 12.45 per 1000 admissions (349 cases) in 2010 (after intervention), with mortality being 73.23% (274 patients) and 66.15% (231 patients) respectively. After adjustment for case mix the intervention was associated with a 19% reduction in the incidence of unexpected cardiac arrest (odds ratio 0.81, 95% confidence interval 0.65-0.98). Conclusions The RRT was able to detect preventable adverse events and reduce the mortality and incidence of unexpected cardiac arrests. PMID:24350104

  12. Cardiac tissue engineering and regeneration using cell-based therapy

    Directory of Open Access Journals (Sweden)

    Alrefai MT

    2015-05-01

    Full Text Available Mohammad T Alrefai,1–3 Divya Murali,4 Arghya Paul,4 Khalid M Ridwan,1,2 John M Connell,1,2 Dominique Shum-Tim1,2 1Division of Cardiac Surgery, 2Division of Surgical Research, McGill University Health Center, Montreal, QC, Canada; 3King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 4Department of Chemical and Petroleum Engineering, School of Engineering, University of Kansas, Lawrence, KS, USA Abstract: Stem cell therapy and tissue engineering represent a forefront of current research in the treatment of heart disease. With these technologies, advancements are being made into therapies for acute ischemic myocardial injury and chronic, otherwise nonreversible, myocardial failure. The current clinical management of cardiac ischemia deals with reestablishing perfusion to the heart but not dealing with the irreversible damage caused by the occlusion or stenosis of the supplying vessels. The applications of these new technologies are not yet fully established as part of the management of cardiac diseases but will become so in the near future. The discussion presented here reviews some of the pioneering works at this new frontier. Key results of allogeneic and autologous stem cell trials are presented, including the use of embryonic, bone marrow-derived, adipose-derived, and resident cardiac stem cells. Keywords: stem cells, cardiomyocytes, cardiac surgery, heart failure, myocardial ischemia, heart, scaffolds, organoids, cell sheet and tissue engineering

  13. Cardiac metastases of osteosarcoma

    International Nuclear Information System (INIS)

    Osteosarcoma is a malignancy whose various sites of metastasis greatly modify its ultimate prognosis. We report a case of simultaneous pulmonary and cardiac metastases in a 41-year-old male patient with osteosarcoma of the tibia, presenting after more then one year of completion of adjuvant therapy with progressive dyspnea and cyanosis. Diagnosis was made on computerized tomogram and echocardiogram. The metastatic mass entirely occupying the right ventricle and the pulmonary artery proved fatal. (author)

  14. Hepato-cardiac disorders

    OpenAIRE

    Fouad, Yasser Mahrous; Yehia, Reem

    2014-01-01

    Understanding the mutual relationship between the liver and the heart is important for both hepatologists and cardiologists. Hepato-cardiac diseases can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. Differential diagnoses of liver injury are extremely important in a cardiologist’s clinical practice calling for collaboration between cardiologists and hepatologists due to the many oth...

  15. Cardiac Tissue Engineering

    OpenAIRE

    MILICA RADISIC; GORDANA VUNJAK-NOVAKOVIC

    2009-01-01

    We hypothesized that clinically sized (1-5 mm thick),compact cardiac constructs containing physiologically high density of viable cells (~108 cells/cm3) can be engineered in vitro by using biomimetic culture systems capable of providing oxygen transport and electrical stimulation, designed to mimic those in native heart. This hypothesis was tested by culturing rat heart cells on polymer scaffolds, either with perfusion of culture medium (physiologic interstitial velocity, supplementation of p...

  16. Cardiac potassium channel subtypes

    DEFF Research Database (Denmark)

    Schmitt, Nicole; Grunnet, Morten; Olesen, Søren-Peter

    2014-01-01

    About 10 distinct potassium channels in the heart are involved in shaping the action potential. Some of the K(+) channels are primarily responsible for early repolarization, whereas others drive late repolarization and still others are open throughout the cardiac cycle. Three main K(+) channels drive the late repolarization of the ventricle with some redundancy, and in atria this repolarization reserve is supplemented by the fairly atrial-specific KV1.5, Kir3, KCa, and K2P channels. The role of ...

  17. Cardiac manifestations in brucellosis.

    OpenAIRE

    Lubani, M; Sharda, D; Helin, I

    1986-01-01

    Cardiac involvement in childhood brucellosis is rare and when present mimics findings usually noted in acute rheumatic fever with carditis. We report five children aged 6 to 11 years. Echocardiography showed mitral valve vegetations in one, functional mitral valve incompetence in two, and sluggish myocardial function in one. All the patients presented with fever, arthralgia, and malaise, four of them had leucopenia, and all five showed relative lymphocytosis. Blood cultures grew Brucella meli...

  18. Understand Your Risk for Cardiac Arrest

    Science.gov (United States)

    Understand Your Risk for Cardiac Arrest Updated:Dec 10,2014 Cardiac arrest may be caused by almost any known heart condition. Most cardiac arrests occur when ... content was last reviewed on 11/14/2014. Cardiac Arrest • Home • About Cardiac Arrest • Understand Your Risk for ...

  19. Predictors of low cardiac output in decompensated severe heart failure

    Directory of Open Access Journals (Sweden)

    Marcelo Eidi Ochiai

    2011-01-01

    Full Text Available OBJECTIVE: To identify predictors of low cardiac output and mortality in decompensated heart failure. INTRODUCTION: Introduction: Patients with decompensated heart failure have a high mortality rate, especially those patients with low cardiac output. However, this clinical presentation is uncommon, and its management is controversial. METHODS: We studied a cohort of 452 patients hospitalized with decompensated heart failure with an ejection fraction of 60 years, and 64.6% were men. Low cardiac output was present in 281 (63% patients on admission. Chagas disease was the cause of heart failure in 92 (20.4% patients who had higher B type natriuretic peptide levels (1,978.38 vs. 1,697.64 pg/mL; P = 0.015. Predictors of low cardiac output were Chagas disease (RR: 3.655, P<0.001, lower ejection fraction (RR: 2.414, P<0.001, hyponatremia (RR: 1.618, P = 0.036, and renal dysfunction (RR: 1.916, P = 0.007. Elderly patients were inversely associated with low cardiac output (RR: 0.436, P = 0.001. Predictors of mortality were Chagas disease (RR: 2.286, P<0.001, ischemic etiology (RR: 1.449, P = 0.035, and low cardiac output (RR: 1.419, P = 0.047. CONCLUSIONS: In severe decompensated heart failure, predictors of low cardiac output are Chagas disease, lower ejection fraction, hyponatremia, and renal dysfunction. Additionally, Chagas disease patients have higher B type natriuretic peptide levels and a worse prognosis independent of lower ejection fraction.

  20. Molecular nuclear cardiac imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dong Soo; Paeng, Jin Chul [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    2004-04-01

    Molecular nuclear cardiac imaging has included Tc-99m Annexin imaging to visualize myocardial apoptosis, but is now usually associated with gene therapy and cell-based therapy. Cardiac gene therapy was not successful so far but cardiac reporter gene imaging was made possible using HSV-TK (herpes simplex virus thymidine kinase) and F-18 FHBG (fluoro-hydroxymethylbutyl guanine) or I-124 FIAU (fluoro-deoxyiodo-arabino-furanosyluracil). Gene delivery was performed by needle injection with or without catheter guidance. TK expression did not last longer than 2 weeks in myocardium. Cell-based therapy of ischemic heart or failing heart looks promising, but biodistribution and differentiation of transplanted cells are not known. Reporter genes can be transfected to the stem/progenitor cells and cells containing these genes can be transplanted to the recipients using catheter-based purging or injection. Repeated imaging should be available and if promoter are varied to let express reporter transgenes, cellular (trans)differentiation can be studied. NIS (sodium iodide symporter) or D2R receptor genes are promising in this aspect.

  1. Cardiac emergencies in children.

    Science.gov (United States)

    Schamberger, M S

    1996-06-01

    Pediatric cardiac emergencies require very specific treatment in the emergency room setting. Considering the possibility of a cardiac problem as the cause for the presenting symptoms is the initial step in successful management. Many patients present with what is initially considered a primary pulmonary disorder such as pneumonia, asthma, or bronchiolitis. Airway stabilization and ventilatory support, if needed, remain the first steps in stabilizing the patient. Many neonates with acutely decompensating heart disease may require the patency of the ductus arteriosus for survival. Prostaglandin E given as continuous infusion is the treatment of choice. Congestive heart failure can present at any age. In older patients, it is often due to myocarditis and is characterized by low cardiac output. Supportive measures, fluid restriction, and inotropic support are the basic concepts for initial treatment. Supraventricular tachycardia is a frequent arrhythmia, especially in young children. If the patient is unstable, immediate intravenous administration of adenosine or synchronized cardioversion are the initial interventions. In stable patients, vagal maneuvers may be attempted to abort the arrhythmia. PMID:8793920

  2. Feocromocitoma cardíaco / Cardiac Pheochromocytoma

    Scientific Electronic Library Online (English)

    Gustavo L., Knop; Roberto A., Margaria; Aldo, Arévalo; Omar D., Bergés; José L., Galarza.

