WorldWideScience
1

Reality of out of hospital cardiac arrest  

OpenAIRE

The high mortality rates associated with out of hospital cardiac arrest, particularly those occurring in the home, stress the need for early treatment in the form of publicly accessible external defibrillators

O’rourke, M. F.

2005-01-01

2

Out-of-hospital cardiac arrests in children  

OpenAIRE

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 outc...

Kamarainen Antti

2010-01-01

3

Out of hospital cardiac arrest and associated injury.  

OpenAIRE

Three patients are described who sustained injuries around the time of a collapse that led to out of hospital cardiac arrest. In this group of patients the importance of taking a complete medical history and recording the circumstances of the syncopal episode cannot be overemphasised. If cardiac output is successfully restored the possibility of occult traumatic injury must be considered in high risk patients.

Jones, A. I.; Stuart, M. J.; Gray, A. J.

1998-01-01

4

Out-of-hospital cardiac arrests in children  

Directory of Open Access Journals (Sweden)

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.

Kamarainen Antti

2010-01-01

5

Circadian variation in witnessed out of hospital cardiac arrest  

OpenAIRE

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...

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

2000-01-01

6

Out-of-hospital therapeutic hypothermia in cardiac arrest victims  

Directory of Open Access Journals (Sweden)

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

Holzer Michael

2009-10-01

7

Horses and Zebras: complex cardiac anatomy in a patient with out-of-hospital cardiac arrest  

OpenAIRE

This case report describes a woman presenting after out-of-hospital cardiac arrest with several cardiac anomalies, including a form fruste of Ebstein’s anomaly complicated by a large tricuspid valve vegetation. On autopsy, she proved to have unstable plaques in epicardial vessels that likely caused arrhythmic sudden cardiac death, a reminder that even in the presence of rare anomalies, common things are common.

Brown, Samuel M.; Miller, Dylan V.; Vezina, Daniel; Dean, Nathan C.; Grissom, Colin K.

2011-01-01

8

Electronic registration of out-of-hospital cardiac arrests  

DEFF Research Database (Denmark)

Introduction: The reported incidences of out-of-hospital cardiac arrests (OHCA) in western countries vary considerably. According to the latest report from Danish Cardiac Arrest Database (DCAD) the incidence rate in Denmark in 2004 was 51/100,000/year. The report states however that this number is uncertain. As the first region in the country, North Denmark Region has introduced a prehospital electronic healthcare record (designated amPHI™) in all of its 50 emergency ambulances. We used data from amPHI™ to examine the incidence of OHCA in the region.   Methods: We extracted patient data from the amPHI™ database from 1st May to 31st December 2006. We then identified the patients who met the criteria for OHCA set by the DCAD: “Situations to which an ambulance is called, and where either the ambulance-staff or others have performed chest compressions or given electrical defibrillation”. We stratified those patients according to whether they received first aid, the identity of the first aid provider and the initial cardiac rhythm as diagnosed by the patient monitor.   Results: 18,666 patients where in contact with an emergency ambulance in the study period. Of those 296 (89/100,000/year) met the definition of cardiac arrest. 83 of those (28 %) received first aid. The first aid was provided by layman (68 %), physicians (11 %), nurses (11 %) and first-aiders (4 %). In 6 % the identity of the first aid provider was unknown. The majority of the patients (n = 177 (58 %)) had asystole upon ambulance arrival. 37 (12 %) had ventricular fibrillation, 32 (10 %) had other arrhythmias, 21 (7 %) had sinus rhythm and a single patient (0.3 %) had ventricular tachycardia.   Conclusions: We have shown amPHI™ to be a valuable tool for accessing information about OHCA. By a stringent electronic registration we found a considerably higher incidence rate for OHCA, than documented by the analogue nationwide registry. Further we discovered a high rate of first aid to OHCA-patients. Finally our data showed a high occurence of asystolia in patients who met the official criteria for OHCA.

Nielsen, Niels Dalsgaard; Dahl, Michael

2007-01-01

9

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

DEFF Research Database (Denmark)

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.

