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Sample records for out-of hospital cardiac

  1. Out-of-hospital cardiac arrests in children

    Directory of Open Access Journals (Sweden)

    Kamarainen Antti

    2010-01-01

    Full Text Available Prehospital pediatric cardiac arrest is a rare event compared with adult cardiac arrest. Despite the recent advancements in postresuscitation care improving the outcome of adult patients, similar evidence is lacking in pediatric victims of cardiac arrest. In this brief article, the current data on pediatric cardiac arrest occurring in the prehospital setting are reviewed. The annual incidence of pediatric out-of-hospital cardiac arrest is approximately 8-10 cases per 100,000 persons. The outcome is generally poor, as only 2-9.6% of patients survive to hospital discharge. The neurologic outcome of survivors is good in 24-31% of patients. Current evidence is insufficient to strongly support or refute the use of mild therapeutic hypothermia during the postresuscitation phase in pediatric patients. The application of a goal-directed treatment protocol for pediatric cardiac arrest and postresuscitation syndrome needs to be evaluated.

  2. Circadian variation in witnessed out of hospital cardiac arrest

    OpenAIRE

    Soo, L.; Gray, D.; Young, T.; Hampton, J.

    2000-01-01

    OBJECTIVES—To examine the effect on circadian variation of out of hospital cardiac arrest according to the underlying aetiology and presenting rhythm of arrest, and to explore strategies that might help to improve survival outcome using circadian variation.?DESIGN—Population based retrospective study.?SETTING—County of Nottinghamshire with a total population of 993 914 and an area of 2183 km2.?SUBJECTS—Between 1 January 1991 and 3 December 1994, all witnessed cardiac arres...

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

    DEFF Research Database (Denmark)

    Weeke, Peter; Folke, Fredrik

    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.

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

    DEFF Research Database (Denmark)

    Bagai, Akshay; McNally, Bryan F

    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.

  5. 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 ...

  6. Bystander initiated and dispatcher assisted cardiopulmonary resuscitation in out-of-hospital cardiac arrest

    OpenAIRE

    Bohm, Katarina

    2009-01-01

    Cardiac arrest (CA) is a common cause of death. In Sweden approximately 6 000- 10 000 people annually suffer a CA outside hospital. Cardiopulmonary resuscitation (CPR) can save lives in an out-of-hospital cardiac arrest (OHCA). The aim of this thesis was to describe various aspects of CPR and the emergency medical dispatcher (EMD) organisation to find approaches for enhancing bystander intervention in OHCA. Methods and results: In Study I, 315 consecutive cases of OHCA duri...

  7. Post-hypothermia fever is associated with increased mortality after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Hassager, Christian

    2013-01-01

    Post-cardiac arrest fever has been associated with adverse outcome before implementation of therapeutic hypothermia (TH), however the prognostic implications of post-hypothermia fever (PHF) in the era of modern post-resuscitation care including TH has not been thoroughly investigated. The aim of the study was to assess the prognostic implication of PHF in a large consecutive cohort of comatose survivors after out-of-hospital cardiac arrest (OHCA) treated with TH.

  8. Numerators, denominators, and survival rates: reporting survival from out-of-hospital cardiac arrest.

    Science.gov (United States)

    Eisenberg, M S; Cummins, R O; Larsen, M P

    1991-11-01

    This study demonstrates the effect of different denominators on the survival rate from out-of-hospital cardiac arrest. We retrospectively analyzed data from a cardiac arrest surveillance system in King County, Washington during the years 1976 to 1988, and calculated survival rates using eight different definitions of denominators. The eight survival rates ranged from 16% to 49% discharge from hospital. The denominator for the lowest survival rate included all cases of cardiac arrest for whom emergency medical services personnel started cardiopulmonary resuscitation. The denominator for the highest survival rate included: all cases of presumed cardiac etiology; first recorded rhythm was ventricular fibrillation; collapse witnessed; cardiopulmonary resuscitation started by bystanders within 4 minutes; and definitive care provided within 8 minutes. The definition of cases included in the denominator can dramatically effect the resultant survival rate. There must be national and international agreement about definitions of denominators for valid cross community comparisons. PMID:1930393

  9. Out of hospital cardiac arrest : with focus on bystander CPR and public access defibrillation

    OpenAIRE

    Ringh, Mattias

    2014-01-01

    Background: Out-of-hospital cardiac arrest (OHCA) annually affecting hundreds of thousands of pa¬tients in Europe alone. Survival is highly dependent on time to treatment (cardiopulmonary resuscitation (CPR) and defibrillation). Long emergency medical system (EMS) time inter¬vals and low bystander CPR rates are major obstacles for increased survival. New treat¬ment strategies are needed to reach and treat patients faster. Automated external defibrilla¬tors (AEDs) make it is possible for l...

  10. 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...

  11. Assessing the impact of prehospital intubation on survival in out-of-hospital cardiac arrest.

    LENUS (Irish Health Repository)

    Egly, Joshua

    2012-02-01

    There is a developing body of literature documenting adverse survival outcome of out-of-hospital endotracheal intubation for critical multiple trauma and head injury patients. OBJECTIVE: To compare the rates of survival to hospital admission and discharge of nontraumatic out-of-hospital cardiac arrest (OHCA) patients who received successful out-of-hospital endotracheal intubation and those who were not intubated. METHODS: We conducted a retrospective analysis from an ongoing database of OHCA patients brought to a large suburban tertiary care emergency department by paramedic services between 1995 and 2006. We dichotomized patients by whether they were successfully endotracheally intubated or not prior to hospital arrival. Utstein style cardiac arrest variables were abstracted for all cases. All survivors to hospital admission were reviewed to exclude those patients in whom intubation was not attempted or unnecessary, such as those who had successful first-shock recovery of spontaneous circulation. We used chi square and logistic regression techniques for analysis, using survival to discharge as the primary outcome and survival to admission as a secondary outcome. RESULTS: There were 1,515 total cases with 33 early survivors excluded. Overall, 1,220 (86.2%) were intubated; of those intubated, 270 (20.2%) survived to admission and 93 (7.0%) survived to discharge. Upon univariate analysis, there was no difference in survival between intubated and non intubated groups (6.5% vs 10.0%, OR = 0.63, 95% CI 0.37,1.08). For patients initially in ventricular fibrillation\\/ventricular tachycardia (VT\\/VF), in a multivariate Logit model, intubation significantly decreased survival to discharge, adjusted odds ratio (OR) = 0.52 (95% confidence interval 0.27, 0.998). Intubated non-VF patients were more likely to survive to admission, adjusted OR 2.96 (1.04, 8.43), but not to discharge (1.8% vs. 1.0%, p = 1.0). CONCLUSION: This observational study in an unselected population shows that patients in VF\\/VT arrest who underwent out-of-hospital intubation were less likely to survive to discharge than those not intubated. Out-of-hospital intubation of patients with non-VF arrest was associated with an increased rate of survival to admission, but not survival to discharge. Future prospective studies are needed to define the role of out-of-hospital endotracheal intubation in cardiac arrest patients.

  12. Success of organ donation after out-of-hospital cardiac death and the barriers to its acceptance

    OpenAIRE

    Kaufman, Bradley J.; Wall, Stephen P.; Gilbert, Alexander J.; Dubler, Nancy N.; Goldfrank, Lewis R.

    2009-01-01

    It is well documented that transplants save lives and improve quality of life for patients suffering from kidney, liver, and heart failure. Uncontrolled donation after cardiac death (UDCD) is an effective and ethical alternative to existing efforts towards increasing the available pool of organs. However, people who die from an out-of-hospital cardiac arrest are currently being denied the opportunity to be organ donors except in those few locations where out-of-hospital UDCD programs are acti...

  13. 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.

  14. Out-of-hospital cardiac arrest : A study on factors associated with cardiopulmonary resuscitation, early defibrillation and survival

    OpenAIRE

    Hollenberg, Jacob

    2008-01-01

    p>Cardiac disease is the most common cause of mortality in the Western World and the majority of these cardiac deaths is due to out-of-hospital cardiac arrest (OHCA). In Sweden, an estimated 5,000-10,000 people suffer an OHCA annually. The objective of this thesis is to study patient characteristics and survival in patients with OHCA, to explore the importance of pre-hospital factors and in-hospital factors and to investigate the benefits of an early defibrillation program. ...

  15. Comparison of Role of Early (<6 Hours) to Later (>6 Hours) or No Cardiac Catheterization Following Resuscitation From Out-of-hospital Cardiac Arrest

    OpenAIRE

    Strote, Justin A.; Maynard, Charles; Olsufka, Michele; Nichol, Graham; Copass, Michael K.; Cobb, Leonard A.; Kim, Francis

    2011-01-01

    Despite reports of patients with resuscitated sudden cardiac arrest (rSCA) receiving acute cardiac catheterization, the efficacy of this strategy is largely unknown. We hypothesized that acute cardiac catheterization of patients with rSCA would improve survival to hospital discharge. A retrospective cohort of 240 patients with out-of-hospital rSCA due to ventricular tachycardia or fibrillation was identified from 11 institutions in Seattle, Washington, between 1999 and 2002. Patients were gro...

  16. Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway

    Directory of Open Access Journals (Sweden)

    Sunde Geir A

    2012-12-01

    Full Text Available Abstract Background Although there are numerous supraglottic airway alternatives to endotracheal intubation, it remains unclear which airway technique is optimal for use in prehospital cardiac arrests. We evaluated the use of the laryngeal tube (LT as an airway management tool among adult out-of-hospital cardiac arrest (OHCA patients treated by our ambulance services in the Haukeland and Innlandet hospital districts. Methods Post-resuscitation forms and data concerning airway management in 347 adult OHCA victims were retrospectively assessed with regard to LT insertion success rates, ease and speed of insertion and insertion-related problems. Results A total of 402 insertions were performed on 347 OHCA patients. Overall, LT insertion was successful in 85.3% of the patients, with a 74.4% first-attempt success rate. In the minority of patients (n?=?46, 13.3%, the LT insertion time exceeded 30 seconds. Insertion-related problems were recorded in 52.7% of the patients. Lack of respiratory sounds on auscultation (n?=?100, 28.8%, problematic initial tube positioning (n?=?85, 24.5%, air leakage (n?=?61, 17.6%, vomitus/aspiration (n?=?44, 12.7%, and tube dislocation (n?=?17, 4.9% were the most common problems reported. Insertion difficulty was graded and documented for 95.4% of the patients, with the majority of insertions assessed as being “Easy” (62.5% or “Intermediate” (24.8%. Only 8.1% of the insertions were considered to be “Difficult”. Conclusions We found a high number of insertion related problems, indicating that supraglottic airway devices offering promising results in manikin studies may be less reliable in real-life resuscitations. Still, we consider the laryngeal tube to be an important alternative for airway management in prehospital cardiac arrest victims.

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

    DEFF Research Database (Denmark)

    Steinmetz, Jacob; Barnung, 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 implementation), separated by a 4-month period in which the above-mentioned change took place. RESULTS: We found that 30-day survival increased after the implementation from 31/372 (8.3%) to 67/419 (16%), P=0.001. ROSC at hospital admission, as well as survival to hospital discharge, were obtained in a significantly higher proportion from 23.4% to 39.1%, P<0.0001, and from 7.9% to 16.3%, P=0.0004, respectively. Treatment after implementation was confirmed as a significant predictor of better 30-day survival in a logistic regression analysis. CONCLUSION: The implementation of new resuscitation guidelines was associated with improved 30-day survival after OHCA Udgivelsesdato: 2008/8

  18. 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 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, 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 PM(2.5), lag3 of PM(10), lag3 of PM(10-2.5), lag3 of NO(x) and lag4 of CO. An IQR increase of PM(2.5) and PM(10) 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 O(3) slightly increased the association between OHCA and PM(2.5) and PM(10). No susceptible groups were identified.

  19. 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.

  20. 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).

  1. Out-of-hospital cardiac arrest: 10 years of progress in research and treatment.

    Science.gov (United States)

    Hollenberg, J; Svensson, L; Rosenqvist, M

    2013-06-01

    Cardiac disease is the most common cause of mortality in Western countries, with most deaths due to out-of-hospital cardiac arrest (OHCA). In Sweden, 5000-10 000 OHCAs occur annually. During the last decade, the time from cardiac arrest to start of cardiopulmonary resuscitation (CPR) and defibrillation has increased, whereas survival has remained unchanged or even increased. Resuscitation of OHCA patients is based on the 'chain-of-survival' concept, including early (i) access, (ii) CPR, (iii) defibrillation, (iv) advanced cardiac life support and (v) post-resuscitation care. Regarding early access, agonal breathing, telephone-guided CPR and the use of 'track and trigger systems' to detect deterioration in patients' condition prior to an arrest are all important. The use of compression-only CPR by bystanders as an alternative to standard CPR in OHCA has been debated. Based on recent findings, guidelines recommend telephone-guided chest compression-only CPR for untrained rescuers, but trained personnel are still advised to give standard CPR with both compressions and ventilation, and the method of choice for this large group remains unclear and demands for a randomized study. Data have shown the benefit of public access defibrillation for dispatched rescuers (e.g. police and fire fighters) but data are not as strong for the use of automated defibrillators (AEDs) by trained or untrained rescuers. Postresuscitation, use of therapeutic hypothermia, the importance of specific prognostic survival factors in the intensive care unit and the widespread use of percutaneous coronary intervention have all been considered. Despite progress in research and improved treatment regimens, most patients do not survive OHCA. Particular areas of interest for improving survival include (i) identification of high-risk patients prior to their arrest (e.g. early warning symptoms and genes); (ii) increased use of bystander CPR training (e.g. in schools) and simplified CPR techniques; (iii) better identification of high-incidence sites and better recruitment of AEDs (via mobile phone solutions?); (iv) improved understanding of the use of therapeutic hypothermia; (v) determining which patients should undergo immediate coronary angiography on hospital admission; and (vi) clarifying the importance of extracorporeal membrane oxygenation during CPR. PMID:23480824

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

    Directory of Open Access Journals (Sweden)

    Busch Michael

    2008-09-01

    Full Text Available 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 prognostication, as well as the clinical importance of the different parameters used and the application of TH in these patients. Results Prognostication was conducted within 24–48 hours in the majority (72% of the participating ICUs. The most commonly applied parameters and tests were a clinical neurological examination (100%, prehospital data (76%, CCT (56% and EEG (52%. The parameters and tests considered to be of greatest importance for accurate prognostication were prehospital data (56%, neurological examination (52%, and EEG (20%. In 76% of the ICUs, a multidisciplinary approach to prognostication was applied, but only one ICU used a standardised protocol. Therapeutic hypothermia was in routine use in 80% of the surveyed ICUs. Conclusion Despite the routine use of TH, outcome prediction was performed early and was mainly based on prehospital information, neurological examination and CCT and EEG evaluation. Somatosensory evoked potentials appear to be underused and underrated, while the importance of prehospital data, CCT and EEG to appear to be overrated as methods for making accurate predictions. More evidence-based protocols for prognostication in cardiac arrest survivors, as well as additional studies on the effect of TH on known prognostic parameters are needed.

  3. 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)

  4. Development of a Web GIS Application for Visualizing and Analyzing Community Out of Hospital Cardiac Arrest Patterns

    OpenAIRE

    Semple, Hugh; Qin, Han; Sasson, Comilla

    2013-01-01

    Improving survival rates at the neighborhood level is increasingly seen as a priority for reducing overall rates of out-of-hospital cardiac arrest (OHCA) in the United States. Since wide disparities exist in OHCA rates at the neighborhood level, it is important for public health officials and residents to be able to quickly locate neighborhoods where people are at elevated risk for cardiac arrest and to target these areas for educational outreach and other mitigation strateg...

  5. Factors Associated With Successful Resuscitation After Out-of-Hospital Cardiac Arrest and Temporal Trends in Survival and Comorbidity

    DEFF Research Database (Denmark)

    SØholm, Helle; Hassager, Christian

    2015-01-01

    STUDY OBJECTIVE: Out-of-hospital cardiac arrest has an overall poor prognosis. We sought to identify what temporal trends and influencing factors existed for this condition in one region. METHODS: We studied consecutive out-of-hospital cardiac arrest patients from 2007 to 2011 with attempted resuscitation in Copenhagen. From an Utstein database, we assessed survival to admission and comorbidity with the Charlson comorbidity index from the National Patient Registry and employment status from the Danish Rational Economic Agents Model database. We used logistic regression analyses to identify factors associated with outcome. RESULTS: Of a total of 2,527 attempted resuscitations in out-of-hospital cardiac arrest patients, 40% (n=1,015) were successfully resuscitated and admitted to the hospital. The strongest independent factors associated with successful resuscitation were shockable primary rhythm (multivariate odds ratio [OR]=3.9; 95% confidence interval [CI] 3.1 to 5.0), witnessed arrest (multivariate OR=3.5; 95% CI 2.7 to 4.6), and out-of-hospital cardiac arrest in a public area (multivariate OR=2.1; 95% CI 1.6 to 2.8), whereas no comorbidity (multivariate OR=1.1; 95% CI 0.8 to 1.45), sex (multivariate OR=1.14; 95% CI 0.91 to 1.44), and employment status (multivariate OR=1.17; 95% CI 0.89 to 1.56) were not independently associated with outcome. The number of patients with a high comorbidity burden (Charlson comorbidity index ?3) increased during the study period (P trend <.001), from 18% to 31% (P trend <.001), whereas the percentage of out-of-hospital cardiac arrest patients with successful resuscitation to hospital admission increased by 3% per year during the study period, from 37% in 2007 to 43% in 2011 (P trend <.001). CONCLUSION: Our observations confirm the importance of key features that influence out-of-hospital cardiac arrest survival to hospital admission but are not highly influenced by public health actions. Despite increased illness burden, this short term outcome from cardiac arrest improved as care system efforts matured.

  6. 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.

  7. 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.

  8. 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.

  9. Out-of-hospital cardiac arrests in children and adolescents : Incidences, outcomes, and household socioeconomic status

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Wissenberg, Mads

    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 years); and high school adolescents/young adults (16-21 years). Multivariate logistic regression analyses were used to investigate associations between pre-hospital factors and study endpoints: return of spontaneous circulation and survival. RESULTS: A total of 459 individuals were included. Overall incidence of OHCA was 3.3 per 100,000 inhabitants per year. The incidence rates for infants, pre-school children, school children and high school adolescents were 11.5, 3.5, 1.3 and 5.3 per 100,000 inhabitants. Overall bystander CPR rate was 48.8%, and for age groups: 55.4%, 41.2%, 44.9% and 63.0%, respectively. Overall 30-day survival rate was 8.1%, and for age groups: 1.4%, 4.5%, 16.1% and 9.3%, respectively. High parental education was associated with improved survival after OHCA (OR 3.48, CI 1.27-9.41). Significant crude difference in survival (OR 3.18, CI 1.22-8.34) between high household incomes vs. low household incomes was found. CONCLUSION: OHCA incidences and survival rates varied significantly between age groups. High parental education was found to be associated with improved survival after OHCA.

  10. Out-of-Hospital Cardiac Arrests in Children and Adolescents : Incidences, Outcomes, and Household Socioeconomic Status

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Wissenberg, Mads

    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 2001-2010. The population was divided into infants (<1 year); pre-school children (1-5 years); school children (6-15 years); and high school adolescents/young adults (16-21 years). Multivariate logistic regression analyses were used to investigate associations between pre-hospital factors and study endpoints: return of spontaneous circulation and survival. RESULTS: A total of 459 individuals were included. Overall incidence of OHCA was 3.3 per 100,000 inhabitants per year. The incidence rates for infants, pre-school children, school children and high school adolescents were 11.5, 3.5, 1.3 and 5.3 per 100,000 inhabitants. Overall bystander CPR rate was 48.8%, and for age groups: 55.4%, 41.2%, 44.9% and 63.0%, respectively. Overall 30-day survival rate was 8.1%, and for age groups: 1.4%, 4.5%, 16.1% and 9.3%, respectively. High parental education was associated with improved survival after OHCA (OR 3.48, CI 1.27-9.41). Significant crude difference in survival (OR 3.18, CI 1.22-8.34) between high household incomes vs. low household incomes was found. CONCLUSION: OHCA incidences and survival rates varied significantly between age groups. High parental education was found to be associated with improved survival after OHCA.

  11. The Cardiocerebral Resuscitation protocol for treatment of out-of-hospital primary cardiac arrest

    Directory of Open Access Journals (Sweden)

    Ewy Gordon A

    2012-09-01

    Full Text Available Abstract Out-of-hospital cardiac arrest (OHCA is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF. But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol.

  12. Population density, call-response interval, and survival of out-of-hospital cardiac arrest

    Directory of Open Access Journals (Sweden)

    Ogawa Toshio

    2011-04-01

    Full Text Available Abstract Background Little is known about the effects of geographic variation on outcomes of out-of-hospital cardiac arrest (OHCA. The present study investigated the relationship between population density, time between emergency call and ambulance arrival, and survival of OHCA, using the All-Japan Utstein-style registry database, coupled with geographic information system (GIS data. Methods We examined data from 101,287 bystander-witnessed OHCA patients who received emergency medical services (EMS through 4,729 ambulatory centers in Japan between 2005 and 2007. Latitudes and longitudes of each center were determined with address-match geocoding, and linked with the Population Census data using GIS. The endpoints were 1-month survival and neurologically favorable 1-month survival defined as Glasgow-Pittsburgh cerebral performance categories 1 or 2. Results Overall 1-month survival was 7.8%. Neurologically favorable 1-month survival was 3.6%. In very low-density (2 and very high-density (?10,000/km2 areas, the mean call-response intervals were 9.3 and 6.2 minutes, 1-month survival rates were 5.4% and 9.1%, and neurologically favorable 1-month survival rates were 2.7% and 4.3%, respectively. After adjustment for age, sex, cause of arrest, first aid by bystander and the proportion of neighborhood elderly people ?65 yrs, patients in very high-density areas had a significantly higher survival rate (odds ratio (OR, 1.64; 95% confidence interval (CI, 1.44 - 1.87; p Conclusion Living in a low-density area was associated with an independent risk of delay in ambulance response, and a low survival rate in cases of OHCA. Distribution of EMS centers according to population size may lead to inequality in health outcomes between urban and rural areas.

  13. 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 ...

  14. Comparison of role of early (less than six hours) to later (more than six hours) or no cardiac catheterization after resuscitation from out-of-hospital cardiac arrest.

    Science.gov (United States)

    Strote, Justin A; Maynard, Charles; Olsufka, Michele; Nichol, Graham; Copass, Michael K; Cobb, Leonard A; Kim, Francis

    2012-02-15

    Despite reports of patients with resuscitated sudden cardiac arrest (rSCA) receiving acute cardiac catheterization, the efficacy of this strategy is largely unknown. We hypothesized that acute cardiac catheterization of patients with rSCA would improve survival to hospital discharge. A retrospective cohort of 240 patients with out-of-hospital rSCA caused by ventricular tachycardia or fibrillation was identified from 11 institutions in Seattle, Washington from 1999 through 2002. Patients were grouped into those receiving acute catheterization within 6 hours (?6-hour group, n = 61) and those with deferred catheterization at >6 hours or no catheterization during the index hospitalization (>6-hour group, n = 179). Attention was directed to survival to hospital discharge, neurologic status, extent of coronary artery disease, presenting electrocardiographic findings, and symptoms before arrest. Propensity-score methods were used to adjust for the likelihood of receiving acute catheterization. Survival was greater in patients who underwent acute catheterization (72% in the ?6-hour group vs 49% in the >6-hour group, p = 0.001). Percutaneous coronary intervention was performed in 38 of 61 patients (62%) in the ?6-hour group and 13 of 170 patients (7%) in the >6-hour group (p bystander cardiopulmonary resuscitation, daytime presentation, history of percutaneous coronary intervention or stroke, and acute ST-segment elevation were positively associated with receiving cardiac catheterization. In conclusion, in this series of patients who sustained out-of-hospital cardiac arrest, acute catheterization (<6 hours of presentation) was associated with improved survival. PMID:22100026

  15. Incidence of iatrogenic dyscarbia during mild therapeutic hypothermia after successful resuscitation from out-of-hospital cardiac arrest.

    Science.gov (United States)

    Falkenbach, Patrik; Kämäräinen, Antti; Mäkelä, Antti; Kurola, Jouni; Varpula, Tero; Ala-Kokko, Tero; Perttilä, Juha; Tenhunen, Jyrki

    2009-09-01

    To investigate the incidence of iatrogenic dyscarbia in survivors of out-of-hospital cardiac arrest treated with induced mild hypothermia.We performed a retrospective cohort study of the ventilatory management based on blood gas analyses of patients resuscitated from prehospital cardiac arrest. In the pilot phase, we assessed the ventilatory management in the patients treated in one university hospital during a 4-year study period. Subsequently, a more recent (1-year) retrospective cohort of resuscitated patients from all five Finnish university hospitals concerning the first 48h after hospital admission was analyzed. Core temperatures and temperature corrected (or non-corrected) blood gas analysis results with focus on carbon dioxide tension were analyzed. In addition, a survey was performed to investigate the ventilatory strategies in all Finnish hospitals providing mild hypothermia for cardiac arrest victims.The pilot cohort suggested a high incidence of hypo- or hyper-carbia during hypothermia treatment. In the multicenter patient population of 122 patients contributing a total of 1627 measurements, the PaCO(2) distribution was as follows: less than 4 kPa in 148 samples out of 1627 (9%), 4-4.6 kPa in 404 (25%), 4.7-6 kPa in 887 (55%) and more than 6 kPa in 188 samples (12%). There was a significant difference in the incidence of hypercarbia between the hospitals (p<0.05).We conclude that normocarbia was achieved/maintained only in approximately 55% of the samples. The incidence of hypo- or hyper-carbia (dyscarbia) was high (45%). This may predispose for serious derangements in the cerebral perfusion of the resuscitated patient. These results call for vigilance in adjustment of the ventilatory management to meet the needs of the patients treated with mild hypothermia. PMID:19586703

  16. Prediction of survival after out-of-hospital cardiac arrest: results of a community-based study in Vienna.

    Science.gov (United States)

    Gaul, G B; Gruska, M; Titscher, G; Blazek, G; Havelec, L; Marktl, W; Muellner, W; Kaff, A

    1996-10-01

    The objective of this study was the assessment of out-of-hospital cardiac arrest and the definition of possible predictive factors for final hospital discharge. Out of a database of 89,557 consecutive missions of the Vienna emergency medical system (EMS) during 1990, there were 623 missions due to a collapse of non-traumatic origin: in 374 cases (60.0%) the patients were declared dead without further attempts at resuscitation. The remaining 249 patients were analysed for predictive factors at site. Survival to hospital admission: 109 patients survived to hospital admission (43.7%); bystander support had a small impact (P < 0.05) on survival to hospital arrival whereas age and gender had no predictive power. Most patients with ventricular tachycardia/fibrillation (VT/VF) survived primarily (69 of 117, i.e. 59.0%). Survival to hospital discharge: 27 patients were discharged from hospital care (10.8%). ECG findings on arrival of the EMS physician at the site proved to be the only powerful predictor for survival: 24 of 117 patients with VT/VF survived compared with only one of 81 with primary asystole, two of 39 with severe bradycardia, and no patient with electromechanical dissociation. PMID:8923577

  17. Effectiveness of mechanical versus manual chest compressions in out-of-hospital cardiac arrest resuscitation: a pilot study.

    Science.gov (United States)

    Dickinson, E T; Verdile, V P; Schneider, R M; Salluzzo, R F

    1998-05-01

    A prospective, randomized effectiveness trial was undertaken to compare mechanical versus manual chest compressions as measured by end-tidal CO2 (ETCO2) in out-of-hospital cardiac arrest patients receiving advanced cardiac life support (ACLS) resuscitation from a municipal third-service, emergency medical services (EMS) agency. The EMS agency responds to approximately 6,700 emergencies annually, 79 of which were cardiac arrests in 1994, the study year. Following endotracheal intubation, all cardiac arrest patients were placed on 100% oxygen via the ventilator circuit of the mechanical cardiopulmonary resuscitation (CPR) device. Patients were randomized to receive mechanical CPR (TCPR) or human/manual CPR (HCPR) based on an odd/even day basis, with TCPR being performed on odd days. ETCO2 readings were obtained 5 minutes after the initiation of either TCPR or HCPR and again at the initiation of patient transport to the hospital. All patients received standard ACLS pharmacotherapy during the monitoring interval with the exception of sodium bicarbonate. CPR was continued until the patient was delivered to the hospital emergency department. Age, call response interval, initial electrocardiogram (ECG) rhythm, scene time, ETCO2 measurements, and arrest outcome were identified for all patients. Twenty patients were entered into the study, with 10 in each treatment group. Three patients in the TCPR group were excluded. Measurements in the HCPR group revealed a decreasing ETCO2 during the resuscitation in 8 of 10 patients (80%) and an increasing ETCO2 in the remaining 2 patients. No decrease in ETCO2 was noted in the TCPR group, with 4 of 7 patients (57%) actually showing an increased reading and 3 of 7 patients (43%) showing a constant ETCO2 reading. The differences in the ETCO2 measurements between TCPR and HCPR groups were statistically significant. Both groups were similar with regards to call response intervals, patient ages, scene times, and initial ECG rhythms. One patient in the TCPR group was admitted to the hospital but later died, leaving no survivors in the study. TCPR appears to be superior to standard HCPR as measured by ETCO2 in maintaining cardiac output during ACLS resuscitation of out-of-hospital cardiac arrest patients. PMID:9596436

  18. 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.

  19. 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

  20. 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

    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 care. DESIGN, SETTING, AND PARTICIPANTS Patients with out-of-hospital cardiac arrest for which resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29?111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n?=?7390) and those with cardiac arrests witnessed by emergency medical services personnel (n?=?2253), leaving a study population of 19?468 patients. MAIN OUTCOMES AND MEASURES Temporal trends in bystander CPR, bystander defibrillation, 30-day survival, and 1-year survival. RESULTS The median age of patients was 72 years; 67.4% were men. Bystander CPR increased significantly during the study period, from 21.1% (95% CI, 18.8%-23.4%) in 2001 to 44.9% (95% CI, 42.6%-47.1%) in 2010 (P?

  1. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl

    2011-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases.

  2. 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.

  3. Long QT interval in a patient after out-of-hospital cardiac arrest with hypocalcaemia, undergoing therapeutic hypothermia.

    Science.gov (United States)

    Szymanski, Filip M; Karpinski, Grzegorz; Platek, Anna E; Puchalski, Bartosz; Filipiak, Krzyszof J

    2013-12-01

    A 53-year-old woman was hospitalized after out-of-hospital cardiac arrest due to ventricular fibrillation. Initial electrocardioagram showed sinus rhythm of 117 beats per minute, 452 ms QTc interval, ST-segment depression up to 1 mm in V(2)-V(6), and ST-elevation in lead aVR. Patient was treated with primary coronary angioplasty and therapeutic hypothermia, during which QTc interval prolonged up to 616 ms and Osborn wave was seen in lead V(4), along with elevation of ST-segment in I, II, III, aVF, V(5) and V(6); negative T waves in I, II, aVL, aVF, and V(2)-V(6). Laboratory test results showed hypocalcaemia. After rewarming and ion correction QT abnormalities resolved. PMID:24029493

  4. Systematic downloading and analysis of data from automated external defibrillators used in out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Hansen, Marco Bo; Lippert, Freddy Knudsen

    2014-01-01

    BACKGROUND: Valuable information can be retrieved from automated external defibrillators (AEDs) used in victims of out-of-hospital cardiac arrest (OHCA). We describe our experience with systematic downloading of data from deployed AEDs. The primary aim was to compare the proportion of shockable rhythm from AEDs used by laypersons with the corresponding proportion recorded by the Emergency Medical Services (EMS) on arrival. METHODS: In a 20-month study, we collected data on OHCAs in the Capital Region of Denmark where an AED was deployed prior to arrival of EMS. The AEDs were brought to the emergency medical dispatch centre for data downloading and rhythm analysis. Patient data were retrieved from the medical records from the admitting hospital, whereas data on EMS rhythm analyses were obtained from the Danish Cardiac Arrest Register between 2001 and 2010. RESULTS: A total of 121 AEDs were deployed, of which 91 cases were OHCAs with presumed cardiac origin. The prevalence of initial shockable rhythm was 55.0% (95% CI [44.7-64.8%]). This was significantly greater than the proportion recorded by the EMS (27.6%, 95% CI [27.0-28.3%], p<0.0001). Shockable arrests were significantly more likely to be witnessed (92% vs. 34%, p<0.0001) and the bystander CPR rate was higher (98% vs. 85%, p=0.04). More patients with initial shockable rhythm achieved return of spontaneous circulation upon hospital arrival (88% vs. 7%, p<0.0001) and had higher 30-day survival rate (72% vs. 5%, p<0.0001). CONCLUSION: AEDs used by laypersons revealed a higher proportion of shockable rhythms compared to the EMS rhythm analyses.

  5. 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.