    2006-10-01

    Full Text Available Los feocromocitomas cardíacos primarios (FCP) son sumamente infrecuentes. Hasta el presente son menos de 50 los casos comunicados en el mundo. Presentamos el caso de un tumor intrapericárdico, que resultó ser un feocromocitoma primario, en una mujer de mediana edad, cuyo signo principal fue hiperten [...] sión arterial severa (HTAs). Los estudios diagnósticos por imágenes corroboraron la presencia de un tumor intrapericárdico como único hallazgo y los estudios bioquímicos de catecolaminas y sus metabolitos excretados por orina reafirmaron el diagnóstico etiológico. El tumor fue resecado quirúrgicamente sin complicaciones mediante cirugía cardíaca convencional con circulación extracorpórea (CEC) y paro cardíaco con cardioplejía. Siete meses después de la operación, la paciente se encuentra asintomática y normotensa. Abstract in english Primary cardiac pheochromocytomas (PCP) are extremely rare. To date, less than 50 cases have been reported worldwide. In this report we present the case of an intrapericardial tumor in a middle aged woman, that was finally diagnosed as a primary pheochromocytoma, of which the main sign was severe hy [...] pertension (sHTN). Diagnostic imaging studies confirmed the presence of an intrapericardial tumor as the only finding, and biochemical assessment of urinary catecholamines and their metabolites further confirmed the diagnosis. The tumor was surgically resected without complications, using conventional on-pump cardiac surgery with cardiac arrest and cardioplegia. At follow-up seven months post surgery, the patient remains asymptomatic and normotensive.

  3. Cardiac hybrid imaging

    Energy Technology Data Exchange (ETDEWEB)

    Gaemperli, Oliver [University Hospital Zurich, Cardiac Imaging, Zurich (Switzerland); University Hospital Zurich, Nuclear Cardiology, Cardiovascular Center, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich, Cardiac Imaging, Zurich (Switzerland); Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland)

    2014-05-15

    Hybrid cardiac single photon emission computed tomography (SPECT)/CT imaging allows combined assessment of anatomical and functional aspects of cardiac disease. In coronary artery disease (CAD), hybrid SPECT/CT imaging allows detection of coronary artery stenosis and myocardial perfusion abnormalities. The clinical value of hybrid imaging has been documented in several subsets of patients. In selected groups of patients, hybrid imaging improves the diagnostic accuracy to detect CAD compared to the single imaging techniques. Additionally, this approach facilitates functional interrogation of coronary stenoses and guidance with regard to revascularization procedures. Moreover, the anatomical information obtained from CT coronary angiography or coronary artery calcium scores (CACS) adds prognostic information over perfusion data from SPECT. The use of cardiac hybrid imaging has been favoured by the dissemination of dedicated hybrid systems and the release of dedicated image fusion software, which allow simple patient throughput for hybrid SPECT/CT studies. Further technological improvements such as more efficient detector technology to allow for low-radiation protocols, ultra-fast image acquisition and improved low-noise image reconstruction algorithms will be instrumental to further promote hybrid SPECT/CT in research and clinical practice. (orig.)

  4. Amiloidosis cardiaca / Cardiac amyloidosis

    Scientific Electronic Library Online (English)

    Mauricio, Duque; Jorge E, Velásquez; Jorge E, Marín; Julián M, Aristizábal; Vladimir, Astudillo; Jorge E, Marín; Luis E, Medina; Edgardo, González; Laura, Duque; William, Uribe.

    2009-06-01

    Full Text Available La amiloidosis cardiaca es una manifestación de un grupo de enfermedades sistémicas que en conjunto se conocen como amiloidosis. Se considera una causa importante de las enfermedades infiltrativas que pueden ser responsables tanto del compromiso cardiaco como de otros órganos. Dado el avance en el e [...] ntendimiento de la fisiopatología de la enfermedad, el reconocimiento de sus causas primarias y secundarias, y de las nuevas opciones terapéuticas, se describe un caso típico del compromiso cardiaco y posteriormente se hace una revisión del tema que abarca la mayoría de los tópicos que guardan relación con la amiloidosis primaria con compromiso cardiaco. Abstract in english Cardiac amyloidosis is a manifestation of a group of systemic diseases, known as amyloidosis. It is considered an important cause of infiltrative diseases that may be responsible for both the heart and other organs’ involvement. Given the progress in the understanding of the pathophysiology of the d [...] isease, the recognition of its primary and secondary causes and the new therapeutic options, a typical case of cardiac involvement is described and a review of the subject that covers the great majority of topics related to primary amyloidosis with cardiac involvement is made.

  5. Amiloidosis cardiaca Cardiac amyloidosis

    Directory of Open Access Journals (Sweden)

    Mauricio Duque

    2009-06-01

    Full Text Available La amiloidosis cardiaca es una manifestación de un grupo de enfermedades sistémicas que en conjunto se conocen como amiloidosis. Se considera una causa importante de las enfermedades infiltrativas que pueden ser responsables tanto del compromiso cardiaco como de otros órganos. Dado el avance en el entendimiento de la fisiopatología de la enfermedad, el reconocimiento de sus causas primarias y secundarias, y de las nuevas opciones terapéuticas, se describe un caso típico del compromiso cardiaco y posteriormente se hace una revisión del tema que abarca la mayoría de los tópicos que guardan relación con la amiloidosis primaria con compromiso cardiaco.Cardiac amyloidosis is a manifestation of a group of systemic diseases, known as amyloidosis. It is considered an important cause of infiltrative diseases that may be responsible for both the heart and other organs’ involvement. Given the progress in the understanding of the pathophysiology of the disease, the recognition of its primary and secondary causes and the new therapeutic options, a typical case of cardiac involvement is described and a review of the subject that covers the great majority of topics related to primary amyloidosis with cardiac involvement is made.

  6. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... patient. Now this requires and incredible amount of teamwork. Under the leadership of Mark in the lab ... eluding stents than many hospitals because of the skill of our cardiologists and the success of this ...

  7. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... hospital for cardiovascular disease compared to many other causes of illness. And if you look at the ... It claims as many lives as the next causes, including cancer, chronic obstructive lung disease or emphysema, ...

  8. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... people’s lives. But the question first might come up, why do we need this, what's the purpose, ... t come to the hospital, then we end up with part of the muscle dying. And so ...

  9. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... have here, you'll notice that deaths from cardiovascular disease have been declining over the last decade ... re looking at discharges from the hospital for cardiovascular disease, you'll see that although it may ...

  10. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... requires and incredible amount of teamwork. Under the leadership of Mark in the lab and Lee and ... eluding stents than many hospitals because of the skill of our cardiologists and the success of this ...

  11. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... those devices as a result, because they're costly. And even to this day, we use far fewer drug-eluding stents than many hospitals because of the skill of our cardiologists and ...

  12. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... that they were boasting about getting with the drug-eluding stents. And we had a cardiology meeting ... even to this day, we use far fewer drug-eluding stents than many hospitals because of the ...

  13. Indeterminacy of Spatiotemporal Cardiac Alternans

    CERN Document Server

    Zhao, Xiaopeng

    2007-01-01

    Cardiac alternans, a beat-to-beat alternation in action potential duration (at the cellular level) or in ECG morphology (at the whole heart level), is a marker of ventricular fibrillation, a fatal heart rhythm that kills hundreds of thousands of people in the US each year. Investigating cardiac alternans may lead to a better understanding of the mechanisms of cardiac arrhythmias and eventually better algorithms for the prediction and prevention of such dreadful diseases. In paced cardiac tissue, alternans develops under increasingly shorter pacing period. Existing experimental and theoretical studies adopt the assumption that alternans in homogeneous cardiac tissue is exclusively determined by the pacing period. In contrast, we find that, when calcium-driven alternans develops in cardiac fibers, it may take different spatiotemporal patterns depending on the pacing history. Because there coexist multiple alternans solutions for a given pacing period, the alternans pattern on a fiber becomes unpredictable. Usin...