Weeke, Peter; Folke, Fredrik

2010-01-01

10

Hospital admissions and pharmacotherapy before out-of-hospital cardiac arrest according to age  

DEFF Research Database (Denmark)

BACKGROUND: The underlying etiology of sudden cardiac death varies with age and is likely to be reflected in type and number of healthcare contacts. We aimed to determine the specific type of healthcare contact shortly before out-of-hospital cardiac arrest (OHCA) across ages. METHODS: OHCA patients were identified in the nationwide Danish Cardiac Arrest Register and Copenhagen Medical Emergency Care Unit (2001-2006). We matched every OHCA patients with 10 controls on sex and age. Healthcare contacts were evaluated 30 days before event by individual-level-linkage of nationwide registers. RESULTS: We identified 16,924 OHCA patients, median age 70.0 years (Q1-Q3: 59-80). OHCA patients had a higher number of hospitalizations and received more pharmacotherapy compared to the control population across all ages (p for difference 89) were

Weeke, Peter; Folke, Fredrik

2012-01-01

11

Therapeutic hypothermia post out-of-hospital cardiac arrest - more questions than answers?  

OpenAIRE

Nearly a decade since the introduction of therapeutic hypothermia to the ICU for cooling out-of-hospital cardiac arrest patients, key questions remain unanswered: when should cooling be initiated, how rapidly should the patient be cooled and using which device? The Time to Target Temperature study group provides important baseline data on the striking direct relationship between body temperature and survival from out-of-hospital cardiac arrest.

Lyon, Richard

2011-01-01

12

Out-of-hospital therapeutic hypothermia in cardiac arrest victims  

OpenAIRE

Abstract Despite many years of research, outcome after cardiac arrest is dismal. Since 2005, the European Resuscitation Council recommends in its guidelines the use of mild therapeutic hypothermia (32-34°) for 12 to 24 hours in patients successfully resuscitated from cardiac arrest. The benefit of resuscitative mild hypothermia (induced after resuscitation) is well established, while the benefit of preservative mild to moderate hypothermia (induced during cardiac arrest) needs furt...

Holzer Michael; Arrich Jasmin; Behringer Wilhelm; Sterz Fritz

2009-01-01

13

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

OpenAIRE

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...

Bohm, Katarina

2009-01-01

14

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

OpenAIRE

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 c...

Sunde Geir A; Brattebø Guttorm; Ødegården Terje; Kjernlie Dag F; Rødne Emma; Heltne Jon-Kenneth

2012-01-01

15

Successful resuscitation of out of hospital cardiac arrest patients in the emergency department  

OpenAIRE

Background. We examined factors associated with the successful resuscitation, in the emergency department (ED), of adult, out-of-hospital cardiac arrest (OHCA) patients.Methods. The study cohort consisted of adult patients (over 18 years of age) who presented to the ED in 2009 with a diagnosis of cardiac arrest. Data were retrieved from the institutional database. Results. A total of 122 adult, non-traumatic, OHCA patients were enrolled in the study. There were no significant differences betw...

Shou-Yen Chen; Shih-Hao Wang; Yi-Ming Weng; Yu-Che Chang; Yu-Jr Lin; Ko-Chen Chang; Jiun-Hao Yu

2011-01-01

16

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

OpenAIRE

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 speci...

Busch Michael; Søreide Eldar

2008-01-01

17

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

OpenAIRE

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 t...

Ewy Gordon A

2012-01-01

18

Effectiveness of ambulance paramedics versus ambulance technicians in managing out of hospital cardiac arrest.  

OpenAIRE

OBJECTIVE: To determine the effectiveness of extended trained ambulance personnel (paramedics) for the management of out of hospital cardiac arrest. METHODS: A retrospective cohort study of patients who suffered a cardiac arrest between 1 January 1992 and 31 July 1994, and who were transported to their local accident and emergency (A&E) department. Data were collected on basic demography, operational time intervals, and ambulance crew status. Further clinical data were collected, and outcome ...

Nguyen-van-tam, J. S.; Dove, A. F.; Bradley, M. P.; Pearson, J. C.; Durston, P.; Madeley, R. J.

1997-01-01

19

Circumstances and causes of out-of-hospital cardiac arrest in sudden death survivors  

OpenAIRE

Objective—To study the circumstances and medical profile of out-of-hospital sudden cardiac arrest (SCA) patients in whom resuscitation was attempted by the ambulance service, and to identify causes of SCA in survivors and factors that influence resuscitation success rate.?Methods—During a five year period (1991-95) all cases of out-of-hospital SCA between the ages of 20 and 75 years and living in the Maastricht area in the Netherlands were studied. Information was gathered about the c...