  6. Assessment of the Efficacy of Pulsed Biphasic Defibrillation Shocks for Treatment of Out-of-hospital Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Jean-Philippe Didon

    2008-10-01

    Full Text Available This study evaluates the efficacy of a Pulsed Biphasic Waveform (PBW for treatment of out-of-hospital cardiac arrest (OHCA patients in ventricular fibrillation (VF. Large database (2001-2006, collected with automated external defibrillators (AED, (FRED®, Schiller Medical SAS, France, is processed.In Study1 we compared the defibrillation efficacy of two energy stacks (90-130-180 J vs. (130-130-180 J in 248 OHCA VF patients. The analysis of the first shock PBW efficacy proves that energies as low as 90 J are able to terminate VF in a large proportion of OHCA patients (77% at 5 s and 69% at 30 s. Although the results show a trend towards the benefit of higher energy PBW with 130 J (86% at 5 s, 73% at 30 s, the difference in shock efficacy does not reach statistical significance. Both PBW energy stacks (90-130-180 J and (130-130-180 J achieve equal success rates of defibrillation. Analysis of the post-shock rhythm after the first shock is also provided.For Study2 of 21 patients with PBW shocks (130-130-180 J, we assessed some attending OHCA circumstances: call-to-shock delay (median 16min, range 11-41 min, phone advices of CPR (67%. About 50% of the patients were admitted alive to hospital, and 19% were discharged from hospital. After the first shock, patients admitted to hospital are more often presenting organized rhythm (OR (27% to 55% than patients not admitted (0% to 10%, with significant difference at 15 s and 30 s. Post-shock VFs appear significantly rare until 15s for patients admitted to hospital (0% to 9% than for patients not admitted to hospital (40% to 50%. Return of OR (ROOR and efficacy to defibrillate VF at 5 s and 15 s with first shock are important markers to predict patient admission to hospital.

  7. 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.

  8. Out of hospital cardiac arrest outside home in Sweden, change in characteristics, outcome and availability for public access defibrillation

    Directory of Open Access Journals (Sweden)

    Rosenqvist Mårten

    2009-04-01

    Full Text Available Abstract Background A large proportion of patients who suffer from out of hospital cardiac arrest (OHCA outside home are theoretically candidates for public access defibrillation (PAD. We describe the change in characteristics and outcome among these candidates in a 14 years perspective in Sweden. Methods All patients who suffered an OHCA in whom cardiopulmonary resuscitation (CPR was attempted between 1992 and 2005 and who were included in the Swedish Cardiac Arrest Register (SCAR. We included patients in the survey if OHCA took place outside home excluding crew witnessed cases and those taken place in a nursing home. Results 26% of all OHCAs (10133 patients out of 38710 patients fulfilled the inclusion criteria. Within this group, the number of patients each year varied between 530 and 896 and the median age decreased from 68 years in 1992 to 64 years in 2005 (p for trend = 0.003. The proportion of patients who received bystander CPR increased from 47% in 1992 to 58% in 2005 (p for trend The median time from cardiac arrest to defibrillation among witnessed cases was 12 min in 1992 and 10 min in 2005 (p for trend = 0.029. Survival to one month among all patients increased from 8.1% to 14.0% (p for trend = 0.01. Among patients found in a shockable rhythm survival increased from 15.3% in 1992 to 27.0% in 2005 (p for trend Conclusion In Sweden, there was a change in characteristics and outcome among patients who suffer OHCA outside home. Among these patients, bystander CPR increased, but the occurrence of VF decreased. One-month survival increased moderately overall and highly significantly among patients found in VF, even though the time to defibrillation changed only moderately.

  9. 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.

  10. Survival after Out-of-Hospital Cardiac Arrest in Relation to Sex : A Nationwide Registry-based Study

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Hansen, Carolina Malta

    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 20012010. A total of 19,372 patients were included. RESULTS: One-third were female, with a median age of 75 years (IQR 65-83). Compared to females, males were five years younger; and less likely to have severe comorbidities e.g. chronic obstructive pulmonary disease (12.8% vs. 16.5%); but more likely to have arrest outside of the home (29.4% vs. 18.7%), receive bystander CPR (32.9% vs. 25.9%), and have a shockable rhythm (32.6% vs. 17.2%), all p<0.001. Thirty-day crude survival increased in males (3.0% in 2001 to 12.9% in 2010); and in females (4.8% in 2001 to 6.7% in 2010), p<0.001. Multivariable logistic regression analyses adjusted for patient characteristics including comorbidities, showed no survival difference between sexes in patients with a non-shockable rhythm (OR1.00;CI0.72-1.40), while female sex was positively associated with survival in patients with a shockable rhythm (OR1.31;CI1.07-1.59). Analyses were rhythm-stratified due to interaction between sex and heart rhythm. There was no interaction between sex and calendar-year. CONCLUSIONS: Temporal increase in crude survival was more marked in males due to poorer prognostic characteristics in females with a lower proportion of shockable rhythm. In an adjusted model, female sex was positively associated with survival in patients with a shockable rhythm.

  11. Survival after out-of-hospital cardiac arrest in relation to sex : A nationwide registry-based study

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Hansen, Carolina Malta

    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). Compared to females, males were five years younger; and less likely to have severe comorbidities, e.g., chronic obstructive pulmonary disease (12.8% vs. 16.5%); but more likely to have arrest outside of the home (29.4% vs. 18.7%), receive bystander CPR (32.9% vs. 25.9%), and have a shockable rhythm (32.6% vs. 17.2%), all p<0.001. Thirty-day crude survival increased in males (3.0% in 2001 to 12.9% in 2010); and in females (4.8% in 2001 to 6.7% in 2010), p<0.001. Multivariable logistic regression analyses adjusted for patient characteristics including comorbidities, showed no survival difference between sexes in patients with a non-shockable rhythm (OR 1.00; CI 0.72-1.40), while female sex was positively associated with survival in patients with a shockable rhythm (OR 1.31; CI 1.07-1.59). Analyses were rhythm-stratified due to interaction between sex and heart rhythm; there was no interaction between sex and calendar-year. CONCLUSIONS: Temporal increase in crude survival was more marked in males due to poorer prognostic characteristics in females with a lower proportion of shockable rhythm. In an adjusted model, female sex was positively associated with survival in patients with a shockable rhythm.

  12. Survival after out-of-hospital cardiac arrest in relation to sex : a nationwide registry-based study

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Hansen, Carolina Malta

    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). Compared to females, males were five years younger; and less likely to have severe comorbidities, e.g., chronic obstructive pulmonary disease (12.8% vs. 16.5%); but more likely to have arrest outside of the home (29.4% vs. 18.7%), receive bystander CPR (32.9% vs. 25.9%), and have a shockable rhythm (32.6% vs. 17.2%), all p<0.001. Thirty-day crude survival increased in males (3.0% in 2001 to 12.9% in 2010); and in females (4.8% in 2001 to 6.7% in 2010), p<0.001. Multivariable logistic regression analyses adjusted for patient characteristics including comorbidities, showed no survival difference between sexes in patients with a non-shockable rhythm (OR 1.00; CI 0.72-1.40), while female sex was positively associated with survival in patients with a shockable rhythm (OR 1.31; CI 1.07-1.59). Analyses were rhythm-stratified due to interaction between sex and heart rhythm; there was no interaction between sex and calendar-year. CONCLUSIONS: Temporal increase in crude survival was more marked in males due to poorer prognostic characteristics in females with a lower proportion of shockable rhythm. In an adjusted model, female sex was positively associated with survival in patients with a shockable rhythm.

  13. 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 and followed for 48 hours. Results: Serum potassium levels decreased during cooling from a median admission value of 4.0?mmol/L (quartiles 3.6-4.5?mmol/L) to a nadir of 3.6?mmol/L (3.5-3.9?mmol/L) 6 hours after target temperature (p=0.005), and 76% reached values of 5.5?mmol/L. Potassium supplementation was initiated at 3.5?mmol/L (quartiles 3.2-3.6?mmol/L) and stopped at 4.5?mmol/L (4.1-4.8?mmol/L). A total of 11% of patients experienced ventricular fibrillation (VF) or ventricular tachycardia (VT). Potassium levels in patients experiencing VF or VT were lower, though not significantly (p=0.119) compared to the rest of the patients. Conclusion: Serum potassium decreases significantly during the induction of TH (p=0.005). Potassium levels were not found to be different in patients with and without VF/VT in this study, perhaps due to the low number of patients, as a difference has been seen in other studies. It is recommended that an infusion of supplementary potassium be initiated during the early cooling phase in order to avoid severe hypokalemia (serum potassium 5.5?mmol/L), as serum potassium increases during rewarming.

  14. ECG Case of the Month: Out-of-Hospital Cardiac Arrest.

    Science.gov (United States)

    El Hajj, Stephanie C; Bordelon, Curley J; Glancy, D Luke

    2014-01-01

    A muscular-appearing 50-year-old man was found down in his home by family members. Paramedics documented pulseless electrical activity and began cardiopulmonary resuscitation that included placement of an endotracheal tube. The resuscitation was continued in the hospital emergency department (ED), and after 20 minutes, an arterial pulse returned. An electrocardiogram (ECG) was obtained (Figure 1). Meanwhile, a past history established that the patient was a personal trainer who seemed fit and healthy until 10 days earlier, when he came to the ED because he had begun to lose his balance and fall frequently. Computed tomography (CT) at that time revealed lytic lesions in the fifth lumbar vertebra and extensive retroperitoneal lymphadenopathy involving the aortic, iliac, and obturator chains and the perirectal region. Arrangements had then been made for outpatient workup of a presumed malignancy. PMID:25311462

  15. 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.

  16. 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.

  17. 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.

  18. Does Pre-hospital Endotracheal Intubation Improve Survival in Adults with Non-traumatic Out-of-hospital Cardiac Arrest? A Systematic Review

    Directory of Open Access Journals (Sweden)

    Ling Tiah

    2014-11-01

    Full Text Available Introduction: Endotracheal intubation (ETI is currently considered superior to supraglottic airway devices (SGA for survival and other outcomes among adults with non-traumatic out-of-hospital cardiac arrest (OHCA. We aimed to determine if the research supports this conclusion by conducting a systematic review. Methods: We searched the MEDLINE, Scopus and CINAHL databases for studies published between January 1, 1980, and 30 April 30, 2013, which compared pre-hospital use of ETI with SGA for outcomes of return of spontaneous circulation (ROSC; survival to hospital admission; survival to hospital discharge; and favorable neurological or functional status. We selected studies using pre-specified criteria. Included studies were independently screened for quality using the Newcastle-Ottawa scale. We did not pool results because of study variability. Study outcomes were extracted and results presented as summed odds ratios with 95% CI. Results: We identified five eligible studies: one quasi-randomized controlled trial and four cohort studies, involving 303,348 patients in total. Only three of the five studies reported a higher proportion of ROSC with ETI versus SGA with no difference reported in the remaining two. None found significant differences between ETI and SGA for survival to hospital admission or discharge. One study reported better functional status at discharge for ETI versus SGA. Two studies reported no significant difference for favorable neurological status between ETI and SGA. Conclusion: Current evidence does not conclusively support the superiority of ETI over SGA for multiple outcomes among adults with OHCA. [West J Emerg Med. 2014;15(7:-0.

  19. 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.

  20. 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.

  1. Risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about what lifestyle means to them : a mixed methods study

    OpenAIRE

    Forslund, Ann-sofie; Lundblad, Dan; Jansson, Jan-ha?kan; Zingmark, Karin; So?derberg, Siv

    2013-01-01

    Background: The known risk factors for coronary heart disease among people prior suffering an out-of-hospital cardiac arrest with validated myocardial infarction aetiology and their thoughts about what lifestyle means to them after surviving have rarely been described. Therefore the aim of the study was to describe risk factors and lifestyle among survivors. Methods: An explanatory mixed methods design was used. All people registered in the Northern Sweden MONICA myocardial registry between t...

  2. 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.

  3. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions-A nationwide prospective feasibility study

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl

    2010-01-01

    AIM OF THE STUDY: Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases. METHODS: We conducted a prospective, observational study of out-of-hospital cardiac arrest with non-traumatic etiology (>18 years of age) occurring from the 1st to the 31st of January 2009 and treated by the primary Danish emergency medical service operator, covering approximately 85% of the population. One hundred and ninety-one cases were eligible for analysis. Follow-up was up to one year or death. Quality of CPR was evaluated using measurements of transthoracic impedance. RESULTS: The majority of patients were treated by ambulances with ALS capability (54%). Interruptions in CPR related to loading of the patient into the emergency medical service vehicle were substantial, but independent of whether patients were managed by ALS or BLS capable units (222s versus 224s, P=0.76) as were duration of interruptions during rhythm analysis alone (20s versus 22s, P=0.33) and defibrillation (24s versus 26s, P=0.07). CONCLUSIONS: Nationwide, routine monitoring of transthoracic impedance is feasible. CPR is hampered by extended interruptions, particularly during loading of the patient into the emergency medical service vehicle, rhythm analysis and defibrillation.

  4. 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.

  5. 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

    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 for post-resuscitation data. Exercise was defined as moderate/vigorous physical activity. RESULTS: A total of 1393 OHCA-patients were included with 91(7%) arrests occurring during exercise. Exercise-related OHCA-patients were younger (60 ± 13 vs. 65 ± 15, p<0.001) and predominantly male (96% vs. 69%, p<0.001). The arrest was more frequently witnessed (94% vs. 86%, p=0.02), bystander CPR was more often performed (88% vs. 54%, p<0.001), time to ROSC was shorter (12 min (IQR: 5-19) vs. 15 (9-22), p=0.007) and the primary rhythm was more frequently shock-able (91% vs. 49%, p<0.001) compared to non-exercise patients. Cardiac etiology was the predominant cause of OHCA in both exercise and non-exercise patients (97% vs. 80%, p<0.001) and acute coronary syndrome was more frequent among exercise patients (59% vs. 38%, p<0.001). One-year mortality was 25% vs. 65% (p<0.001), and exercise was even after adjustment associated with a significantly lower mortality (HR=0.40 (95%CI: 0.23-0.72), p=0.002). CONCLUSIONS: OHCA occurring during exercise was associated with a significantly lower mortality in successfully resuscitated patients even after adjusting for confounding factors. Acute coronary syndrome was more common among exercise-related cardiac arrest patients.

  6. 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.

  7. 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.

  8. No Fate But What We Make: a Case of Full Recovery After Out-of-Hospital Cardiac Arrest

    OpenAIRE

    Andrade Maria J; Ferreira Jorge; Sousa Pedro J; Miranda Mafalda; Gonçalves Pedro A; Romão Cristina

    2009-01-01

    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 departme...

  9. 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.

  10. Out-of-hospital CPR: better outcome for our patients

    OpenAIRE

    Golia, Enrica; Piro, Maddalena; Tubaro, Marco

    2011-01-01

    Out-of-hospital cardiac arrest is a leading cause of death in developed countries and early resuscitation attempts are crucial to improve survival rates and neurological outcome. Gräsner and colleagues performed an intriguing analysis on the combined approach of mild therapeutic hypothermia (MTH) and immediate percutaneous coronary intervention (PCI) for post-resuscitation care of 584 patients with out-of-hospital cardiac arrest from the German Resuscitation Registry. PCI was independently as...

  11. Treatment and outcomes of ST segment elevation myocardial infarction and out-of-hospital cardiac arrest in a regionalized system of care based on presence or absence of initial shockable cardiac arrest rhythm.

    Science.gov (United States)

    Thomas, Joseph L; Bosson, Nichole; Kaji, Amy H; Ji, Yong; Sung, Gene; Shavelle, David M; French, William J; Koenig, William; Niemann, James T

    2014-10-01

    The aim of this study was to evaluate the treatment and outcomes of patients with ST-segment elevation myocardial infarctions complicated by out-of-hospital cardiac arrest in a regional system of care. In this retrospective study, the effect of the absence of an initial shockable arrest rhythm was analyzed. The primary end point of survival with good neurologic outcome in patients with and without an initial shockable arrest rhythm was adjusted for age, witnessed arrest, bystander cardiopulmonary resuscitation, and treatment with therapeutic hypothermia and percutaneous coronary intervention. One-hundred sixty-eight of 348 patients (49%) survived to hospital discharge. Patients with a shockable initial rhythm were more likely to receive therapeutic hypothermia (48% vs 37%, risk ratio 1.2, 95% confidence interval [CI] 1.0 to 1.5) and to be treated in the cardiac catheterization laboratory (80% vs 43%, risk ratio 2.8, 95% CI 2.0 to 3.8). The likelihood of survival with good neurologic outcome in patients with a shockable initial rhythm compared with those presenting without a shockable rhythm was 4.8 (95% CI 2.7 to 8.7). In patients who underwent percutaneous coronary intervention, the likelihood of survival with good neurologic outcome was higher (risk ratio 2.7, 95% CI 1.1 to 6.8) in those with a shockable rhythm. In conclusion, the absence of an initial shockable rhythm in patients with ST-segment elevation myocardial infarctions plus out-of-hospital cardiac arrest is associated with significantly worse survival and neurologic outcome. These differences persist despite application of therapies including therapeutic hypothermia and percutaneous coronary intervention within a regionalized system of care. PMID:25118120

  12. 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.

  13. 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.

  14. 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 to 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 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 Rhythmic Delta Activity (RDA) seem to be associated with a better prognosis, whereas suppressed voltage and burst-suppression patterns were associated with poor prognosis.

  15. 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.

  16. Predictors of survival and favorable functional outcomes after an out-of-hospital cardiac arrest in patients systematically brought to a dedicated heart attack center (from the Harefield Cardiac Arrest Study).

    Science.gov (United States)

    Iqbal, M Bilal; Al-Hussaini, Abtehale; Rosser, Gareth; Salehi, Saleem; Phylactou, Maria; Rajakulasingham, Ramyah; Patel, Jayna; Elliott, Katharine; Mohan, Poornima; Green, Rebecca; Whitbread, Mark; Smith, Robert; Ilsley, Charles

    2015-03-15

    Despite advances in cardiopulmonary resuscitation (CPR), survival remains low after out-of-hospital cardiac arrest (OOHCA). Acute coronary ischemia is the predominating precipitant, and prompt delivery of patients to dedicated facilities may improve outcomes. Since 2011, all patients experiencing OOHCA in London, where a cardiac etiology is suspected, are systematically brought to heart attack centers (HACs). We determined the predictors for survival and favorable functional outcomes in this setting. We analyzed 174 consecutive patients experiencing OOHCA from 2011 to 2013 brought to Harefield Hospital-a designated HAC in London. We analyzed (1) all-cause mortality and (2) functional status using a modified Rankin scale (mRS 0 to 6, where mRS0-3(+) = favorable functional status). The overall survival rates were 66.7% (30 days) and 62.1% (1 year); and 54.5% had mRS0-3(+) at discharge. Patients with mRS0-3(+) had reduced mortality compared to mRS0-3(-): 30 days (1.2% vs 72.2%, p <0.001) and 1 year (5.3% vs 77.2%, p <0.001). Multivariate analyses identified lower patient comorbidity, absence of cardiogenic shock, bystander CPR, ventricular tachycardia/ventricullar fibrillation as initial rhythm, shorter duration of resuscitation, prehospital advanced airway, absence of adrenaline and inotrope use, and intra-aortic balloon pump use as predictors of mRS0-3(+). Consistent predictors of increased mortality were the presence of cardiogenic shock, advanced airway use, increased duration of resuscitation, and absence of therapeutic hypothermia. A streamlined delivery of patients experiencing OOHCA to dedicated facilities is associated with improved functional status and survival. Our study supports the standardization of care for such patients with the widespread adoption of HACs. PMID:25644852

  17. 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.

  18. 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.

  19. 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.

  20. 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).

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

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

    OpenAIRE

    Ravindranath, Thyyar M.; John Scott Baird

    2012-01-01

    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 sophistic...

  10. 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.

  11. 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

  12. Various aspects of treatment in cardiac arrest prior to hospital arrival

    OpenAIRE

    Nordberg, Per

    2014-01-01

    Background and aims: Out-of-hospital cardiac arrest (OHCA) is a major public health issue, affecting almost 300,000 victims per year in Europe, who have an overall survival rate of about 10 per cent. In general, the current Emergency Medical Services (EMS) do not have the capacity to act quickly and effectively enough in regard to this vast group of patients. The objectives of the current work were: to study the importance of bystander cardiopulmonary resuscitation (CPR) from a...

  13. Electrocardiogram characteristics prior to in-hospital cardiac arrest.

    Science.gov (United States)

    Attin, Mina; Feld, Gregory; Lemus, Hector; Najarian, Kayvan; Shandilya, Sharad; Wang, Lu; Sabouriazad, Pouya; Lin, Chii-Dean

    2015-06-01

    Survival after in-hospital cardiac arrest (I-HCA) remains time of occurrence and location of ST segment changes prior to I-HCA. Increased age was significantly associated with failure to survive to discharge (p machine learning model for I-HCA. PMID:25236259

  14. Estimating the out-of-hospital mortality rate using patient discharge data

    OpenAIRE

    Farsi, Mehdi; Ridder, Geert

    2006-01-01

    This paper is a case study of the use of public use administrative data for the estimation of empirical relations when key dependent variables are not available in the data. It is shown that the out-of-hospital mortality rates can be identified using the patient discharge data without post-discharge death records. Using data on the lengths of hospitalizations and out-of-hospital spells, the mortality rates before and after discharge as well as discharge and re-hospitalization rates are estima...

  15. Out-of-pocket costs for paediatric admissions in district hospitals in Kenya

    OpenAIRE

    Barasa, EW; Ayieko, P; Cleary, S.; ENGLISH, M.

    2012-01-01

    Objective To describe out-of-pocket costs of inpatient care for children under 5years of age in district hospitals in Kenya. Methods A total of 256 caretakers of admitted children were interviewed in 2-week surveys conducted in eight hospitals in four provinces in Kenya. Caretakers were asked to report care seeking behaviour and expenditure related to accessing inpatient care. Family socio-economic status was assessed through reported expenditure in the previous month. Results Seventy eight p...

  16. Cost-effectiveness of Out-of-Hospital Continuous Positive Airway Pressure for Acute Respiratory Failure

    Science.gov (United States)

    Thokala, Praveen; Goodacre, Steve; Ward, Matt; Penn-Ashman, Jerry; Perkins, Gavin D.

    2015-01-01

    Study objective We determine the cost-effectiveness of out-of-hospital continuous positive airway pressure (CPAP) compared with standard care for adults presenting to emergency medical services with acute respiratory failure. Methods We developed an economic model using a United Kingdom health care system perspective to compare the costs and health outcomes of out-of-hospital CPAP to standard care (inhospital noninvasive ventilation) when applied to a hypothetical cohort of patients with acute respiratory failure. The model assigned each patient a probability of intubation or death, depending on the patient’s characteristics and whether he or she had out-of-hospital CPAP or standard care. The patients who survived accrued lifetime quality-adjusted life-years (QALYs) and health care costs according to their age and sex. Costs were accrued through intervention and hospital treatment costs, which depended on patient outcomes. All results were converted into US dollars, using the Organisation for Economic Co-operation and Development purchasing power parities rates. Results Out-of-hospital CPAP was more effective than standard care but was also more expensive, with an incremental cost-effectiveness ratio of £20,514 per QALY ($29,720/QALY) and a 49.5% probability of being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold. The probability of out-of-hospital CPAP’s being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold depended on the incidence of eligible patients and varied from 35.4% when a low estimate of incidence was used to 93.8% with a high estimate. Variation in the incidence of eligible patients also had a marked influence on the expected value of sample information for a future randomized trial. Conclusion The cost-effectiveness of out-of-hospital CPAP is uncertain. The incidence of patients eligible for out-of-hospital CPAP appears to be the key determinant of cost-effectiveness. PMID:25737210

  17. 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.

  18. Microbial Contamination of Staff’s Hand while Going out of Hospital

    Directory of Open Access Journals (Sweden)

    Naderinasab, M. (PhD

    2013-01-01

    Full Text Available Background and Objective: Cross-transmission of microorganisms by the hands of health care workers is considered as a main transmission route of nosocomial infections. The aim of this study was to investigate the microbial contamination of health-care worker’s hands while going out of hospital. Material and Methods: Wearing the sterile glove with liquid culture, we obtained 100 Samples from the staff’s hands of three departments (clerical department, emergency ward and central laboratory of Emam Reza hospital. After that, the samples were cultured. Results: Of all personnel, 40% have the habit of washing their hands. Of these, 95 percent wash their hands with water and soap, and 5 percent with alcohol rubs. Of 100 cultured samples, 90 have microorganisms including non-pathogen gram-positive bacillus (29%, coagulase-positive staphylococcus (39%, coagulase-negative staphylococcus (47%, Enterococci (3%, micrococcus (25% and candida (3%. Contamination in those who had not washed their hands is 62.6% and in those who washed is 37.7% (P=0.04. Conclusion: Hands of health-care workers become progressively contaminated by the potential pathogens during daily activities. To reduce the rate of contamination, it is helpful if we ask staff to wash their hands while going out of hospital. Keywords: Microbial Flora; Hospital’s Staff; Hand Washing

  19. Audit of cardiac catheterisation in a district general hospital: implications for training

    OpenAIRE

    SMITH, L; Spyer, G; Dean, J.

    1999-01-01

    OBJECTIVE—To assess complications of diagnostic cardiac catheterisation in a non-surgical centre by review of the first three years' experience and audit of 2804 diagnostic left heart procedures.?DESIGN—Analysis of a prospective database of cardiac catheter procedures.?SETTING—District general hospital without available on site cardiac surgery.?RESULTS—The rate of major complications of cardiac catheterisation was 0.07%. Mortality was 0.07%, and the rate of arterial complications (requiring s...

  20. 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.

  1. Getting the most out of cardiac rehabilitation: a review of referral and adherence predictors

    OpenAIRE

    Jackson, L.; Leclerc, J.; Erskine, Y.; Linden, W.

    2005-01-01

    Comprehensive cardiac rehabilitation reduces mortality and morbidity but is utilised by only a fraction of eligible cardiac patients, with the participation rate of women being only about half that of men. This quantitative review assesses 32 studies meeting inclusion criteria, describing 16 804 patients, 5882 of whom were female. It was found that the main predictor of referral to a cardiac rehabilitation programme was the physician’s endorsement of the effectiveness of such a programme. P...

  2. Nutritional Status of the Cardiac Patients Hospitalized in Cardiology Ward of Alzahra Hospital and its Comparison with Healthy Eating Index

    OpenAIRE

    N. Bahreini; M. Entezari; A. Hassansadeh; M. Ganjalideshti; Jalali, M

    2007-01-01

    Cardiovascular diseases are getting epidemic due to social reconstruction, technology advancement and over population in urban areas, inappropriate food habits and immobility. This study has tried to define the indexes of healthy nutrition in cardiac patients hospitalized in cardiac ward of Alzahra hospital and to compare it with Healthy Eating Index (HEI). Healthy Eating Index has been also designed to evaluate diet quality in different societies. This is a descriptive analytical study...

  3. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management.

    Science.gov (United States)

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

    2007-01-01

    A review of U.S. poison center data for 2004 showed over 40,000 exposures to salicylate-containing products. A guideline that determines the conditions for emergency department referral and pre-hospital 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 out-of-hospital management of patients with a suspected exposure to salicylates by 1) describing the process by which a specialist in poison information should evaluate an exposure to salicylates, 2) identifying the key decision elements in managing cases of salicylate exposure, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. 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) Patients with stated or suspected self-harm or who are the victims of a potentially malicious administration of a salicylate, should be referred to an emergency department immediately. This referral should be guided by local poison center procedures. In general, this should occur regardless of the dose reported (Grade D). 2) The presence of typical symptoms of salicylate toxicity such as hematemesis, tachypnea, hyperpnea, dyspnea, tinnitus, deafness, lethargy, seizures, unexplained lethargy, or confusion warrants referral to an emergency department for evaluation (Grade C). 3) Patients who exhibit typical symptoms of salicylate toxicity or nonspecific symptoms such as unexplained lethargy, confusion, or dyspnea, which could indicate the development of chronic salicylate toxicity, should be referred to an emergency department (Grade C). 4) Patients without evidence of self-harm should have further evaluation, including determination of the dose, time of ingestion, presence of symptoms, history of other medical conditions, and the presence of co-ingestants. The acute ingestion of more than 150 mg/kg or 6.5 g of aspirin equivalent, whichever is less, warrants referral to an emergency department. Ingestion of greater than a lick or taste of oil of wintergreen (98% methyl salicylate) by children under 6 years of age and more than 4 mL of oil of wintergreen by patients 6 years of age and older could cause systemic salicylate toxicity and warrants referral to an emergency department (Grade C). 5) Do not induce emesis for ingestions of salicylates (Grade D). 6) Consider the out-of-hospital administration of activated charcoal for acute ingestions of a toxic dose if it is immediately available, no contraindications are present, the patient is not vomiting, and local guidelines for its out-of-hospital use are observed. However, do not delay transportation in order to administer activated charcoal (Grade D). 7) Women in the last trimester of pregnancy who ingest below the dose for emergency department referral and do not have other referral conditions should be directed to their primary care physician, obstetrician, or a non-emergent health care facility for evaluation of maternal and fetal risk. Routine referral to an emergency department for immediate

  4. 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.

  5. Ambient air pollution, temperature and out-of-hospital coronary deaths in Shanghai, China.

    Science.gov (United States)

    Dai, Jinping; Chen, Renjie; Meng, Xia; Yang, Changyuan; Zhao, Zhuohui; Kan, Haidong

    2015-08-01

    Few studies have evaluated the effects of ambient air pollution and temperature in triggering out-of-hospital coronary deaths (OHCDs) in China. We evaluated the associations of air pollution and temperature with daily OHCDs in Shanghai, China from 2006 to 2011. We applied an over-dispersed generalized additive model and a distributed lag nonlinear model to analyze the effects of air pollution and temperature, respectively. A 10 ?g/m(3) increase in the present-day PM10, PM2.5, SO2, NO2 and CO were associated with increases in OHCD mortality of 0.49%, 0.68%, 0.88%, 1.60% and 0.08%, respectively. A 1 °C decrease below the minimum-mortality temperature corresponded to a 3.81% increase in OHCD mortality on lags days 0-21, and a 1 °C increase above minimum-mortality temperature corresponded to a 4.61% increase over lag days 0-3. No effects were found for in-hospital coronary deaths. This analysis suggests that air pollution, low temperature and high temperature may increase the risk of OHCDs. PMID:25875162

  6. 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

  7. Prevalence of 22q11.2 microdeletion in 146 patients with cardiac malformation in a referral hospital of North India

    Science.gov (United States)

    2010-01-01

    Background The 22q11.2 microdeletion syndrome is a common condition that is associated with cardiac as well as extra-cardiac manifestations. Its prevalence and manifestations from north India has not been reported. This study was designed to determine the prevalence and ability of clinical criteria to predict 22q11.2 microdeletion. Methods A total of 146 cases of cardiac malformation requiring tertiary care at a teaching hospital were prospectively screened for 22q11.2 microdeletion using fluorescence in situ hybridization test. Detailed clinical information was obtained as per guidelines of Tobias, et al (1999). Results Nine out of 146 patients (6.16%) was found to have 22q11.2 microdeletion. All the positive patients showed the presence of extra-cardiac features of 22q11.2 microdeletion syndrome. None of the cases with isolated cardiac defect were positive for microdeletion. Conclusions It seems that 22q11.2 microdeletion syndrome is over-suspected in children with isolated congenital heart defects. Screening for 22q11.2 microdeletion should be considered in those cardiac malformation cases which have extra-cardiac manifestations in the form of facial dysmorphism and hypocalcaemia. PMID:20573211

  8. Cardiocerebral resuscitation: advances in cardiac arrest resuscitation

    Directory of Open Access Journals (Sweden)

    Erwin Mulia

    2011-11-01

    Full Text Available 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 arrest. Because cardiocerebral resuscitation results in improved survival and cerebral function in patients with witnessed cardiac arrest and a shockable rhythm whom have greatest chance of survival, it should replace CPR especially for non hospitalized cardiac arrest.(Med J Indones 2011; 20:306-9Keywords: cardiocerebral resuscitation, cardiac arrest,  cardiopulmonary resuscitation

  9. Effect of bystander initiated cardiopulmonary resuscitation on ventricular fibrillation and survival after witnessed cardiac arrest outside hospital.

    OpenAIRE

    Herlitz, J.; Ekstro?m, L.; Wennerblom, B.; Axelsson, A.; Ba?ng, A.; Holmberg, S.

    1994-01-01

    OBJECTIVE--To describe the proportion of patients who were discharged from hospital after witnessed cardiac arrest outside hospital in relation to whether a bystander initiated cardiopulmonary resuscitation. PATIENTS--All patients with witnessed cardiac arrest outside hospital before arrival of the ambulance and in whom cardiopulmonary resuscitation was attempted by the emergency medical service in Gothenburg during 1980-92. RESULTS--Cardiopulmonary resuscitation was initiated by a bystander ...

  10. 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...

  11. 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.