  14. Hospital Ethics Committees in Poland.

    Science.gov (United States)

    Czarkowski, Marek; Kaczmarczyk, Katarzyna; Szyma?ska, Beata

    2015-12-01

    According to UNESCO guidelines, one of the four forms of bioethics committees in medicine are the Hospital Ethics Committees (HECs). The purpose of this study was to evaluate how the above guidelines are implemented in real practice. There were 111 hospitals selected out of 176 Polish clinical hospitals and hospitals accredited by Center of Monitoring Quality in Health System. The study was conducted by the survey method. There were 56 (50 %) hospitals that responded to the survey. The number of HECs members fluctuated between 3 and 16 members, where usually 5 (22 % of HECs) members were part of the board committee. The composition of the HECs for professions other than physicians was diverse and non-standardized (nurses-in 86 % of HECs, clergy-42 %, lawyers-38 %, psychologists-28 %, hospital management-23 %, rehab staff-7 %, patient representatives-3 %, ethicists-2 %). Only 55 % of HECs had a professional set of standards. 98 % of HECs had specific tasks. 62 % of HECs were asked for their expertise, and 55 % prepared <6.88 % of the opinions were related to interpersonal relations between hospital personnel, patients and their families with emphasis on the interactions between superiors and their inferiors or hospital staff and patients and their families. Only 12 % of the opinions were reported by the respondents as related to ethical dilemmas. In conclusion, few Polish hospitals have HECs, and the structure, services and workload are not always adequate. To ensure a reliable operation of HECs requires the development of relevant legislation, standard operating procedures and well trained members. PMID:25388547

  15. Opium decreases the age at myocardial infarction and sudden cardiac death : a long- and short-term outcome evaluation

    DEFF Research Database (Denmark)

    Roohafza, Hamidreza; Talaei, Mohammad

    2013-01-01

    UNLABELLED: BACKGROUND: Opium dependence is a recognized individual and public health threat, but little is known about its association with acute myocardial infarction (AMI) or sudden cardiac death (SCD). METHODS: In a cross-sectional study followed by a one-year matched longitudinal cohort, all 569 men hospitalized with AMI in all Cardiac Care Units (CCU) of Isfahan, Iran, were recruited in a six-month period. In addition, 123 out-of-hospital deaths were included that were diagnosed as SCD at the same duration. Among those discharged alive, 126 opium dependents were matched with 126 nondependents (mostly nonusers) according to age and smoking status, and were followed for one year. Opium dependence was measured using the ICD10 criteria and Severity of Dependence Scale (SDS) questionnaire. The method was validated by morphine blood levels. Biochemical measurements, blood pressure, blood cell counts, anthropometrics, and ejection fraction were measured at baseline and repeated at the end of follow-up. RESULTS: There were 118 (17.1%) patients with an average of 17.4 ± 10.4 years of abuse who met the criteria for opium dependency. Opium dependence decreased the age at event by 3.6 (95% CI: 1.2 - 6.0) years and was independent of smoking (P = 0.003). In terms of cardiovascular risk factors such as ejection fraction, in addition to post-AMI mortality and morbidity, no significant associations were noted at baseline or after one year of follow-up. The odds ratio of sustained smoking after AMI was 1.92 (95% CI: 1.04 - 3.52) in opium dependents (P = 0.033). CONCLUSION: Despite public opinion, opium did not improve cardiovascular risk factors, or post-AMI mortality and morbidity. Conversely, there were irrefutable findings regarding the detrimental effects of opium dependence.

  16. Cardiac morbidity risk and depression and anxiety : a disorder, symptom and trait analysis among cardiac surgery patients

    DEFF Research Database (Denmark)

    Tully, Phillip J; Pedersen, Susanne S.

    2011-01-01

    The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity. Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom Questionnaire and a measure of Type D personality traits. Postoperative cardiac morbidity was confirmed after surgery during the index hospitalization and included stroke,renal failure, ventilation>24 h, deep sternal wound infection, reoperation, arrhythmia and 30-day mortality at any location (n=59, 37.3% of total). After adjustment for age, recent myocardial infarction, heart failure, hypertension, urgency of surgery and time spent on cardiopulmonary bypass generalized anxiety disorder was associated with cardiac morbidity (odds ratio [OR]=3.26, 95% confidence interval [CI] 1.10-9.67, p=0.03). Adjusted analysis of personality traits revealed the NA component of Type D personality was associated with cardiac morbidity (OR=1.07, 95% CI 1.01-1.14, p=0.03). The Mood and Anxiety Symptom Questionnaire subscales were not associated with increased morbidity risk. Affective disorders, affective phenotypes, and personality traits were differentially associated with post-cardiac surgery morbidity outcomes independent of cardiac surgery morbidity risk factors. Concurrent investigation of depression and anxiety with respect to cardiac outcomes warrants further research.

  17. Heart disease and hospital deaths: an empirical study.

    OpenAIRE

    Kelly, J V; Hellinger, F J

    1987-01-01

    This study examines the effects of selected characteristics of hospitals and physicians on the mortality rates of heart patients who survive their first day in the hospital. Separate multivariate regression analyses are conducted for three groups: (1) patients who undergo a direct heart revascularization or coronary artery bypass graft (CABG) operation; (2) patients who undergo a cardiac catheterization and do not undergo a CABG operation; and (3) patients with a principal diagnosis of acute ...

  18. Videoscope-assisted cardiac surgery

    OpenAIRE

    Chiu, Kuan-Ming; Chen, Robert Jeen-Chen

    2014-01-01

    Videoscope-assisted cardiac surgery (VACS) offers a minimally invasive platform for most cardiac operations such as coronary and valve procedures. It includes robotic and thoracoscopic approaches and each has strengths and weaknesses. The success depends on appropriate hardware setup, staff training, and troubleshooting efficiency. In our institution, we often use VACS for robotic left-internal-mammary-artery takedown, mitral valve repair, and various intra-cardiac operations such as tricuspi...

  19. Impact of pulmonary hypertension on cardiac surgery.

    Directory of Open Access Journals (Sweden)

    G. Tinic?

    2012-08-01

    Full Text Available BACKGROUND: Pulmonary hypertension (PH is a frequent condition in patients with congenital heart diseases and left ventricle diseases. Preoperative PH causes higher mortality rate after heart surgery and adverse cardiac events. METHODS: We performed a prospective study which included 159 patients with preoperative PH that had undergone cardiac surgery between November 2008 and November 2011 in the Institute of Cardiovascular Diseases of Ia?i. 28 patients had class 1.4.4 pulmonary artery hypertension (due to congenital cardiac shunts and 131 patients had class 2 PH (due to left heart diseases. The preoperative echocardiography included: assessment of the left ventricular volume and ejection fraction, systolic pressure in the pulmonary artery; right ventricular end-diastolic diameter; right atrium area indexed for body surface area; pulmonary acceleration/ejection time ratio; TAPSE; determination of the severity of the associated tricuspid regurgitation; pericardial fluid presence. The primary endpoint was perioperative mortality; the secondary endpoints included: pericardial, pleural, hepatic or renal complications; the need for a new surgical procedure; postoperative mechanical ventilation > 24 hours; intensive care unit length of stay; postoperative inotropic support duration; the need for intra-aortic balloon pump; the need for pulmonary vasodilator drugs. RESULTS: The mortality rate was 2.51% and was statistically associated with NYHA IV preoperative class, the pulmonary acceleration/ejection time ratio, TAPSE, the presence of pericardial fluid, the indexed area of the right atrium and the concomitant CABG. Severe pulmonary hypertension(sPAP > 60 mmHg is associated with significant mortality rate increase, longer hospitalization in the intensive care unit, mechanical ventilation over 24 hours, lengthy inotropic support and renal, hepatic and pericardial complications. Residual PH and perioperative right ventricle dysfunction are common clinical entities after cardiac surgery, with important prognostic implications. CONCLUSIONS: Pulmonary hypertension and right ventricle dysfunction are strong negative prognostic factor for cardiac surgery. The surgical procedure should be done in the early stages of pulmonary hypertension. Echocardiography is an useful, simple and reproducible tool, able to classify the operative risk.

  20. [Czech paediatric cardiac surgery - history and presence].