Vreede-swagema, J. J. M.; Gorgels, A.; Dubois-arbouw, W.; Dalstra, J.; Daemen, M.; Ree, J. W.; Stijns, R.; Wellens, H.

1998-01-01

20

Unrecognized mediastinal tumor causing sudden tracheal obstruction and out-of-hospital cardiac arrest.  

Science.gov (United States)

We report a case of a 13-year-old boy with a presumed neck cyst who developed sudden tracheal obstruction and out-of-hospital cardiac arrest. Cardiorespiratory collapse occurred due to an improperly diagnosed mediastinal tumor. This report serves to alert Emergency Physicians and emergency medical services personnel of the rare and rapidly progressive nature of respiratory compromise caused by a mediastinal tumor, which may have lethal consequences if not recognized and treated promptly. PMID:18439784

Suominen, Pertti K; Kanerva, Jukka A; Saliba, Kenneth J; Taivainen, Tomi R

2010-06-01

21

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

OpenAIRE

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...

Ringh, Mattias

2014-01-01

22

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

OpenAIRE

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

Busch, Michael

2012-01-01

23

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

OpenAIRE

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-...

Lyon Richard M; Nelson Magnus J

2013-01-01

24

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

OpenAIRE

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 r...

Ogawa Toshio; Akahane Manabu; Tanabe Seizan; Horiguchi Hiromasa; Miyata Hiroaki; Yasunaga Hideo; Koike Soichi; Imamura Tomoaki

2011-01-01

25

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

LENUS (Irish Health Repository)

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.

Egly, Joshua

2012-02-01

26

General practitioner contribution to out-of-hospital cardiac arrest outcome: A national registry study.  

Science.gov (United States)

Background: There is a wide variation in reported survival from out-of-hospital cardiac arrest (OHCA). One factor in this variation may be the contribution of general practitioners to pre-hospital resuscitation. Studies using self-reported data describe increased survival proportions when general practitioners are involved. Objectives: This study aims to investigate the contribution of general practitioner involvement in out-of-hospital cardiac arrest events. Design and Setting: A retrospective observational study using data collected from ambulance records in the Republic of Ireland to describe general practitioner (GP) contribution to pre-hospital resuscitation attempts (n = 2369). Analysis is limited to patients with presumed cardiac cause and first arrest rhythm recorded as shockable (n = 510). Results: When a GP is present at scene (n = 199) patients are less likely to achieve return of spontaneous circulation (ROSC) (P < 0.001) or be transported to hospital (P < 0.001). When GPs participate in resuscitation (n = 92), patients are more likely to have collapsed in a public place (P < 0.01), receive bystander CPR (P < 0.001) and survive to hospital discharge (P < 0.001). Multiple logistic analysis of survival suggests that GP participation in resuscitation increases the odds of survival (4.6; 95% CI 1.6-13.3) and having collapsed in a public place increases chances of survival (5.8; 95% CI 2.1-15.7). Conclusion: Our analysis suggests that in this subgroup, GP participation in OHCA resuscitation attempts is associated with improved patient survival. Furthermore, resuscitation is more likely to be ceased at scene when a GP is present, highlighting the role that GPs play in the compassionate management of death in unviable circumstances. PMID:25387228

Masterson, Siobhán; Vellinga, Akke; Wright, Peter; Dowling, John; Bury, Gerard; Murphy, Andrew W

2014-11-11

27

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

Science.gov (United States)

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

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

2010-06-01

28

Effectiveness of Public Access Defibrillation with AEDs for Out-of-Hospital Cardiac Arrests in Japan.  

Science.gov (United States)

In Japan, about 60,000 out-of-hospital cardiac arrests of cardiac etiology occur annually. Early initiation of cardiopulmonary resuscitation (CPR) and early defibrillation with public access automated external defibrillators (AEDs) by bystanders is the key to increasing survival after an out-of-hospital cardiac arrest (OHCA). Japanese data shows that nationwide dissemination of public access AEDs actually increases the rate of survival with a good neurological outcome after OHCA. Recently, the number of public access AEDs has been increasing rapidly, but implementation of AED use and CPR by public bystanders has not been sufficiently frequent, despite having become more common than before. To improve the rate of OHCA survival with a good neurological outcome by making effective use of AEDs, there need to be further spread of AEDs with specific installation criteria as well as infrastructure development for promoting AED use. In addition, educational activities and practical programs should be introduced in the community setting. Recently, many reports, including by the Utstein Osaka Project, have showed that chest compression-only CPR is as effective as conventional CPR with rescue breathing. To save more lives, we should encourage the widespread practice of CPR by widely diffusing AEDs and simplified chest compression-only CPR training. PMID:25237222