  12. 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%) chilory 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)

  13. HOW DO HOSPITALS RESPOND TO MARKET ENTRY? EVIDENCE FROM A DEREGULATED MARKET FOR CARDIAC REVASCULARIZATION.

    Science.gov (United States)

    Li, Suhui; Dor, Avi

    2014-07-01

    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. Copyright © 2014 John Wiley & Sons, Ltd. PMID:24990327

  14. 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.

  15. 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

  16. Utility of a dedicated pediatric cardiac anticoagulation program: the Boston Children's Hospital experience.

    Science.gov (United States)

    Murray, Jenna M; Hellinger, Amy; Dionne, Roger; Brown, Loren; Galvin, Rosemary; Griggs, Suzanne; Mittler, Karen; Harney, Kathy; Manzi, Shannon; VanderPluym, Christina; Baker, Annette; O'Brien, Patricia; O'Connell, Cheryl; Almond, Christopher S

    2015-04-01

    Congenital heart disease is the leading cause of stroke in children. Warfarin therapy can be difficult to manage safely in this population because of its narrow therapeutic index, multiple drug and dietary interactions, small patient size, high-risk cardiac indications, and lack of data to support anticoagulation recommendations. We sought to describe our institution's effort to develop a dedicated cardiac anticoagulation service to address the special needs of this population and to review the literature. In 2009, in response to Joint Commission National Patient Safety Goals for Anticoagulation, Boston Children's Hospital created a dedicated pediatric Cardiac Anticoagulation Monitoring Program (CAMP). The primary purpose was to provide centralized management of outpatient anticoagulation to cardiac patients, to serve as a disease-specific resource to families and providers, and to devise strategies to evolve clinical care with rapidly emerging trends in anticoagulation care. Over 5 years the CAMP Service, staffed by a primary pediatric cardiology attending, a full-time nurse practitioner, and administrative assistant with dedicated support from pharmacy and nutrition, has enrolled over 240 patients ranging in age from 5 months to 55 years. The most common indications include a prosthetic valve (34 %), Fontan prophylaxis (20 %), atrial arrhythmias (11 %), cardiomyopathy (10 %), Kawasaki disease (7 %), and a ventricular assist device (2 %). A patient-centered multi-disciplinary cardiac anticoagulation clinic was created in 2012. Overall program international normalized ratio (INR) time in therapeutic range (TTR) is favorable at 67 % (81 % with a 0.2 margin) and has improved steadily over 5 years. Pediatric-specific guidelines for VKOR1 and CYP2C9 pharmacogenomics testing, procedural bridging with enoxaparin, novel anticoagulant use, and quality metrics have been developed. Program satisfaction is rated highly among families and providers. A dedicated pediatric cardiac anticoagulation program offers a safe and effective strategy to standardize anticoagulation care for pediatric cardiology patients, is associated with high patient and provider satisfaction, and is capable of evolving care strategies with emerging trends in anticoagulation. PMID:25573076

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

    Directory of Open Access Journals (Sweden)

    T. Pacheco Tabuenca

    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 conocimiento, 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.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 understand 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.

  19. 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...

  20. 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.)

  1. 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.)

  2. 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 comptient, 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)

  3. Use of the out-of-hours emergency dental service at two south-east London hospitals

    Directory of Open Access Journals (Sweden)

    Wright Desmond

    2009-07-01

    Full Text Available Abstract Background Prior to the introduction of the 2006 NHS dental contract in England and Wales, general dental practitioners (GDPs were responsible for the provision of out-of-hours (OOH emergency dental services (EDS; however there was great national variation in service provision. Under the contractual arrangements introduced 1st April 2006, local commissioning agencies became formally responsible for the provision of out-of-hours emergency dental services. This study aimed to examine patients' use of an out-of-hours emergency dental service and to determine whether the introduction of the 2006 national NHS dental contract had resulted in a change in service use, with a view to informing future planning and commissioning of care. Methods A questionnaire was administered to people attending the out-of-hours emergency dental service at two inner city London hospitals over two time periods; four weeks before and six months after the introduction of the dental contract in April 2006. The questionnaire explored: reasons for attending; dental registration status and attendance; method of access; knowledge and use of NHS Direct; satisfaction with the service; future preferences for access and use of out-of-hours dental services. Data were compared to determine any impact of the new contract on how and why people accessed the emergency dental service. Results The response rate was 73% of attendees with 981 respondents for the first time period and 546 for the second. There were no significant differences between the two time periods in the gender, age, ethnic distribution or main language of service users accessing the service. Overall, the main dental problem was toothache (72% and the main reason for choosing this service was due to the inability to access another emergency dental service (42%. Significantly fewer service users attended the out-of-hours emergency dental service during the second period because they could not get an appointment with their own dentist (p = 0.002 from 28% to 20% and significantly more service users in the second period felt the emergency dental service was easier to get to than their own dentist (P = 0.003 from 8% to 14%. Service users found out about the service from multiple sources, of which family and friends were the most common source (30%. In the second period fewer service users were obtaining information about the service from dental receptionists (P = 0.002 from 14% to 9% and increased use of NHS Direct for a dental problem was reported (P = 0.002 from 16% to 22% along with more service users being referred to the service by NHS Direct (P = 0.02 from 19% to 24%. The most common preference for future emergency dental care was face-to-face with a dentist (79%. Conclusion This study has provided an insight into how and why people use an out-of-hours emergency dental service and has helped to guide future commissioning of these services. Overall, the service was being used in much the same way both before and after the 2006 dental contract. Significantly more use was being made of NHS Direct after April 2006; however, informal information networks such as friends and family remain an important source of information about accessing emergency dental services.

  4. Cardiac arrhythmias 48 hours before, during, and 48 hours after discharge from hospital following acute myocardial infarction.

    OpenAIRE

    Morrison, G. W.; Kumar, E. B.; Portal, R. W.; Aber, C. P.

    1981-01-01

    The cardiac rate and rhythm were studied by 24-hour ambulatory electrocardiographic recording in 44 patients before, during, and after being discharged from hospital following an acute myocardial infarction. The first recordings were started 48 hours before discharge, the second on the morning of the day of discharge, and the third 48 hours after discharge (at home). While in hospital and after returning home the heart rate fell during sleep but there was no diurnal variation in the frequency...

  5. Pleuropulmonary and cardiac changes after cardiac surgery in plain-film radiography and their influence on the length of hospital treatment

    International Nuclear Information System (INIS)

    Of the parameters investigated, the increase in size of the cardiac shadow was the only one to have an effect on the length of the patients' stay in the hospital. In patients with increased heart size after surgery, pleural effusions on the right side were rather more frequent than in the control group. Intrapulmonary or pleural changes were frequent. The length of stationary treatment was not affected by the incidence or localisation of these. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Deborah Caruso, MD

    2014-11-01

    Full Text Available 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.

  7. 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.

  8. Focused nurse-defibrillation training: a simple and cost-effective strategy to improve survival from in-hospital cardiac arrest

    OpenAIRE

    Stewart John A

    2010-01-01

    Abstract Time to first defibrillation is widely accepted to correlate closely with survival and recovery of neurological function after cardiac arrest due to ventricular fibrillation or ventricular tachycardia. Focused training of a cadre of nurses to defibrillate on their own initiative may significantly decrease time to first defibrillation in cases of in-hospital cardiac arrest outside of critical care units. Such a program may be the best single strategy to improve in-hospital survival, s...

  9. 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

  10. Use of the out-of-hours emergency dental service at two south-east London hospitals

    OpenAIRE

    Wright Desmond; Jones Kate; Austin Rupert; Donaldson Nora; Gallagher Jennifer E

    2009-01-01

    Abstract Background Prior to the introduction of the 2006 NHS dental contract in England and Wales, general dental practitioners (GDPs) were responsible for the provision of out-of-hours (OOH) emergency dental services (EDS); however there was great national variation in service provision. Under the contractual arrangements introduced 1st April 2006, local commissioning agencies became formally responsible for the provision of out-of-hours emergency dental services. This study aimed to examin...

  11. 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.

  12. All in a day's work An innovative one-stop clinic is keeping frail older people out of hospital.

    Science.gov (United States)

    Trueland, Jennifer

    A rapid access service for frail older is improving the care they receive and preventing hospital admissions by providing comprehensive assessment and diagnostic tests in one clinic setting. The multidisciplinary team can usually organise packages of health and social care that enable patients to return home. PMID:24568402

  13. Medication and Dietary Supplement Interactions among a Low-Income, Hospitalized Patient Population Who Take Cardiac Medications

    Science.gov (United States)

    Gardiner, Paula; Filippelli, Amanda C.; Sadikova, Ekaterina; Jack, Brian W.

    2015-01-01

    Purpose. To identify characteristics associated with the use of potentially harmful combinations of dietary supplements (DS) and cardiac prescription medications in an urban, underserved, inpatient population. Methods. Cardiac prescription medication users were identified to assess the prevalence and risk factors of potentially harmful dietary supplement-prescription medication interactions (PHDS-PMI). We examined sociodemographic and clinical characteristics for crude (?2 or t-tests) and adjusted multivariable logistic regression associations with the outcome. Results. Among 558 patients, there were 121 who also used a DS. Of the 110 participants having a PHDS-PMI, 25% were asked about their DS use at admission, 75% had documentation of DS in their chart, and 21% reported the intention to continue DS use after discharge. A multivariable logistic regression model noted that for every additional medication or DS taken the odds of having a PHDS-PMI increase and that those with a high school education are significantly less likely to have a PHDS-PMI than those with a college education. Conclusion. Inpatients at an urban safety net hospital taking a combination of cardiac prescription medications and DS are at a high risk of harmful supplement-drug interactions. Providers must ask about DS use and should consider the potential for interactions when having patient discussions about cardiac medications and DS.

  14. Cardiac arrest in children

    Directory of Open Access Journals (Sweden)

    Tress Erika

    2010-01-01

    Full Text Available Major advances in the field of pediatric cardiac arrest (CA were made during the last decade, starting with the publication of pediatric Utstein guidelines, the 2005 recommendations by the International Liaison Committee on Resuscitation, and culminating in multicenter collaborations. The epidemiology and pathophysiology of in-hospital and out-of-hospital CA are now well described. Four phases of CA are described and the term "post-cardiac arrest syndrome" has been proposed, along with treatment goals for each of its four phases: immediate post-arrest, early post-arrest, intermediate and recovery phase. Hypothermia is recommended to be considered as a therapy for post-CA syndrome in comatose patients after CA, and large multicenter prospective studies are underway. We reviewed landmark articles related to pediatric CA published during the last decade. We present the current knowledge of epidemiology, pathophysiology and treatment of CA relevant to pre-hospital and acute care health practitioners.

  15. Antimicrobial Susceptibility Pattern of Clinical Isolates of Pseudomonas aeruginosa in an Indian Cardiac Hospital.

    Directory of Open Access Journals (Sweden)

    S.Meenakumari

    2011-09-01

    Full Text Available Out of the 5933 samples collected a total of 51 isolates of pseudomonas aeruginosa were collected consecutively between 26-December-2010 to 28-February-2011 from different patients. The total of 51 positive isolates consists both of pediatric as well as adult patients. The study was therefore carried out using bothmanual (Kirby-Bauer method as well as automated (Vitek2 system method to determine the Antimicrobial susceptibility pattern of pseudomonas aeruginosa isolates from in-patients and out-patients attending the microbiology section of the hospitals. The isolation rate of Pseudomonas aeruginosa was found to be 8.5% out of the total positive samples which were analyzed. In my study, notable sensitivity (100% to P.aeruginosa was observed against Aztreonam while it was found to be different in case of a study carried out in India earlier which observed Carbepenems with 19.40% resistance. In the study colistin showed the highest (100% sensitivity followed by Amikacin against P. aeruginosa , which is in corroboration with an earlier report published from India. Amikacin seems to be a promising therapy for Pseudomonal infection. Hence, its use should be restricted to severe nosocomial infections, in order to avoid rapid emergence of resistant strains. The sensitivity of Pseudomonas aeruginosa towards Imipenem is found to be 35.294% and towards Meropenem is 41.176%, which is different in case of the earlier study from India. An effective national and state level antibiotic policy and draft guidelines should be introduced to preserve the effectiveness of antibiotics and for better patient management.

  16. Cardiac tumors in a tertiary care cancer hospital: clinical features, echocardiographic findings, treatment and outcomes

    Directory of Open Access Journals (Sweden)

    Joseph Swafford

    2012-02-01

    Full Text Available Cardiac tumors are a rare entity, comprised of tumors with diverse histology and natural history. We report the clinical characteristics, echocardiograhic findings, therapy and outcome of 59 patients with primary and metastatic cardiac tumors. Our institutional echocardiogram data base from 1993 through 2005 was reviewed to identify patients diagnosed with intra-cardiac tumor. A total of 59 patients with cardiac tumors were identified and included in the study. The patient’s characteristics, presenting symptoms, diagnostic tests, location, histology of the tumor, treatment and one year survival rate of this population was collected from the medical records. Of the 59 cardiac tumor cases, 16 (27% were primary cardiac tumors and 43 (73% were secondary cardiac tumors. The most common primary tumor was sarcoma affecting 13 (81% of the 16 cases. Of these, 5 patients were angiosarcoma, 5 unclassified sarcoma, one myxoid sarcoma and 2 maignant fibrous histiocytoma. The mean age at presentation was 41.1 years, and the most common location was right atrium affecting 6 cases (37.5%. The most common symptom of dyspnea was present in 10 (62.5% cases. Eleven (25.6% of the 43 secondary cardiac tumors were metastasis from renal cell carcinoma. The mean age at presentation was 55.4 years. Right atrium was the most frequent location affecting 18 (42% of the 43 patients. The most common presenting symptom was dyspnea in 15 (35% cases. For both primary and secondary tumors, dyspnea was the most common symptom and right atrium was most frequently involved. Sarcoma was the most common primary cardiac tumor while metastasis from renal cell carcinoma was the most common secondary tumor.

  17. 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.

  18. Cardiac surgery in patients on hemodialysis: Eight years experience of the Tunisian military hospital

    OpenAIRE

    Gharsallah Hedi; Trabelsi Walid; Hajjej Zied; Nasri Mourad; Lebbi Anis; Jebali Mohamed; Ferjani Mustapha

    2010-01-01

    End-stage renal disease (ESRD) is known to be an important risk factor for cardiac operations performed with cardiopulmonary bypass. We investigated the influence of preoperative status on perioperative mortality and morbidity. We retrospectively analyzed data from 26 patients with ESRD, who were on maintenance dialysis and underwent a cardiac surgical procedure bet-ween 2000 and 2007. Of them, 61.5% of the patients had isolated coronary artery bypass grafting (CABG) and 38.5% h...

  19. Level of incongruence during cardiac rehabilitation and prediction of future CVD-related hospitalizations plus all-cause mortality.

    Science.gov (United States)

    Meyer, Fiorenza A; Stauber, Stefanie; Wilhelm, Matthias; Znoj, Hansjörg; von Känel, Roland

    2015-07-01

    Independent of traditional risk factors, psychosocial risk factors increase the risk of cardiovascular disease (CVD). Studies in the field of psychotherapy have shown that the construct of incongruence (meaning a discrepancy between desired and achieved goals) affects the outcome of therapy. We prospectively measured the impact of incongruence in patients after undergoing a cardiac rehabilitation program. We examined 198 CVD patients enrolled in a 8-12 week comprehensive cardiac rehabilitation program. Patients completed the German short version of the Incongruence Questionnaire and the SF-36 Health Questionnaire to measure quality of life (QoL) at discharge of rehabilitation. Endpoints at follow-up were CVD-related hospitalizations plus all-cause mortality. During a mean follow-up period of 54.3 months, 29 patients experienced a CVD-related hospitalization and 3 patients died. Incongruence at discharge of rehabilitation was independent of traditional risk factors a significant predictor for CVD-related hospitalizations plus all-cause mortality (HR 2.03, 95% CI 1.29-3.20, p = .002). We also found a significant interaction of incongruence with mental QoL (HR .96, 95% CI .92-.99, p = .027), i.e. incongruence predicted poor prognosis if QoL was low (p = .017), but not if QoL was high (p = .74). Incongruence at discharge predicted future CVD-related hospitalizations plus all-cause mortality and mental QoL moderated this relationship. Therefore, incongruence should be considered for effective treatment planning and outcome measurement. PMID:25929544

  20. Sex differences in case fatality before and after admission to hospital after acute cardiac events: analysis of community based coronary heart disease register.

    OpenAIRE

    Sonke, G. S.; Beaglehole, R.; Stewart, A. W.; Jackson, R.; Stewart, F. M.

    1996-01-01

    OBJECTIVE: To determine whether the reported higher case fatality in hospital after an acute cardiac event in women can be explained by sex differences in mortality before admission and in baseline risk factors. DESIGN: Analyses of data from a community based coronary heart disease register. SETTING: Auckland region, New Zealand. SUBJECTS: 5106 patients aged 25-64 years with an acute cardiac event leading to coronary death or definite myocardial infarction within 28 days of onset, occurring b...

  1. Hospital-based versus community-based shared care cardiac rehabilitation after acute coronary syndrome : protocol for a randomized clinical trial

    DEFF Research Database (Denmark)

    Bertelsen, Jannik Buus; Refsgaard, Jens

    2013-01-01

    Participation in cardiac rehabilitation (CR) is poor although CR reduces morbidity and mortality. One way in which attendance may potentially be improved is by involving municipal health-care centres (MHCC) and the patient's general practitioner (GP) to a larger degree in a model of shared care cardiac rehabilitation (SC-CR). Our study tests the feasibility of SC-CR and compares the attendance and effects of SC-CR with the individually tailored hospital-based CR (H-CR) programme.

  2. 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.

  3. 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...

  4. Femoral sheath removal after cardiac catheterization in the Jordanian hospitals: An explorative study

    Directory of Open Access Journals (Sweden)

    Manar M. Nabolsi

    2013-03-01

    Full Text Available Objectives: The purpose of this study was to investigate the methods of sheath removal (femostop, compressor and manual compression among Jordanian patients post cardiac catherization. Material and Methods: A descriptive explorative design utilized to collect data from 87 patients underwent cardiac catherization. Data collected on demographics, health remarks and complication pre and post cardiac catherization and in relation to sheath removal methods and complications. Results: The majority of the patients (94.2%, n = 80 had a manual sheath removal compared to 1% (n = 1 compression and 7% (n = 6 had femostop method. Kruskal-Wallis H test revealed there were significance difference in PTT and ACT reports in relation to type of procedures (0.24, p 0.015; 0.32, p = 0.005 respectively. However, there were no significant differences between methods of sheath removal methods in relation to pain level, MAP before, MAP after, and heart rate with p value > 0.05. Patient’s age had negative association with HR after the procedure (BTAU = -0.19, p = 0.02, while no significant differences found in post catherization complication (hematoma and pain level and all other health remarks (p > 0.05 in regards to patients’ age and gender. Moreover, patients’ MAP readings were significantly different in relation to number of rest hour that patients had post cardiac catherization (p = 0.049. Conclusion: The study found that most patients and health professionals preferred manual removal methods of sheath post cardiac catherization. Cardiac health professionals, has to consider health remarks and demographic characteristics of their patients when planning care for their patients and more research needed to explore these issues.

  5. Nurses Opinions Regarding Delirium Care in the Older General Hospital Population and in Older Cardiac Surgery Patients Specifically: A Multicentre Survey among Dutch Nurses

    Directory of Open Access Journals (Sweden)

    Roelof Ettema

    2014-12-01

    Full Text Available Background: Delirium is a high prevalent postoperative complication in older cardiac surgery patients and can have drastic consequence for the patient. Preventive interventions, diagnosis and treatment of delirium require specialized knowledge and skills. Objective: To gain insight in the current opinion and beliefs of nurses in hospitals concerning prevention, diagnosis and treatment of delirium in older hospital patients in general and specifically in older cardiac surgery patients. Methods: In a cross-sectional study from February to July 2010, we distributed a survey on beliefs on delirium care among 368 nurses in three hospitals in the Netherlands, in one hospital in all wards with older patients and in two hospitals in the cardiac surgery wards only. Results: Although in literature incidence rates up to 54.9% in cardiac surgery patients in hospitals are reported, with a response rate of 68% (250, half of the nurses believe that the incidence of delirium is not even 10%. Two thirds think that delirium in patients is preventable. Although, the Delirium Observation Scale is most often used for screening delirium, nearly all nurses do not routinely screen patients for delirium. Opinions on delirium of nurses working in cardiac surgery wards did not differ from nurses caring for older patients in other hospital wards. Conclusions: Nurses do have knowledge on delirium care, but there is a gap between the reported incidence in literature and the estimation of the occurrence of delirium by nurses. A two-way causal relationship emerges: because nurses underestimate the occurrence, they do not screen patients on a routine basis. And because they do not screen patients on a routine basis they underestimate the incidence.

  6. Avaliação da aderência ao programa de reabilitação cardíaca em um hospital particular geral / Evaluating compliance to a cardiac rehabilitation program in a private general hospital

    Scientific Electronic Library Online (English)

    Vanessa, Mair; Ana Paula, Breda; Marcos Eduardo Boquembuzo, Nunes; Luciana Diniz Nagem Janot de, Matos.

    2013-09-01

    Full Text Available OBJETIVO: Identificar os principais fatores que influenciaram o participante do nosso programa de reabilitação cardiovascular a faltar em suas terapias e correlacioná-los a idade, risco cardiovascular e motivação de nossa população. MÉTODOS: Realizou-se um estudo retrospectivo transversal com 42 pac [...] ientes (69,15±13,93 anos) participantes do programa de reabilitação cardíaca de um hospital geral particular de São Paulo, por meio da análise de duas escalas: a Escala de Barreiras para Reabilitação Cardíaca e a Escala de Disposição. Utilizou-se a correlação de Spearman para relacioná-las com absenteísmo, risco cardiovascular, idade e tempo de reabilitação cardíaca. RESULTADOS: A pontuação total da escala de barreiras foi 31±6 e o escore médio foi de 1,47±0,31. As principais barreiras foram relacionadas às subescalas "viagem/conflito de trabalho" e "problemas pessoais/familiares". A porcentagem de absenteísmo foi 8,4% do número de sessões possíveis de serem realizadas no mês. As faltas e os cancelamentos apresentaram correlação positiva com o risco cardiovascular (p=0,01; r=0,4) e correlações negativas com Escala de Disposição inicial (p=0,03; r=-0,35) e idade (p=0,02; r=-0,35). CONCLUSÃO: "Viagem/conflito de trabalho", "problemas pessoais/familiares" e baixa disposição inicial foram os principais fatores de absenteísmo em um programa de reabilitação cardíaca de um hospital geral particular de São Paulo. Abstract in english OBJECTIVE: Identify the primary factors that influenced the participant in our cardiovascular rehabilitation program towards missing their therapy sessions, and to correlate those factors with age, cardiovascular risk, and motivation of our population. METHODS: We conducted a retrospective study wit [...] h 42 patients (69.15±13.93 years) participating in the cardiac rehabilitation program at a general hospital in São Paulo, through the analysis of two scales applied during the initial evaluation: Cardiac Rehabilitation Barriers Scale and scale of the original provision. We used Spearman correlation to relate them to absenteeism, cardiovascular risk age and duration of cardiac rehabilitation. RESULTS: The total score of barriers was 31±6 and the mean score of 1.47±0.31. The main barriers subscales were related to "travel/labor dispute" and "personal problems/family." The percentage of absenteeism was 8.4% in the number of sessions that could be made in the month. The faults and cancellations were positively correlated with cardiovascular risk (p=0.01; r=0.4) and negatively with scale provision of baseline (p=0.03; r=-0.35) and age (p=0.02; r=-0.35). CONCLUSION: "Travel/labor dispute", "personal/ family problems", and low initial provision are the main factors absenteism in a cardiac rehabilitation program in a general hospital in São Paulo.

  7. 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.

  8. Koronarangiografi bør overvejes efter hjertestop uden for hospital

    DEFF Research Database (Denmark)

    Moesgaard, Jacob; LØfgren, Bo

    2011-01-01

    Cardiac arrest has a poor prognosis. Ischaemic heart disease is the main cause of out-of-hospital cardiac arrest. This paper is a review of the essential studies on acute coronary angiography and angioplasty in post resuscitation care. No randomised studies were found. Observational studies support the use of acute angiography in ST-segment elevation myocardial infarction. The negative predictive value of ST-segment elevation can be low after out-of-hospital cardiac arrest, and acute angiography should be considered regardless of electrocardiographic findings.

  9. 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...

  10. Dimensionality of the hospital anxiety and depression scale (HADS) in cardiac patients : comparison of Mokken scale analysis and factor analysis

    DEFF Research Database (Denmark)

    Emons, Wilco H M; Sijtsma, Klaas

    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 adequately capture the structure of the HADS. Of the three corresponding scales, two scales of five items each were found to be structurally sound and reliable. These scales covered the two key attributes of anxiety and (anhedonic) depression. The findings suggest that the HADS may be reduced to a 10-item questionnaire comprising two 5-item scales measuring anxiety and depressive symptoms.

  11. Do we need cardiac arrest centres in Australia?

    Science.gov (United States)

    Stub, D; Bernard, S; Smith, K; Bray, J E; Cameron, P; Duffy, S J; Kaye, D M

    2012-11-01

    The mortality rate post admission to hospital after successful resuscitation from out-of-hospital cardiac arrest is high, with significant variation between regions and individual institutions. While prehospital factors such as age, bystander cardiopulmonary resuscitation and total cardiac arrest time are known to influence outcome, several aspects of post-resuscitative care including therapeutic hypothermia, coronary intervention and goal-directed therapy may also influence patient survival. Regional systems of care have improved provider experience and patient outcomes for those with ST elevation myocardial infarction and life-threatening traumatic injury. In particular, hospital factors such as hospital size and interventional cardiac care capabilities have been found to influence patient mortality. This paper reviews the evidence supporting the possible development and implementation of Australian cardiac arrest centres. PMID:22757740

  12. The Role of Attitude to the Disease in Cardiac Patients Undergoing Vital Threat in the Formation of the Prediction of their Mental Adaptation to Post-hospital Period

    Directory of Open Access Journals (Sweden)

    Trifonova E.A.,

    2015-02-01

    Full Text Available The study was supported by the grant of the President of the Russian Federation MK-2076.2012.6. In the current study, the authors evaluated the role of relationship to disease in cardiac patients undergoing vital threat in the formation of the prediction of their mental adaptation in the distant post-hospital period. Longitudinal study (in-hospital and one year after discharge included two groups: patients with urgent cardiac status (N=47, 36 men, 11 women, age 34 to 66 years and patients with atrial arrhythmias, passing minimally invasive surgery (N=41, 22 men, 19 women, age 41 to 69 years. In-hospital stage used interviews and tests, questionnaires, and post-hospital stage was conducted using a telephone interview. We found that patients with a history of life-threatening cardiac condition, are less concerned about the disease than patients expecting to be relatively safe after minimally invasive surgery. In the forecast of the emotional status of patients, the severity of anxiety and disturbance of interpersonal relationships in the hospital period play an important role. Predictor of adherence to medical recommendations for men is a high disease concern, and in women – greater emotional stability.

  13. 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.

  14. Cardiac tamponade (image)

    Science.gov (United States)

    Cardiac tamponade is a condition involving compression of the heart caused by blood or fluid accumulation in the ... so they cannot adequately fill or pump blood. Cardiac tamponade is an emergency condition that requires hospitalization.

  15. 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

  16. 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)

  17. 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; Yh, Lip Gregory; Jolly Kate; Lee Kaeng; Aj, Stevens

    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...

  18. 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...

  19. 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.

  20. 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.

  1. Regional cardiac resuscitation systems of care

    Directory of Open Access Journals (Sweden)

    NICHOL GRAHAM

    2010-09-01

    Full Text Available Out-of-hospital cardiac arrest (OOHCA is a common public health problem, with large and important regional variations in outcomes. Survival rates vary widely among patients treated with OOHCA by emergency medical services (EMS, or among patients transported to the hospital after return of spontaneous circulation. Most regions lack a well-coordinated approach to post-cardiac arrest care. Effective hospital-based interventions for OOHCA exist but are used infrequently. Increased volume of patients or procedures of individual providers and hospitals is associated with better outcomes for several other clinical disorders. Regional systems of cardiac resuscitation include a process for identification of patients with OOHCA, standard field and hospital care protocols for patients with OOHCA, monitoring of care processes and outcome, and periodic review and feedback of these quality improvement data to identify problems and implement solutions. Similar systems have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. Many more people could survive OOHCA if regional systems of cardiac resuscitation were implemented and maintained. The time has come to do so wherever feasible.

  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. 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.

  4. 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.

  5. Cardiac arrest associated with febrile illness due to U.K. acquired Cyclospora cayetanensis.

    Science.gov (United States)

    Burrell, Christopher; Reddy, Srinivasulu; Haywood, Guy; Cunningham, Richard

    2007-01-01

    This report describes a 43 yr old man diagnosed with U.K. acquired cyclospora cayetanensis infection resulting in fever and diarrhoea. In course of the febrile illness, he suffered an out of hospital cardiac arrest. Extensive cardiac investigation including a transthoracic echocardiogram, coronary angiogram, and cardiac electrophysiological studies failed to identify the cause. The possible links between cyclospora infection and cardiac arrest are explored. Fever has been reported as a precipitant for idiopathic ventricular fibrillation in patients with the Brugada syndrome but also rarely in individuals with normal hearts. Clinicians should be aware of a possible link between any febrile illness and potentially fatal ventricular dysrhythmia. PMID:16684571

  6. 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 ...

  7. 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.

  8. 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.

  9. Cardiac arrest in Ontario: circumstances, community response, role of prehospital defibrillation and predictors of survival.

    OpenAIRE

    Brison, R. J.; Davidson, J R; Dreyer, J F; Jones, G; Maloney, J.; Munkley, D P; O'Connor, H M; Rowe, B. H.

    1992-01-01

    OBJECTIVES: To describe the patient characteristics, circumstances and community response in cases of out-of-hospital cardiac arrest; to evaluate the effect on survival of the introduction of prehospital defibrillation; and to identify factors that predict survival. DESIGN: Population-based before-and-after clinical trial. SETTING: Five Ontario communities: London, Sudbury, the Greater Niagara region, Kingston and Ottawa. PATIENTS: A consecutive sample of 1510 primary cardiac arrest patients ...

  10. Forskelle mellem hospitaler i prognose efter hjertestop uden for hospital

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Bro-Jeppesen, John

    2009-01-01

    INTRODUCTION: There are substantial differences in long-term survival of patients resuscitated from out-of-hospital cardiac arrest, and the level of care during hospitalization may be a contributing factor. The purpose of this study was to determine if a difference in long-term prognosis between hospitals could be detected in patients surviving cardiac arrest in Copenhagen. MATERIAL AND METHODS: The mobile emergency care unit attempted resuscitation in 1,098 patients with out-of-hospital cardiac arrest in the period 2002 to 2006, among whom return of spontaneous circulation occurred in 336 (30%) of the patients admitted to hospital. Survival was determined using the Central Population Registry through Statistics Denmark. RESULTS: Patients admitted to a tertiary facility were younger, more frequently male, they had more commonly ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) as their initial rhythm, and they had more frequently received bystander cardiopulmonary resuscitation. Survival at 4.6 years was 41% in patients admitted to the tertiary hospital and 10% in patients admitted to other hospitals, p < 0.0001. After adjustment for other known risk factors, patients admitted to other hospitals had a hazard ratio of 1.8 for death (95% confidence interval: 1,4-2,5) compared with patients admitted to a tertiary facility. CONCLUSION: The survival rate after out-of-hospital cardiac arrest was significantly higher in patients admitted to a tertiary facility than among patients admitted to less specialized hospitals. Further studies are needed to identify causal factors. Udgivelsesdato: 2009-Jun-22

  11. 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

    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 scene, deliver initial drug therapy and transport the patient to the most appropriate (not necessarily the closest) cardiac facility. Primary PCI is the treatment of choice, but thrombolysis followed by coronary angiography and possibly PCI is a valid alternative, according to patient's baseline risk, time from symptoms onset and primary PCI-related delay. Paramedics and nurses have an important role in pre-hospital STEMI care and their empowerment is essential to increase the effectiveness of the system. Strong cooperation between cardiologists and emergency medicine doctors is mandatory for optimal pre-hospital STEMI care. Scientific societies have an important role in guideline implementation as well as in developing quality indicators and performance measures; health care professionals must overcome existing barriers to optimal care together with political and administrative decision makers.

  12. Abasto, surtimiento y gasto de bolsillo en medicamentos en hospitales públicos de México en 2009 / Supply prescription filling and out-of-pocket expenditures on medicines in public hospitals in Mexico in 2009

    Scientific Electronic Library Online (English)

    Sergio, Sesma-Vázquez; Octavio, Gómez-Dantés; Veronika J, Wirtz; Manuel, Castro-Tinoco.