    Science.gov (United States)

    Hu?ín, Bohumil

    2012-01-01

    The beginnings of the Paediatric Cardiac Surgery in the Czech Republic date back to the period immediately after the end of World War II. Its protagonists were Prof. Emerich Polák from the Surgical Clinic in Prague, Vinohrady, Prof. Jan Bedrna from Surgical Clinic in Hradec Kralove, Prof. Vladislav Rapant from Surgical Clinic in Olomouc and Prof. Václav Kafka from the Second Surgical Clinic in Prague. They started with operations of the patent ductus arteriosus, the Blalock-Taussig shunt in cyanotic heart defects and resection of coarctation of the aorta. Operations of congenital heart defects, on the open heart were elaborated namely by cardiosurgeons in Brno, under the leadership of Professor Jan Navrátil. On the extension of those methods participated Professor Jaroslav Procházka in Hradec Kralove and Prof. Václav Kafka at the newly opened department of Paediatric surgery in Prague. In the next period, attention of paediatric cardiac surgery was directed at operations of critical congenital heart defects in the smallest children. Palliative operations of the critical heart defects in newborns and infants were first introduced at the clinic of paediatric surgery of the Paediatric University Hospital in Prague. Radical operations of infants and newborns with extra-corporal circulation were elaborated in the Children's heart centre in Prague, Motol. Initiative in the further development of paediatric cardiac surgery was taken over by the Children's heart centre in Prague since its founding in 1977. There was concentrated all medical care of children born with a congenital heart defect in the Czech Republic. This concentration of specialized care at one institution allowed to accumulate extremely large experience with the diagnostics and surgical treatment of congenital heart defects in all age groups with the decrease of patients mortality after operations to 1% even for the smallest children and enabled continuously monitor the quality of life of patients treated for congenital heart defect up to adulthood. It was followed by a system of care for adults with congenital heart defect in cooperation with cardiac surgery departments for adults. Excellent level of paediatric cardiac surgery in the Czech Republic is currently confirmed by comparison of the results in the global database operations of congenital heart defects, led by the European Association for Cardiothoracic Surgery (EACTS). PMID:22779769

  1. Registry of Unexplained Cardiac Arrest

    Science.gov (United States)

    2015-04-13

    Cardiac Arrest; Long QT Syndrome; Brugada Syndrome; Catecholaminergi Polymorphic Ventricular Tachycardia; Idiopathic VentricularFibrillation; Early Repolarization Syndrome; Arrhythmogenic Right Ventricular Cardiomyopathy

  2. Diagnostic imaging of cardiac hypertrophy

    International Nuclear Information System (INIS)

    As imaging techniques for cardiac hypertrophy, the ultrasonic dimension gauze technique, echocardiography, ventriculography and the RI technique including emission RI tomography were outlined. (Chiba, N.)

  3. Time Out of Work and Skill Depreciation

    OpenAIRE

    Edin, Per-Anders; Gustavsson, Magnus

    2004-01-01

    This paper investigates the role of skill depreciation in the relationship between work interruptions and subsequent wages. Using a unique longitudinal dataset, the Swedish part of the International Adult Literacy Survey, we are able to analyze changes in literacy skills for individuals as a function of time out of work. In general, we find statistically strong evidence on a negative relationship between work interruptions and skills. Our analysis suggests that depreciation of general (litera...

  4. OUT-OF-PLANE CMOS COMPATIBLE MAGNETOMETERS

    OpenAIRE

    El Ghorba, M.; André, N; Sobieski, S.; Raskin, J. -P.

    2007-01-01

    Three-dimensional MEMS magnetometers with use of residual stresses in thin multilayers cantilevers are presented. Half-loop cantilevers based on Lorentz-force deflection convert magnetic flux in changes, thanks to piezoresistive transducers mounted in Wheatstone bridge. Magnetic field in the order of 10 Gauss was measured with a sensitivity of 0.015 mV/Gauss. A Finite Element Model of the device has been developed with Ansys for static and dynamic simulations. Novel out-of-p...

  5. The crack kinking out of an interface

    OpenAIRE

    Veljkovi? Jelena M.

    2005-01-01

    Kinking of a plane strain crack out of an interface between the two dissimilar isotropic elastic materials is analyzed. Analysis is focused on the initiation of kinking and thus the segment of the crack leaving the interface is imagined to be short compared to the segment in the interface. The analysis provides the stress intensity factors and energy release rate of the kinked cracks in terms of the corresponding quantities for the interfacial crack. The energy release rate is enhanced if the...

  6. Hypertrophic phenotype in cardiac cell assemblies solely by structural cues and ensuing self-organization

    OpenAIRE

    Chung, Chiung-yin; Bien, Harold; Sobie, Eric A; Dasari, Vikram; McKinnon, David; Rosati, Barbara; Entcheva, Emilia

    2011-01-01

    In vitro models of cardiac hypertrophy focus exclusively on applying “external” dynamic signals (electrical, mechanical, and chemical) to achieve a hypertrophic state. In contrast, here we set out to demonstrate the role of “self-organized” cellular architecture and activity in reprogramming cardiac cell/tissue function toward a hypertrophic phenotype. We report that in neonatal rat cardiomyocyte culture, subtle out-of-plane microtopographic cues alter cell attachment, increase biomechanical ...

  7. General practitioners' satisfaction with and attitudes to out-of-hours services

    Directory of Open Access Journals (Sweden)

    Wesseling Geertjan

    2005-03-01

    Full Text Available Abstract Background In recent years, Dutch general practitioner (GP out-of-hours service has been reorganised into large-scale GP cooperatives. Until now little is known about GPs' experiences with working at these cooperatives for out-of-hours care. The purpose of this study is to gain insight into GPs' satisfaction with working at GP cooperatives for out-of-hours care in separated and integrated cooperatives. Methods A GP cooperative separate from the hospital Accident and Emergency (A&E department, and a GP cooperative integrated within the A&E department of another hospital. Both cooperatives are situated in adjacent geographic regions in the South of the Netherlands. One hundred GPs were interviewed by telephone; fifty GPs working at the separated GP cooperative and fifty GPs from the integrated GP cooperative. Opinions on different aspects of GP cooperatives for out-of-hours care were measured, and regression analysis was performed to investigate if these could be related to GP satisfaction with out-of-hours care organisation. Results GPs from the separated model were more satisfied with the organisation of out-of-hours care than GPs from the integrated model (70 vs. 60 on a scale score from 0 to 100; P = 0.020. Satisfaction about out-of-hours care organisation was related to opinions on workload, guarantee of gatekeeper function, and attitude towards out-of-hours care as being an essential part of general practice. Cooperation with medical specialists was much more appreciated at the integrated model (77 vs. 48; P Conclusion GPs in this study appear to be generally satisfied with the organisation of GP cooperatives for out-of-hours care. Furthermore, GPs working at the separated cooperative seem to be more satisfied compared to GPs working at the integrated cooperative.

  8. Depression among hospitalized and non-hospitalized gonadal cancer patients in tertiary care public hospitals in Karachi.

    Science.gov (United States)

    Yousaf, Tahira; Zadeh, Zainab Fotowwat

    2015-03-01

    The study aimed at determining the differences in the levels of depression between hospitalized and non-hospitalized Gonadal cancer patients in tertiary care public hospitals in Karachi. The present study was conducted at the Jinnah Postgraduate Medical Centre and Civil Hospital, Karachi, from July to October 2009. One hundred adult patients diagnosed with Gonadal cancer volunteered for the study. Cases with any other co-morbidity were excluded. Urdu version of Siddiqui Shah Depression Scale (SSDS) was administered. Purposive and snowball sampling methods were used for data collection. The ages of participants in the sample ranged from 20 to 27 years with the mean age of 23.85 years. The participants belonged to the lower and middle classes. Out of the 30 hospitalized gonadal cancer patients 40% were moderately depressed and 60% were severely depressed, whereas out of 70 non-hospitalized gonadal cancer patients 74.3% were mildly depressed, 24.3% were moderately depressed and only 1.4% were severely depressed, which clearly indicated that the depression level of hospitalized gonadal cancer patients was high as compared to non-hospitalized gonadal cancer patients. PMID:25772968

  9. Robotic Mitral Valve Repair: A Community Hospital Experience

    OpenAIRE

    Jones, Bruce A.; Krueger, Steve; Howell, Derek; Meinecke, Barbara; Dunn, Shannon

    2005-01-01

    Robotically assisted cardiac surgery has been presented as less invasive than conventional surgery, with shortened hospital stays and faster return to daily activities. We evaluated our experience with the da Vinci robot to determine whether we could in fact demonstrate those findings.

  10. Antifibrinolytics in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Achal Dhir

    2013-01-01

    Full Text Available Cardiac surgery exerts a significant strain on the blood bank services and is a model example in which a multi-modal blood-conservation strategy is recommended. Significant bleeding during cardiac surgery, enough to cause re-exploration and/or blood transfusion, increases morbidity and mortality. Hyper-fibrinolysis is one of the important contributors to increased bleeding. This knowledge has led to the use of anti-fibrinolytic agents especially in procedures performed under cardiopulmonary bypass. Nothing has been more controversial in recent times than the aprotinin controversy. Since the withdrawal of aprotinin from the world market, the choice of antifibrinolytic agents has been limited to lysine analogues either tranexamic acid (TA or epsilon amino caproic acid (EACA. While proponents of aprotinin still argue against its non-availability. Health Canada has approved its use, albeit under very strict regulations. Antifibrinolytic agents are not without side effects and act like double-edged swords, the stronger the anti-fibrinolytic activity, the more serious the side effects. Aprotinin is the strongest in reducing blood loss, blood transfusion, and possibly, return to the operating room after cardiac surgery. EACA is the least effective, while TA is somewhere in between. Additionally, aprotinin has been implicated in increased mortality and maximum side effects. TA has been shown to increase seizure activity, whereas, EACA seems to have the least side effects. Apparently, these agents do not differentiate between pathological and physiological fibrinolysis and prevent all forms of fibrinolysis leading to possible thrombotic side effects. It would seem prudent to select the right agent knowing its risk-benefit profile for a given patient, under the given circumstances.