Iwami, Taku

2012-05-01

29

Temporal variation of out-of-hospital cardiac arrests in an equatorial climate  

Directory of Open Access Journals (Sweden)

Full Text Available Marcus EH Ong1, Faith SP Ng2, Susan Yap1, Kok Leong Yong1, Mary A Peberdy3, Joseph P Ornato41Department of Emergency Medicine, Singapore General Hospital, Singapore; 2Clinical Trials and Epidemiology Research Unit (now known as Singapore Clinical Research Institute, Singapore; 3Division of Cardiology, Virginia Commonwealth University – Medical College of Virginia, Richmond, VA, USA; 4Department of Emergency Medicine, Virginia Commonwealth University – Medical College of Virginia, Richmond, VA, USAObjective: We aimed to determine whether there is a seasonal variation of out-of-hospital cardiac arrests (OHCA in an equatorial climate, which does not experience seasonal environmental change.Methods: We conducted an observational prospective study looking at the occurrence of OHCA in Singapore. Included were all patients with OHCA presented to Emergency Departments across the country. We examined the monthly, daily, and hourly number of cases over a threeyear period. Data was analyzed using analysis of variance (ANOVA.Results: From October, 1st 2001 to October, 14th 2004, 2428 patients were enrolled in the study. Mean age for cardiac arrests was 60.6 years with 68.0% male. Ethnic distribution was 69.5% Chinese, 15.0% Malay, 11.0% Indian, and 4.4% Others. There was no significant seasonal variation (spring/summer/fall/winter of events (ANOVA P = 0.71, monthly variation (P = 0.88 or yearly variation (P = 0.26. We did find weekly peaks on Mondays and a circadian pattern with daily peaks from 9–10 am.Conclusions: We did not find any discernable seasonal pattern of cardiac arrests. This contrasts with findings from temperate countries and suggests a climatic influence on cardiac arrest occurrence. We also found that sudden cardiac arrests follow a circadian pattern.Keywords: cardiopulmonary resuscitation, cardiac arrest, seasonal pattern, circadian pattern

Marcus EH Ong

2010-04-01

30

Prehospital Lactated Ringer's Solution Treatment and Survival in Out-of-Hospital Cardiac Arrest: A Prospective Cohort Analysis  

OpenAIRE

In a cohort of more than 500,000 individuals who experienced out-of-hospital cardiac arrest in Japan, Akihito Hagihara and colleagues studied whether administration of lactated Ringer's solution was associated with survival and functional outcomes.

Hagihara, Akihito; Hasegawa, Manabu; Abe, Takeru; Wakata, Yoshifumi; Nagata, Takashi; Nabeshima, Yoshihiro

2013-01-01

31

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

LENUS (Irish Health Repository)

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.

Masterson, Siobhán

2011-05-01

32

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

OpenAIRE

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...

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

2009-01-01

33

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

OpenAIRE

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 et...

Hayashi, Hoei; Ujike, Yoshihito

2005-01-01

34

Mechanical CPR devices compared to manual CPR during out-of-hospital cardiac arrest and ambulance transport: a systematic review  

OpenAIRE

Abstract Aims The aim of this paper was to conduct a systematic review of the published literature to address the question: “In pre-hospital adult cardiac arrest (asystole, pulseless electrical activity, pulseless Ventricular Tachycardia and Ventricular Fibrillation), does the use of mechanical Cardio-Pulmonary Resuscitation (CPR) devices compared to manual CPR during Out-of-Hospital Cardiac Arrest and ambulance transport, improve outcomes (e.g. Quality of CPR, Return Of Sp...

Ong Marcus; Mackey Kevin E; Zhang Zhong; Tanaka Hideharu; Ma Matthew; Swor Robert; Shin Sang

2012-01-01

35

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

Directory of Open Access Journals (Sweden)

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.

Sunde Geir A

2012-12-01

36

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

DEFF Research Database (Denmark)

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

Steinmetz, Jacob; Barnung, S.

2008-01-01

37

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

DEFF Research Database (Denmark)

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.