    Full Text Available OBJETIVO. Analizar la disponibilidad de medicamentos en las farmacias hospitalarias, el surtimiento de prescripciones a pacientes egresados y el gasto de bolsillo en medicamentos de pacientes hospitalizados. MATERIAL Y MÉTODOS. Análisis descriptivo de la Encuesta Nacional de Satisfacción y Trato Ade [...] cuado (ENSATA) de 2009 con una muestra representativa de hospitales públicos sobre disponibilidad de una lista de 83 medicamentos en el momento de la visita a la farmacia, la proporción del surtimiento de recetas a pacientes en el momento de su alta y su gasto de bolsillo durante su estancia hospitalaria. RESULTADOS. En total se entrevistó a 26 271 pacientes egresados de los 160 hospitales públicos visitados. La disponibilidad de medicamentos en el ámbito nacional fue de 82%. Los hospitales de los Servicios Estatales de Salud (SESA) mostraron una disponibilidad de 77% (variación de 30 a 96%). El surtimiento completo de recetas fue de 97% en las instituciones de seguridad social, cifra que contrasta con 56.2% de los hospitales de los SESA, que además presentaron una gran varianza entre estados (13 a 94%) La mediana del gasto de pacientes hospitalizados fue de 150 pesos moneda nacional (1% gastó más de 10 000 pesos. CONCLUSIONES. La falta de los medicamentos en los hospitales tiene un impacto económico en el gasto de los hogares, particularmente en aquellos que cuentan con pocos recursos, y puede aumentar la morbilidad o mortalidad de los pacientes hospitalizados en las instituciones públicas. Abstract in english OBJECTIVE. To analyze the availability of drugs in public hospitals, the prescription-filling patterns for in-patients when they are discharged and their out-of-pocket expenditure during their hospitalization. MATERIAL AND METHODS. Using the National Satisfaction and Responsiveness Survey (ENSATA) 2 [...] 009, which includes a representative sample of public hospitals in Mexico in 2009, the availability of 83 essential medicines in the hospital pharmacies at the day of visit, the proportion of prescriptions completely filled for patients when they are discharged and their out-of-pocket expenditure during their hospitalization were analyzed. RESULTS. A total of 26 271 patients in 160 public hospitals were interviewed. The mean availability of drugs was 82% for all hospitals, with the lowest availability for the Ministry of Health (SESA) hospitals (77%, with a range of 30 to 96%). Patients discharged at social security hospitals received in 97% of cases a complete prescription filling, while in SESA hospitals the average was only 56.2%, with a large variance among states (13 to 94%). The median inpatient spending was 150 pesos in national currency (1% spent over 10 000 pesos). CONCLUSIONS. The lack of medicines in public hospitals may increase in-patient morbidity and mortality and has an economic impact on household spending, particularly in those with scarce resources.

  13. What Is Cardiac Rehabilitation?

    Science.gov (United States)

    ... special help in making lifestyle changes. During your rehabilitation program you’ll… • Have a medical evaluation to ... rate, blood pressure and EKG monitored. A cardiac rehabilitation (rehab) program takes place in a hospital or ...

  14. 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.

  15. 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).

    Science.gov (United States)

    Lee, Andy Y; Moss, Arthur J; Ruwald, Martin H; Kutyifa, Valentina; McNitt, Scott; Polonsky, Bronislava; Zareba, Wojciech; Ruwald, Anne-Christine

    2015-05-15

    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. PMID:25817576

  16. Reduced between-hospital variation in short term survival after acute myocardial infarction: the result of improved cardiac care?

    Science.gov (United States)

    Murphy, N F; MacIntyre, K; Stewart, S; Capewell, S; McMurray, J J V

    2005-01-01

    Objectives: To re-examine interhospital variation in 30 day survival after acute myocardial infarction (AMI) 10 years on to see whether the appointment of new cardiologists and their involvement in emergency care has improved outcome after AMI. Design: Retrospective cohort study. Setting: Acute hospitals in Scotland. Participants: 61 484 patients with a first AMI over two time periods: 1988–1991; and 1998–2001. Main outcome measures: 30 day survival. Results: Between 1988 and 1991, median 30 day survival was 79.2% (interhospital range 72.1–85.1%). The difference between highest and lowest was 13.0 percentage points (age and sex adjusted, 12.1 percentage points). Between 1998 and 2001, median survival rose to 81.6% (and range decreased to 78.0–85.6%) with a difference of 7.6 (adjusted 8.8) percentage points. Admission hospital was an independent predictor of outcome at 30 days during the two time periods (p < 0.001). Over the period 1988–1991, the odds ratio for death ranged, between hospitals, from 0.71 (95% confidence interval (CI) 0.58 to 0.88) to 1.50 (95% CI 1.19 to 1.89) and for the period 1998–2001 from 0.82 (95% CI 0.60 to 1.13) to 1.46 (95% CI 1.07 to 1.99). The adjusted risk of death was significantly higher than average in nine of 26 hospitals between 1988 and 1991 but in only two hospitals between 1998 and 2001. Conclusions: The average 30 day case fatality rate after admission with an AMI has fallen substantially over the past 10 years in Scotland. Between-hospital variation is also considerably less notable because of better survival in the previously poorly performing hospitals. This suggests that the greater involvement of cardiologists in the management of AMI has paid dividends. PMID:15894761

  17. Red Blood Cell Membrane Alpha-linolenic Acid and the Risk of Sudden Cardiac Arrest

    OpenAIRE

    Lemaitre, Rozenn N.; King, Irena B.; Sotoodehnia, Nona; Rea, Thomas D.; Raghunathan, Trivellore E.; Rice, Ken; Lumley, Thomas; Knopp, Robert H.; Cobb, Leonard A.; Copass, Michael K.; Siscovick, David S.

    2009-01-01

    Higher levels of long-chain n-3 polyunsaturated fatty acids in red blood cell membranes are associated with lower risk of sudden cardiac arrest. Whether membrane levels of ?-linolenic acid, a medium-chain n-3 polyunsaturated fatty acid, show a similar association is unclear. We investigated the association of red blood cell membrane alpha-linolenic acid with sudden cardiac arrest risk in a population-based case-control study. Cases, aged 25–74 years, were out-of-hospital sudden cardiac arr...

  18. 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.

  19. Prehospital cooling in cardiac arrest - the next frontier?

    Directory of Open Access Journals (Sweden)

    Søreide Eldar

    2009-10-01

    Full Text Available Abstract Therapeutic hypothermia (TH in unconscious survivors of out-of-hospital cardiac arrest (OHCA is now a well-documented part of post-resuscitation care. Implementation of TH into daily clinical practice has been far more successful in the Scandinavian countries than in the rest of the world. Still, many questions remain. One of them is whether prehospital cooling will result in better outcomes.

  20. Repair of a Complex Congenital Cardiac Defect

    Medline Plus

    Full Text Available ... cardiac surgery program provides surgical care to approximately 1,100 patients, including more than 700 cases of ... webcast. My name is Emile Bacha. I'm one of the cardiac surgeons at Children's Hospital Boston ...

  1. Prospective controlled study of post-transfusion hepatitis after cardiac surgery in a large referral hospital in India.

    Science.gov (United States)

    Dasarathy, S; Misra, S C; Acharya, S K; Irshad, M; Joshi, Y K; Venugopal, P; Tandon, B N

    1992-06-01

    We studied the risk of post-transfusion hepatitis (PTH) in recipients of blood collected from voluntary donors screened for HBsAg. Two hundred and fifty patients without any previous history of liver disease or transfusion were followed up for 12 months subsequent to cardiac surgery. Thirty-five of them had closed-heart surgery without receiving transfusion and served as controls. The remaining 215 patients received single-point transfusions (mean 4 +/- 2.4 units). None of the controls and 15 (6.9%) blood recipients developed PTH. Three (20%) patients had hepatitis-B-virus-induced hepatitis while the remainder (80%) had non A, non B (NANB) hepatitis. The number of units of blood transfused and surrogate markers for development of PTH (donor alanine aminotransferase, anti-HBc and anti-HBs antibody) were not associated with the occurrence of PTH (p greater than 0.05). Nine (60%) of the 15 patients developing PTH were asymptomatic. All the patients recovered from the PTH, except one who died of fulminant hepatitis. At the end of 1 year of follow-up, none of the patients had evidence of chronic hepatitis. Only three (25%) of the patients with NANB-PTH developed anti-hepatitis C virus (HCV) antibody during the follow-up. We conclude that the incidence of PTH in India is similar to other parts of the world and NANB virus was the major cause of the PTH. The absence of chronicity and lack of seroconversion to anti-HCV antibody in the majority of the patients after 1 year of follow-up may suggest the possibility of a NANB virus other than HCV as the major cause of PTH in India. PMID:1323739

  2. Resultados de la revascularización coronaria en el cardiocentro del Hospital «Hermanos Ameijeiras», en un período de 20 años / Results of coronary revascularization in the Cardiac Center of the "Hermanos Ameijeiras" Clinical Surgical Hospital over 20 years

    Scientific Electronic Library Online (English)

    Manuel, Nafeh Abi-Rezk; Raiza, Hernández Núñez; Natanael, Carballo Hidalgo; Alejandro, Villar Inclan; Luis, Guevara González; Nicolás, Chaos González; Rigoberto, Chil Díaz; Katina, Rodríguez Rey.

    2011-03-01

    Full Text Available INTRODUCCIÓN. En el cardiocentro del Hospital «Hermanos Ameijeiras», la cirugía cardiovascular se practica hace más de 20 años, a lo largo de los cuales se fueron introduciendo y desarrollando diversas técnicas de revascularización miocárdica. El objetivo de esta investigación fue describir los resu [...] ltados de la cirugía de revascularización coronaria en ese período. MÉTODOS. Se realizó una investigación descriptiva, longitudinal, retrospectiva, con cortes transversales quinquenales, comparando cada quinquenio con el siguiente. Del total de 763 pacientes sometidos a revascularización coronaria en el período comprendido entre enero de 1985 y diciembre del 2004, se excluyeron 17 por presentar historias clínicas extraviadas o con datos incompletos y 15 pacientes operados sin circulación extracorpórea, por lo que el universo de estudio quedó conformado por 731 pacientes, operados todos con circulación extracorpórea. RESULTADOS. Predominaron los pacientes con edades entre 51 y 60 años de edad y del sexo masculino; con el tabaquismo y la hipertensión arterial como factores de riesgo más frecuentes. Los estados clínicos predominantes fueron la angina estable crónica y la angina inestable. Predominó la revascularización con tres puentes con tendencia al ascenso, así como el uso de la vena safena, pero con una evolución ascendente en el empleo de la arteria mamaria interna y disminución en la implantación de la vena safena como único conducto. El tiempo de circulación extracorpórea y de paro anóxico mostró una tendencia a la disminución. Las complicaciones más frecuentes fueron las sepsis urinaria y respiratoria. Disminuyeron las muertes por causas cardíacas, entre las cuales el fallo multiorgánico y el bajo gasto cardíaco fueron las principales. Disminuyó el bajo gasto transoperatorio pero hubo tendencia al aumento en el posoperatorio y del fallo multiorgánico. CONCLUSIONES. El uso de revascularización coronaria tuvo una tendencia ascendente en estos 20 años, sobre todo en pacientes de la tercera edad y del sexo masculino, en los que el tabaquismo y la hipertensión arterial fueron los factores de riesgo mayormente asociados. Predominó la revascularización con tres puentes y el uso de la safena, pero con tendencia al uso ascendente de la arteria mamaria interna. La mortalidad tuvo un comportamiento decreciente. Abstract in english INTRODUCTION. In Cardiac Center of the "Hermanos Ameijeiras" Clinical Surgical Hospital cardiovascular surgery is done from more twenty years ago introducing and developing different techniques of myocardial revascularization. The objective of present research was to describe the results of coronary [...] revascularization over that period. METHODS. A retrospective, longitudinal and descriptive research with five-year cross-sectional cuts was conducted comparing each five-year period with the following one. From the total of 763 patients underwent coronary revascularization from January,1985 to December, 2004, 17 patients were excluded due to missing medical records or with incomplete data and 15 patients operated on without extracorporeal circulation, thus, the universe included 731 patients operated on with this technique. RESULTS. There was predominance the patients aged between 51 and 60years and male sex where smoking and high blood pressure were the more frequent risk factors. The predominant clinical stages were the chronic stable angina and the unstable angina as well as revascularization with three bridges and a trend to rise, as well as the saphenous vein use but with an ascending evolution as the only duct. The time of extracorporeal circulation and anoxic arrest showed a trend to decrease. The more frequent complications were the urinary and respiratory sepsis. There was a decrease of deaths from cardiac causes among which the multiorgan failure and the low cardiac output were the major ones. The low transoperative output decreased but there was a trend to increase during the postoperative one and of the multiorgan

  3. Resultados de la revascularización coronaria en el cardiocentro del Hospital «Hermanos Ameijeiras», en un período de 20 años Results of coronary revascularization in the Cardiac Center of the "Hermanos Ameijeiras" Clinical Surgical Hospital over 20 years

    Directory of Open Access Journals (Sweden)

    Manuel Nafeh Abi-Rezk

    2011-03-01

    Full Text Available INTRODUCCIÓN. En el cardiocentro del Hospital «Hermanos Ameijeiras», la cirugía cardiovascular se practica hace más de 20 años, a lo largo de los cuales se fueron introduciendo y desarrollando diversas técnicas de revascularización miocárdica. El objetivo de esta investigación fue describir los resultados de la cirugía de revascularización coronaria en ese período. MÉTODOS. Se realizó una investigación descriptiva, longitudinal, retrospectiva, con cortes transversales quinquenales, comparando cada quinquenio con el siguiente. Del total de 763 pacientes sometidos a revascularización coronaria en el período comprendido entre enero de 1985 y diciembre del 2004, se excluyeron 17 por presentar historias clínicas extraviadas o con datos incompletos y 15 pacientes operados sin circulación extracorpórea, por lo que el universo de estudio quedó conformado por 731 pacientes, operados todos con circulación extracorpórea. RESULTADOS. Predominaron los pacientes con edades entre 51 y 60 años de edad y del sexo masculino; con el tabaquismo y la hipertensión arterial como factores de riesgo más frecuentes. Los estados clínicos predominantes fueron la angina estable crónica y la angina inestable. Predominó la revascularización con tres puentes con tendencia al ascenso, así como el uso de la vena safena, pero con una evolución ascendente en el empleo de la arteria mamaria interna y disminución en la implantación de la vena safena como único conducto. El tiempo de circulación extracorpórea y de paro anóxico mostró una tendencia a la disminución. Las complicaciones más frecuentes fueron las sepsis urinaria y respiratoria. Disminuyeron las muertes por causas cardíacas, entre las cuales el fallo multiorgánico y el bajo gasto cardíaco fueron las principales. Disminuyó el bajo gasto transoperatorio pero hubo tendencia al aumento en el posoperatorio y del fallo multiorgánico. CONCLUSIONES. El uso de revascularización coronaria tuvo una tendencia ascendente en estos 20 años, sobre todo en pacientes de la tercera edad y del sexo masculino, en los que el tabaquismo y la hipertensión arterial fueron los factores de riesgo mayormente asociados. Predominó la revascularización con tres puentes y el uso de la safena, pero con tendencia al uso ascendente de la arteria mamaria interna. La mortalidad tuvo un comportamiento decreciente.INTRODUCTION. In Cardiac Center of the "Hermanos Ameijeiras" Clinical Surgical Hospital cardiovascular surgery is done from more twenty years ago introducing and developing different techniques of myocardial revascularization. The objective of present research was to describe the results of coronary revascularization over that period. METHODS. A retrospective, longitudinal and descriptive research with five-year cross-sectional cuts was conducted comparing each five-year period with the following one. From the total of 763 patients underwent coronary revascularization from January,1985 to December, 2004, 17 patients were excluded due to missing medical records or with incomplete data and 15 patients operated on without extracorporeal circulation, thus, the universe included 731 patients operated on with this technique. RESULTS. There was predominance the patients aged between 51 and 60years and male sex where smoking and high blood pressure were the more frequent risk factors. The predominant clinical stages were the chronic stable angina and the unstable angina as well as revascularization with three bridges and a trend to rise, as well as the saphenous vein use but with an ascending evolution as the only duct. The time of extracorporeal circulation and anoxic arrest showed a trend to decrease. The more frequent complications were the urinary and respiratory sepsis. There was a decrease of deaths from cardiac causes among which the multiorgan failure and the low cardiac output were the major ones. The low transoperative output decreased but there was a trend to increase during the postoperative one and of the multiorgan failure. CONCLUSIONS. The use of c

  4. Usefulness of cardiac arrest centers?- extending lifesaving post-resuscitation therapies: the Arizona experience.

    Science.gov (United States)

    Kern, Karl B

    2015-05-25

    The post-cardiac arrest syndrome is a complex, multisystems response to the global ischemia and reperfusion injury that occurs with the onset of cardiac arrest, its treatment (cardiopulmonary resuscitation) and the re-establishment of spontaneous circulation. Regionalization of post-cardiac arrest care, utilizing specified cardiac arrest centers (CACs), has been proposed as the best solution to providing optimal care for those successfully resuscitated after out-of-hospital cardiac arrest. A multidisciplinary team of intensive care specialists, including critical care/pulmonologists, cardiologists (general, interventional, and electrophysiology), neurologists, and physical medicine/rehabilitation experts, is crucial for such centers. Particular attention to the timely initiation of targeted temperature management and early coronary angiography/percutaneous coronary intervention is best provided by such CACs. A State-wide program of CACs was started in Arizona in 2007. This is a voluntary program, whereby medical centers agree to provide all resuscitated cardiac arrest patients brought to their facility with state-of-the-art post-resuscitation care, including targeted temperature management for comatose patients and strong consideration for emergent coronary angiography for all patients with a likely cardiac etiology for their cardiac arrest. Survival improved by more than 50% at facilities that became CACs with a commitment to provide aggressive post-resuscitation care to all such patients. Providing aggressive, post-resuscitation care is the next real opportunity to increase long-term survival for cardiac arrest patients. (Circ J 2015; 79: 1156-1163). PMID:25877829

  5. 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.

  6. Assessment of the prognosis in patients who remain comatose after resuscitation from cardiac arrest.

    DEFF Research Database (Denmark)

    Ramberg, Emilie; Fedder, Anette Marianne

    2014-01-01

    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.

  7. 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 ...

  8. Prehospital randomised assessment of a mechanical compression device in cardiac arrest (PaRAMeDIC trial protocol

    Directory of Open Access Journals (Sweden)

    McCabe Chris

    2010-11-01

    Full Text Available Abstract Background Survival after out-of-hospital cardiac arrest is closely linked to the quality of CPR, but in real life, resuscitation during prehospital care and ambulance transport is often suboptimal. Mechanical chest compression devices deliver consistent chest compressions, are not prone to fatigue and could potentially overcome some of the limitations of manual chest compression. However, there is no high-quality evidence that they improve clinical outcomes, or that they are cost effective. The Prehospital Randomised Assessment of a Mechanical Compression Device In Cardiac Arrest (PARAMEDIC trial is a pragmatic cluster randomised study of the LUCAS-2 device in adult patients with non-traumatic out-of-hospital cardiac arrest. Methods/design The primary objective of this trial is to evaluate the effect of chest compression using LUCAS-2 on mortality at 30 days post out-of-hospital cardiac arrest, compared with manual chest compression. Secondary objectives of the study are to evaluate the effects of LUCAS-2 on survival to 12 months, cognitive and quality of life outcomes and cost-effectiveness. Methods: Ambulance service vehicles will be randomised to either manual compression (control or LUCAS arms. Adult patients in out-of-hospital cardiac arrest, attended by a trial vehicle will be eligible for inclusion. Patients with traumatic cardiac arrest or who are pregnant will be excluded. The trial will recruit approximately 4000 patients from England, Wales and Scotland. A waiver of initial consent has been approved by the Research Ethics Committees. Consent will be sought from survivors for participation in the follow-up phase. Conclusion The trial will assess the clinical and cost effectiveness of the LUCAS-2 mechanical chest compression device. Trial Registration: The trial is registered on the International Standard Randomised Controlled Trial Number Registry (ISRCTN08233942.

  9. Use of Automated External Defibrillators in Cardiac Arrest

    Science.gov (United States)

    2005-01-01

    Executive Summary Objective The objectives were to identify the components of a program to deliver early defibrillation that optimizes the effectiveness of automated external defibrillators (AEDs) in out-of-hospital and hospital settings, to determine whether AEDs are cost-effective, and if cost-effectiveness was determined, to advise on how they should be distributed in Ontario. Clinical Need Survival in people who have had a cardiac arrest is low, especially in out-of-hospital settings. With each minute delay in defibrillation from the onset of cardiac arrest, the probability of survival decreases by 10%. (1) Early defibrillation (within 8 minutes of a cardiac arrest) has been shown to improve survival outcomes in these patients. However, in out-of-hospital settings and in certain areas within a hospital, trained personnel and their equipment may not be available within 8 minutes. This implies that “first responders” should take up the responsibility of delivering shock. The first responders in out-of-hospital settings are usually bystanders, firefighters, police, and community volunteers. In hospital settings, they are usually nurses. These first responders are not trained in reading electrocardiograms and identifying abnormal heart rhythms restorable by defibrillation. The Technology An AED is a device that can analyze a heart rhythm and deliver a shock if needed. Thus, AEDs can be used by first responders to deliver early defibrillation in out-of-hospital and hospital settings. However, simply providing an AED would not likely improve survival outcomes. Rather, AEDs have a role in strengthening the “chain of survival,” which includes prompt activation of the 911 telephone system, early cardiopulmonary resuscitation (CPR), rapid defibrillation, and timely advanced life support. In the chain of survival, the first step for a witness of a cardiac arrest in an out-of-hospital setting is to call 911. Second, the witness initiates CPR (if she or he is trained in CPR). If the witness cannot initiate CPR, or the first responders of the 911 system (e.g., firefighters/police) have arrived, the first responders initiate CPR. Third, the witness or first responders apply an AED to the patient. The device reads the patient’s heart rhythm and prompts for shock when indicated. Fourth, the patient is handed over to the advanced life-support team with subsequent admission to an intensive care unit in a hospital. The use of AEDs requires developing and implementing a program at sites where the cardiac arrest rate is high, where a number of potential first responders are trained and retained, and where patients are transferred to an advanced care facility after initiating resuscitation. Obviously, placing an AED at a site where no cardiac arrests are likely to occur would be futile, as would placing an AED at a site where no one knows how to use it. Moreover, abandoning patients after initial resuscitation by not transferring them to an advanced care facility would negate all earlier efforts. Thus, it is important to identify the essential components of an AED program that might also optimize the effectiveness of AED use. Methods There is a large body of literature on the use of AEDs in various settings ranging from closed environments such as hospitals, airlines, and casinos to open places such as sports fields and highways. There is little doubt regarding the effectiveness and safety of AEDs to treat people in cardiac arrest. It is intuitive that these devices should be provided in hospitals in areas that are not readily accessible to the traditional responders, the “code blue team.” Similarly, it is intuitive to provide AEDs in out-of-hospital settings where the risk of cardiac arrest is high and a response plan involving trained first responders in the use of AEDs is in place. Thus, the Medical Advisory Secretariat reviewed the literature and focused on the components of an AED program in out-of-hospital settings that maximize the effectiveness and cost-effectiveness of the program i

  10. 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.

  11. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... sudden death. Sudden death, even you survive to go to the hospital but survive out of those ... 35 percent going to have it, 65 percent go to die -- to survive may be under 65. ...

  12. Sudden cardiac death: Role of therapeutic hypothermia

    Directory of Open Access Journals (Sweden)

    Matthias Derwall

    2012-05-01

    Full Text Available Permanent neurocognitive deficits due to cerebral sequelae account for the majority of long-term morbidity and mortality in survivors of cardiac arrest today. Albeit therapeutic hypothermia had been used as effective measure to ameliorate cerebral ischemia-reperfusion injury during surgery for decades, it was not yet introduced into regular post-arrest care until 2003 due to significant side effects of profound hypothermia. These include shivering, higher infection rates, coagulopathy or cardiac arrhythmias, but are less frequently observed with mild therapeutic hypothermia. When body temperature is kept around 33°C, the beneficial effects of hypothermia clearly outweigh its adverse effects. Therefore, treatment of comatose survivors of out-of-hospital cardiac arrest using mild therapeutic hypothermia has now been widely adopted around the globe. Although it still remains controversial who, how, when, and for how long to cool, with only six patients requiring treatment to save one additional life, it is clear that therapeutic hypothermia is the single most effective intervention in brain resuscitation available today.

  13. 42 CFR 486.322 - Condition: Relationships with hospitals, critical access hospitals, and tissue banks.

    Science.gov (United States)

    2010-10-01

    ...Conditions for Coverage: Organ Procurement Organizations Organ Procurement Organization...hospital in regard to donation after cardiac death (if the OPO has a protocol for donation after cardiac death) and the requirements...

  14. 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.

  15. Incidence of Subclinical Hypothyroidism in Cardiac Surgery Patients. Comparison of Presentation Characteristics, Hospital and Medium-Term Outcomes with Euthyroid Patients

    OpenAIRE

    Aarne Jyrala; Nicole M Gatto; Gregory L. Kay

    2012-01-01

    Subclinical hypothyroidism (SCHT) is common, with an occurrence of up to 10% of the adult population and defined biochemically only by elevated TSH and normal T4. SCHT affects negatively on lipid and carbohydrate metabolism increasing the risk of ischemic heart disease, affects negatively on cardiac performance and have a close correlation with renal function. The aim of this study is to compare presentation characteristics and outcomes between euthyroid pts and pts with SCHT who underwent ca...

  16. 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

  17. 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.

  18. 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.

  19. Trastuzumab-associated cardiac dysfunction

    International Nuclear Information System (INIS)

    We analyzed 127 consecutive patients who received trastuzumab-based chemotherapy from December, 2003 to February, 2009 in our hospital. Of 127 patients, cardiac dysfunction appeared in 6 patients (4.7%). Cardiac dysfunction was defined as a decline in left ventricular (LV) ejection fraction (EF) ?55% with absolute reduction of at least 10% from baseline. Among the 6 patients with cardiac dysfunction, one patient suffered symptomatic heart failure. Other patients were asymptomatic. The 4 patients of the 5 patients recovered their cardiac dysfunction after withdrawal of trastuzumab. Patients with trastuzumab-associated cardiac dysfunction had a history of administration of epirubicin or taxane, lower registration LVEF, and larger LV end-diastolic dimension (?49 mm). We recommend that LV function be assessed by echocardiography or multigated radionuclide angiography scans prior to instituting trastuzumab therapy and at three-month intervals during therapy. Trastuzumab should be discontinued in patients who develop a decrease in LVEF below 45% or congestive heart failure. (author)

  20. 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

    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. Udgivelsesdato: 2005-Nov

  1. 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 trialand 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

  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. More efficient hospitals are closing.

    Science.gov (United States)

    Cleverly, W O

    1993-04-01

    An examination of factors related to hospital closures reveals a disconcerting trend. Hospitals that closed in 1991 appear to have been more efficient than hospitals that closed in 1990, and hospitals that closed in 1990 appear to have been more efficient than hospitals that closed in 1989. This trend suggests that future hospital closures may pull relatively efficient hospitals out of the healthcare system. The end result may be increases, not decreases, in total healthcare costs. PMID:10145793

  5. Cardiac perioperative complications in noncardiac surgery

    Directory of Open Access Journals (Sweden)

    Radovanovi? Dragana

    2008-01-01

    Full Text Available Anesthesiologists are confronted with an increasing population of patients undergoing noncardiac surgery who are at risk for cardiac complications in the perioperative period. Perioperative cardiac complications are responsible for significant mortality and morbidity. The aim of the present study was to determine the incidence of perioperative (operative and postoperative cardiac complications and correlations between the incidence of perioperative cardiac complications and type of surgical procedure, age, presence of concurrent diseases. A total of 100 patients with cardiac diseases undergoing noncardiac surgery were included in the prospective study (Group A 50 patients undergoing intraperitoneal surgery and Group B 50 patients undergoing breast and thyroid surgery. The patients were followed up during the perioperative period and after surgery until leaving hospital to assess the occurrence of cardiac events. Cardiac complications (systemic arterial hypertension, systemic arterial hypotension, abnormalities of cardiac conduction and cardiac rhythm, perioperative myocardial ischemia and acute myocardial infarction occurred in 64% of the patients. One of the 100 patients (1% had postoperative myocardial infarction which was fatal. Systemic arterial hypertension occurred in 57% of patients intraoperatively and 33% postoperatively, abnormalities of cardiac rhythm in 31% of patients intraoperatively and 17% postoperatively, perioperative myocardial ischemia in 23% of patients intraoperatively and 11% of postoperatively. The most often cardiac complications were systemic arterial hypertension, abnormalities of cardiac rhythm and perioperative myocardial ischemia. Factors independently associated with the incidence of cardiac complications included the type of surgical procedure, advanced age, duration of anaesthesia and surgery, abnormal preoperative electrocardiogram, abnormal preoperative chest radiography and diabetes.

  6. Crisis management during anaesthesia: cardiac arrest

    OpenAIRE

    Runciman, W (William); Morris, R; Watterson, L; Williamson, J.; Paix, A.

    2005-01-01

    Background: Cardiac arrest attributable to anaesthesia occurs at the rate of between 0.5 and 1 case per 10 000 cases, tends to have a different profile to that of cardiac arrest occurring elsewhere, and has an in-hospital mortality of 20%. However, as individual practitioners encounter cardiac arrest rarely, the rapidity with which the diagnosis is made and the consistency of appropriate management varies considerably.

  7. 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 ... on the camera it looks like it's a big blob of tissue where you really can't ...

  8. What to Expect When Starting Cardiac Rehabilitation

    Science.gov (United States)

    ... Rehabilitation Your doctor may refer you to cardiac rehabilitation (rehab) during an office visit or while you're in the hospital recovering from a heart attack or heart surgery . If your doctor doesn' ...

  9. Repair of a Complex Congenital Cardiac Defect

    Medline Plus

    Full Text Available ... live webcast. My name is Emile Bacha. I'm one of the cardiac surgeons at Children's Hospital ... the heart is immobile and has stopped. I'm not quite certain whether he's going to want ...

  10. Metalepsis out of Bounds

    Directory of Open Access Journals (Sweden)

    Saartje Gobyn

    2013-12-01

    Full Text Available This is a review of the panel “Metalepsis out of Bounds” presented at the 2013 ENN conference. The three convenors proposed complementary remarks to the extent that they either questioned the conceptualization, examined the functioning of metalepsis or applied theoretical models to textual material. Beside an in depth reflection upon the concept, broader questions concerning narrative and popular assumptions of narratology arose.

  11. 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

    Directory of Open Access Journals (Sweden)

    Pablo Castro G

    2004-06-01

    Full Text Available 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 centers. 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 <40%. On admission, 39% received angiotensin converting enzyme (ACE inhibitors, 15% beta-blocker, 25% digoxin, 16% spironolactone and 53% furosemide. The mean hospital stay was 11±10 days and mortality was 4.5%. Conclusions: The elderly is the age group most commonly admitted to hospital due to HF. The main etiologies were ischemic and hypertensive. The main causes for decompensations were noncompliance with diet or medical prescriptions and infections. A significant proportion had a relatively well preserved ventricular systolic function (Rev Méd Chile 2004; 132: 655-62

  12. Reducción de la morbilidad y de los costos hospitalarios en cirugía cardiaca, mediante una estrategia prequirúrgica ambulatoria / Morbidity and hospital cost reduction in cardiac surgery using a presurgery ambulatory strategy

    Scientific Electronic Library Online (English)

    Nydia, Ávila-Vanzzini; Jorge, Kuri-Alfaro; Laura Leticia, Rodríguez-Chávez; Gabriela, Meléndez-Ramírez; Sergio, Trevethan-Cravioto; Alejandro, Quiroz-Martínez; Héctor, Herrera-Bello; Valentín, Herrera-Alarcón; Humberto, Martínez-Hernández; Marco Antonio, Martínez-Ríos.