  11. Rabdomiosarcoma cardíaco / Cardiac Rhabdomyosarcoma

    Scientific Electronic Library Online (English)

    Genaro A, Vilcarromero Arbulú.

    2013-04-01

    Full Text Available Los tumores cardíacos primarios son una patología de baja prevalencia a nivel mundial, con predominio de los tumores benignos. Los malignos, mucho más infrecuentes, son de alta mortalidad y poca supervivencia a pesar de tratamiento quirúrgico o quimioterápico. Son de diagnóstico clínico impreciso, p [...] ero se cuenta con herramientas diagnósticas muy confiables. En esta presentación se describe el caso de una paciente sin factores de riesgo cardiovascular y sin antecedentes familiares de importancia, que solicitó atención médica por disnea a esfuerzos moderados como único síntoma, por lo que se le realizaron estudios por imágenes que revelaron una masa en la aurícula izquierda. Se efectuaron la resección quirúrgica de la masa tumoral y su posterior estudio, en el que se arribó al diagnóstico de rabdomiosarcoma cardíaco. Posteriormente se indicó quimioterapia, con la intención de mejora en la supervivencia. Asimismo, se realiza una revisión de la bibliografía en el diagnóstico y el manejo de los tumores cardíacos primarios malignos. Abstract in english The prevalence of primary cardiac tumors is low worldwide, with a predominance of benign tumors. Malignant tumors, even more rare, present high mortality and low survival rates despite surgery or chemotherapy. Its clinical diagnosis is inaccurate, but there are very reliable diagnostic tools. This r [...] eport describes the case of a patient with no cardiovascular risk factors or significant family history, who asked for medical care due to dyspnea on moderate exertion as the only symptom. She was performed imaging studies, which revealed a mass in the left atrium. Surgical resection and analysis of the tumor were performed, concluding that its diagnosis was cardiac rhabdomyosarcoma. Chemotherapy was indicated in order to improve survival. Also, a review of the literature was made for the diagnosis and management of malignant primary cardiac tumors.

  12. Depression, not anxiety, is independently associated with 5-year hospitalizations and mortality in patients with ischemic heart disease

    DEFF Research Database (Denmark)

    Versteeg, Henneke; Hoogwegt, Madelein T; Hansen, Tina B; Pedersen, Susanne S.; Zwisler, Ann-Dorthe; Thygesen, Lau C

    2013-01-01

    The objective of the current study was to examine whether depression and anxiety are independently associated with 5-year cardiac-related hospitalizations and all-cause mortality in patients with ischemic heart disease (IHD).

  13. Stars Spring up Out of the Darkness

    Science.gov (United States)

    2006-01-01

    [figure removed for brevity, see original site] Click on the image for movie of Stars Spring up Out of the Darkness This artist's animation illustrates the universe's early years, from its explosive formation to its dark ages to its first stars and mini-galaxies. Scientists using NASA's Spitzer Space Telescope found patches of infrared light splattered across the sky that might be the collective glow of clumps of the universe's first objects. Astronomers do not know if these first objects were stars or 'quasars,' which are black holes voraciously consuming surrounding gas. The movie begins with a flash of color that represents the birth of the universe, an explosion called the Big Bang that occurred about 13.7 billion years ago. A period of darkness ensues, where gas begins to clump together. The universe's first stars are then shown springing up out of the gas clumps, flooding the universe with light, an event that probably happened about a few hundred million years after the Big Bang. Though these first stars formed out of gas alone, their deaths seeded the universe with the dusty heavy chemical elements that helped create future generations of stars. The first stars, called Population III stars (our star is a Population I star), were much bigger and brighter than any in our nearby universe, with masses about 1,000 times that of our sun. They grouped together into mini-galaxies, which then merged to form galaxies like our own mature Milky Way galaxy. The first quasars, not shown here, ultimately became the centers of powerful galaxies that are more common in the distant universe.

  14. Permanent cardiac pacemaker in infants and children.

    Science.gov (United States)

    Dasmahapatra, H K; Jamieson, M P; Brewster, G M; Doig, B; Pollock, J C

    1986-08-01

    Between October 1970 and November 1984, 26 infants and children aged 11 days to 18 years (mean 5.7 years) received 42 permanent cardiac pacemakers (26 primary implants, 16 re-implants) for congenital or surgically acquired heart block, bradycardia and sinus node dysfunction. Twenty-two patients had unipolar pacing and 4 bipolar pacing. Of 26 primary implantations, 2 had fixed rate epicardial pacing, 16 ventricular demand pacing (13 epicardial, 3 endocardial), 3 epicardial VAT (P-synchronous) pacing and 5 DDD (universal) pacing (4 epicardial, one endocardial). Fourteen patients required a further 19 operations for change of generators (16), ventricular lead (1), generator site (1) and generator encasing (1). Thirty-day hospital mortality was 11.5% (3/26), of which one death was possibly related to pacing failure. Four patients died during the follow-up period (3 months to 10 years; mean 3.4 years). Sixteen of the 19 survivors achieved complete symptomatic relief, without any medical therapy. Our results indicate that modern cardiac pacemaker systems are safe and reliable, and are associated with major relief of symptoms in this age group. PMID:2429390

  15. Health Instruction Packages: Cardiac Anatomy.

    Science.gov (United States)

    Phillips, Gwen; And Others

    Text, illustrations, and exercises are utilized in these five learning modules to instruct nurses, students, and other health care professionals in cardiac anatomy and functions and in fundamental electrocardiographic techniques. The first module, "Cardiac Anatomy and Physiology: A Review" by Gwen Phillips, teaches the learner to draw and label…

  16. Nerve Growth in Cardiac Muscle

    OpenAIRE

    Davies, A.H.; De Souza, B. A.; Glasby, M. A.; Gschmeissner, S E; Huang, C.L.-H.

    1986-01-01

    The failure of reinnervation after cardiac transplantation is probably a consequence of scar formation at the suture lines. However, it must be established whether there are any intrinsic properties of the muscle that prevent reinnervation. This is examined in experimental peripheral nerve implants using cardiac muscle isografts.

  17. Molecular mechanisms of cardiac aging

    Directory of Open Access Journals (Sweden)

    Tian-Jun Zhou

    2010-12-01

    Full Text Available Age-associated changes in cardiovascular structure/function are implicated in the markedly increased risk for cardiovascular disease in older persons. Aging not only prolongs exposure to several other cardiovascular risks, but also leads to intrinsic cardiac changes, which reduces cardiac functional reserve, predisposes the heart to stress and contributes to increased cardiovascular mortality in the elderly. Intrinsic cardiac aging in the murine model closely recapitulates age-related cardiac changes in humans, including left ventricular hypertrophy, fibrosis and diastolic dysfunction. Cardiac aging in mice is accompanied by accumulation of mitochondrial protein oxidation, increased mitochondrial DNA mutations, increased mitochondrial biogenesis, as well as decreased cardiac SERCA2 protein. All of these age-related changes are significantly attenuated in mice overexpressing catalase targeted to mitochondria (mCAT. These findings demonstrate the critical role of mitochondrial reactive oxygen species (ROS in cardiac aging and support the potential application of mitochondrial antioxidants to cardiac aging and age-related cardiovascular diseases.

  18. Ways out of the environmental crisis

    International Nuclear Information System (INIS)

    The book documents the interdisciplinary papers held at a meeting on 'Ways out of the environmental crisis' in November 1985. Guided by the principle of concrete responsibilities emphasis was on the following subjects: Time presses - definition and consequences of the awareness of an imminent environmental catastrophe; air pollution and water pollution recapitulated; economic strategies for the benefit of pollution abatement; ethical and theological aspects; acceptable environmental policies - prospects and perspectives. The papers reflect the relation between the environment, the present generation, posterity, gross national producns and energy consumption, and present a number of scientifically founded alternative strategies. (HSCH) With 16 figs., 1 tab

  19. "Out of the box" professional development

    Science.gov (United States)

    2015-04-01

    At a recent AAPT meeting, I was part of a conversation about professional development that focused on conferences. We discussed the current meeting structure used by AAPT and some alternative formats. This discussion added greatly to my own understanding of new ways for teachers to receive their professional development. This conversation also began my friendship with Kelly O'Shea, a physics teacher from New York. She is also a blogger (check her out at https://kellyoshea.wordpress.com) and an innovative educator. Through my relationship with Kelly, I have grown in my own knowledge of two "out of the box" ways teachers are getting their professional development.