Weeke, Peter; Jensen, Aksel

2014-01-01

38

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

Directory of Open Access Journals (Sweden)

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

Lyon Richard M

2013-01-01

39

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)

40

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

OpenAIRE

Introduction: Cardiovascular disease remains the most common cause of death in the United States and most other Western nations. Among these deaths, sudden, out-of-hospital cardiac arrest claims approximately 1000 lives each day in the United States alone. Most of these cardiac arrests are due to ventricular fibrillation. Though highly reversible with the rapid application of a defibrillator, ventricular fibrillation is otherwise fatal within minutes, even when cardiopulmonary resuscitation i...

Paolo Terranova; Paolo Valli; Barbara Severgnini; Simonetta Dell'Orto; Enrico Maria Greco

2006-01-01

41

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

OpenAIRE

Abstract Background Current 2005 guidelines for advanced cardiac life support strongly recommend immediate defibrillation for out-of-hospital cardiac arrest. However, findings from experimental and clinical studies have indicated a potential advantage of pretreatment with chest compression-only cardiopulmonary resuscitation (CPR) prior to defibrillation in improving outcomes. The aim of this meta-analysis is to evaluate the beneficial effect of chest compression-first versus ...

Meier Pascal; Baker Paul; Jost Daniel; Jacobs Ian; Henzi Bettina; Knapp Guido; Sasson Comilla

2010-01-01

42

Out-of-hospital cardiac arrest: two and a half years experience of an accident and emergency department in Hong Kong.  

OpenAIRE

The results are presented of 2 1/2 years of experience of patients with out-of-hospital cardiac arrests who were resuscitated in an accident and emergency department (A&E) attached to an acute district hospital in Hong Kong. Out of 263 cases of out-of-hospital cardiac arrest as a result of a variety of causes only seven patients survived (3%) and among the 135 patients with cardiac aetiology only four survived (3%). Ways to improve the outcome for out-of-hospital cardiac arrest are discussed.

Wong, T. W.; Yeung, K. C.

1995-01-01

43

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

DEFF Research Database (Denmark)

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.

Chisholm, Gro E; Grejs, Anders

2014-01-01

44

Differences between out-of-hospital cardiac arrest in residential and public locations and implications for public-access defibrillation  

DEFF Research Database (Denmark)

The majority of out-of-hospital cardiac arrests (OHCAs) occur in residential locations, but knowledge about strategic placement of automated external defibrillators in residential areas is lacking. We examined whether residential OHCA areas suitable for placement of automated external defibrillators could be identified on the basis of demographic characteristics and characterized individuals with OHCA in residential locations.

Folke, Fredrik; Gislason, Gunnar H

2010-01-01

45

Surviving out-of-hospital cardiac arrest: just a matter of defibrillators?  

Science.gov (United States)

Out-of-hospital sudden cardiac arrest (OHCA) is a leading cause of death all over the world. Although the outcome of OHCA resulting from 'nonshockable' rhythms (asystole and pulseless electrical activity) is poor regardless of resuscitation efforts, 'shockable' rhythms such as ventricular tachycardia or fibrillation may carry a good prognosis if early defibrillation is performed. At present, simplified cardiopulmonary resuscitation techniques (hands-only cardiopulmonary resuscitation) and automated external defibrillators (AEDs) offer lay people the possibility to provide lifesaving treatment to OHCA victims in the critical minutes before the arrival of the emergency medical system. Programs aimed at increasing provision of cardiopulmonary resuscitation and use of AEDs by lay people have been set up in different countries, including Italy, and have contributed to improve survival rates. However, success of these programs critically depends on appropriate planning and design, and on cultural predisposition of witnesses to undertake immediate measures of resuscitation in the case of OHCA. Placement of a large number of AEDs may carry high costs and little benefits if it is uncoordinated and not preceded by educational campaigns to spread widely the 'culture of resuscitation' in the population. PMID:24950347

Zorzi, Alessandro; Gasparetto, Nicola; Stella, Federica; Bortoluzzi, Andrea; Cacciavillani, Luisa; Basso, Cristina

2014-08-01

46

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

DEFF Research Database (Denmark)

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.