    2010-12-01

    Full Text Available Los pacientes que van a una cirugía electiva de corazón, se internan a través de una lista de espera de admisión hospitalaria. Desde 1999 existe en el Instituto Nacional de Cardiología Ignacio Chávez, la "vía rápida de internamiento" para pacientes de bajo riesgo quirúrgico, que en el 2004 se extend [...] ió a riesgo moderado, tomando como base criterios propios y criterios internacionalmente aceptados. Objetivos: 1) comparar las dos alternativas de internamiento utilizadas actualmente: vía de internamiento rápido; y el internamiento a través de la lista de espera del departamento de admisión, tomando en consideración los eventos mayores que presentaron como: muerte o complicaciones que prolongaron la estancia hospitalaria a más de 14 días (Infecciones, reoperación, alteraciones del ritmo y de la conducción y otros). 2) Comparar los días de estancia y consumo de recursos hospitalarios. Métodos: Se tomaron dos cohortes de 347 pacientes, el grupo control fue obtenido de la lista de espera del departamento de admisión, mientras que el grupo de la vía de internamiento rápido, tuvo como requisito tener los estudios preoperatorios completos y a los enfermos con comorbilidad resuelta o compensada. Los gastos generados al hospital por cada paciente se calcularon de acuerdo a la clasificación socioeconómica de los enfermos. Análisis estadístico: Se utilizó la prueba t de Student para muestras independientes y variables numéricas y Ji cuadrada para las variables categóricas, se consideró significativo un valor de p Abstract in english In our hospital, the patients that need an elective cardiac surgery are admitted through the admission department on the basis of a waiting list. Since 1999, a fast track to hospitalization program has existed in the National Institute of Cardiology Ignacio Chavez for patients with low surgical risk [...] . Later, in 2004, this program was extended to patients to moderate risk, based on rules accepted worldwide, and our own experience. Objectives: 1) To compare two ways of admission that are used currently: fast track to hospitalization, against admission department waiting list. We compared major events: death or events that increased the hospital stay by more than 14 days (infections, alterations of rhythm and conduction, reoperations and others), 2) To compare the days of hospitalization and money spent by the hospital. Methods: We conformed 2 groups of 347 patients. The admission department waiting list group was admitted before doing their preoperative studies, which is the customary form for hospitalization by our admissions department, while the group of fast track to hospitalization was obligated to have their laboratory exams complete and any other diseases resolved or controlled previously. The monetary cost per patient for the hospital was calculated based on the patient's socioeconomic classification. Statistical analysis: Student t test was conducted on independent samples and numerical variables, and Chi square for categorical variables. We considered a p

  13. 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.

  14. Hyponatremia Presenting as Cardiac Conduction Defect

    Directory of Open Access Journals (Sweden)

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

    2009-04-01

    Full Text Available 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.

  15. 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.

  16. 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

  17. Out of the woods.

    Science.gov (United States)

    Jacobson, J L

    1992-01-01

    Throughout Africa, Asia and Latin America women are pushed out of forests and from their maintenance by governments and private interests for cash crop development disregarding the role of women in conserving forests. In developing countries forests are a source of wood for fuel; 60-80% of women gather wood for family needs in America. Fruits, vegetables, and nuts gathered in woods enhance their diet. Indonesian women pick bananas, mangos, guavas, and avocados from trees around their homes; in Senegal shea-nut butter is made from a local tree fruit to be sold for cash. Women provide labor also in logging, wood processing, and tree nurseries. They make charcoal and grow seedlings for sale. In India 40% of forest income and 75% of forest products export earnings are derived from nonwood resources. Poor, rural women make items out of bamboo, rattan, and rope to sell: 48% of women in an Egyptian province make a living through such activities. In India 600,000 women harvest tendu leaves for use as wrappings for cigarettes. The expansion of commercial tree plantations replacing once communal natural forests has forced poor households to spend up to 4-% of their income on fuel that they used to find in forests. Tribal women in India know the medicinal uses of 300 forest species, and women in Sierra Leone could name 31 products they obtained or made from trees and bushes, while men named only 8 items. Only 1 forestry project appraised by the World Bank during 1984-97 named women as beneficiaries, and only 1 out of 33 rural development programs funded by the World Bank did. Women provide food, fuel, and water for their families in subsistence economies, they know sustainable methods of forestry, yet they are not included in development programs whose success or failure could hinge on more attention to women's contribution and on more equity. PMID:12285836

  18. Oil, Out of Control

    Science.gov (United States)

    Oil, Out of Control is an in-depth Whyfiles story that follows from news coverage of an oil spill off Spain's northwest coast in 2002. This Web site offers a straight look at the issues surrounding this and other famous oil spills, particularly that of the Exxon Valdez off Prince William Sound in 1992. The authors make clear the allegiances of people quoted in the story, while clearly explaining both the science and politics of oil spills and cleanup efforts. The Web site also features a news release from Unocal regarding a spill in Indonesia, with a humorous Whyfiles "plain-English" translation of slippery corporate jargon.

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

    OpenAIRE

    Tubaro, M; Danchin, N; Goldstein, P; Filippatos, G; Hasin, Y; Heras, M.; Jansky, P; Norekval, TM; Swahn, E.; Thygesen, K.; Vrints, C; Zahger, D; Arntz, HR; Bellou, A; De La Coussaye, JE

    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 ...

  20. Complicações que aumentam o tempo de permanência na unidade de terapia intensiva na cirurgia cardíaca / Complications that increase the time of Hospitalization at ICU of patients submitted to cardiac surgery

    Scientific Electronic Library Online (English)

    Artur, Laizo; Francisco Eduardo da Fonseca, Delgado; Glauco Mendonça, Rocha.

    2010-06-01

    Full Text Available OBJETIVO: Apresentar as complicações que aumentam a permanência na Unidade de Terapia Intensiva (UTI) dos pacientes submetidos à cirurgia cardíaca. MÉTODOS: Foram analisados, retrospectivamente, 85 prontuários de pacientes submetidos à cirurgia cardíaca, no período de março a maio de 2009, na Santa [...] Casa de Misericórdia de Juiz de Fora (MG) e, destes pacientes, foram estudados 14 (16,47%) que permaneceram por mais de 5 dias na UTI. Dentre os 85 pacientes, houve três óbitos, sendo dois pacientes operados em caráter de urgência, o que aumenta a morbidade, e um paciente que permaneceu internado e em ventilação mecânica (VM) por 21 dias. RESULTADOS: O estudo demonstrou que as complicações que aumentaram o tempo de internação na UTI foram respiratórias e metabólicas, de acordo com a literatura. CONCLUSÃO: As complicações que aumentam o tempo de permanência na UTI são as relacionadas à função respiratória, doença pulmonar obstrutiva crônica, tabagismo, congestão pulmonar, desmame da VM prolongado, diabetes, infecções, insuficiência renal, acidente vascular encefálico e instabilidade hemodinâmica. Abstract in english OBJECTIVE: To show the complications that increase the permanence at intensive care unit (ICU) of the patients submitted to cardiac surgery. METHODS: Eighty-five handbooks of patients submitted to cardiac surgery had been analyzed, retrospectively, from March to May 2009 at Santa Casa de Misericórdi [...] a de Juiz de Fora (MG) - Brazil - and 14 (16.47%) patients had been studied. They remained more than 5 days at ICU. In 85 patients occurred three deaths: two patients operated in urgency character and this increases the morbidity; one patient who remained in mechanical ventilation (MV) by 21 days. RESULTS: Complications that had increased the time of hospitalization at ICU had been respiratory and metabolic in accordance with literature. CONCLUSION: Complications that increase the time of permanence at ICU are those related to respiratory function, chronic obstructive pulmonary disease, tabagism, pulmonary congestion, time of permanence under MV, diabetes, infections, renal insufficiency, stroke and hemodynamic instability.

  1. Myocardial stunning after resuscitation from cardiac arrest following spinal anaesthesia

    OpenAIRE

    Kurhekar, Pranjali Madhav; Yachendra, VSG; Babu, Simi P; Govindasamy, Raghavelu

    2014-01-01

    Cardiac arrest associated with spinal anaesthesia has been well researched. Myocardial stunning after successful resuscitation from cardiac arrest is seen in up to 2/3rd of in-hospital cardiac arrests. Myocardial stunning after resuscitation from cardiac arrest associated with spinal anaesthesia has probably not been reported earlier. Our case, an ASA physical status I lady, posted for tubal reanastomosis surgery developed bradycardia followed by asystole, approximately 5 minutes after giving...

  2. DIGITAL ANALYSIS OF CARDIAC ACOUSTIC SIGNALS IN CHILDREN

    OpenAIRE

    El-segaier, Milad

    2007-01-01

    DIGITAL ANALYSIS OF CARDIAC ACOUSTIC SIGNALS IN CHILDREN Milad El-Segaier, MD Division of Paediatric Cardiology, Department of Paediatrics, Lund University Hospital, Lund, Sweden SUMMARY Despite tremendous development in cardiac imaging, use of the stethoscope and cardiac auscultation remains the primary diagnostic tool in evaluation of cardiac pathology. With the advent of miniaturized and powerful technology for data acquisition, display and digital signal proces...

  3. 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 ...

  4. 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.

  5. 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.

  6. Toleration out of respect?

    DEFF Research Database (Denmark)

    Lægaard, Sune

    2014-01-01

    Under conditions of pluralism different cultures, interests or values can come into conflict, which raises the problem of how to secure peaceful co-existence. The idea of toleration historically emerged as an answer to this problem. Recently Rainer Forst has argued that toleration should not just be based on a modus vivendi designed to secure peaceful co-existence, but should be based on moral reasons. Forst therefore advances what he calls the ‘respect conception’ of toleration as an in itself morally desirable type of relationship, which is furthermore the only conception of toleration that avoids various so-called ‘paradoxes of toleration’. The paper first examines whether Forst’s respect conception can be applied descriptively to distinguish between actual patterns of behaviour and classify different acts of toleration. Then the focus is shifted to toleration out of respect as a normative prescription, which Forst presents as a requirement of justice. At both levels, it is argued that Forst’s respect conception is problematic since it presupposes that answers to very substantial normative questions, which are precisely what people tend to disagree on under conditions of pluralism, are already at hand. The respect conception therefore seems to be at best a theoretical idea belonging in ideal-theory, not a useful practical solution to actual conflicts under conditions of pluralism.

  7. 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 ...

  8. 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 aely. 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)

  9. Cardiac tamponade

    OpenAIRE

    Wilson, Jennifer G.; Epstein, Sara M.; Ralph Wang; Kanzaria, Hemal K.

    1980-01-01

    Cardiac tamponade is a cardiological emergency requiring prompt treatment in order to avoid a fatal outcome. It can complicate a number of medical conditions and it is important, therefore, that all practitioners are aware of its presentation, diagnosis and management. These are outlined. We suggest that, with certain specific and important exceptions, percutaneous catheter pericardiocentesis is to be recommended in the management of cardiac tamponade. We include a review of 51 consecutive ca...

  10. 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)

  11. 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.

  12. 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.

  13. Cardiac echinococcosis

    Directory of Open Access Journals (Sweden)

    Ivanovi?-Krsti? Branislava A.

    2002-01-01

    Full Text Available Cardiac hydatid disease is rare. We report on an uncommon hydatid cyst localized in the right ventricular wall, right atrial wall tricuspid valve left atrium and pericard. A 33-year-old woman was treated for cough, fever and chest pain. Cardiac echocardiograpic examination revealed a round tumor (5.8 x 4 cm in the right ventricular free wall and two smaller cysts behind that tumor. There were cysts in right atrial wall and tricuspidal valve as well. Serologic tests for hydatidosis were positive. Computed tomography finding was consistent with diagnosis of hydatid cyst in lungs and right hylar part. Surgical treatment was rejected due to great risk of cardiac perforation. Medical treatment with albendazole was unsuccessful and the patient died due to systemic hydatid involvement of the lungs, liver and central nervous system.

  14. 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.

  15. Cardiac amyloidosis.

    Science.gov (United States)

    Kingman, A; Pereira, N L

    2001-05-01

    Cardiac amyloidosis should be considered in a patient with heart failure, who is normotensive with decreased left ventricular systolic function and marked left ventricular hypertrophy by echocardiogram and has decreased voltage by ECG. Furthermore, when the diagnosis of cardiac amyloid is made, it is important to classify the subtype of disease to be able to offer appropriate treatment. Contrary to traditional belief that the prognosis for patients with amyloidosis is dismal, some forms of this disease are curable and other forms are characterized by slow progression of disease. PMID:11381776

  16. 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.

  17. Cardiac Pacemakers

    International Nuclear Information System (INIS)

    A complete survey of physiological biophysical,clinical and engineering aspects of cardiac facing,including the history and an assessment of possible future developments.Among the topics studied are: pacemakers, energy search, heart stimulating with pacemakers ,mathematical aspects of the electric cardio stimulation chronic, pacemaker implants,proceeding,treatment and control

  18. Cardiac Amyloidosis

    Science.gov (United States)

    ... the voltage is lower than normal on an ECG in the setting of thick walls on an ... that the implantation of a defibrillator to prevent sudden death plays any role in the majority of patients with cardiac amyloidosis. Treatment of the Underlying Condition To prevent ...

  19. 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, ascompared with 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.)

  20. 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)

  1. 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

  2. FacilitiesHospitals_HOSPITAL

    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...

  3. FacilitiesHospitals_HOSPITAL

    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...

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

    DEFF Research Database (Denmark)

    SØholm, Helle; Bro-Jeppesen, John

    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 review of individual patient charts for in-hospital post-resuscitation care were collected. RESULTS: A total of 2541 consecutive OHCA-patients were recorded, 245 (10%) of who were current NH-residents. NH-patients were older, more frequently female, had more witnessed arrests, fewer shockable primary rhythm and assumed cardiac aetiology, but shorter time to the return of spontaneous circulation (ROSC) compared to OHCA in non-nursing homes (non-NH). Overall 30-day survival rate was 9% in NH and 18% in non-NH, p<0.001. Of the 245 NH-arrests 79 (32%) patients were admitted to hospital compared to 937 (41%) from non-NH (p<0.001). Thirty-day survival rate in patients admitted to hospital were 27% for NH- and 42% for non-NH-patients, p<0.001. OHCA in NH was, however, not associated with a significantly worse prognosis (HR=0.88 (0.64-1.21), p=0.4) after adjustment for known prognostic factors including co-morbidity. CONCLUSIONS: Nursing home residents resuscitated from OHCA and admitted to hospital have similar survival rates as non-NH-patients when adjusting for known prognostic factors and pre-existing co-morbidity. A policy of not attempting resuscitation in nursing homes at all may therefore not be justified.

  5. 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.

  6. Trasplante cardiaco / Cardiac transplant

    Scientific Electronic Library Online (English)

    Donato, Salas-Segura; Mario, Sánchez Suen; Carlos, Salazar-Vargas.

    2008-12-01

    Full Text Available La insuficiencia cardiaca es un cuadro clínico frecuente y de apreciable mortalidad. A menudo de nuestra área de atracción emergen cardiópatas con diferentes grados de discapacidad, dependientes de familiares para su atención y que requieren re-hospitalizaciones y tratamientos costosos y a pesar de [...] ello con mal pronóstico. Las autoridades sanitarias y particularmente el estado invierten anualmente mucho dinero en el tratamiento de los enfermos que la padecen y también en la cobertura de incapacidades para estos individuos. El trasplante cardiaco se ha implementado en el mundo como una excelente opción de tratamiento de los pacientes con insuficiencia cardiaca, capaz de brindar al menos 10 años de vida a pesar de lo riguroso del seguimiento, tanto para el paciente y su familia, como para el personal medico. El Hospital R. A. Calderón Guardia inició hace un año un Programa de Trasplante Cardiaco, presentamos aquí los 2 primeros pacientes y su seguimiento. Abstract in english Heart failure is a common clinical problem that implies pretty high mortality. From the Calderon Guardia Hospital drawing area emerge individuals with different degrees of disability, depending upon their families for their needs, requiring frequent hospitalizations and expensive treatments and stil [...] l with bad prognosis. The government dedicates large amounts of money to the treatment of these patients and also to cover for their disability. Cardiac transplantation has been implemented worldwide as a viable solution for persons with heart failure, able to expand their life for at least 10 extra years, in spite of the rigorous follow up protocols for the patients and health personnel as well. One year ago the R. A. Calderon Guardia Hospital started a heart transplant program, we herein present the first 2 patients and their follow up.

  7. 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.

  8. Out-of-ecliptic dust

    International Nuclear Information System (INIS)

    Predictions of the number density of interplanetary dust particles out of the ecliptic plane are derived from model computations by adjusting the parameters to the run of brightness of the zodiacal light in the ecliptic plane and at right angles to the Sun from the ecliptic plane to the ecliptic pole. Within the limits of the simple models, surfaces of equal number density are presented. The number density of zodiacal dust particles is not expected to fall below 20% within 0.5 AU above the earth's orbit. The use of space probes in and out of the ecliptic is discussed, and the possibility of discriminating between different dust distribution functions by means of out-of-ecliptic probes is demonstrated for a space probe in an orbit of 1 AU radius and 30 deg inclination with respect to the ecliptic plane

  9. A patient dose survey in a cardiac angiographic suite

    International Nuclear Information System (INIS)

    Full text: A very large set of patient dose survey data. containing 3,564 individual procedures, has been collected in the cardiac angiographic suite in a large teaching hospital. Every procedure for a period of three years has been logged by the radiographer assisting the cardiologist. A diamentor was permanently attached to the tube housing with a read out device located at the control panel. A removable hafnium (Hf) filter (50 ?m) was also available and was used when possible for 'thin' patients in order to reduce patient skin entrance dose. The survey included cardiac angiography and percutaneous transluminal coronary angioplasty procedures. Exposure-area product values were used to estimate effective dose and skin entrance doses for the various types of procedures for conditions where the Hf filter was in and out of the x-ray beam. The large data set has enabled us to illustrate statistical parameters of the data, including relationships between weight, height, sex, use of the Hf filter and dose-area product

  10. Hospitals; hospitals13

    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....

  11. 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 

  12. Do medical outpatients want 'out of hours' clinics?

    Directory of Open Access Journals (Sweden)

    Partridge Martyn R

    2005-06-01

    Full Text Available Abstract Background Patient choice is a major theme in current healthcare delivery. Little is known about patients' wishes regarding the timing of medical outpatient clinics. Methods A questionnaire survey of 300 sequential patients attending cardiac and respiratory clinics to determine patients preferences for out of hours and weekend outpatient clinics. (Out of hours defined as a clinic after 5 pm on Mon – Fri Results Two hundred and 64 patients completed the survey of which 165 (62.5% wanted either an out of hours clinics or a weekend clinic. Sixty four (38.8% specifically stated that this was because of work commitments but for many others, the reasons given were easy to justify. Conclusion Current provision for outpatient consultation may not be convenient for many patients with heart and lung disease. A fuller evaluation of the cost and benefits of more flexible clinic hours is now needed.

  13. Sudden Cardiac Arrest

    Science.gov (United States)

    ... scda_whatis.html What is Sudden Cardiac Arrest? Heart Rhythm Society www.hrsonline.org/News/Sudden-Cardiac-Arrest-SCA-Awareness Sudden Cardiac Arrest (SCA) Awareness MedlinePlus www.nlm.nih.gov/medlineplus/cardiacarrest.html Cardiac Arrest www.nlm.nih.gov/medlineplus/ency/article/000010.htm CPR

  14. All Things Out of Rule

    Science.gov (United States)

    Gregory, Nuala

    2015-01-01

    This article brings together and compares my own artistic practice of drawing/painting and the eighteenth-century novel "Tristram Shandy." In both cases, there is a free play of lines, textual or graphic, which sets "all things out of rule". A whole typology of lines is woven throughout Sterne's text and reappears,…

  15. Cardiac ventriculography

    International Nuclear Information System (INIS)

    Cardiac ventriculography has been used extensively to define the anatomy of the ventricles and related structures in patients with congenital, valvular, coronary, and cardiomyopathic heart disease. Specifically, left ventriculography may provide valuable information about global and segmental left ventricular function, mitral valvular incompetence, and the presence, location, and severity of a number of other abnormalities, including ventricular septal defect and hypertrophic cardiomyopathy. As a result, it should be a routine part of catheterization in patients being evaluated for coronary artery disease, aortic or mitral valvular disease, unexplained left ventricular failure, or congenital heart disease. Similarly, right ventriculography may provide information about global and segmental right ventricular function and can be especially helpful in patients with congenital heart disease

  16. 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.

  17. Phase Out of Leaded Gasoline

    Science.gov (United States)

    1998-01-01

    The Sofia Institute on Local Air Quality is part of the Regional Environmental Center (REC) for Central and Eastern Europe. Its report, Phase Out of Leaded Gasoline, explains why leaded gas is being eliminated and reviews current obstacles facing the phase out, technical and economic factors to consider, and policy measures and instruments for use in the phase out. The report ends with conclusions and recommendations and references. The report is available either online or as a [.pdf] file.

  18. Do hospitals cross-subsidize?

    Science.gov (United States)

    David, Guy; Lindrooth, Richard C; Helmchen, Lorens A; Burns, Lawton R

    2014-09-01

    Despite its salience as a regulatory tool to ensure the delivery of unprofitable medical services, cross-subsidization of services within hospital systems has been notoriously difficult to detect and quantify. We use repeated shocks to a profitable service in the market for hospital-based medical care to test for cross-subsidization of unprofitable services. Using patient-level data from general short-term hospitals in Arizona and Colorado before and after entry by cardiac specialty hospitals, we study how incumbent hospitals adjusted their provision of three uncontested services that are widely considered to be unprofitable. We estimate that the hospitals most exposed to entry reduced their provision of psychiatric, substance-abuse, and trauma care services at a rate of about one uncontested-service admission for every four cardiac admissions they stood to lose. Although entry by single-specialty hospitals may adversely affect the provision of unprofitable uncontested services, these findings warrant further evaluation of service-line cross-subsidization as a means to finance them. PMID:25062300

  19. HCAHPS - Hospital

    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...

  20. Hospital Compare

    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...

  1. Cardiac regeneration therapy: connections to cardiac physiology.

    Science.gov (United States)

    Takehara, Naofumi; Matsubara, Hiroaki

    2011-12-01

    Without heart transplantation, a large number of patients with failing hearts worldwide face poor outcomes. By means of cardiomyocyte regeneration, cardiac regeneration therapy is emerging with great promise as a means for restoring loss of cardiac function. However, the limited success of clinical trials using bone marrow-derived cells and myoblasts with heterogeneous constituents, transplanted at a wide range of cell doses, has led to disagreement on the efficacy of cell therapy. It is therefore essential to reevaluate the evidence for the efficacy of cell-based cardiac regeneration therapy, focusing on targets, materials, and methodologies. Meanwhile, the revolutionary innovation of cardiac regeneration therapy is sorely needed to help the millions of people who suffer heart failure from acquired loss of cardiomyocytes. Cardiac regeneration has been used only in limited species or as a developing process in the rodent heart; now, the possibility of cardiomyocyte turnover in the human heart is being revisited. In the pursuit of this concept, the use of cardiac stem/progenitor stem cells in the cardiac niche must be focused to usher in a second era of cardiac regeneration therapy for the severely injured heart. In addition, tissue engineering and cellular reprogramming will advance the next era of treatment that will enable current cell-based therapy to progress to "real" cardiac regeneration therapy. Although many barriers remain, the prevention of refractory heart failure through cardiac regeneration is now becoming a realistic possibility. PMID:21963835

  2. 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

  3. 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.

  4. 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.

  5. Introduction: Staying Out of Court

    OpenAIRE

    Swaaningen, R.

    2008-01-01

    The ways court procedures can be avoided is a classical theme in socio-legal studies and criminology. The preface to a book published on that theme by the Erasmus School of Law in 1988, on the occasion of its 25th anniversary, covers the then dominant view very well: ‘They [people who advocate out of court settlements, RvS] consider the judge as an ultimum remedium. And that is how it often should be’. Topics covered in that jubilee volume ranged from arbitration and administrative re...

  6. Cardiac Stem Cell Therapy for Cardiac Repair

    OpenAIRE

    Hong, Kyung U.; Bolli, Roberto

    2014-01-01

    The discovery of adult cardiac stem cells (CSCs) and their potential to restore functional cardiac tissue has fueled unprecedented interest in recent years. Indeed, stem-cell–based therapies have the potential to transform the treatment and prognosis of heart failure, for they have the potential to eliminate the underlying cause of the disease by reconstituting the damaged heart with functional cardiac cells. Over the last decade, several independent laboratories have demonstrated the utili...

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

    Directory of Open Access Journals (Sweden)

    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.

  8. 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.

  9. Cardiac Arrest Cases and Automated External Defibrillator Use in Railroad Stations in Tokyo

    Directory of Open Access Journals (Sweden)

    Satoko Fukuike

    2014-11-01

    Full Text Available Objective: Nationwide dissemination of public-access defibrillation (PAD contributed to an increase of survival rate in Japan. We analysed cardiac arrests (CAs that occurred in railroad stations in Tokyo to evaluate PAD in the metropolis. Methods: We collected Utstein data from the Tokyo Fire Department (TFD and analysed CA cases that occurred in stations. In total, 245 non-traumatic CAs from January 1, 2007 to March 31, 2008 were analysed; CAs in children under 8 years were excluded. Results: The rates of pre-hospital return of spontaneous circulation (ROSC were 41 out of 145 witnessed CA patients (28.3% and 12 ROSC out of 100 unwitnessed CA patients (12%. Of 245 CA cases, bystander cardiopulmonary resuscitation (CPR performed in 156 (63.7%, automated external defibrillator (AED used in 117 (47.8% and shock delivered in 65 (26.5%. Rates of ROSC were 31.6% (37/117 with AED use significantly higher than those of 12.5% (16/128 without AED use (P < 0.001. Most CAs occurred on platforms; the use of AEDs on platforms increased from 18/31 (58.1% in 2007 to 32/43 (74.4% in 2008 and ROSC rates increased from 8 (25.8% to 14 (32.6%, respectively. On train CAs: ROSC cases were very few, 1 case each year (8.3%; 7.7% while the use of AED increased from 8/12 (66.7% in 2007 to 10/13 (76.9% in 2008. Conclusion: Bystander CPR and the use of AED at railroad stations improved ROSC for out-of-hospital cardiac arrest (OHCA patients. AED location and strategies for dealing with CAs on trains should be re-evaluated.

  10. The economics of cardiac biomarker testing in suspected myocardial infarction.

    Science.gov (United States)

    Goodacre, Steve; Thokala, Praveen

    2015-03-01

    Suspected myocardial infarction (MI) is a common reason for emergency hospital attendance and admission. Cardiac biomarker measurement is an essential element of diagnostic assessment of suspected MI. Although the cost of a routinely available biomarker may be small, the large patient population and consequences in terms of hospital admission and investigation mean that the economic impact of cardiac biomarker testing is substantial. Economic evaluation involves comparing the estimated costs and effectiveness (outcomes) of two or more interventions or care alternatives. This process creates some difficulties with respect to cardiac biomarkers. Estimating the effectiveness of cardiac biomarkers involves identifying how they help to improve health and how we can measure this improvement. Comparison to an appropriate alternative is also problematic. New biomarkers may be promoted on the basis of reducing hospital admission or length of stay, but hospital admission for low risk patients may incur significant costs while providing very little benefit, making it an inappropriate comparator. Finally, economic evaluation may conclude that a more sensitive biomarker strategy is more effective but, by detecting and treating more cases, is also more expensive. In these circumstances it is unclear whether we should use the more effective or the cheaper option. This article provides an introduction to health economics and addresses the specific issues relevant to cardiac biomarkers. It describes the key concepts relevant to economic evaluation of cardiac biomarkers in suspected MI and highlights key areas of uncertainty and controversy. PMID:25173750

  11. Cardiac Risk Assessment

    Science.gov (United States)

    ... this website will be limited. Search Help? Cardiac Risk Assessment Share this page: Was this page helpful? ... Common Questions | Related Pages What is a cardiac risk assessment? This is a group of tests and ...

  12. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... then 50 percent of them will be sudden death. Sudden death, even you survive to go to the ... if they're at risk for sudden cardiac death? Sudden cardiac death, sometime if give you notice, but ...

  13. Mediastinitis after cardiac transplantation

    Directory of Open Access Journals (Sweden)

    Noedir A. G. Stolf

    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±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.

  14. 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)h stable cardiomyopathy. (author)

  15. Surgical volume, hospital quality, and hospitalization cost in congenital heart surgery in the United States.

    Science.gov (United States)

    Chan, Titus; Kim, Jaewhan; Minich, L LuAnn; Pinto, Nelangi M; Waitzman, Norman J

    2015-01-01

    Hospital volume has been associated with improved outcomes in congenital cardiac surgery. However, the relationship between hospital volume and hospitalization cost remains unclear. This study examines the relationship between hospital surgical volume and hospitalization costs, while accounting for measures of quality, in children undergoing congenital heart surgery. A retrospective, repeated cross-sectional analysis was performed, using discharges from the 2006 and 2009 Kids' Inpatient Database. All pediatric admissions (cost/charge data were included. Multivariate, linear mixed regression models were run on hospitalization costs, with and without adjustment for indicators of quality (hospital mortality rate and complication rate). Both medium and high-volume hospitals (200-400 cases/year and >400 cases/year, respectively) were associated with lower odds of mortality but not occurrence of a complication. Hospital mortality was associated with the largest increase in hospitalization costs. High-volume hospitals (>400 cases/year) were associated with the lowest hospitalization costs per discharge ($37,775, p cost savings. When adjusting for hospital complication rate, high-volume hospitals continued to have the lowest hospitalization costs. High-volume hospitals are associated with a reduction in hospitalization costs that appear to be mediated through improvements in quality. PMID:25099030

  16. Comparison of the Hemodynamic Effects of the Induction Agents Ketamine, Etomidate and Sevoflurane Using the Model of Electrical Velocimetry Based Cardiac Output Monitoring in Pediatric Cardiac Surgical Patients

    OpenAIRE

    Suruchi Hasija; Sandeep Chauhan; Neeti Makhija; Sarvesh Pal Singh; Sanjay Kumar1,; Arin Choudhury; Sachin Talwar; Usha Kiran

    2014-01-01

    Objective: To compare the haemodynamic effects of the induction agents ketamine, etomidate and sevoflurane using the model of electrical velocimetry based cardiac output monitoring in paediatric cardiac surgical patients. Design: Prospective randomized study. Setting: Tertiary care hospital. Participants: 60 children < 2 years age undergoing cardiac surgery. Interventions: The patients were randomized into 3 equal groups to receive 1.5-2.5 mg/kg iv ketamine (group K), 0.2-0.3 mg/kg iv etomida...

  17. 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.

  18. Spatiotemporal order out of noise

    Science.gov (United States)

    Sagués, Francesc; Sancho, José M.; García-Ojalvo, Jordi

    2007-07-01

    Natural systems are undeniably subject to random fluctuations, arising from either environmental variability or thermal effects. The consideration of those fluctuations supposes to deal with noisy quantities whose variance might at times be a sizable fraction of their mean levels. It is known that, under these conditions, noisy fluctuations can interact with the system’s nonlinearities to render counterintuitive behavior, in which an increase in the noise level produces a more regular behavior. In systems with spatial degrees of freedom, this regularity takes the form of spatiotemporal order. An overview is presented of the mechanisms through which noise induces, enhances, and sustains ordered behavior in passive and active nonlinear media, and different spatiotemporal phenomena are described resulting from these effects. The general theoretical framework used in the analysis of these effects is reviewed, encompassing the theory of stochastic partial differential equations and coupled sets of ordinary stochastic differential equations. Experimental observations of self-organized behavior arising out of noise are also described, and details on the numerical algorithms needed in the computer simulation of these problems are given.

  19. Coping to Cardiac Surgery – preview note

    Directory of Open Access Journals (Sweden)

    Juliane Umann

    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.

  20. 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.

  1. Non-invasive ventilation in cardiac surgery: a concise review

    OpenAIRE

    Cabrini, L; Plumari, V P; L. Nobile; Olper, L; Pasin, L; Bocchino, S; Landoni, G; Beretta, L.; Zangrillo, A

    2013-01-01

    Mild to severe respiratory dysfunction is still a common issue after cardiac surgery. Postoperative respiratory complications are associated with prolonged hospitalization and worse survival. In this high-risk surgery, non-invasive ventilation could have relevant positive effects. The present narrative concise review aims to summarize available data on the role of non-invasive ventilation before and after cardiac surgery. Non-invasive ventilation exerts its main effects on the pulmonary and o...

  2. Infective endocarditis and the pacemaker: cardiac implantable electronic device infection.

    Science.gov (United States)

    Yew, K L

    2012-12-01

    We are seeing more implantation of cardiac device such as pacemakers and defibrillators and also cardiac implantable electronic device infection. The infection may affect just the pocket site or progress to deeper infection and bacteraemia. Inadequately treated infection may lead to right sided endocarditis, cardiotomy for pacemaker explantation and increased cost and length of stay in the hospital. We report a Staphylococcal infection of a pacemaker system, its successful medical and surgical management. PMID:23770958

  3. 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.

  4. 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.