  20. Out-of-Plane Cmos Compatible Magnetometers

    CERN Document Server

    Ghorba, M El; Sobieski, S; Raskin, J -P

    2008-01-01

    Three-dimensional MEMS magnetometers with use of residual stresses in thin multilayers cantilevers are presented. Half-loop cantilevers based on Lorentz-force deflection convert magnetic flux in changes, thanks to piezoresistive transducers mounted in Wheatstone bridge. Magnetic field in the order of 10 Gauss was measured with a sensitivity of 0.015 mV/Gauss. A Finite Element Model of the device has been developed with Ansys for static and dynamic simulations. Novel out-of-plane ferromagnetic nickel plate magnetometer is also presented.

  1. Lifestyle after Cardiac Rehabilitation: Did the Message Come across, and Was It Feasible? An Analysis of Patients’ Narratives

    Directory of Open Access Journals (Sweden)

    Marie Veje Knudsen

    2014-11-01

    Full Text Available Lifestyle following heart disease is considered important to prevent and reduce cardiovascular risk factors. Thus, cardiac rehabilitation is focused on potential lifestyle changes. Further insight into patients’ perspective on lifestyle after cardiac rehabilitation is needed as changing habits following heart disease is a complex matter. The objective of this study was to explore the characteristics of lifestyle after cardiac rehabilitation. A phenomenological-hermeneutic approach with qualitative interviews was performed in 20 patients six months after completing a hospital-based cardiac rehabilitation programme in 2012 at Aarhus University Hospital, Denmark. The patients were diagnosed with ischemic heart disease, heart failure or left heart valve disease. The interviews were analysed using the interpretation theory by Ricoeur. The variation in reactions to cardiac rehabilitation were: 1 considering prior lifestyle to be appropriate, maybe with minor adjustments; 2 acknowledging the need for incorporating lifestyle changes; and 3 reconciling or feeling guilt when being unable to manage changes. Participation in the cardiac rehabilitation programme was a positive experience, but it had minor influence on long-term adherence to recommended lifestyle. The important thing in establishing new routines was whether they aroused interest, and whether the experience of changes was perceived as necessary and manageable. In future cardiac rehabilitation, focusing on patients’ interests and supporting them in incorporating recommendations into their everyday life might be essential following heart disease, also after ending cardiac rehabilitation.

  2. Findings of cardiac radionuclide images in myotonic dystrophy

    International Nuclear Information System (INIS)

    Purpose of this study was to report our experiences of cardiac radionuclide imaging in patients with myotonic dystrophy to assess its clinical implications. Consecutive 18 patients (6 men and 12 women with age range of 34-66 years) entered the study. Thallium-201, I-123 beta-methyliodophenylpentadecanoic acid (BMIPP), and I-123 m-iodobenzylguanidine (MIBG) myocardial SPECT were performed 15 minutes and 195 minutes after the injection of the radiotracers (111 MBq). SPECT images were interpreted by consensus of 3 nuclear medicine physicians blinded to clinical information. Bull's eye washout rates of SPECT of the three rediopharmaceuticals, H/M ratios of I-123 MIBG planar images were calculated. Reduced uptake was found in 93 and 103 out of 234 segments on early and delayed Tl-201 SPECT, 110 and 104 out of 234 on I-123 BMIPP, and 71 and 81 out of 221 on I-123 MIBG, respectively. The photopenia was mild in majority. Frequency of photopenic areas was greater in I-123 BMIPP than in Tl-201 (p=0.001) followed by I-123 MIBG (p<0.0001). Photopenia was most often found in infero-posterior wall (p<0.0001). The washout rates and H/M ratios between mild and severe disease were not statistically different after excluding the patients complicated with diabetes mellitus. In conclusion, radionuclide myocardial imaging is frequently abnormal in the patients with myotonic dystrophy. Early detection of the cardiac involvement may be possible in some patients by cardiac radionuclide imaging. (author)

  3. Cardiopulmonary resuscitation; use, training and self-confidence in skills :a self-report study among hospital personnel

    OpenAIRE

    Hopstock Laila A

    2008-01-01

    Abstract Background Immediate start of basic cardiopulmonary resuscitation (CPR) and early defibrillation have been highlighted as crucial for survival from cardiac arrest, but despite new knowledge, new technology and massive personnel training the survival rates from in-hospital cardiac arrest are still low. National guidelines recommend regular intervals of CPR training to make all hospital personnel able to perform basic CPR till advanced care is available. This study investigates CPR tra...

  4. Leadership in cardiac surgery.

    Science.gov (United States)

    Rao, Christopher; Patel, Vanash; Ibrahim, Michael; Ahmed, Kamran; Wong, Kathie A; Darzi, Ara; von Segesser, Ludwig K; Athanasiou, Thanos

    2011-06-01

    Despite the efficacy of cardiac surgery, less invasive interventions with more uncertain long-term outcomes are increasingly challenging surgery as first-line treatment for several congenital, degenerative and ischemic cardiac diseases. The specialty must evolve if it is to ensure its future relevance. More importantly, it must evolve to ensure that future patients have access to treatments with proven long-term effectiveness. This cannot be achieved without dynamic leadership; however, our contention is that this is not enough. The demands of a modern surgical career and the importance of the task at hand are such that the serendipitous emergence of traditional charismatic leadership cannot be relied upon to deliver necessary change. We advocate systematic analysis and strategic leadership at a local, national and international level in four key areas: Clinical Care, Research, Education and Training, and Stakeholder Engagement. While we anticipate that exceptional individuals will continue to shape the future of our specialty, the creation of robust structures to deliver collective leadership in these key areas is of paramount importance. PMID:20884217

  5. Pregnancy and cardiac disease

    Scientific Electronic Library Online (English)

    C, Elliott; K, Sliwa; , R Burton.

    2014-09-01

    Full Text Available Medical disorders in pregnancy are one of the top five causes of maternal mortality in South Africa (SA), cardiac disease (CD) being the main contributor to this group. In developed countries, surgically corrected congenital heart disease (CHD) comprises the greater proportion of maternal deaths fro [...] m CD. In SA and other developing countries, acquired heart disease such as rheumatic heart disease and cardiomyopathies are the major causes, although CHD remains significantly represented. Both congenital and acquired cardiac lesions may present for the first time during pregnancy. CD may also occur for the first time during or after pregnancy, e.g. peripartum cardiomyopathy. The risk to both the mother and the fetus increases exponentially with the complexity of the underlying disease. Generally, the ability to tolerate a pregnancy is related to: (i) the haemodynamic significance of any lesion; (ii) the functional class - New York Heart Association classes III and IV have poorer outcomes; (iii) the presence of cyanosis; and (iv) the presence of pulmonary hypertension. While the ideal time to assess these factors is before conception, women frequently present when already pregnant. This review discusses risk assessment and management of CD in pregnant women and the role of a combined cardiology and obstetric clinic.

  6. Clean out of empty uranium hexafluoride cylinder

    International Nuclear Information System (INIS)

    The uranium hexafluoride (UF6) is one of the most important uranium chemical forms in nuclear fuel cycle, which is used in the uranium enrichment process and in the study of fluoride volatility process, one of the dry reprocessing methods. Normally, UF6 is confined in the solid state in the cylinder type container and handled as gas by adjusting the temperature and pressure. Since it is highly reactive with water vapor in the air, it must be carefully handled. By the reaction with water vapor, particle of UO2F2 appeared as a white cloud and corrosive HF gas are released to the atmosphere. The purpose of this report is to describe safety handling for clean out of empty UF6 cylinder and to summarize physical and chemical properties of uranium compounds in relation to treatment for UF6. The clean-out of the UF6 cylinder was carried out successfully by trapping the generated UO2F2 and HF adequately in a temporary globe box made of the polyvinyl chloride that set up in a laboratory hood. (author)

  7. Surgical experience with cardiac myxomas

    International Nuclear Information System (INIS)