Rajan, Shahzleen; Wissenberg, Mads

2014-01-01

47

Regional variation and outcome of out-of-hospital cardiac arrest (ohca) in Finland – the Finnresusci study  

OpenAIRE

Abstract Background Despite the efforts of the modern Emergency Medical Service Systems (EMS), survival rates for sudden out-of-hospital cardiac arrest (OHCA) have been poor as approximately 10% of OHCA patients survive hospital discharge. Many aspects of OHCA have been studied, but few previous reports on OHCA have documented the variation between different sizes of study areas on a regional scale. The aim of this study was to report the incidence, outcomes and regional vari...

Hiltunen Pamela; Kuisma Markku; Silfvast Tom; Rutanen Juha; Vaahersalo Jukka; Kurola Jouni

2012-01-01

48

Long term outcome after out-of-hospital cardiac arrest with physician staffed emergency medical services: the Utstein style applied to a midsized urban/suburban area  

OpenAIRE

OBJECTIVE—To test the effect of a physician staffed advanced cardiac life support (ALS) system on patient outcome following out-of-hospital cardiac arrest.?DESIGN—Observational study.?SETTING—Two tier basic life support (BLS) and physician staffed ALS services in the midsized urban/suburban area of Heidelberg, Germany.?PATIENTS—All patients suffering out-of-hospital cardiac arrest of cardiac aetiology between January 1992 and December 1994 and who were covered by ALS services....

Bottiger, B.; Grabner, C.; Bauer, H.; Bode, C.; Weber, T.; Motsch, J.; Martin, E.

1999-01-01

49

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

Directory of Open Access Journals (Sweden)

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.

Ewy Gordon A

2012-09-01

50

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

Science.gov (United States)

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

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

2014-10-01

51

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

Directory of Open Access Journals (Sweden)

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.

Ogawa Toshio

2011-04-01

52

Survival to admission after out-of-hospital cardiac arrest in Seoul, South Korea  

Directory of Open Access Journals (Sweden)

Full Text Available Jin-Hue Kim,1 Tai-Hwan Uhm2 1Department of Emergency Medical Technology, Sun Moon University, Asan-si, Chungnam, South Korea; 2Department of Emergency Medical Services, Eulji University, Seongnam-si, Gyeonggi-do, South Korea Purpose: Out-of-hospital cardiac arrest (OHCA data derived according to the Utstein Style guidelines was used to try to determine factors influencing survival to admission (STA and epidemiological rates of OHCA. Patients and methods: This was an observational study of all age groups based on data from prehospital care reports in Seoul, South Korea. The collected data were reported according to the Utstein Style template for OHCA and analyzed in order to compare STA with non-STA. Univariate analysis was conducted using a binomial logistic regression model to identify predictors associated with trauma patients. Results: Eighty-three (4.8% OHCA survivors were admitted to the emergency department with carotid pulse. The median time from arrest to emergency medical personnel defibrillation was statistically significantly shorter in STA cases (8.0 minutes than in non-STA cases (12.0 minutes; P<0.001. Factors independently associated with better prognosis in terms of trauma patients were female sex (odds ratio [OR]: 0.67; 95% confidence interval [95% CI]: 0.50–0.91; P=0.01, arrest at home (OR: 0.36; 95% CI: 0.27–0.49; P<0.001, and witnessed arrest (OR: 2.64; 95% CI: 1.94–3.39; P<0.001. Conclusion: Early basic life support, performed by either a layperson or emergency medical personnel, had a positive effect on STA. Male sex, arrest outside of the home, and witnessed arrest are significantly associated with trauma. Keywords: Utstein Style, prehospital, defibrillation, basic life support

Kim JH

2014-09-01

53

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

OpenAIRE

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 Cardia...

Rosenqvist Mårten; Hollenberg Jacob; Herlitz Johan; Ringh Mattias; Svensson Leif

2009-01-01

54

Resuscitation from out-of-hospital cardiac arrest: is survival dependent on who is available at the scene?  

OpenAIRE

Objective—To determine whether survival from out-of-hospital cardiac arrest is influenced by the on-scene availability of different grades of ambulance personnel and other health professionals.?Design—Population based, retrospective, observational study.?Setting—County of Nottinghamshire with a population of one million.?Subjects—All 2094 patients who had resuscitation attempted by Nottinghamshire Ambulance Service crew from 1991 to 1994; study of 1547 patients whose arrest w...

Soo, L.; Gray, D.; Young, T.; Huff, N.; Skene, A.; Hampton, J.