  5. Epidemiology and management of cardiac arrest: what registries are revealing.

    Science.gov (United States)

    Gräsner, Jan-Thorsten; Bossaert, Leo

    2013-09-01

    Major European institutions report cardiovascular disease (CVD) as the first cause of death in adults, with cardiac arrest and sudden death due to coronary ischaemia as the primary single cause. Global incidence of CVD is decreasing in most European countries, due to prevention, lifestyle and treatment. Mortality of acute coronary events inside the hospital decreases more rapidly than outside the hospital. To improve the mortality of cardiac arrest outside the hospital, reliable epidemiological and process figures are essential: "we can only manage what we can measure". Europe is a patchwork of 47 countries (total population of 830 million), with a 10-fold difference in incidence of coronary heart disease between North and South, East and West, and a 5-fold difference in number of EMS-treated cardiac arrest (range 17-53/1000,000/year). Epidemiology of cardiac arrest should not be calculated as a European average, but it is appropriate to describe the incidence of cardiac arrest, the resuscitation process, and the outcome in each of the European regions, for benchmarking and quality management. Epidemiological reports of cardiac arrest should specify definitions, nominator (number of cases) and denominator (study population). Recently some regional registries in North America, Japan and Europe fulfilled these conditions. The European Registry of Cardiac Arrest (EuReCa) has the potential to achieve these objectives on a pan-European scale. For operational applications, the Utstein definition of "Cardiac arrest" is used which includes the potential of survival. For application in community health, the WHO definition of "sudden death" is frequently used, describing the mode of death. There is considerable overlap between both definitions. But this explains that no single method can provide all information. Integrating data from multiple sources (local, national, multinational registries and surveys, death certificates, post-mortem reports, community statistics, medical records) may create a holistic picture of cardiac arrest in the community. PMID:24054508

  6. Cardiac gated ventilation

    International Nuclear Information System (INIS)

    There are several theoretic advantages to synchronizing positive pressure breaths with the cardiac cycle, including the potential for improving distribution of pulmonary and myocardial blood flow and enhancing cardiac output. The authors evaluated the effects of synchronizing respiration to the cardiac cycle using a programmable ventilator and electron beam CT (EBCT) scanning. The hearts of anesthetized dogs were imaged during cardiac gated respiration with a 50 msec scan aperture. Multi slice, short axis, dynamic image data sets spanning the apex to base of the left ventricle were evaluated to determine the volume of the left ventricular chamber at end-diastole and end-systole during apnea, systolic and diastolic cardiac gating. The authors observed an increase in cardiac output of up to 30% with inspiration gated to the systolic phase of the cardiac cycle in a non-failing model of the heart

  7. Controlled Cardiac Computed Tomography

    Directory of Open Access Journals (Sweden)

    Ge Wang

    2006-04-01

    Full Text Available Cardiac computed tomography (CT has been a hot topic for years because of the clinical importance of cardiac diseases and the rapid evolution of CT systems. In this paper, we propose a novel strategy for controlled cardiac CT that may effectively reduce image artifacts due to cardiac and respiratory motions. Our approach is radically different from existing ones and is based on controlling the X-ray source rotation velocity and powering status in reference to the cardiac motion. We theoretically show that by such a control-based intervention the data acquisition process can be optimized for cardiac CT in the cases of periodic and quasiperiodic cardiac motions. Specifically, we formulate the corresponding coordination/control schemes for either exact or approximate matches between the ideal and actual source positions, and report representative simulation results that support our analytic findings.

  8. 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

  9. Cardiac regeneration: different cells same goal

    OpenAIRE

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

    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...

  10. 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.

  11. Hospital Hints

    Science.gov (United States)

    ... are ready to move to their hospital rooms. Hospital Safety Tips Because you may feel weak or tired, ... when using the toilet. After You Leave the Hospital Older people may have health problems that make it hard for them to live ...

  12. Cardiac Innervation and Sudden Cardiac Death

    OpenAIRE

    Ieda, Masaki; Fukuda, Keiichi

    2009-01-01

    The heart is extensively innervated and its performance is tightly controlled by the nervous system. Cardiac innervation density varies in diseased hearts leading to unbalanced neural activation and lethal arrhythmia. Diabetic sensory neuropathy causes silent myocardial ischemia, characterized by loss of pain perception during myocardial ischemia, which is a major cause of sudden cardiac death in diabetes mellitus (DM). Despite its clinical importance, the mechanisms underlying the control an...

  13. 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 

  14. Cardiac innervation and sudden cardiac death.

    Science.gov (United States)

    Fukuda, Keiichi; Kanazawa, Hideaki; Aizawa, Yoshiyasu; Ardell, Jeffrey L; Shivkumar, Kalyanam

    2015-06-01

    Afferent and efferent cardiac neurotransmission via the cardiac nerves intricately modulates nearly all physiological functions of the heart (chronotropy, dromotropy, lusitropy, and inotropy). Afferent information from the heart is transmitted to higher levels of the nervous system for processing (intrinsic cardiac nervous system, extracardiac-intrathoracic ganglia, spinal cord, brain stem, and higher centers), which ultimately results in efferent cardiomotor neural impulses (via the sympathetic and parasympathetic nerves). This system forms interacting feedback loops that provide physiological stability for maintaining normal rhythm and life-sustaining circulation. This system also ensures that there is fine-tuned regulation of sympathetic-parasympathetic balance in the heart under normal and stressed states in the short (beat to beat), intermediate (minutes to hours), and long term (days to years). This important neurovisceral/autonomic nervous system also plays a major role in the pathophysiology and progression of heart disease, including heart failure and arrhythmias leading to sudden cardiac death. Transdifferentiation of neurons in heart failure, functional denervation, cardiac and extracardiac neural remodeling has also been identified and characterized during the progression of disease. Recent advances in understanding the cellular and molecular processes governing innervation and the functional control of the myocardium in health and disease provide a rational mechanistic basis for the development of neuraxial therapies for preventing sudden cardiac death and other arrhythmias. Advances in cellular, molecular, and bioengineering realms have underscored the emergence of this area as an important avenue of scientific inquiry and therapeutic intervention. PMID:26044253

  15. In-hospital resuscitation evaluated by in situ simulation: a prospective simulation study

    Directory of Open Access Journals (Sweden)

    Wiborg Karsten R

    2011-10-01

    Full Text Available Abstract Background Interruption in chest compressions during cardiopulmonary resuscitation can be characterized as no flow ratio (NFR and the importance of minimizing these pauses in chest compression has been highlighted recently. Further, documentation of resuscitation performance has been reported to be insufficient and there is a lack of identification of important issues where future efforts might be beneficial. By implementing in situ simulation we created a model to evaluate resuscitation performance. The aims of the study were to evaluate the feasibility of the applied method, and to examine differences in the resuscitation performance between the first responders and the cardiac arrest team. Methods A prospective observational study of 16 unannounced simulated cardiopulmonary arrest scenarios was conducted. The participants of the study involved all health care personel on duty who responded to a cardiac arrest. We measured NFR and time to detection of initial rhythm on defibrillator and performed a comparison between the first responders and the cardiac arrest team. Results Data from 13 out of 16 simulations was used to evaluate the ability of generating resuscitation performance data in simulated cardiac arrest. The defibrillator arrived after median 214 seconds (180-254 and detected initial rhythm after median 311 seconds (283-349. A significant difference in no flow ratio (NFR was observed between the first responders, median NFR 38% (32-46, and the resuscitation teams, median NFR 25% (19-29, p Conclusion The main finding of this study was a significant difference between the first responders and the cardiac arrest team with the latter performing more adequate cardiopulmonary resuscitation with regards to NFR. Future research should focus on the educational potential for in-situ simulation in terms of improving skills of hospital staff and patient outcome.

  16. 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.

  17. Emergency medical services and sudden cardiac arrest: the "chain of survival" concept.

    Science.gov (United States)

    Cummins, R O

    1993-01-01

    Early access to the EMS system helps insure early CPR, defibrillation, and advanced care. Early access is easiest to achieve with 911 systems and widespread community education and publicity. It may also be taught during citizen-CPR classes. Early CPR helps patients by slowing the process of dying, but its effectiveness disappears within minutes, and defibrillation must soon follow. A citizenry well-informed about cardiac emergencies and well-trained in CPR appears to be the best method to achieve early recognition and early CPR. The earliest possible delivery of defibrillation is critical and, almost by itself, sufficient for many sudden death cases. It has, therefore, emerged as the single most effective intervention for patients in nontraumatic cardiac arrest. Automated external defibrillators help accomplish this goal and now permit widespread implementation of a variety of early defibrillation programs. Early advanced care helps those who do not immediately convert to an organized cardiac activity or who do not achieve a spontaneous circulation following early defibrillation. Advanced care allows a system to approach its highest possible survival rate by respiratory and anti-arrhythmic stabilization and monitoring of patients in the post-resuscitation period. At present, early CPR and rapid defibrillation, combined with early advanced care, can result in long-term survival rates as high as 30% for witnessed VF. Because neurological and psychological recovery from cardiac arrest are tied to the time within which these critical interdependent treatment modalities are delivered (1, 87), high resuscitation rates will also lead to a high percentage of patients who recover to their pre-arrest neurologic level. The public health challenge is to develop programs that will allow recognition, access, bystander-CPR, defibrillation, and advanced care to be delivered as quickly as possible, ideally within moments of the collapse of a sudden death victim. Achievement of such a goal requires the deployment of multiple properly directed programs within an EMS system; each program lends strength to the chain of survival, thereby enhancing successful recovery and long-term survival. What benefits would occur if a majority of EMS systems in the United States could establish cost-effective programs with respectable survival rates? The AHA estimates that full implementation of potential life-saving mechanisms in the community may save 10,000-100,000 lives each year in the US (2). If the maximum survival rate for all nontraumatic cardiac arrests in mature EMS systems is about 20% (33) among the annual 400,000 out-of-hospital cardiac arrests, 80,000 persons would be saved (33).(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8323592

  18. Perceptions of cardiac rehabilitation patients, specialists and rehabilitation programs regarding cardiac rehabilitation wait times

    Directory of Open Access Journals (Sweden)

    Grace Sherry L

    2012-08-01

    Full Text Available Abstract Background In 2006, the Canadian Cardiovascular Society (CCS Access to Care Working Group recommended a 30-day wait time benchmark for cardiac rehabilitation (CR. The objectives of the current study were to: (1 describe cardiac patient perceptions of actual and ideal CR wait times, (2 describe and compare cardiac specialist and CR program perceptions of wait times, as well as whether the recommendations are appropriate and feasible, and (3 investigate actual wait times and factors that CR programs perceive to affect these wait times. Methods Postal and online surveys to assess perceptions of CR wait times were administered to CR enrollees at intake into 1 of 8 programs, all CCS member cardiac specialists treating patients indicated for CR, and all CR programs listed in Canadian directories. Actual wait times were ascertained from the Canadian Cardiac Rehabilitation Registry. The design was cross-sectional. Responses were described and compared. Results Responses were received from 163 CR enrollees, 71 cardiac specialists (9.3% response rate, and 92 CR programs (61.7% response rate. Patients reported that their wait time from hospital discharge to CR initiation was 65.6?±?88.4?days (median, 42?days, while their ideal median wait time was 28?days. Most patients (91.5% considered their wait to be acceptable, but ideal wait times varied significantly by the type of cardiac indication for CR. There were significant differences between specialist and program perceptions of the appropriate number of days to wait by most indications, with CR programs perceiving shorter waits as appropriate (p? Conclusions Wait times following access to cardiac rehabilitation are prolonged compared with consensus recommendations, and yet are generally acceptable to most patients. Wait times following percutaneous coronary intervention in particular may need to be shortened. Future research is required to provide an evidence base for wait time benchmarks.

  19. Provision of out-of-hours interventional radiology services in the London Strategic Health Authority

    International Nuclear Information System (INIS)

    Aim: To review the provision of out-of-hours interventional radiology (IR) services in the London Strategic Health Authority (SHA). Materials and methods: All 29 acute hospitals in the London SHA were contacted between November 2008 and January 2009. A questionnaire based on the Royal College of Radiologists (RCR) guidelines assessed the provision of out-of-hours IR services. An 'ad-hoc' service was defined as on-call provision where not all the radiologists could perform intervention: If IR was required out of hours, an interventionalist came in when off-duty or the patient was transferred. Results: Seventeen out of the 29 (59%) hospitals provided ad-hoc out-of-hours services, eight (28%) provided a 24-hour rota, and four (14%) provide no out-of-hours cover. No ad-hoc service had formal transfer arrangements to a centre providing a 24 h service. Only two hospitals providing a 24 h service had six radiologists on the rota. Conclusion: Strategic planning for out-of-hours IR across London is recommended. This is likely to be welcomed by the hospitals involved, allowing informal arrangements to be formalized, and collaboration to provide comprehensive regional networks, provided appropriate funding is made available. A national audit is recommended; it is unlikely these findings are unique to London.

  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. Atrial Fibrillation Post Cardiac Surgery Trends Toward Management

    OpenAIRE

    Alqahtani, Awad A. R.

    2010-01-01

    Post operative atrial fibrillation (POAF) is more common than before due to increased numbers of cardiac surgeries. This in turn is associated with increased incidence of post operative complication, length of hospital stay and subsequent increase the cost of hospitalization. Therefore preventing and/or minimizing atrial fibrillation by pharmacological or nonpharmacological means is a reasonable goal. POAF has also been associated with postoperative delirium and neurocognitive decline. The pr...

  2. 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.

  3. Cardiac gallium citrate concentration

    International Nuclear Information System (INIS)

    Cardiac accumulation of 67Ga was noted in a 45 year-old black female with a history of fever and shortness of breath. Cardiac 67Ga uptake has been uncommonly cited and we report such a finding in a case of Cox sackie B viral pericarditis. (orig.)

  4. Garfinkel Cardiac Data

    Science.gov (United States)

    Alan Garfinkel (University of California Los Angeles; Physiological Sci/Med-Cardio)

    2009-01-10

    Cardiac data on multiple variables for a selected population of 220 men and 338 women participating in a drug treatment study of dobutamine for heart attack prevention. Garfinkel, Alan, et. al. "Prognostic Value of Dobutamine Stress Echocardiography in Predicting Cardiac Events in Patients With Known or Suspected Coronary Artery Disease." Journal of the American College of Cardiology 33.3 (1999) 708-16.

  5. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... ll see the implantation of an automated implantable cardiac defibrillator. The surgery will be performed by Dr. Hanscy Seide and ... the use of a cardiac defibrillator in open heart surgery and what is the risk to the phrenic ...

  6. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... Cardiac Defibrillator February 19, 2009 Halifax Health Medical Center, Daytona Beach, FL Welcome to Halifax Health Daytona Beach, Florida. Over the next hour you'll see the implantation of an automated implantable cardiac defibrillator. The surgery will be performed by Dr. Hanscy Seide and ...

  7. 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

  8. 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 ...

  9. 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...

  10. Measuring and explaining mortality in Dutch hospitals; The Hospital Standardized Mortality Rate between 2003 and 2005

    OpenAIRE

    van der Veen André; Pieter Daniel; Koolman Xander; Heijink Richard; Jarman Brian; Westert Gert

    2008-01-01

    Abstract Background Indicators of hospital quality, such as hospital standardized mortality ratios (HSMR), have been used increasingly to assess and improve hospital quality. Our aim has been to describe and explain variation in new HSMRs for the Netherlands. Methods HSMRs were estimated using data from the complete population of discharged patients during 2003 to 2005. We used binary logistic regression to indirectly standardize for differences in case-mix. Out of a total of 101 hospitals 89...

  11. 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

    Scientific Electronic Library Online (English)

    Jaime, Retamal; Jean, Bachler; Ricardo, Mejía; Orlando, Concha; Max, Andresen.

    1201-12-01

    Full Text Available [...] Abstract in english 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.

  12. 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.

  13. Cardiac tamponade due to peripheral inserted central catheter in newborn

    OpenAIRE

    Maria Fernanda Pellegrino da Silva Dornaus; Maria Aparecida Portella; Arno Norberto Warth; Rosana Aparecida Lacava Martins; Mauricio Magalhães; Alice D’Agostini Deutsch

    2011-01-01

    ABSTRACT This article reports the case of an adverse event of cardiac tamponade associated with central catheter peripheral insertion in a premature newborn. The approach was pericardial puncture, which reversed the cardiorespiratory arrest. The newborn showed good clinical progress and was discharged from hospital with no complications associated with the event.

  14. 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.

  15. Pre-hospital treatment of STEMI patients. A scientific statement of the working group acute cardiac care of the European society of cardiology | Tratamiento prehospitalario de los pacientes con IAMCEST. Una declaración científica del Working Group Acute Cardiac Care de la European Society of Cardiology

    OpenAIRE

    Tubaro, M; Danchin, N; Goldstein, P; Filippatos, G; Hasin, Y; Heras, M.; Jansky, P; Norekval, TM; Swahn, E.; Thygesen, K.; Vrints, C; Zahger, D; Arntz, HR; Bellou, A; De La Coussaye, JE

    2012-01-01

    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 ...

  16. Congenital cardiac anomalies in myelomeningocele patients

    Directory of Open Access Journals (Sweden)

    Iman Moeini Naghani

    2014-11-01

    Full Text Available Objective. Myelomeningocele may be isolated but more frequently is associated with other anomalies. Congenital heart disease occurs with different incidence rate in myelomeningocele which is observed more frequently with skeletal malformations. Methods. This study was undertaken in the Children’s Hospital Medical Center between 2010 to 2012 to evaluate 75 myelomeningocele patients for cardiac anomalies, with electrocardiography and echocardiography in addition to clinical examination of the cardiopulmonary system. Demographic information, myelomeningocele location and characteristics, orthopedic deformities, neurological deficits and radiographic findings were studied besides cardiologic assessments. Results. The ages of the patients ranged from 1 day to 4 years. The myelomeningocele locations were lumbosacral, lumbar and sacral area in most cases. Physical examination of the heart was abnormal in 6 children, but echocardiography revealed cardiac anomalies in only two children. Both children were female patients with severe scoliosis, multiple rib deficiencies and associated vertebral anomalies. Conclusion. Congenital heart defects are not very common in MMC patients. Female patients with suspicious clinical examinations for cardiac anomalies and associated rib and vertebral anomalies are advised to be investigated by echocardiography to rule out associated cardiac anomalies.

  17. 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

  18. Hospital fundamentals.

    Science.gov (United States)

    Althausen, Peter L; Hill, Austin D; Mead, Lisa

    2014-07-01

    Under the current system, orthopaedic trauma surgeons must work in some form of hospital setting as our primary service involves treatment of the trauma patient. We must not forget that just as a trauma center cannot exist without our services, we cannot function without their support. As a result, a clear understanding of the balance between physicians and hospitals is paramount. Historical perspective enables physicians and hospital personnel alike to understand the evolution of hospital-physician relationship. This process should be understood upon completion of this chapter. The relationship between physicians and hospitals is becoming increasingly complex and multiple forms of integration exist such as joint ventures, gain sharing, and co-management agreements. For the surgeon to negotiate well, an understanding of hospital governance and the role of the orthopaedic traumatologist is vital to success. An understanding of the value provided by the traumatologist includes all aspects of care including efficiency, availability, cost effectiveness, and research activities. To create effective and sustainable healthcare institutions, physicians and hospitals must be aligned over a sustained period of time. Unfortunately, external forces have eroded the historical basis for the working relationship between physicians and hospitals. Increased competition and reimbursement cuts, coupled with the increasing demands for quality, efficiency, and coordination and the payment changes outlined in healthcare reform, have left many organizations wondering how to best rebuild the relationship. The principal goal for the physician when partnering with a hospital or healthcare entity is to establish a sustainable model of service line management that protects or advances the physician's ability to make impactful improvements in quality of patient care, decreases in healthcare costs, and improvements in process efficiency through evidence-based practices and protocols. PMID:24918827

  19. 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.

  20. Measurement of cardiac volume by computed tomography

    International Nuclear Information System (INIS)

    Noninvasive cardiac volume measurement by CT was attempted. Ten to fifteen non-gated scannings were obtained serially from the upper atria to the left diaphragm in 9 normal subjects and 72 patients (6 hypertensives, 7 aortic valvular diseases, 22 mitral valvular diseases, 5 shunt lesions and 33 ischemic heart diseases). Contrast enhancement CT was performed in most cases, but it was done by 4 - 6 times bolus injections at the level of the left ventricle (LV) to visualize LV lumen in ischemic cardiac patients who had ventriculography. The volume was calculated by summing each slice's volume which was obtained from the area times slice thickness. The total cardiac volume and the volume of each chamber (LA, RA, RV and LV) were calculated. The interventricular septum and LV wall were included into LV volume. There was a good relationship (r = 0.90) between the total cardiac volume by CT and that by chest X-ray. Each volume by CT in 9 normal subjects was: 353 +- 30 ml/m2 in total, RA: 53 +- 17 ml/m2, LA: 54 +- 21 ml/m2, RV: 90 +- 15 ml/m2, and LV: 123 +- 15 ml/m2 (mean +- SD), respectively, and an increment of each volume was shown according to the hemodynamic features of various heart diseases: the total volume was increased significantly in valvular disease, RA and RV volumes in mitral valvular disease with tricuspid regurgitation and ASD, LA volume in mitral valvular disease and shunt lesion and LV volume in aortic and shunt lesion and LV volume in aortic valvular disease and mitral regurgitation. Between the left ventricular lumen volume by CT and its end-diastolic volume by ventriculography (area-length method), there was a good relationship (r = 0.81) in 17 cases without cardiac aneurysms out of 22 ischemic cardiac patients examined by ventriculography (RAO and LAO views). (J.P.N.)

  1. First Case of Heart Transplantation in Afshar Hospital , Yazd with 1 Year Follow-Up

    Directory of Open Access Journals (Sweden)

    M Motafacker

    2004-04-01

    Full Text Available Cardiac transplantation is life saving in patients suffering from end stage cardiac diseases. In recent years , advancement in cardiac surgery has contributed to increasing number of patients who require cardiac transplantation. This report is the first case of heart transplantation in Yazd. Recipient was a 53 years old man with dilated cardiomyopathy and candidate for cardiac transplant. The donor was a 35 years old man with documented brain death due to a car accident. Patient was discharged from hospital 7 days after the operation with no complications and on follow up 1 year after operation , patient is in good condition and under specific care.

  2. 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.

  3. [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

  4. Nursing process for the patient submitted to cardiac cateterism

    Directory of Open Access Journals (Sweden)

    Rosane B. Lourenci

    2006-08-01

    Full Text Available Hospitalization resulted from heart diseases creates a strong emotional charge on patients’ emotional structure, who feel in need of information about their pathology and requests professional assistance systematically, aiming the facing of the unknown, mainly related to the imagination of the gravity of their problem. This study resulted from the need of searching new knowledge that permit to direct the practice towards the coronary patients' care that need the accomplishment of diagnostic invasive procedure (Cardiac Catheterism. The general objective of this study is to elaborate the systematization of care to the hospitalized client submitted to Cardiac Catheterism, form their needs and discuss these needs through the critical analysis of the assistance models. This study has qualitative approach where the used techniques allowed the gathering of the elements that compound the patient's social representation against the Cardiac Catheterism, organized in three stages, that are: Pre analysis (contact with the material to be analyzed, Exploration (Transformation of rough data and Treatment (interference and interpretation of the results. This data was collected from August 2005 to October 2005, in the Cardiac Unity at Santa Casa da Misericórdia Hospital, in Rio de Janeiro. The collection of data begun after the approval by the Ethics Committee in Researches of Antonio Pedro Hospital. At the present project up to this moment we are performing the analysis of the results which at first, showed us that there was confirmation about what has been imagined in the field of feelings that come from the perspective of the accomplishment of the diagnostic invasive procedure (Cardiac Catheterism on hospitalized patients.

  5. Chest pain of cardiac and noncardiac origin.

    Science.gov (United States)

    Lenfant, Claude

    2010-10-01

    Chest pain is one of the most common symptoms driving patients to a physician's office or the hospital's emergency department. In approximately half of the cases, chest pain is of cardiac origin, either ischemic cardiac or nonischemic cardiac disease. The other half is due to noncardiac causes, primarily esophageal disorder. Pain from either origin may occur in the same patient. In addition, psychological and psychiatric factors play a significant role in the perception and severity of the chest pain, irrespective of its cause. Chest pain of ischemic cardiac disease is called angina pectoris. Stable angina may be the prelude of ischemic cardiac disease; and for this reason, it is essential to ensure a correct diagnosis. In most cases, further testing, such as exercise testing and angiography, should be considered. The more severe form of chest pain, unstable angina, also requires a firm diagnosis because it indicates severe coronary disease and is the earliest manifestation of acute myocardial infarction. Once a diagnosis of stable or unstable angina is established, and if a decision is made not to use invasive therapy, such as coronary bypass, percutaneous transluminal coronary angioplasty, or stent insertion, effective medical treatment of associated cardiac risk factors is a must. Acute myocardial infarction occurring after a diagnosis of angina greatly increases the risk of subsequent death. Chest pain in women warrants added attention because women underestimate their likelihood to have coronary heart disease. A factor that complicates the clinical assessment of patients with chest pain (both cardiac and noncardiac in origin) is the relatively common presence of psychological and psychiatric conditions such as depression or panic disorder. These factors have been found to cause or worsen chest pain; but unfortunately, they may not be easily detected. Noncardiac chest pain represents the remaining half of all cases of chest pain. Although there are a number of causes, gastroesophageal disorders are by far the most prevalent, especially gastroesophageal reflux disease. Fortunately, this disease can be diagnosed and treated effectively by proton-pump inhibitors. The other types of non-gastroesophageal reflux disease-related noncardiac chest pain are more difficult to diagnose and treat. In conclusion, the cause of chest pain must be accurately diagnosed; and treatment must be pursued according to the cause, especially if the cause is of cardiac origin. PMID:20837193

  6. 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 belongsed 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)

  7. Hospital Inspections

    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...

  8. Medicaid: Out-of-Pocket Cost Exemptions

    Science.gov (United States)

    ... Term Services and Supports Delivery Systems Quality of Care Data and Systems Enrollment Strategies Program Integrity Financing and Reimbursement Indian Health and Medicaid Outreach Tools Medicaid State Plan Amendments Out-of-Pocket Cost Exemptions Population Groups Exempt from Out of ...

  9. 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.

  10. 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

  11. A survey of factors associated with the successful recognition of agonal breathing and cardiac arrest by 9-1-1 call takers: design and methodology

    Directory of Open Access Journals (Sweden)

    Kasaboski Ann

    2009-07-01

    Full Text Available Abstract Background Cardiac arrest victims most often collapse at home, where only a modest proportion receives life-saving bystander cardiopulmonary resuscitation. As many as 40% of all sudden cardiac arrest victims have agonal or abnormal breathing in the first minutes following cardiac arrest. 9-1-1 call takers may wrongly interpret agonal breathing as a sign of life, and not initiate telephone cardiopulmonary resuscitation instructions. Improving 9-1-1 call takers' ability to recognize agonal breathing as a sign of cardiac arrest could result in improved bystander cardiopulmonary resuscitation and survival rates for out-of-hospital cardiac arrest victims. Methods/Design The overall goal of this study is to design and conduct a survey of 9-1-1 call takers in the province of Ontario to better understand the factors associated with the successful identification of cardiac arrest (including patients with agonal breathing over the phone, and subsequent administration of cardiopulmonary resuscitation instructions to callers. This study will be conducted in three phases using the Theory of Planned Behaviour. In Phase One, we will conduct semi-structured qualitative interviews with a purposeful selection of 9-1-1 call takers from Ontario, and identify common themes and belief categories. In Phase Two, we will use the qualitative interview results to design and pilot a quantitative survey. In Phase Three, a final version of the quantitative survey will be administered via an electronic medium to all registered call takers in the province of Ontario. We will perform qualitative thematic analysis (Phase One and regression modelling (Phases Two and Three, to determine direct and indirect relationship of behavioural constructs with intentions to provide cardiopulmonary resuscitation instructions. Discussion The results of this study will provide valuable insight into the factors associated with the successful recognition of agonal breathing and cardiac arrest by 9-1-1 call takers. This will guide future interventional studies, which may include continuing education and protocol changes, in order to help increase the number of callers appropriately receiving cardiopulmonary resuscitation instructions, and save the lives of more cardiac arrest victims. Trial registration Clinicaltrials.gov NCT00848588

  12. 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.

  13. 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.

  14. 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 ...

  15. 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 ...

  16. 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. Stoner, ... disease. We got over 360,000 people in United State with going to die with heart disease in ...

  17. Cardiac Tumors; Tumeurs cardiaques

    Energy Technology Data Exchange (ETDEWEB)

    Laissy, J.P.; Fernandez, P. [Centre Hospitalier Universitaire Bichat Claude Bernard, Service d' Imagerie, 76 - Rouen (France); Mousseaux, E. [Hopital Europeen Georges Pompidou (HEGP), Service de Radiologie Cardio Vasculaire et Interventionnelle, 75 - Paris (France); Dacher, J.N. [Centre Hospitalier Universitaire Charles Nicolle, 75 - Rouen (France); Crochet, D. [Centre Hospitalier Universitaire, Hopital Laennec, Centre Hemodynamique, Radiologie Thoracique et Vasculaire, 44 - Nantes (France)

    2004-04-01

    Metastases are the most frequent tumors of the heart even though they seldom are recognized. Most primary cardiac tumors are benign. The main role of imaging is to differentiate a cardiac tumor from thrombus and rare pseudo-tumors: tuberculoma, hydatid cyst. Echocardiography is the fist line imaging technique to detect cardiac tumors, but CT and MRl arc useful for further characterization and differential diagnosis. Myxoma of the left atrium is the most frequent benign cardiac tumor. It usually is pedunculated and sometimes calcified. Sarcoma is the most frequent primary malignant tumor and usually presents as a sessile infiltrative tumor. Lymphoma and metastases are usually recognized by the presence of known tumor elsewhere of by characteristic direct contiguous involvement. Diagnosing primary and secondary pericardial tumors often is difficult. Imaging is valuable for diagnosis, characterization, pre-surgical evaluation and follow-up. (author)

  18. Cardiac muscle cells

    Science.gov (United States)

    Nathanael Reveal (None; )

    2007-07-02

    Cardiac muscles are found only in the heart. They work together to bring deoxygenated blood in and push oxygenated blood out into the body. Essentially, they keep your heart pumping and your body alive.

  19. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... Daytona Beach, Florida. Over the next hour you'll see the implantation of an automated implantable cardiac ... by Dr. Donald Stoner. In just moments, you'll see how the implantable cardioverter-defibrillator significantly improves ...

  20. 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...

  1. Cardiac magnetic resonance spectroscopy.

    OpenAIRE

    Neubauer, S.

    2003-01-01

    This review describes recent advances in cardiac magnetic resonance spectroscopy (MRS). MRS allows noninvasive characterization of the metabolic state of cardiac muscle, in both animal and human models. Recent experimental MRS studies have allowed new insights into the essential role of energetics in heart failure. Various new studies suggest a rapidly growing role of MRS for phenotyping new genetically modified mouse models, and recent methodologic advances include development of absolute qu...

  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. Missed cardiac tamponade

    OpenAIRE

    Thomson-moore, Alexandra Louise

    2011-01-01

    Cardiac tamponade can have an insidious onset, becoming life threatening when an adequate cardiac output can no longer be maintained. This case provides an example of a presentation where all the classic signs were present but unfortunately they were missed, in this way providing good revision of what these signs are. It gives some anaesthetic and procedure based perspectives for this rare presentation. It is noteworthy for the speed at which symptoms and signs resolved after the tamponade wa...

  4. 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...

  5. Functional cardiac tissue engineering

    OpenAIRE

    Liau, Brian; Zhang, Donghui; Bursac, Nenad

    2012-01-01

    Heart attack remains the leading cause of death in both men and women worldwide. Stem cell-based therapies, including the use of engineered cardiac tissues, have the potential to treat the massive cell loss and pathological remodeling resulting from heart attack. Specifically, embryonic and induced pluripotent stem cells are a promising source for generation of therapeutically relevant numbers of functional cardiomyocytes and engineering of cardiac tissues in vitro. This review will describe ...

  6. [Cardiac CT: new applications].

    Science.gov (United States)

    Pesenti-Rossi, D; Baron, N; Allouch, P; Convers, R; Gibault-Genty, G; Aubert, S

    2014-11-01

    Since the introduction of the 64-generation scanners, the accuracy and robustness of the diagnosis of coronary artery disease has progressed. The main advantage of cardiac CT is the exclusion of coronary artery disease by its excellent negative predictive value. Currently, cardiac CT applications extend thanks to innovations both in terms of technological development systems scanner or stents implanted, that the evolution of surgical procedures such as TAVI. PMID:25261169

  7. 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.

  8. Intrinsic cardiac ganglia

    Directory of Open Access Journals (Sweden)

    Ahmet Birand

    2008-12-01

    Full Text Available Heart has been considered as the source and the seat of emotions, passion and love. But from the dawn of XIXth century, scientists have emphasized that the heart, though life depends on its ceaseless activity, is merely a electromechanical pump, pumping oxygenated blood. Nowadays, we all know that heart pumps blood commensurate with the needs of the body and this unending toil, and its regulation depends on the intrinsic properties of the myocardium, Frank-Starling Law and neurohumoral contribution. It has been understood, though not clearly enough, that these time-tensions may cause structural or functional cardiac impairments and arrhythmias are related to the autonomic nervous system. Less well known and less taken in account in daily cardiology practice is the fact that heart has an intrinsic cardiac nervous system, or “heart brain” consisting of complex ganglia, intrinsic cardiac ganglia containing afferent (receiving, local circuit (interneurons and efferent (transmitting sympathetic and parasympathetic neurons.This review enlightens structural and functional aspects of intrinsic cardiac ganglia as the very first step in the regulation of cardiac function. This issue is important for targets of pharmacological treatment and techniques of cardiac surgery interventions as repair of septal defects, valvular interventions and congenital corrections.