    Cardiac myxomas are the most common benign intracardiac tumours. We studied the clinical presentation of cardiac myxomas and the morbidity, mortality and recurrence rate following surgery at our institution over a 6 year period. This historical longitudinal study was performed at department of Cardiac Surgery, Armed forces Institute of Cardiology and National Institute of Heart Diseases Rawalpindi, Pakistan between January 2002 and March 2008 a total number of 8506 cardiac operations were performed. Of these 34 patients (19 males, 15 females) underwent complete excision of primary or recurrent intracardiac myxomas. Pre-operative diagnosis was established by echocardiography. All patients underwent operation soon after the diagnosis of a myxoma was made. Complete tumour excision followed by close inspection and copious saline irrigation of the cardiac chambers was done in each case. Of the 32 patients who survived the surgery, 29 patients were followed up at regular intervals for recurrence. The mean follow-up period was 34 months. Cardiac myxomas constituted 0.40% of the total cardiac operations at our institution. They most commonly occurred in the fourth decade. The commonest location was the left atrium (LA) (79%) followed by the right atrium (RA) (14%). Only one patient had myxoma in the right ventricle (RV). Patients with LA myxoma simulated mitral stenosis clinically whereas patients with RA and RV myxomas presented with features of right heart failure. A smaller percentage presented with embolic and constitutional symptoms. There were two early deaths. One recurrence was noted at 27 months after surgery. No late deaths were observed in the study. Cardiac myxomas form a very small percentage of the cardiac cases. A high index of suspicion is essential for diagnosis. Echocardiography is the ideal diagnostic tool as also for follow-up. Immediate surgical treatment is indicated in all patients. Cardiac myxomas can be excised with a low rate of mortality and morbidity. (author)

  8. Medical Waste Generation in Hospitals and Associated Factors in Ibadan Metropolis, Nigeria

    OpenAIRE

    A. B. Wahab; D.A. Adesanya

    2011-01-01

    The study was conducted to determine the quantities of waste generated in selected hospitals in Ibadan Metropolis Nigeria and examine the factors that influenced the choice of methods and facilities used in managing waste generated. Eight hospitals were selected through systematic random sampling procedure using a sample size of 20% out of 21 public hospitals and 10% out of 42 private hospitals that rendered tertiary or secondary health-care services representing four public and private hospi...

  9. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... on this next slide, you're looking at discharges from the hospital for cardiovascular disease, you'll ... about one percent will not even be low -- 0.2, 0.1 percent. [ Would a patient know ...

  10. Use of intensified comprehensive cardiac rehabilitation to improve risk factor control in patients with type 2 diabetes mellitus or impaired glucose tolerance--the randomized DANish StUdy of impaired glucose metabolism in the settings of cardiac rehabilitation (DANSUK) study

    DEFF Research Database (Denmark)

    Soja, Anne Merete Boas; Zwisler, Ann-Dorthe Olsen

    2007-01-01

    The DANish StUdy of impaired glucose metabolism in the settings of cardiac rehabilitation (DANSUK) examined the effect of an intensified multifactorial intervention on risk factor profile in 104 patients with type 2 diabetes mellitus (T2DM) or impaired glucose tolerance (IGT) attending hospital-based outpatient comprehensive cardiac rehabilitation (CCR) compared to usual care (UC).

  11. Endothelial Progenitor Cells in Peripheral Blood of Cardiac Catheterization Personnel

    Directory of Open Access Journals (Sweden)

    Soheir Korraa1, Tawfik M.S.1, Mohamed Maher 2 and Amr Zaher

    2014-07-01

    Full Text Available Background: The aim of the present study was to evaluate the rejuvenation capacity among cardiac catheterization technicians occupationally exposed to ionizing radiation. Subjects and methods: The individual annual collective dose information was measured by thermoluminscent personal dosimeters (TLD for those technicians and found to be ranging between 2.16 and 8.44 mSv/y. Venous blood samples were obtained from 30 cardiac catheterization technicians exposed to X-ray during fluoroscopy procedures at the National Heart Institute in Embaba. The control group involved 25 persons not exposed to ionizing radiation and not working in hospitals in addition to 20 persons not exposed to ionizing radiation and working in hospitals. Blood samples were assayed for total and differential blood counts, micronucleus formation (FMN plasma stromal derived growth factor-1? (SDF-1 ? and cell phenotype of circulating endothelial progenitor cells (EPCs, whose surface markers were identified as the CD34, CD133 and kinase domain receptors (KDR. Results: SDF-1? (2650± 270 vs. 2170 ± 430 pg/ml and FMN (19.9 ± 5.5 vs. 2.8 ± 1.4/1000 cells were significantly higher among cardiac catheterization staff compared to those of the controls respectively. Similarly, EPCs: CD34 (53 ± 3.9 vs. 48 ± 8.5/105 mononuclear cells, CD133 (62.4 ± 4.8 vs. 54.2 ± 10.6 /105 mononuclear cells KDR (52.7 ± 10.6 vs.43.5± 8.2 /105 mononuclear cells were also significantly higher among cardiac catheterization staff compared to the values of controls respectively. Smoking seemed to have a positive effect on the FMN and SDF-1 but had a negative effect on EPCs. It was found that among cardiac catheterization staff, the numbers of circulating progenitor cells had increased and accordingly there was an increased capacity for tissue repair. Conclusion: In conclusion, the present work shows that occupational exposure to radiation, well within permissible levels, leaves a genetic mark on the somatic DNA of the cardiac catheterization technician. On the other hand, exposure of workers to ionizing radiation stimulates regenerative processes as indicated by the increase in EPCs numbers and SDF-1 levels. This regenerative process is decreased by smoking as evidenced by increased levels of SDF-1 and decreased numbers of EPCs. The technicians who work in cardiac catheterization laboratories should therefore carefully follow radiation protection procedures and should minimize radiation exposure to avoid possible genotoxic effects.

  12. GAMER with out-of-core computation

    CERN Document Server

    Schive, Hsi-Yu; Chiueh, Tzihong

    2010-01-01

    GAMER is a GPU-accelerated Adaptive-MEsh-Refinement code for astrophysical simulations. In this work, two further extensions of the code are reported. First, we have implemented the MUSCL-Hancock method with the Roe's Riemann solver for the hydrodynamic evolution, by which the accuracy, overall performance and the GPU versus CPU speed-up factor are improved. Second, we have implemented the out-of-core computation, which utilizes the large storage space of multiple hard disks as the additional run-time virtual memory and permits an extremely large problem to be solved in a relatively small-size GPU cluster. The communication overhead associated with the data transfer between the parallel hard disks and the main memory is carefully reduced by overlapping it with the CPU/GPU computations.

  13. Getting the most out of professional associations.

    Science.gov (United States)

    Escoffery, Cam; Kenzig, Melissa; Hyden, Christel

    2015-05-01

    In this commentary, three public health professionals working in diverse career settings share their perspectives on how to get the most out of professional associations. This article demonstrates how you can benefit from active involvement in your membership in professional associations and attending professional conferences. Methods to participate actively in your association include volunteering for one-time opportunities or standing committees, mentoring, and reviewing publications and manuscripts. Being active in professional organizations, such as the Society for Public Health Education, offers personal career development skill-building and opportunities for leadership and mentoring across all career stages. Experiences on how participation in professional organizations helped shape the authors' careers are shared. PMID:25583973

  14. Economic networks in and out of equilibrium

    CERN Document Server

    Squartini, Tiziano

    2013-01-01

    Economic and financial networks play a crucial role in various important processes, including economic integration, globalization, and financial crises. Of particular interest is understanding whether the temporal evolution of a real economic network is in a (quasi-)stationary equilibrium, i.e. characterized by smooth structural changes rather than abrupt transitions. Smooth changes in quasi-equilibrium networks can be generally controlled for, and largely predicted, via an appropriate rescaling of structural quantities, while this is generally not possible for abrupt transitions in non-stationary networks. Here we study whether real economic networks are in or out of equilibrium by checking their consistency with quasi-equilibrium maximum-entropy ensembles of graphs. As illustrative examples, we consider the International Trade Network (ITN) and the Dutch Interbank Network (DIN). We show that, despite the globalization process, the ITN is an almost perfect example of quasi-equilibrium network, while the DIN ...

  15. Service and business model for technology enabled and home-based cardiac rehabilitation programs.

    Science.gov (United States)

    Sarela, Antti; Whittaker, Frank; Korhonen, Ilkka

    2009-01-01

    Cardiac rehabilitation programs are comprehensive life-style programs aimed at preventing recurrence of a cardiac event. However, the current programs have globally significantly low levels of uptake. Home-based model can be a viable alternative to hospital-based programs. We developed and analysed a service and business model for home based cardiac rehabilitation based on personal mentoring using mobile phones and web services. We analysed the different organizational and economical aspects of setting up and running the home based program and propose a potential business model for a sustainable and viable service. The model can be extended to management of other chronic conditions to enable transition from hospital and care centre based treatments to sustainable home-based care. PMID:19964213

  16. Licking as an out-of-hospital burns treatment-An isolated cultural phenomenon?

    LENUS (Irish Health Repository)

    Seoighe, Deirdre M

    2012-02-01

    Wound management in burns is a potentially complex issue. Salivary constituents have been shown experimentally to be of benefit in the treatment of thermal injuries. In our clinical experience we have encountered patients who have saliva directly applied to the burn wound prior to presenting to the national burns service. The practice is known as "Licking". We report two cases to illustrate the presentations we have encountered. We believe that these illustrate an isolated phenomenon unique to the Republic of Ireland.