1999-01-01

55

Mechanical CPR devices compared to manual CPR during out-of-hospital cardiac arrest and ambulance transport: a systematic review  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Aims The aim of this paper was to conduct a systematic review of the published literature to address the question: “In pre-hospital adult cardiac arrest (asystole, pulseless electrical activity, pulseless Ventricular Tachycardia and Ventricular Fibrillation, does the use of mechanical Cardio-Pulmonary Resuscitation (CPR devices compared to manual CPR during Out-of-Hospital Cardiac Arrest and ambulance transport, improve outcomes (e.g. Quality of CPR, Return Of Spontaneous Circulation, Survival”. Methods Databases including PubMed, Cochrane Library (including Cochrane database for systematic reviews and Cochrane Central Register of Controlled Trials, Embase, and AHA EndNote Master Library were systematically searched. Further references were gathered from cross-references from articles and reviews as well as forward search using SCOPUS and Google scholar. The inclusion criteria for this review included manikin and human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review. Excluded were review articles, case series and case reports. Results Out of 88 articles identified, only 10 studies met the inclusion criteria for further review. Of these 10 articles, 1 was Level of Evidence (LOE 1, 4 LOE 2, 3 LOE 3, 0 LOE 4, 2 LOE 5. 4 studies evaluated the quality of CPR in terms of compression adequacy while the remaining six studies evaluated on clinical outcomes in terms of return of spontaneous circulation (ROSC, survival to hospital admission, survival to discharge and Cerebral Performance Categories (CPC. 7 studies were supporting the clinical question, 1 neutral and 2 opposing. Conclusion In this review, we found insufficient evidence to support or refute the use of mechanical CPR devices in settings of out-of-hospital cardiac arrest and during ambulance transport. While there is some low quality evidence suggesting that mechanical CPR can improve consistency and reduce interruptions in chest compressions, there is no evidence that mechanical CPR devices improve survival, to the contrary they may worsen neurological outcome.

Ong Marcus

2012-06-01

56

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

Directory of Open Access Journals (Sweden)

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

Paolo Terranova

2006-10-01

57

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

Directory of Open Access Journals (Sweden)

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

Meier Pascal

2010-09-01

58

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

Directory of Open Access Journals (Sweden)

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

Edouard Matevossian

2009-04-01

59

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

OpenAIRE

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 advan...

Søreide Eldar; Busch Michael

2010-01-01

60

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

OpenAIRE

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 en...

Jean-Philippe Didon; Vessela Krasteva; Guy Fontaine; Irena Jekova; Manuel Contini; Johann-Jakob Schmid

2008-01-01

61

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)

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.

Krarup, Niels Henrik; Terkelsen, Christian Juhl

2011-01-01

62

Epidemiology and Outcomes in Out-of-hospital Cardiac Arrest: A Report from the NEDIS-Based Cardiac Arrest Registry in Korea.  

Science.gov (United States)

Sudden cardiac death (SCD) is a significant issue affecting national health policies. The National Emergency Department Information System for Cardiac Arrest (NEDIS-CA) consortium managed a prospective registry of out-of-hospital cardiac arrest (OHCA) at the emergency department (ED) level. We analyzed the NEDIS-CA data from 29 participating hospitals from January 2008 to July 2009. The primary outcomes were incidence of OHCA and final survival outcomes at discharge. Factors influencing survival outcomes were assessed as secondary outcomes. The implementation of advanced emergency management (drugs, endotracheal intubation) and post-cardiac arrest care (therapeutic hypothermia, coronary intervention) was also investigated. A total of 4,156 resuscitation-attempted OHCAs were included, of which 401 (9.6%) patients survived to discharge and 79 (1.9%) were discharged with good neurologic outcomes. During the study period, there were 1,662,470 ED visits in participant hospitals; therefore, the estimated number of resuscitation-attempted CAs was 1 per 400 ED visits (0.25%). Factors improving survival outcomes included younger age, witnessed collapse, onset in a public place, a shockable rhythm in the pre-hospital setting, and applied advanced resuscitation care. We found that active advanced multidisciplinary resuscitation efforts influenced improvement in the survival rate. Resuscitation by public witnesses improved the short-term outcomes (return of spontaneous circulation, survival admission) but did not increase the survival to discharge rate. Strategies are required to reinforce the chain of survival and high-quality cardiopulmonary resuscitation in Korea. PMID:25552889

Yang, Hyuk Jun; Kim, Gi Woon; Kim, Hyun; Cho, Jin Seong; Rho, Tai Ho; Yoon, Han Deok; Lee, Mi Jin

2015-01-01

63

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)

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.