  9. 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 f...

  10. A rare cardiac tumor: Biatrial myxoma

    Directory of Open Access Journals (Sweden)

    ?smail Ba?yi?it

    2015-03-01

    Full Text Available A child aged 12 years old with palpitation, short of breath and fever for six months was admitted to our pediatric emergency department. Echocardiography was applied to the patient whom hospitalized with prior diagnosis of the urinary tract infection, due to the 3/6 cardiac murmur. Biatrial masses were found, bigger on the right atrium and smaller on the left atrium, to attach the septum with the same pedicule. Both masses with the pedicule were removed through defect following right atriotomy. The patient was discharged on postoperatif fifth days with health.

  11. Cardiac retransplantation is an efficacious therapy for primary cardiac allograft failure

    Directory of Open Access Journals (Sweden)

    Acker Michael A

    2008-05-01

    Full Text Available Abstract Background Although orthotopic heart transplantation has been an effective treatment for end-stage heart failure, the incidence of allograft failure has increased, necessitating treatment options. Cardiac retransplantation remains the only viable long-term solution for end-stage cardiac allograft failure. Given the limited number of available donor hearts, the long term results of this treatment option need to be evaluated. Methods 709 heart transplants were performed over a 20 year period at our institution. Repeat cardiac transplantation was performed in 15 patients (2.1%. A retrospective analysis was performed to determine the efficacy of cardiac retransplantation. Variables investigated included: 1 yr and 5 yr survival, length of hospitalization, post-operative complications, allograft failure, recipient and donor demographics, renal function, allograft ischemic time, UNOS listing status, blood group, allograft rejection, and hemodynamic function. Results Etiology of primary graft failure included transplant arteriopathy (n = 10, acute rejection (n = 3, hyperacute rejection (n = 1, and a post-transplant diagnosis of metastatic melanoma in the donor (n = 1. Mean age at retransplantation was 45.5 ± 9.7 years. 1 and 5 year survival for retransplantation were 86.6% and 71.4% respectively, as compared to 90.9% and 79.1% for primary transplantation. Mean ejection fraction was 67.3 ± 12.2% at a mean follow-up of 32.6 ± 18.5 mos post-retransplant; follow-up biopsy demonstrated either ISHLT grade 1A or 0 rejection (77.5 ± 95.7 mos post-transplant. Conclusion Cardiac retransplantation is an efficacious treatment strategy for cardiac allograft failure.

  12. Out-of-body–induced hippocampal amnesia

    OpenAIRE

    Out-of-body-induced hippocampal amnesia.

    2014-01-01

    Transformation of experiences into long-term memory is a remarkable capability. However, some experiences are so extreme that they are not translated into coherent or lasting memories. Clinical reports suggest that one potential mechanism for memory disturbance could be “dissociative experiences,” in which events are experienced in a distance from the body (out-of-body). Here, we experimentally induced an illusory out-of-body experience on healthy participants while they were experiencing...

  13. 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; Louis P. Perrault; 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...

  14. [Obesity and cardiac failure].

    Science.gov (United States)

    Galinier, M; Pathak, A; Roncalli, J; Massabuau, P

    2005-01-01

    Obesity alone is the cause of 11% of cases of cardiac failure in men and 14% of cases in women in the United States. The frequency of obesity continues to rise in our country, 41% of our compatriots being obese or overweight. It is expected that obesity will become an important cause of cardiac failure in the coming years. The Framingham study showed that, after correction for other risk factors, for every point increase in body mass index, the increase in risk of developing cardiac failure was 5% in men and 7% in women. There are three physiopathological mechanisms to explain the adverse effects of obesity on left ventricular function: an increase in ventricular preload secondary to increased plasma volume induced by the high fatty mass; an increase in left ventricular afterload due to the common association of hypertension generated by activation of the sympathetic nervous system by hyperinsulinism; and systolic and diastolic dysfunction due to changes in the myocardial genome and coronary artery disease induced by risk factors of atherosclerosis aggravated by obesity. The adipocyte also secretes a number of hormones which act directly or indirectly on the myocardium: angiotensin II, leptin, resistin, adrenomedulin, cytokines. These haemodynamic and hormonal changes profoundly modify the genetic expression of the myocardium in obesity, favourising hypertrophy of the myocyte and the development of interstitial fibrosis. Whether it be eccentric in the absence of hypertension or concentric when hypertension is associated with obesity, left ventricular hypertrophy, although normalising left ventricular wall stress, has adverse consequences causing abnormal relaxation and decreased left ventricular compliance. Therefore, in obese patients, two forms of cardiac failure may be observed. The more common is due to diastolic dysfunction, obesity being one of the principal causes of cardiac failure with preserved systolic function. Cardiac failure due to systolic dysfunction is less common and may be observed in cases with inappropriate left ventricular hypertrophy which does not normalise abnormal left ventricular wall stress leading to cardiomyopathy, and in cases with associated coronary artery disease. Whatever the underlying mechanism, the diagnosis of cardiac failure is made more difficult by obesity. From the prognostic point of view, in the global population of patients with cardiac failure, obesity improves survival because it counteracts the adverse effect of cachexia; however, obesity increases the risk of sudden death. In fact, obesity is associated with dynamic change in QT interval. In cases of cardiac failure secondary to obesity-related cardiomyopathy, loss of weight leads to an improved functional status and a reduction of left ventricular remodelling and an increase of the ejection fraction. PMID:15724418

  15. Cardiac asthma in elderly patients: incidence, clinical presentation and outcome

    Directory of Open Access Journals (Sweden)

    Ray Patrick

    2007-05-01

    Full Text Available Abstract Background Cardiac asthma is common, but has been poorly investigated. The objective was to compare the characteristics and outcome of cardiac asthma with that of classical congestive heart failure (CHF in elderly patients. Methods Prospective study in an 1,800-bed teaching hospital. Results Two hundred and twelve consecutive patients aged ? 65 years presenting with dyspnea due to CHF (mean age of 82 ± 8 years were included. Findings of cardiac echocardiography and natriuretic peptides levels were used to confirm CHF. Cardiac asthma patients were defined as a patient with CHF and wheezing reported by attending physician upon admission to the emergency department. The CHF group (n = 137 and the cardiac asthma group (n = 75, differed for tobacco use (34% vs. 59%, p 2 (47 ± 15 vs. 41 ± 11 mmHg, p Conclusion Patients with cardiac asthma represented one third of CHF in elderly patients. They were more hypercapnic and experienced more distal airway obstruction. However, outcomes were similar.

  16. 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.

  17. Hospital Ethics Committees in Poland.

    Science.gov (United States)

    Czarkowski, Marek; Kaczmarczyk, Katarzyna; Szyma?ska, Beata

    2014-11-12

    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 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

  18. Hospitality Management.

    Science.gov (United States)

    College of the Canyons, Valencia, CA.

    A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…

  19. Academic Hospitality

    Science.gov (United States)

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  20. Drug treatment of cardiac failure.

    Science.gov (United States)

    Achong, M R; Kumana, C R

    1982-01-01

    Treatment of cardiac failure should first be aimed at reversing or ameliorating the underlying pathological processes. This review highlights the common problems and pitfalls in the use of digoxin, diuretics and vasodilators in patients with cardiac failure. PMID:21289849

  1. Drug Treatment of Cardiac Failure

    OpenAIRE

    Achong, M. R.; Kumana, C. R.

    1982-01-01

    Treatment of cardiac failure should first be aimed at reversing or ameliorating the underlying pathological processes. This review highlights the common problems and pitfalls in the use of digoxin, diuretics and vasodilators in patients with cardiac failure.

  2. Pediatric cardiac postoperative care

    Directory of Open Access Journals (Sweden)

    Auler Jr. José Otávio Costa

    2002-01-01

    Full Text Available The Heart Institute of the University of São Paulo, Medical School is a referral center for the treatment of congenital heart diseases of neonates and infants. In the recent years, the excellent surgical results obtained in our institution may be in part due to modern anesthetic care and to postoperative care based on well-structured protocols. The purpose of this article is to review unique aspects of neonate cardiovascular physiology, the impact of extracorporeal circulation on postoperative evolution, and the prescription for pharmacological support of acute cardiac dysfunction based on our cardiac unit protocols. The main causes of low cardiac output after surgical correction of heart congenital disease are reviewed, and methods of treatment and support are proposed as derived from the relevant literature and our protocols.

  3. Sudden cardiac death.

    Science.gov (United States)

    Kuriachan, Vikas P; Sumner, Glen L; Mitchell, L Brent

    2015-04-01

    Sudden death accounts for 300,000-400,000 deaths annually in the United States. Most sudden deaths are cardiac, and most sudden cardiac deaths are related to arrhythmias secondary to structural heart disease or primary electrical abnormalities of the heart. The most common structural disease leading to sudden death is ischemic heart disease. Nonischemic cardiomyopathy and other structural abnormalities such as arrhythmogenic ventricular dysplasia and hypertrophic cardiomyopathy may also be causative. Patients without structural disease have a primary electrical abnormality, such as long-QT syndrome or Brugada syndrome. Severe left ventricular systolic dysfunction is the main marker for sudden death in patients with ischemic or nonischemic cardiomyopathy. In other conditions, other markers for structural heart disease and electrical abnormalities need to be considered. It is seen that ?-blocker therapy is associated with a reduction in sudden cardiac death across a broad range of disorders. Nevertheless, the implantable cardioverter defibrillator remains the most effective treatment strategy in selected patients. PMID:25813838

  4. 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

  5. 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.

  6. Cardiac risk assessment before carotid endarterectomy

    International Nuclear Information System (INIS)

    Preoperative cardiac assessment is an essential step to identify the patients at risk, optimize any dysfunction, anticipate perioperative and postoperative problems and plan special management. Carotid endarterectomy (CEA) has become one of the most commonly performed vascular procedures in Western countries. The awareness of the potential beneficial role and hazards of CEA is not proportionate to the magnitude of this problem in our countries, not only among patients, but also among the medical disciplines. This report is a retrospective analysis of the prevalence of coronary artery diseases among 442 patients who were referred to the Division of Vascular Surgery at the King Khalid University Hospital in Riyadh, Saudi Arabia with suspicion of carotid artery disease. Eighty-two patients proved to have significant carotid artery stenosis and had thorough preoperative cardiac assessment by senior cardiologist. All cases had clinical assessment and ECG, 66 cases had echocardiogram examination, 44 had Dipyridamole Thallium-scan and 12 had coronary angiogram. Sixty-eight patients underwent 76 carotid endarterectomy. Four of them had MI and only one case died during preoperative period. This study shows that cardiac screening studies have a potential role in the candidates for carotid surgery in influencing the decision to operate and intensify of perioperative monitoring and care. We believe that the teamwork should involve vascular surgeons, cardiologist and anesthetist tr surgeons, cardiologist and anesthetist to manage such critical patients properly. (author)

  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. 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.

  9. Cardiac Bioelectricity and Arrhythmias

    Science.gov (United States)

    Flavio Fenton (Cornell University; )

    2006-09-22

    Deep inside a human heart, its pacemaker sends out bursts of electrical signals that keep the heart pumping rhythmically, supplying life-giving oxygen to the body. When these electrical waves become disorganized, the heart starts beating irregularly or arrhythmically. Flavio Fenton and Elizabeth Cherry of Cornell University made this interactive program to provide education on arrhythmias. It presents detailed information on cardiac anatomy, normal cardiac electrophysiology, and different kinds of arrhythmias using a combination of words, pictures, and interactive, computer simulations and animations.

  10. 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

  11. Uncharted Paths*: Hospital Networks in Critical Care

    OpenAIRE

    Iwashyna, Theodore J.; Christie, Jason D.; Kahn, Jeremy M.; Asch, David A.

    2009-01-01

    Wide variation between hospitals in the quality of critical care lead to many potentially avoidable deaths. Regionalization of critical care is a possible solution; regionalization has been implemented for trauma and neonatal intensive care, and it is under active discussion for medical and cardiac critical care. However, regionalization is only one possible approach to reorganizing critical care services. This commentary introduces the technique of network analysis as a framework for the fol...

  12. In-Hospital Mortality among Rural Medicare Patients with Acute Myocardial Infarction: The Influence of Demographics, Transfer, and Health Factors

    Science.gov (United States)

    Muus, Kyle J.; Knudson, Alana D.; Klug, Marilyn G.; Wynne, Joshua

    2011-01-01

    Context/Purpose: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in-hospital mortality predictors among rural transfer patients. Methods: Cross-sectional retrospective analyses on…

  13. 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

  14. 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.

  15. 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)

  16. France, Germany drop out of ITER race

    International Nuclear Information System (INIS)

    The list of countries willing to host a multi-billion dollar fusion facility got much shorter when France and Germany effectively took themselves out of the competition, making Japan the odd-on favorite as the site for the International Thermonuclear Experimental Reactor (ITER) if it is built. This article describes the history and the possible future for the ITER

  17. Zero bias anomaly out of equilibrium

    OpenAIRE

    Gutman, D. B.; Gefen, Yuval; Mirlin, A. D.

    2007-01-01

    The non-equilibrium zero bias anomaly (ZBA) in the tunneling density of states of a diffusive metallic film is studied. An effective action describing virtual fluctuations out-of-equilibrium is derived. The singular behavior of the equilibrium ZBA is smoothed out by real processes of inelastic scattering.

  18. Colleges Call Debate Contests out of Order

    Science.gov (United States)

    Young, Jeffrey R.

    2008-01-01

    Competitive debate has traditionally served as a laboratory for the democratic process and an important training ground for future policy makers. In recent years, a growing number of teams have played the game out of traditional bounds. They have turned events into commentaries on debate itself, in performances that bear little resemblance to the…

  19. Fast-Track Cardiac Anaesthesia at a Tertiary Care Cardiac Centre in Nepal

    Directory of Open Access Journals (Sweden)

    Jeju Nath Pokhrel

    2013-11-01

    Full Text Available Background: With the evolution of anesthesia and surgical procedures, fast track cardiac anaesthesia has gained an increased interest, mainly based on the possibility of reducing health costs without compromising patient care and has been implemented at a tertiary care cardiac centre in Nepal. Objective: The purpose of this study is to evaluate the status of fast track cardiac anaesthesia after open heart procedures and suitability of existing anaesthetic technique for fast-track extubation. Methods: After standard anaesthesia and surgical technique, we retrospectively reviewed the duration of mechanical ventilation, length of Intensive Care Unit stay, reintubation, and incidence of inhospital mortality in consecutive adult patients undergoing open heart surgery during six months period. Results: The median time of the extubation was six hours, median days of the ICU stay was three days. Five cases were reintubated because of the respiratory failure which is about 1.8% out of 277 cases. Seven patients (2.5% died of sepsis and low cardiac output syndrome. Conclusions: Fast track anaesthesia is suitable with applied anesthetic technique in our centre. However there exists relatively small risk of re-intubation (1.8%.

  20. Sepsis in the pediatric cardiac intensive care unit.

    Science.gov (United States)

    Wheeler, Derek S; Jeffries, Howard E; Zimmerman, Jerry J; Wong, Hector R; Carcillo, Joseph A

    2011-07-01

    The survival rate for children with congenital heart disease (CHD) has increased significantly coincident with improved techniques in cardiothoracic surgery, cardiopulmonary bypass and myocardial protection, and perioperative care. Cardiopulmonary bypass, likely in combination with ischemia-reperfusion injury, hypothermia, and surgical trauma, elicits a complex, systemic inflammatory response that is characterized by activation of the complement cascade, release of endotoxin, activation of leukocytes and the vascular endothelium, and release of proinflammatory cytokines. This complex inflammatory state causes a transient immunosuppressed state, which may increase the risk of hospital-acquired infection in these children. Postoperative sepsis occurs in nearly 3% of children undergoing cardiac surgery and has been associated with longer length of stay and mortality risks in the pediatric cardiac intensive care unit. Herein, we review the epidemiology, pathobiology, and management of sepsis in the pediatric cardiac intensive care unit. PMID:22337571

  1. Intraoperative cardiac emergencies.

    Science.gov (United States)

    Tyler, Chrystal L

    2015-03-01

    Intraoperative cardiac emergencies require prompt recognition and management in order to optimize patient safety and recovery. This article addresses the perioperative management of hypertension, myocardial infarction, arrhythmias, autonomic dysreflexia, tamponade, and tension pneumothorax. These complications can occur in patients with underlying coexisting disease, but can also occur in surgical patients regardless of the underlying disorder. PMID:25725533

  2. Evaluation of 6 cardiac troponin assays in patients with acute coronary syndrome.

    OpenAIRE

    Saadeddin, Salam M.; Habbab, Moh D. A.; Siddieg, Hisham H.; Al Seeni, Mohammed N.; Tahery, Ashraf B.; Dafterdar, Rofaida M.

    2003-01-01

    OBJECTIVES An increasing body of evidence has demonstrated the value of strategies based on cardiac troponin (cTn) assays in the diagnosis, prognosis and monitoring of patients with acute coronary syndrome (ACS). We evaluated the performance and the practicability of 6 commercially available assays (5 cTnI and 1 cTnT) in patients with ACS. METHODS This study was carried out between October 2001 and June 2002 at Armed Forces Hospital in collaboration with Prince Sultan Cardiac Center,...

  3. Does the circadian pattern for acute cardiac events presentation vary with fasting?

    OpenAIRE

    Suwaidi Al; Bener A; Gehani A; Behair S; Mohanadi D; Salam A; Ha, Binali

    2006-01-01

    Background: Over one billion Muslims fast worldwide during the month of Ramadan. The impact of fasting on circadian presentation with acute cardiac events is unknown. Aim: To determine if fasting has any effect on the circadian presentation of acute cardiac events. Setting and Design: A prospective study in a general hospital. Materials and Methods: Patients with acute coronary events were divided into two groups based on the history of fasting. Information about age, gender, cardiova...

  4. Inpatient psychotherapeutic treatment for cardiac patients with depression in Germany - short term results

    OpenAIRE

    Barth, Ju?rgen; Paul, Juliane; Ha?rter, Martin; Bengel, Ju?rgen

    2005-01-01

    The purpose of the PROTeCD(Psychotherapeutic Resource-Orientated Treatment for Cardiac Patients with Depression)-study was to develop and to evaluate a brief psychotherapeutic intervention for rehabilitation in-patients with coronary heart disease (CHD) and depressive disorders. In three cardiac rehabilitation hospitals all patients were screened for mental distress at admission. Patients generally stay for 3 to 4 weeks before being referred to outpatient care.

  5. Sudden unexpected death of epileptic patient due to cardiac arrhythmia after seizure.

    Science.gov (United States)

    Dasheiff, R M; Dickinson, L J

    1986-02-01

    Sudden unexpected death (SUD) occurred in an epileptic patient after a seizure. The patient had a witnessed seizure with electrocardiographic evidence of a cardiac arrhythmia. Immediate cardiopulmonary resuscitation in the hospital was ineffective. Autopsy revealed no anatomic cause of death. This case supports a cardiac cause for SUD in this patient. The mechanism of death remains speculative despite its setting in an epilepsy center. The seven-year experience with SUD at the epilepsy center is reviewed. PMID:3947265

  6. 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 ex...

  7. 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)

  8. [Cardiac amyloidosis. General review].

    Science.gov (United States)

    Laraki, R

    1994-04-01

    Cardiac amyloidosis, most often of AL type, is a non-exceptional disease as it represents 5 to 10% of non-ischemic cardiomyopathies. It realizes typically a restrictive cardiomyopathy. Nevertheless the wide diversity of possible presentation makes it a "big shammer" which must be evoked in front of every unexplained cardiopathy after the age of forty. If some associated manifestations can rapidly suggest the diagnosis, as a peripheric neuropathy especially a carpal tunnel syndrome or palpebral ecchymosis, cardiac involvement can also evolve in an apparently isolated way. The most suggestive paraclinic elements for the diagnosis are, in one hand, the increased myocardial echogenicity with a "granular sparkling" appearance seen throughout all walls of the left ventricle and, in the other hand, the association of a thickened left ventricle and a low voltage (electrocardiogram could also show pseudo-infarct Q waves). In front of such aspects, the proof of amyloidosis is brought by an extra-cardiac biopsy or by scintigraphy with labelled serum amyloid P component, so that the indications of endomyocardial biopsy are very limited today. The identification of the amyloid nature of a cardiopathy has an direct therapeutic implication: it contra-indicates the use of digitalis, calcium channel blockers and beta-blockers. The treatment of AL amyloidosis (chemotherapy with alkylant agents) remains very unsatisfactory especially in the cardiac involvement which is the most frequent cause of death (in AL amyloidosis). Last, cardiac amyloidosis is a bad indication for transplantation which results are burden by rapid progression of deposits especially in the gastro-intestinal tract and the nervous system. PMID:8059146

  9. 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.

  10. Head out of water immersion: A simulation model of microgravity?

    Science.gov (United States)

    Verheyden, B.; Beckers, F.; Aubert, Ae.

    Introduction. It is well known that during weightlessness a redistribution of body fluids occurs towards the upper parts of the body causing altered cardiovascular reflex activities. During head out of water immersion (HOI), the hydrostatic pressure on the soft tissues of the lower limbs causes thoracic blood volume to increase, comparably with the observed haemodynamics during weightlessness. The purpose of this study was to evaluate HOI as a simulation model of microgravity concerning the cardiovascular autonomic control system. Methods. Heartbeat and continuous blood pressure (fingerplethysmography) were measured in 18 (age=22.2± 10.3yr) healthy subjects in different conditions: Supine, sitting and standing in air (25C); upright submersion in thermo neutral water (34C) up to the shoulders (HOI). After 5 minutes of accommodation to the position and condition, recordings were made for 10 minutes. Time domain parameters (MeanRR, SD, rMSSD and pNN50) as well as frequency domain parameters (Total Power, high frequency (HF), low frequency (LF)) of HRV and BPV were calculated. An index of baroreflex sensitivity was determined by the sequence method. Results from the HOI experiment were compared to results obtained from microgravity phases in parabolic flights in 5 subjects. Results. Cardiac autonomic control during HOI was characterized by a gain in vagal predominance as shown by a decrease of the LF/HF-ratio from 950 ± 130 ms2 during standing control towards 389 ± 119 ms2 during HOI and a increase of BRS by approximately 20%. As a result, heart rate decreased by approximately 28% during HOI. The same evolution was shown during the transition from a standing control position towards 0G obtained during parabolic flights. LF power of BPV, as a marker of peripheral vasomotor sympathetic activity, decreased significantly both in absolute values and normalized units during HOI compared to standing and seated control (p cardiac autonomic reflex activity. In contrast, results from this study suggest that peripheral autonomic cardiovascular control is different during HOI compared to real microgravity obtained during parabolic flights. Probably, different intravascular pressure gradients in microgravity and during HOI result in a proper peripheral autonomic reflex modulation through the activity of low pressure baroreceptors.

  11. 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.)

  12. 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.)

  13. Decay out of a Superdeformed Band

    OpenAIRE

    Gu, J. Z.; Weidenmueller, H. A.

    1999-01-01

    Using a statistical model for the normally deformed states and for their coupling to a member of the superdeformed band, we calculate the ensemble average and the fluctuations of the intensity for decay out of the superdeformed band and of the intraband decay intensity. We show that both intensities depend on two dimensionless variables: The ratio $\\Gamma^{\\downarrow}/\\Gamma_S$ and the ratio $\\Gamma_N/d$. Here, $\\Gamma^{\\downarrow}$ is the spreading width for the mixing of t...

  14. Fungi causing dying out of heather seedlings

    Directory of Open Access Journals (Sweden)

    Maria Kowalik

    2005-12-01

    Full Text Available The aim of the study was to determine the fungi causing dying out of one-yearold heather seedlings. Observations were carried out on: 'Amethyst', 'Annemarie', 'Colette', 'Perestroika' and 'Reini'. The shoots revealing necrotic symptoms were plated on PDA medium. 25 species of fungi were isolated. Among them Pestalotia sydowiana, Alternaria alternata, Cylindrocarpon destructans, Leptosphaeria coniothyrium and Epicoccum purpurascens were dominant, while Mammaria echinobotryoides, Phoma leveillei, Kaissleriella subalpina, Botrytis cinerea and Phytophthora cinnamomi occurred less frequently.

  15. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa).

    Science.gov (United States)

    Jacobs, Ian; Nadkarni, Vinay; Bahr, Jan; Berg, Robert A; Billi, John E; Bossaert, Leo; Cassan, Pascal; Coovadia, Ashraf; D'Este, Kate; Finn, Judith; Halperin, Henry; Handley, Anthony; Herlitz, Johan; Hickey, Robert; Idris, Ahamed; Kloeck, Walter; Larkin, Gregory Luke; Mancini, Mary Elizabeth; Mason, Pip; Mears, Gregory; Monsieurs, Koenraad; Montgomery, William; Morley, Peter; Nichol, Graham; Nolan, Jerry; Okada, Kazuo; Perlman, Jeffrey; Shuster, Michael; Steen, Petter Andreas; Sterz, Fritz; Tibballs, James; Timerman, Sergio; Truitt, Tanya; Zideman, David

    2004-12-01

    Outcome following cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress toward international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports of cardiac arrest, international registries have yet to be developed. In April 2002 a task force of ILCOR met in Melbourne, Australia, to review worldwide experience with the Utstein definitions and reporting templates. The task force revised the core reporting template and definitions by consensus. Care was taken to build on previous definitions, changing data elements and operational definitions only on the basis of published data and experience derived from those registries that have used Utstein-style reporting. Attention was focused on decreasing the complexity of the existing templates and addressing logistical difficulties in collecting specific core and supplementary (i.e., essential and desirable) data elements recommended by previous Utstein consensus conference. Inconsistencies in terminology between in-hospital and out-of-hospital Utstein templates were also addressed. The task force produced a reporting tool for essential data that can be used for both quality improvement (registries) and research reports and that should be applicable to both adults and children. The revised and simplified template includes practical and succinct operational definitions. It is anticipated that the revised template will enable better and more accurate completion of all reports of cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage, confidentiality, management, and registry implementation are acknowledged and potential solutions offered. Uniform collection and tracking of registry data should enable better continuous quality improvement within every hospital, EMS system, and community. PMID:15582757

  16. Validation of the EuroQol questionnaire in cardiac rehabilitation

    OpenAIRE

    Schweikert, B.; Hahmann, H.; Leidl, Reiner

    2005-01-01

    Objective: To analyse the psychometric properties of the EuroQol questionnaire (EQ-5D) applied to patients with acute coronary syndromes (ACS).Setting: Rehabilitation hospital.Patients and design: 106 consecutive patients with ACS (51% myocardial infarction, 42% coronary artery bypass grafting, 7% angina) completed the EQ-5D, the 36 item short form health survey (SF-36), and the MacNew questionnaire at admission, at discharge, and three months after inpatient cardiac rehabilitation. Acceptanc...

  17. Orofacial pain of cardiac origin, serial of clinical cases

    OpenAIRE

    Lo?pez-lo?pez, Jose?; Adserias-garriga, Maria J.; Garcia-vicente, Laia; Jane?-salas, Enric; Chimenos-ku?stner, Eduardo; Pereferrer-kleine, Damia?n

    2012-01-01

    Objective: To determine the clinical characteristics of the orofacial pain of cardiac origin in patients visited when doing a treadmill exercise test, at the cardiology service of the Can Ruti Hospital in Badalona (Barcelona, Spain). Study design: The sample of that study included thirty patients visiteding when doing a treadmill exercise test, at the cardiology service. The questionnaire has been asked to a sample of 30 patients. Results: Eleven of the 30 patients included in this study pres...

  18. Fast-tracking in pediatric cardiac surgery - The current standing

    Directory of Open Access Journals (Sweden)

    Mittnacht Alexander

    2010-01-01

    Full Text Available Fast-tracking in cardiac surgery refers to the concept of early extubation, mobilization and hospital discharge in an effort to reduce costs and perioperative morbidity. With careful patient selection, fast-tracking can be performed in many patients undergoing surgery for congenital heart disease (CHD. In order to accomplish this safely, a multidisciplinary coordinated approach is necessary. This manuscript reviews currently used anesthetic techniques, patient selection, and available information about the safety and patient outcome associated with this approach.

  19. 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 ...

  20. Resuscitation review to improve nursing performance during cardiac arrest.

    Science.gov (United States)

    Carpico, Bronwynne; Jenkins, Peggy

    2011-01-01

    The purpose of this study was to evaluate the effect of Resuscitation Review Simulation Education (RRSE) on improving adherence to hospital protocols and American Heart Association (AHA) resuscitation standards. Prior to implementing the RRSE on two nursing units, performance was evaluated during a simulated cardiac arrest using a mannequin and comparing performance against AHA algorithms. Performance was measured at two separate periods: preintervention and 3 months after the intervention. Both units improved overall scores after the RRSE. PMID:21263274

  1. 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...

  2. Phrenic nerve injury in infants and children undergoing cardiac surgery.

    OpenAIRE

    Mok, Q.; Ross-Russell, R; Mulvey, D.; GREEN, M; Shinebourne, E. A.

    1991-01-01

    Fifty infants and 50 children less than 15 years undergoing palliative or corrective cardiac surgery in the Brompton Hospital between March and October 1988 had direct percutaneous stimulation of the phrenic nerve before and after operation. Ten patients, six under 1 year of age and four over, developed unilateral phrenic nerve injury. In those aged less than 1 year recovery after operation was prolonged because their diaphragmatic palsy made it difficult to wean them from the ventilator. Old...

  3. 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.

  4. Avaliação do conhecimento geral de médicos emergencistas de hospitais de Salvador - Bahia sobre o atendimento de vítimas com parada cardiorrespiratória / Assessment of the general knowledge of emergency physicians from the hospitals of the city of Salvador (Brazil) on the care of cardiac arrest patients

    Scientific Electronic Library Online (English)

    Nivaldo Menezes, Filgueiras Filho; Antônio Carlos, Bandeira; Thales, Delmondes; Adriano, Oliveira; Alberto Soares, Lima Junior; Vinicius, Cruz; Fábio, Vilas-Boas; Álvaro, Rabelo Junior.

    2006-11-01

    Full Text Available OBJETIVO: Identificar a proporção de médicos emergencistas com habilitação em cursos de imersão (SAVC - Suporte Avançado de Vida em Cardiologia e SAVT - Suporte Avançado de Vida no Trauma), relacionando variáveis: idade, sexo, especialidade médica, titulação e tipo de hospital com o grau de conhecim [...] ento teórico no atendimento de vítimas de parada cardiorrespiratória. MÉTODOS: Foram avaliados de forma consecutiva, de novembro/2003 a julho/2004, os emergencistas de hospitais públicos e privados da cidade de Salvador - Bahia, que voluntariamente aceitaram participar do estudo. Esses responderam a um questionário construído de informações das variáveis de interesse: perfil do profissional, realização ou não dos cursos de imersão SAVC e SAVT, avaliação cognitiva com 22 questões objetivas sobre ressuscitação cardiopulmonar. Calculou-se para cada participante um valor de acertos indicado como variável escore. Esse questionário foi validado a partir do resultado do escore dos instrutores do curso SAVC em Salvador - BA. RESULTADOS: Dos 305 médicos que responderam ao questionário, 83 (27,2%) haviam realizado o curso SAVC, tendo como média da variável escore o valor de 14,9+3,0, comparada com os 215 médicos (70,5%) que não o haviam feito e cuja média foi de 10,5+3,5 (p=0,0001). A média do escore dos 65 cardiologistas (21,5%) foi de 14,1+3,3, comparada com os 238 médicos (78,5%) que eram de outras especialidades, com média de 9,7+3,7(p=0,0001). Não foi identificada diferença da média do escore entre os médicos que haviam ou não realizado o curso SAVT (p=0,67). CONCLUSÃO: Na amostra avaliada, o conhecimento teórico sobre ressucitação cárdio-pulmonar (RCP) foi superior naqueles profissionais que realizaram o SAVC, diferente do que ocorreu naqueles que realizaram o SAVT. Os especialistas em Cardiologia que realizaram o SAVC demonstraram um conhecimento teórico superior, sobre o atendimento de vítimas de parada cárdio-respiratória (PCR), quando comparado com as demais especialidades avaliadas em conjunto - Clínica Médica, Cirurgia e Ortopedia. Abstract in english OBJECTIVE: To identify the proportion of emergency physicians certified in immersion courses (ACLS - Advanced Cardiac Life Support and ATLS - Advanced Trauma Life Support) correlating the variables of age, gender, medical specialty, academic title, and type of hospital with the level of theoretical [...] knowledge on the care of Cardiac Arrest (CA) victims. METHODS: Emergency physicians from public and private hospitals of the city of Salvador, State of Bahia - Brazil, were consecutively evaluated from November, 2003 to July, 2004. They volunteered to participate in the study, and responded to a questionnaire consisting of information on the following variables of interest: professional profile, participation or not in ACLS and ATLS immersion courses, and cognitive assessment with 22 objective questions on Cardiopulmonary Resuscitation (CPR). A score of correct answers was calculated for each participant, and then designated as score variable. This questionnaire was validated based on the result of the score obtained by ACLS course instructors in Salvador, BA. RESULTS: Of the 305 physicians who responded to the questionnaire, 83 (27.2%) had attended the ACLS course and had a mean score variable of 14.9+3.0 compared with the 215 physicians (70.5%) who had not attended the course and whose mean was 10.5+ 3.5 (p=0.0001). The mean score of the 65 cardiologists (21.5%) was 14.1+3.3 compared with the mean of 9.7+3.7(p=0.0001) of the 238 physicians (78.5%) from other specialties. No difference was observed in the mean scores between physicians who had attended the ATLS course or not (p=0.67). CONCLUSION: In the sample studied, theoretical knowledge on CPR was higher among physicians who had attended the ACLS course, as opposed to those who had attended the ATLS course. Cardiologists who had attended the ACLS demonstrated a higher theoretical knowledge on the care of CA patients when compared to physi

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. Cardiac function studies

    International Nuclear Information System (INIS)

    A total of 27 patients were subjected tointramyocardial sequential scintiscanning (first pass) using 99m-Tc human serum albumin. A refined method is described that is suitable to analyse clinically relevant parameters like blood volume, cardiac output, ejection fraction, stroke volume, enddiastolic and endsystolic volumes as well as pulmonal transition time and uses a complete camaracomputer system adapted to the requirements of a routine procedure. Unless there is special hardware available, the method does not yet appear mature enough to be put into general practice. Its importance recently appeared in a new light due to the advent of particularly shortlived isotopes. For the time being, however, ECG-triggered equilibrium studies are to be preferred for cardiac function tests. (TRV)

  12. Fetal cardiac assessment

    International Nuclear Information System (INIS)

    The better understanding of fetal cardiovascular physiology coupled with improved technology for non-invasive study of the fetus now enable much more detailed assessment of fetal cardiac status than by heart rate alone. Even the latter, relatively simple, measurement contains much more information than was previously realized. It is also increasingly clear that no single measurement will provide the answer to all clinical dilemmas either on cardiac function or the welfare of the fetus as a whole. There are obvious clinical advantages in measuring several variables from one signal and the measurement of heart rate, heart rate variation and waveform from the ECG in labour is a potentially useful combination. Systolic time intervals or flow measurements could easily be added or used separately by combining real-time and Doppler ultrasound probes

  13. 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 ...