  17. Trends in Cardiac Pacemaker Batteries

    Directory of Open Access Journals (Sweden)

    Venkateswara Sarma Mallela

    2004-10-01

    Full Text Available Batteries used in Implantable cardiac pacemakers-present unique challenges to their developers and manufacturers in terms of high levels of safety and reliability. In addition, the batteries must have longevity to avoid frequent replacements. Technological advances in leads/electrodes have reduced energy requirements by two orders of magnitude. Micro-electronics advances sharply reduce internal current drain concurrently decreasing size and increasing functionality, reliability, and longevity. It is reported that about 600,000 pacemakers are implanted each year worldwide and the total number of people with various types of implanted pacemaker has already crossed 3 million. A cardiac pacemaker uses half of its battery power for cardiac stimulation and the other half for housekeeping tasks such as monitoring and data logging. The first implanted cardiac pacemaker used nickel-cadmium rechargeable battery, later on zinc-mercury battery was developed and used which lasted for over 2 years. Lithium iodine battery invented and used by Wilson Greatbatch and his team in 1972 made the real impact to implantable cardiac pacemakers. This battery lasts for about 10 years and even today is the power source for many manufacturers of cardiac pacemakers. This paper briefly reviews various developments of battery technologies since the inception of cardiac pacemaker and presents the alternative to lithium iodine battery for the near future.

  18. Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest : prognostic implications

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper

    2014-01-01

    AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopressor support and mortality. METHODS: In a 6-year period, 310 comatose OHCA patients treated with TH were included. Temperature, hemodynamic parameters and level of vasopressors were registered from admission to 24h after rewarming. Level of vasopressor support was assessed by the cardiovascular sub-score of Sequential Organ Failure Assessment (SOFA). The population was stratified by use of dopamine as first line intervention (D-group) or use of dopamine+norepinephrine/epinephrine (DA-group). Primary endpoint was 30-day mortality and secondary endpoint was in-hospital cause of death. RESULTS: Patients in the DA-group carried a 49% all-cause 30-day mortality rate compared to 23% in the D-group, plog-rank<0.0001, corresponding to an adjusted hazard ratio (HR) of 2.0 (95% CI: 1.3-3.0), p=0.001). The DA-group had an increased 30-day mortality due to neurological injury (HR=1.7 (95% CI: 1.1-2.7), p=0.02). Cause of death was anoxic brain injury in 78%, cardiovascular failure in 18% and multi-organ failure in 4%. The hemodynamic changes of TH reversed at normothermia, although the requirement for vasopressor support (cardiovascular SOFA?3) persisted in 80% of patients. CONCLUSIONS: In survivors after OHCA treated with TH the induced hemodynamic changes reversed after normothermia, while the need for vasopressor support persisted. Patients requiring addition of norepinephrine/epinephrine on top of dopamine had an increased 30-day all-cause mortality, as well as death from neurological injury.

  19. Acute kidney injury in septua- and octogenarians after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Schmid Christof

    2011-08-01

    Full Text Available Abstract Background An increasing number of septua- and octogenarians undergo cardiac surgery. Acute kidney injury (AKI still is a frequent complication after surgery. We examined the incidence of AKI and its impact on 30-day mortality. Methods A retrospective study between 01/2006 and 08/2009 with 299 octogenarians, who were matched for gender and surgical procedure to 299 septuagenarians at a university hospital. Primary endpoint was AKI after surgery as proposed by the RIFLE definition (Risk, Injury, Failure, Loss, End-stage kidney disease. Secondary endpoint was 30-day mortality. Perioperative mortality was predicted with the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE. Results Octogenarians significantly had a mean higher logistic EuroSCORE compared to septuagenarians (13.2% versus 8.5%; p -1 × 1.73 m-2. In contrast, septuagenarians showed a slightly higher median body mass index (28 kg × m-2 versus 26 kg × m-2 and were more frequently active smoker at time of surgery (6.4% versus 1.6%, p The RIFLE classification provided accurate risk assessment for 30-day mortality and fair discriminatory power. Conclusions The RIFLE criteria allow identifying patients with AKI after cardiac surgery. The high incidence of AKI in septua- and octogenarians after cardiac surgery should prompt the use of RIFLE criteria to identify patients at risk and should stimulate institutional measures that target AKI as a quality improvement initiative for patients at advanced age.

  20. Developing an analytical tool for evaluating EMS system design changes and their impact on cardiac arrest outcomes: combining geographic information systems with register data on survival rates

    Directory of Open Access Journals (Sweden)

    Sund Björn

    2013-02-01

    Full Text Available Abstract Background Out-of-hospital cardiac arrest (OHCA is a frequent and acute medical condition that requires immediate care. We estimate survival rates from OHCA in the area of Stockholm, through developing an analytical tool for evaluating Emergency Medical Services (EMS system design changes. The study also is an attempt to validate the proposed model used to generate the outcome measures for the study. Methods and results This was done by combining a geographic information systems (GIS simulation of driving times with register data on survival rates. The emergency resources comprised ambulance alone and ambulance plus fire services. The simulation model predicted a baseline survival rate of 3.9 per cent, and reducing the ambulance response time by one minute increased survival to 4.6 per cent. Adding the fire services as first responders (dual dispatch increased survival to 6.2 per cent from the baseline level. The model predictions were validated using empirical data. Conclusion We have presented an analytical tool that easily can be generalized to other regions or countries. The model can be used to predict outcomes of cardiac arrest prior to investment in EMS design changes that affect the alarm process, e.g. (1 static changes such as trimming the emergency call handling time or (2 dynamic changes such as location of emergency resources or which resources should carry a defibrillator.

  1. Where do out-of-hours calls to a consultant microbiologist come from?

    LENUS (Irish Health Repository)

    Humphreys, H

    2009-08-01

    There is little in the literature about out-of-hours calls to medical microbiologists. The calls taken by a consultant medical microbiologist over a five-year period in an Irish tertiary referral hospital were reviewed. Excluding calls on weekend mornings and significant evening positive blood cultures, the mean annual number of calls on a one-in-four rota was 89 (range 70-111). Over 90% of calls were received before midnight and 51% were from specialist registrars. Medical specialties, neurosurgery and intensive care were the most common departments seeking advice. Two-thirds of calls related to the management of an individual patient, but advice on infection prevention and control is increasingly requested. Calls out-of-hours are not insignificant but little is known about how these vary between hospitals and what contribution they make to patient care.

  2. Metoclopramide-induced cardiac arrest

    Directory of Open Access Journals (Sweden)

    Martha M. Rumore

    2011-11-01

    Full Text Available The authors report a case of cardiac arrest in a patient receiving intravenous (IV metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s underlying metoclopramide’s cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and reporting of bradydysrrhythmias and cardiac arrest in patients receiving metoclopramide.

  3. Diagnosis and Treatment of Penetrating Cardiac Injury One Year after Thoracic Stab Wound

    Directory of Open Access Journals (Sweden)

    MH Soltani

    2005-10-01

    Full Text Available In any patient with a history of penetrating thoracic trauma, cardiac injury must be kept in mind. Here, we describe a 36 years-old female referred to this hospital with severe chest pain and hypotension. After primary evaluation and suggestion of AMI, streptokinase was started for the patient and because of deterioration of vital signs, cardiac surgery consultation was requested. After performing urgent echocardiography, massive pericardial tamponade was detected. Visualization of a knife blade on C.X.R and past medical history of thoracic stab injury led to a diagnosis of delayed cardiac tamponade and urgent sternotomy was performed. The blade that had penetrated the right ventricular chamber was extracted. Six days after operation, patient was discharged without any problem. This case study suggests the importance of high suspicion to cardiac injury in any patient with chest pain and a history of chest trauma.

  4. Cardiac and vascular malformations

    International Nuclear Information System (INIS)

    Malformations of the heart and great vessels show a high degree of variation. There are numerous variants and defects with only few clinical manifestations and are only detected by chance, such as a persistent left superior vena cava or a partial anomalous pulmonary venous connection. Other cardiovascular malformations are manifested directly after birth and need prompt mostly surgical interventions. At this point in time echocardiography is the diagnostic modality of choice for morphological and functional characterization of malformations. Additional imaging using computed tomography (CT) or magnetic resonance imaging (MRI) is only required in a minority of cases. If so, the small anatomical structures, the physiological tachycardia and tachypnea are a challenge for imaging modalities and strategies. This review article presents the most frequent vascular, cardiac and complex cardiovascular malformations independent of the first line diagnostic imaging modality. (orig.)