  14. 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 ...

  15. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... from it. This is a very complex procedure. Mortality is no that high. Remember we're dealing ... Florida and one of six of the first hospitals in the country to have it. So we ...

  16. Out-of-body-induced hippocampal amnesia.

    Science.gov (United States)

    Bergouignan, Loretxu; Nyberg, Lars; Ehrsson, H Henrik

    2014-03-25

    Theoretical models have suggested an association between the ongoing experience of the world from the perspective of one's own body and hippocampus-based episodic memory. This link has been supported by clinical reports of long-term episodic memory impairments in psychiatric conditions with dissociative symptoms, in which individuals feel detached from themselves as if having an out-of-body experience. Here, we introduce an experimental approach to examine the necessary role of perceiving the world from the perspective of one's own body for the successful episodic encoding of real-life events. While participants were involved in a social interaction, an out-of-body illusion was elicited, in which the sense of bodily self was displaced from the real body to the other end of the testing room. This condition was compared with a well-matched in-body illusion condition, in which the sense of bodily self was colocalized with the real body. In separate recall sessions, performed ?1 wk later, we assessed the participants' episodic memory of these events. The results revealed an episodic recollection deficit for events encoded out-of-body compared with in-body. Functional magnetic resonance imaging indicated that this impairment was specifically associated with activity changes in the posterior hippocampus. Collectively, these findings show that efficient hippocampus-based episodic-memory encoding requires a first-person perspective of the natural spatial relationship between the body and the world. Our observations have important implications for theoretical models of episodic memory, neurocognitive models of self, embodied cognition, and clinical research into memory deficits in psychiatric disorders. PMID:24616529

  17. Out-of-body–induced hippocampal amnesia

    Science.gov (United States)

    Bergouignan, Loretxu; Nyberg, Lars; Ehrsson, H. Henrik

    2014-01-01

    Theoretical models have suggested an association between the ongoing experience of the world from the perspective of one’s own body and hippocampus-based episodic memory. This link has been supported by clinical reports of long-term episodic memory impairments in psychiatric conditions with dissociative symptoms, in which individuals feel detached from themselves as if having an out-of-body experience. Here, we introduce an experimental approach to examine the necessary role of perceiving the world from the perspective of one’s own body for the successful episodic encoding of real-life events. While participants were involved in a social interaction, an out-of-body illusion was elicited, in which the sense of bodily self was displaced from the real body to the other end of the testing room. This condition was compared with a well-matched in-body illusion condition, in which the sense of bodily self was colocalized with the real body. In separate recall sessions, performed ?1 wk later, we assessed the participants’ episodic memory of these events. The results revealed an episodic recollection deficit for events encoded out-of-body compared with in-body. Functional magnetic resonance imaging indicated that this impairment was specifically associated with activity changes in the posterior hippocampus. Collectively, these findings show that efficient hippocampus-based episodic-memory encoding requires a first-person perspective of the natural spatial relationship between the body and the world. Our observations have important implications for theoretical models of episodic memory, neurocognitive models of self, embodied cognition, and clinical research into memory deficits in psychiatric disorders. PMID:24616529

  18. Inherited cardiac disease

    OpenAIRE

    Philippe Charron

    2012-01-01

    Major advances have been achieved over the two last decades in the field of genetic cardiovascular diseases, not only through increased recognition and understanding of underlying molecular defects but also through rapid translation of knowledge into clinical practice. Genetic counseling and organization of cardiac family screening has become part of the medical management of these diseases, and these should be performed systematically unless an acquired cause has been diagnosed...

  19. 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...

  20. "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.

  1. 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

  2. Opting out of nuclear energy is feasible

    International Nuclear Information System (INIS)

    The nuclear catastrophe at Chernobyl marks an historic event in the utilization of nuclear energy. It has taught us that to use the atom for energy generation means a more or less endless threat to humanity. The time has therefore come to change direction, effect a turn in energy policy - a turn towards more ecologically and socially compatible forms of energy production and utilization. Already today it is technically feasible to opt out of nuclear technology. In the long run, decentral energy systems and the mobilisation of the vast potential for energy conservation will be cheaper, will provide more suitable places of work and, especially, will be safer. (orig.)

  3. Traumatismo cardíaco com retenção de corpo estranho em criança de sete anos Cardiac trauma with retained pellets in a seven year-old child

    Directory of Open Access Journals (Sweden)

    Fernando Antonio Campelo Spencer Netto

    1998-08-01

    Full Text Available This is a case report about a seven year-old child who arrived at Emergency Department of Hospital da Restauração with gunshot wound on precordial area and clinical signs of cardiac tamponade. The roentgenogram showed 27 retained pellets in cardiac area. Thoracotomy was performed and repaired a cardiac wound in right ventricule. The patient developed conduction disturbance and valvar defect, but was discharged on the tenth postoperative day. Diagnosis, treatment and complications of retained projectiles are discussed.

  4. Cardiac tissue engineering

    Directory of Open Access Journals (Sweden)

    MILICA RADISIC

    2005-03-01

    Full Text Available 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 perfluorocarbons, or with electrical stimulation (continuous application of biphasic pulses, 2 ms, 5 V, 1 Hz. Tissue constructs cultured without perfusion or electrical stimulation served as controls. Medium perfusion and addition of perfluorocarbons resulted in compact, thick constructs containing physiologic density of viable, electromechanically coupled cells, in contrast to control constructs which had only a ~100 mm thick peripheral region with functionally connected cells. Electrical stimulation of cultured constructs resulted in markedly improved contractile properties, increased amounts of cardiac proteins, and remarkably well developed ultrastructure (similar to that of native heart as compared to non-stimulated controls. We discuss here the state of the art of cardiac tissue engineering, in light of the biomimetic approach that reproduces in vitro some of the conditions present during normal tissue development.

  5. Cardiac hybrid imaging

    International Nuclear Information System (INIS)

    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.)

  6. 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.)

  7. Impact of the introduction of a daily trauma list on out-of-hours operating.

    OpenAIRE

    Jennings, A. G.; Saeed, K.; Dolan, S; Wise, D. I.

    1999-01-01

    The British Orthopaedic Association have recommended that all hospitals should have daily, consultant-led, trauma lists. We have prospectively examined the introduction of a daily trauma list on the out-of-hours operating and the management of trauma in one district hospital. The data collected were compared with a corresponding 6-month period in 1996. It was found that the mean usage of the list was 2 h 38 min; 10% of lists were not used. There has been a significant reduction in the number ...

  8. 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.

  9. Hospitals for sale.

    Science.gov (United States)

    Costello, Michael M; West, Daniel J; Ramirez, Bernardo

    2011-01-01

    The pace of hospital merger and acquisition activity reflects the economic theory of supply and demand: Publicly traded hospital companies, private equity funds, and large nonprofit hospital systems are investing capital to purchase and operate freestanding community hospitals at a time when many of those hospitals find themselves short of capital reserves and certain forms of management expertise. But the sale of those community hospitals also raises questions about the impact of absentee ownership on the communities which those hospitals serve. PMID:21864058

  10. 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...

  11. 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...

  12. [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

  13. 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.

  14. Charged Colloidal Rods Out of Equilibrium

    Directory of Open Access Journals (Sweden)

    Kyongok Kang

    2014-12-01

    Full Text Available This article is a comprehensive overview of the ongoing research of the author on charged colloidal rods out of equilibrium, under external electric fields and at high concentrations around the glass transition. The suspensions of fd-virus particles are used as a model system for charged colloidal rods, which exhibit several disorder-order (and liquid-crystalline phase transitions. When a low AC electric field is applied to suspensions in isotropic-nematic coexistence concentration, with frequencies that are sufficiently low to polarize the electric double layer and the layer of condensed ions, various phases/states are induced: a chiral nematic, a dynamical state where nematic domains persistently melt and form, and a uniform homeotropic phase. A point in the field-amplitude versus frequency diagram, where various transitions lines meet, can be identified as a non-equilibrium critical point. Without an electric field, at high concentrations of charged fd-rods, various self-assembled orientation textures are found beyond the isotropic-nematic coexistence regions, and a glass transition is observed on approach and within the glass state that are probed. The presented system exhibits transient behaviors of repulsive glasses and slow dynamics out of equilibrium.

  15. 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

  16. A knowledge translation collaborative to improve the use of therapeutic hypothermia in post-cardiac arrest patients: protocol for a stepped wedge randomized trial

    OpenAIRE

    Wax Randy; Rubenfeld Gordon; Ferguson Niall; Dorian Paul; Needham Dale M; Brooks Steve C; Scales Damon C; Dainty Katie N; Zwarenstein Merrick; Thorpe Kevin; Morrison Laurie J

    2011-01-01

    Abstract Background Advances in resuscitation science have dramatically improved survival rates following cardiac arrest. However, about 60% of adults that regain spontaneous circulation die before leaving the hospital. Recently it has been shown that inducing hypothermia in cardiac arrest survivors immediately following their arrival in hospital can dramatically improve both overall survival and neurological outcomes. Despite the strong evidence for its efficacy and the apparent simplicity o...

  17. Sudden Cardiac Arrest and Physical Activity

    Medline Plus

    Full Text Available ... Videos & Tools You Are Here: Home ? Latest Health News ? Sudden Cardiac Arrest and Physical Activity URL of ... page: http://www.nlm.nih.gov/medlineplus/videos/news/Sudden_Cardiac_040815-1.html Sudden Cardiac Arrest ...

  18. What to Expect during Cardiac Rehabilitation

    Science.gov (United States)

    ... NHLBI on Twitter. What To Expect During Cardiac Rehabilitation During cardiac rehabilitation (rehab), you'll learn how to: Increase your ... Rate This Content: NEXT >> December 24, 2013 Cardiac Rehabilitation Clinical Trials Clinical trials are research studies that ...

  19. How to teach practical skills in medicine: out of hospital training

    OpenAIRE

    Higgins, M.F.; Macken, Alan P; Coyle, O; Cullen, Walter; McGrath, D; O'Gorman, Clodagh S

    2013-01-01

    “See one, do one, teach one” is the traditional paradigm for teaching medicine while working, the apprenticeship model. This paradigm is based on training during long working hours and with evaluation by mentors1. More recently, medical education is turning towards more structured programmes of teaching skills, where formal training can be objectively assessed using competency-based assessment2. At an undergraduate level this is driven by the requirement of a newly-qu...

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

    Science.gov (United States)

    ... 2014 Content source: CDC/National Center for Health Statistics Page maintained by: Office of Information Services Home A-Z Index Policies Using this Site Link to Us Contact CDC Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30329-4027, USA 800-CDC-INFO ( ...

  1. Basic life-support kit in an out-of-hospital emergency

    OpenAIRE

    Lederer, Wolfgang; Rieger, Michael; Kroesen, Gunnar; Wiedermann, Franz J.

    2009-01-01

    An 8-year-old boy suffered a skull fracture and severe brain injury while attending a skiing event. A physician, equipped with his private emergency kit accomplished placement of a venous access line enabling administration of analgesic and sedating medication with ketamine and midazolam. When the helicopter emergency medical service arrived on the scene the patient’s peripheral circulation had decreased to such an extent that further attempts to place a second peripheral venous line were i...

  2. 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.

  3. 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 ...

  4. 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

  5. Out of Context: Thinking Cultural Studies Diasporically

    Directory of Open Access Journals (Sweden)

    Grant Farred

    2011-04-01

    Full Text Available This essay on cultural studies and the African Diaspora argues for a rethinking of cultural studies in two critical ways: firstly, that cultural studies, from its founding institutional and conceptual moment, cannot but be thought diasporically; and, secondly, that cultural studies be thought ‘out of’, or, against, context—that is, cultural studies is most revealing in its political and literary articulation when it is not read, as many of its advocates claim, contextually. This essay offers a broad critique of cultural studies and the (African diaspora but derives its most cogent and creative argument from its ability to read together the work of two diasporic authors, deracinated South African and Australian writers, J. M. Coetzee and David Malouf.

  6. Politics out of the History of Politics

    Directory of Open Access Journals (Sweden)

    Diana Sartori

    2012-11-01

    Full Text Available Wendy Brown’s approach in Politics out of History is characterized by an attempt to analyze the presence of the past which can be read not only under the light of Nietzsche’s legacy, but also through a comparison with Hannah Arendt’s conception of the gap between the past and the future. Like Arendt, Brown aims to look at the present as the site of politics and freedom, even though the former conceives the break with tradition as the unavoidable starting point, while the latter assumes that that break is not fully accomplished because it was not recognized. Rather, it produces Wounded Attachments whose effect is that of limiting the possibility of left criticism. Moving from this parallel, Brown’s analysis is compared to the Italian philosophy of sexual difference, stressing their common interest in thinking freedom beyond a female identity built on a presumed common oppression.

  7. Negotiate way out of siting dilemmas

    International Nuclear Information System (INIS)

    Can America negotiate itself out of its high-level radioactive waste dilemma by finding communities willing to volunteer as host sites? The authors think such a possibility exists. In fact, they see little other way to successfully locate controversial facilities in the future. A decide-announce-defend strategy only sparks community anger, solidifies opposition, and leads to expensive court battles without achieving results. The Office of Nuclear Waste Negotiator was established by the Nuclear Waste Policy Act to negotiate with states an Indian tribes about hosting a permanent nuclear waste repository and an interim Monitored Retrievable Storage (MRS) facility. Twenty communities and Indian tribes submitted applications for grants to study the possibility of hosting an MRS facility. Whether or not one of these potential hosts decides to make a commitment, the efficacy of negotiation has been demonstrated. Neither courtroom procedures nor administrative flats have engendered similar success

  8. 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.

  9. Cardiac tamponade: a review of diagnosis and anaesthetic and surgical management illustrated by three case reports

    OpenAIRE

    Callander, C. C.; Mousdale, S.

    1989-01-01

    Cardiac tamponade is an uncommon problem in a district general hospital. Three patients were admitted to the intensive therapy unit at Northampton General Hospital with tamponade in a 7-week period, each with a different underlying aetiology. Their case histories are presented and the management in the light of these described. The aetiology, physiology, clinical signs and investigations leading to the diagnosis are considered. In the discussion the opportunity is taken to review the recent l...

  10. What is the requirement for out-of-hours operating in orthopaedics?

    OpenAIRE

    M. McKee; Priest, P.; Ginzler, M; BLACK, N

    1993-01-01

    Recent reports have emphasized the need to reduce the amount of unsupervised surgery performed at night by junior doctors. However there is little guidance about when an operation must be performed urgently and when it can be postponed safely. This study describes the existing pattern of out-of-hours trauma and orthopaedic surgery in four hospitals and reports the views of a panel of surgeons and anaesthetists on the extent to which operating could be postponed until the following day. Operat...

  11. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... good, living muscle that not only can you sense what the heart muscle is doing, but you ... them out of it because they don't sense any discomfort for that. They’ll feel their ...

  12. Hospital Outpatient PPS Partial Hospitalization Program LDS

    U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Partial Hospitalization Program LDS This file contains select claim level data and is derived from 2010 claims...

  13. Structural Measures - Hospital

    U.S. Department of Health & Human Services — A list of hospitals and the availability of structural measures at that hospital. A structural measure reflects the environment in which hospitals care for...

  14. Out-of-office blood pressure: from measurement to control

    Directory of Open Access Journals (Sweden)

    Baguet JP

    2012-05-01

    Full Text Available Jean-Philippe Baguet1,21Department of Cardiology, University Hospital, 2Bioclinic Radiopharmaceutics Laboratory, INSERM U1039, Joseph Fourier University, Grenoble, FranceAbstract: Hypertension is an important risk factor for the development of cardiovascular disease, and is a major cause of morbidity and mortality worldwide. Traditionally, hypertension diagnosis and treatment and clinical evaluations of antihypertensive efficacy have been based on office blood pressure (BP measurements; however, there is increasing evidence that office measures may provide inadequate or misleading estimates of a patient’s true BP status and level of cardiovascular risk. The introduction, and endorsement by treatment guidelines, of 24-hour ambulatory BP monitoring and self (or home BP monitoring has facilitated more reliable and reproducible estimations of true BP, including the identification of white-coat and masked hypertension, and evaluation of BP variability. In addition, ambulatory BP monitoring enables accurate assessment of treatment effectiveness over 24 hours and both ambulatory and self BP monitoring may lead to better tailoring of therapy according to BP profile and concomitant disease. This review describes the clinical benefits and limitations of out-of-office assessments and their applications for effective management of hypertension and attainment of BP control.Keywords: ambulatory, ABPM, SBPM, blood pressure measurement, hypertension

  15. [No compression of cardiac cavities in transthoracic ultrasound does not exclude cardiac tamponade.

    Science.gov (United States)

    Juhl-Olsen, Peter; Frederiksen, Christina Alcaraz; Sloth, Erik

    2014-11-24

    The clinical presentation of cardiac tamponade is difficult to distinguish from other causes of shock. Pericardial fluid is easy to visualize with cardiac ultrasound and a key sign of overt cardiac tamponade is the compression of right side cavities. We present two cases in which cardiac tamponade was present, but where compression of cardiac cavities could not be demon-strated with transthoracic cardiac ultrasound. This emphasizes that cardiac tamponade is still a clinical diagnosis. PMID:25430575

  16. 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).

  17. Shear viscosity and out of equilibrium dynamics

    CERN Document Server

    El, Andrej; Xu, Zhe; Greiner, Carsten

    2009-01-01

    Using Grad’s method, we calculate the entropy production and derive a formula for the second-order shear viscosity coefficient in a one-dimensionally expanding particle system, which can also be considered out of chemical equilibrium. For a one-dimensional expansion of gluon matter with Bjorken boost invariance, the shear tensor and the shear viscosity to entropy density ratio ?/s are numerically calculated by an iterative and self-consistent prescription within the second-order Israel-Stewart hydrodynamics and by a microscopic parton cascade transport theory. Compared with ?/s obtained using the Navier-Stokes approximation, the present result is about 20% larger at a QCD coupling ?s ? 0.3 (with ?/s ? 0.18) and is a factor of 2–3 larger at a small coupling ?s ? 0.01. We demonstrate an agreement between the viscous hydrodynamic calculations and the microscopic transport results on ?/s, except when employing a small ?s . On the other hand, we demonstrate that for such small ?s , the gluon syst...

  18. [New cardiac pacemakers].

    Science.gov (United States)

    Daubert, J C; Ritter, P; Mabo, P; Kermarrec, A

    1991-06-15

    Because of the extraordinary technological progress made over the past years in pulse generators, the objective and indications of definitive cardiac pacing have greatly changed. All the different advantages are aimed at mimicking the electrophysiological and mechanical conditions of normal heart function. We have seen the development of: DDD mode dual chamber pacemakers, which in cases of AV block recreate normal AV synchrony; single chamber rate-responsive units piloted by an external captor responding to the organism's metabolic needs (intra-corporal vibrations resulting from exercise, respiratory rate, minute ventilation, QT interval, central temperature, SV O2...); they provide effective correction of atrial (AAI-R mode) or ventricular (VVI-R mode) chronotopic incompetencies often associated with chronic conduction disorders which make it impossible for patients paced in VVI or AAI mode to adapt heart rate to exercise level; and finally, "universal" pacemakers capable of pacing in all the single or dual chamber modes with rate responsiveness to one or several captors. These new pacemakers offer adaptability to the paced patient's needs as they vary throughout his lifetime. These units will probably be the "standard" cardiac pacemakers of the future. PMID:1829827

  19. 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.

  20. Cardiac chamber scintiscanning

    International Nuclear Information System (INIS)

    The two methods of cardiac chamber scintiscanning, i.e. 'first pass' and 'ECG-triggered' examinations, are explained and compared. Two tables indicate the most significant radiation doses of the applied radio tracers, i.e. 99m-Tc-pertechnetate and 99m-Tc-HSA, to which a patient is exposed. These averaged values are calculated from various data given in specialised literature. On the basis of data given in literature, an effective half-life of approximately 5 hours in the intravascular space was calculated for the erythrocytes labelled with technetium 99m. On this basis, the radiation doses for the patients due to 99m-Tc-labelled erythrocytes are estimated. The advantages and disadvantages of the two methods applied for cardiac chamber scintiscanning are put into contrast and compared with the advantages and disadvantages of the quantitative X-ray cardiography of the left heart. The still existing problems connected with the assessment of ECG-triggered images are discussed in detail. The author performed investigations of his own, which concerned the above-mentioned problems. (orig./MG)

  1. Effects of Out-of-Home Mental Health Treatment on Probability of Criminal Charge During the Transition to Adulthood

    OpenAIRE

    Pullmann, Michael

    2011-01-01

    Criminal justice-related outcomes for youth who have been served in out-of-home mental health settings such as residential treatment and inpatient hospitalization are unclear. This study longitudinally modeled the changing probability of being charged with a crime from age 16 to 25, including being served in out-of-home treatment and aging into adulthood, while controlling for person-level covariates such as gender, race, past criminal charges, and mental health diagnoses. Results indicated t...

  2. Providing palliative care in primary care: how satisfied are GPs and district nurses with current out-of-hours arrangements?

    OpenAIRE

    Shipman, C; Addington-Hall, J; Barclay, S.; Briggs, J.; Cox, I; Daniels, L.; D Millar

    2000-01-01

    The complex needs of palliative care patients require an informed, expert, and swift response from out-of-hours general medical services, particularly if hospital admission is to be avoided. Few general practitioners (GPs) reported routinely handing over information on their palliative care patients, particularly to GP co-operatives. District nurses and inner-city GPs were least satisfied with aspects of out-of-hours care. Most responders wanted 24-hour availability of specialist palliative c...

  3. Automatic Implantable Cardiac Defibrillator

    Medline Plus

    Full Text Available ... patient in the hospital even though less than 10 percent going to survive. Is rate -- this is of men. A lot of heart diseased men are prevalent, more -- it’s just for men to have heart disease, ...

  4. 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.

  5. 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.

  6. 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.

  7. Screening for diabetic cardiac autonomic neuropathy using a new handheld device

    DEFF Research Database (Denmark)

    Gulichsen, Elisabeth; Fleischer, Jesper

    2012-01-01

    Cardiac autonomic neuropathy (CAN) is a serious complication of longstanding diabetes and is associated with an increased morbidity and reduced quality of life in patients with diabetes. The present study evaluated the prevalence of CAN diagnosed by reduced heart rate variability (HRV) using a newly developed device in a large, unselected, hospital-based population of patients with diabetes.

  8. Dinosaurs, Hospital Ecosystems, and the Future of Family Medicine

    OpenAIRE

    Glazner, Cherie

    2008-01-01

    The continued presence of the family physician within hospital systems is key to family medicine remaining an attractive, viable specialty in the ever-evolving world of medicine. One physician muses about her place in this complex ecosystem and believes that family physicians lose their voice and thus risk their own extinction when they opt out of hospital practice.

  9. Cardiac Nonmyocytes in the Hub of Cardiac Hypertrophy.

    Science.gov (United States)

    Kamo, Takehiro; Akazawa, Hiroshi; Komuro, Issei

    2015-06-19

    Cardiac hypertrophy is characterized by complex multicellular alterations, such as cardiomyocyte growth, angiogenesis, fibrosis, and inflammation. The heart consists of myocytes and nonmyocytes, such as fibroblasts, vascular cells, and blood cells, and these cells communicate with each other directly or indirectly via a variety of autocrine or paracrine mediators. Accumulating evidence has suggested that nonmyocytes actively participate in the development of cardiac hypertrophy. In this review, recent progress in our understanding of the importance of nonmyocytes as a hub for induction of cardiac hypertrophy is summarized with an emphasis of the contribution of noncontact communication mediated by diffusible factors between cardiomyocytes and nonmyocytes in the heart. PMID:26089366

  10. Management of asthma in hospital: a prospective audit

    OpenAIRE

    Bucknall, C. E.; Robertson, C.; Moran, F.; Stevenson, R. D.

    1988-01-01

    In a prospective study of management of asthma in hospital patients with acute asthma admitted to a single hospital over a calendar year were surveyed. Altogether 157 out of 194 admissions (81%) were studied. The patients (16 of whom had been admitted twice and one three times) were interviewed at home about two weeks after discharge, and their hospital records were reviewed. When interviewed an appreciable proportion of patients said that their asthma had been poorly controlled after their d...

  11. Mortality in the elderly during respite hospital care.

    OpenAIRE

    Mccaffrey, P. M.; Gilmore, D. H.; Beringer, T. R.

    1989-01-01

    This study examined the mortality in the elderly during 243 respite hospital admissions. Sixty-four dependent elderly patients entered a regular respite care scheme and were admitted to hospital for a period of 4 weeks out of every 12 weeks. The mortality rate in hospital was one death per 976 days, in comparison to one death per 1296 days at home. This small increase in mortality should not deprive patients and their carers from access to respite care.

  12. PERICARDIAL TUBERCULOSIS COMPLICATED WITH CARDIAC TAMPONADE (IN SPANISH

    Directory of Open Access Journals (Sweden)

    Lora-Andosilla Mario

    2014-06-01

    Full Text Available Introduction: the tuberculous pericarditis (TP is a potentially lethal complication of the Mycobacterium tuberculosis infection. Occasionally it could come to advance stages and to produce cardiac tamponade. Case report: a case report of a 39-year-old male patient, drug-dependent and HIV carrier with irregular treatment is presented. Attended in the Hospital Universitario del Caribe in Cartagena. Colombia. The patient consulted for respiratory and cardiovascular symptomatology, by which it was initially considered the heart failure and pneumonia. Subsequently the clinical symptomatology suggestive of cardiac tamponade were installed and confirmed by thoracic radiography and echocardiogram. And the tamponade was treated with puncture and pericardial window. The diagnosis of TP was confirmed by the pericardial biopsy and treated with antituberculous drugs with adequate improvement. Conclusions: the TP is chronic symptomatology that could lead to an acute phase, of high mortality, as it is the cardiac tamponade. The elevated clinical suspicion, the images, the laboratory and the histopathology allow to confirm them and the opportune intervention reduces the morbidity and mortality. Rev.cienc.biomed. 2014;5(2:329-335. KEYWORDS Tuberculous pericarditis, Pericardial effusion, cardiac tamponade.

  13. 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.

  14. 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.

  15. Extracorporeal life support in pediatric cardiac dysfunction

    Directory of Open Access Journals (Sweden)

    Kececioglu Deniz

    2010-11-01

    Full Text Available Abstract Background Low cardiac output (LCO after corrective surgery remains a serious complication in pediatric congenital heart diseases (CHD. In the case of refractory LCO, extra corporeal life support (ECLS extra corporeal membrane oxygenation (ECMO or ventricle assist devices (VAD is the final therapeutic option. In the present study we have reviewed the outcomes of pediatric patients after corrective surgery necessitating ECLS and compared outcomes with pediatric patients necessitating ECLS because of dilatated cardiomyopathy (DCM. Methods A retrospective single-centre cohort study was evaluated in pediatric patients, between 1991 and 2008, that required ECLS. A total of 48 patients received ECLS, of which 23 were male and 25 female. The indications for ECLS included CHD in 32 patients and DCM in 16 patients. Results The mean age was 1.2 ± 3.9 years for CHD patients and 10.4 ± 5.8 years for DCM patients. Twenty-six patients received ECMO and 22 patients received VAD. A total of 15 patients out of 48 survived, 8 were discharged after myocardial recovery and 7 were discharged after successful heart transplantation. The overall mortality in patients with extracorporeal life support was 68%. Conclusion Although the use of ECLS shows a significantly high mortality rate it remains the ultimate chance for children. For better results, ECLS should be initiated in the operating room or shortly thereafter. Bridge to heart transplantation should be considered if there is no improvement in cardiac function to avoid irreversible multiorgan failure (MFO.

  16. Does Intraoperative Ulinastatin Improve Postoperative Clinical Outcomes in Patients Undergoing Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

    OpenAIRE

    Qiu-Lan He; Fei Zhong; Fang Ye; Ming Wei; Wei-Feng Liu; Mei-Na Li; Qiao-Bo Li; Wen-Qi Huang; Lai-Bao Sun; Hai-Hua Shu

    2014-01-01

    Introduction. The systematic meta-analysis of randomized controlled trials (RCTs) evaluated the effects of intraoperative ulinastatin on early-postoperative recovery in patients undergoing cardiac surgery. Methods. RCTs comparing intraoperative ulinastatin with placebo in cardiac surgery were searched through PubMed, Cochrane databases, Medline, SinoMed, and the China National Knowledge Infrastructure (1966 to May 20th, 2013). The primary endpoints included hospital mortality, postoperative c...

  17. Multithreaded cardiac CT

    International Nuclear Information System (INIS)

    Phase-correlated CT, as it is used for cardiac imaging, is the most popular and the most important but also the most demanding special CT application in the clinical routine, today. Basically, it fulfills the four-dimensional imaging task of depicting a quasiperiodically moving object at any desired motion phase with significantly reduced motion artifacts. Although image quality with phase-correlated reconstruction is far better than with standard reconstruction, there are motion artifacts remaining and improvements of temporal resolution are required. As a well-known alternative to simply decreasing rotation time, we consider a spiral cone-beam CT scanner that has G x-ray guns and detectors mounted. We call this a multisource or a multithreaded CT scanner. Aiming for improved temporal resolution the relative temporal resolution ?, which measures the fraction of a motion period that enters the image, is studied as a function of the motion rate (heart rate) and the degree of scan overlap (pitch value) for various configurations. The parameters to optimize are the number of threads G and the interthread parameters ?? and ?z, which are the angular and the longitudinal separation between adjacent threads, respectively. To demonstrate the improvements approximate image reconstruction of multithreaded raw data is performed by using a generalization of the extended parallel back projection cone-beam reconstruction algorithm [Med. Phys. 31(6), 1623-1641 (2004)] to the cass. 31(6), 1623-1641 (2004)] to the case of multithreaded CT. Reconstructions of a simulated cardiac motion phantom and of simulated semi-antropomorphic phantoms are presented for two and three threads and compared to the single-threaded case to demonstrate the potential of multithreaded cardiac CT. Patient data were acquired using a clinical double-threaded CT scanner to validate the theoretical results. The optimum angle ?? between the tubes is 90 deg.for a double-threaded system, and for triple-threaded scanners it is 60 deg.or 120 deg.. In all cases, ?z=0 results as an optimum, which means that the threads should be mounted in the same transversal plane. However, the dependency of the temporal resolution on ?z is very weak and a longitudinal separation ?z?0 would not deteriorate image quality. The mean temporal resolution achievable with an optimized multithreaded CT scanner is a factor of G better than the mean temporal resolution obtained with a single-threaded scanner. The standard reconstructions showed decreased cone-beam artifacts with multithreaded CT compared to the single-threaded case. Our phase-correlated reconstructions demonstrate that temporal resolution is significantly improved with multithreaded CT. The clinical patient data confirm our results

  18. Trends in Cardiac Pacemaker Batteries