Trygve Eftestøl

2005-10-01

64

Regional variation and outcome of out-of-hospital cardiac arrest (ohca in Finland – the Finnresusci study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Despite the efforts of the modern Emergency Medical Service Systems (EMS, survival rates for sudden out-of-hospital cardiac arrest (OHCA have been poor as approximately 10% of OHCA patients survive hospital discharge. Many aspects of OHCA have been studied, but few previous reports on OHCA have documented the variation between different sizes of study areas on a regional scale. The aim of this study was to report the incidence, outcomes and regional variation of OHCA in the Finnish population. Methods From March 1st to August 31st, 2010, data on all OHCA patients in the southern, central and eastern parts of Finland was collected. Data collection was initiated via dispatch centres whenever there was a suspected OHCA case or if a patient developed OHCA before arriving at the hospital. The study area includes 49% of the Finnish population; they are served by eight dispatch centres, two university hospitals and six central hospitals. Results The study period included 1042 cases of OHCA. Resuscitation was attempted on 671 patients (64.4%, an incidence of 51/100,000 inhabitants/year. The initial rhythm was shockable for 211 patients (31.4%. The survival rate at one-year post-OHCA was 13.4%. Of the witnessed OHCA events with a shockable rhythm of presumed cardiac origin (n=140, 64 patients (45.7% were alive at hospital discharge and 47 (33.6% were still living one year hence. Surviving until hospital admission was more likely if the OHCA occurred in an urban municipality (41.5%, p=0.001. Conclusions The results of this comprehensive regional study of OHCA in Finland seem comparable to those previously reported in other countries. The survival of witnessed OHCA events with shockable initial rhythms has improved in urban Finland in recent decades.

Hiltunen Pamela

2012-12-01

65

Neurologic Recovery Following Prolonged Out-of-Hospital Cardiac Arrest With Resuscitation Guided by Continuous Capnography  

OpenAIRE

A 54-year-old man with no known cardiac disease collapsed outdoors in a small rural community. The cardiac arrest was witnessed, and immediate cardiopulmonary resuscitation was begun by a bystander and a trained first responder who was nearby. The patient was moved into a building across the street for continued resuscitation. First responders arrived with an automated external defibrillator, and ventricular fibrillation was documented. First responders delivered 6 defibrillation shocks, 4 of...

White, Roger D.; Goodman, Bruce W.; Svoboda, Mary A.

2011-01-01

66

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

Directory of Open Access Journals (Sweden)

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.

Jean-Philippe Didon

2008-10-01

67

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

DEFF Research Database (Denmark)

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

Weeke, P; Jensen, Aksel Karl Georg

2012-01-01

68

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

Directory of Open Access Journals (Sweden)

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.

Hayashi,Hoei

2005-04-01

69

Potential Utility of Near Infrared Spectroscopy in out-of-hospital cardiac arrest: An Illustrative Case Series  

Science.gov (United States)

Aims We evaluated the measurement of tissue oxygen content (StO2) by continuous Near Infrared Spectroscopy (NIRS) during and following CPR, and compared the changes in StO2 and end-tidal CO2 (ETCO2) as a measure of return of spontaneous circulation (ROSC) or re-arrest. Methods This is a case series of five patients who experienced out-of hospital cardiac arrest. Patients included those who had already experienced ROSC, were being transported to the hospital, or who were likely to have a reasonable amount of time remaining in the resuscitation efforts. Patients were continuously monitored from the scene using continuous ETCO2 monitoring, and a NIRS StO2 monitor until patients reached the hospital. ETCO2 and StO2 values were continuously recorded and analyzed for comparison of when patients were clinically identified to have ROSC or re-arrest. Results Four of five patients had StO2 and EtCO2 recorded during an episode of CPR and all were monitored during the post-arrest period. Three patients experienced re-arrest en route to the hospital. Downward trends were noted in StO2 prior to each re-arrest, and rapid increases were noted after ROSC. StO2 data showed less variance than ETCO2 in the peri-arrest period. Conclusions This preliminary study in humans demonstrates that StO2 dynamically changes during periods of hemodynamic instability in post-arrest patients. These data suggest that a decline in StO2 level may correlate with re-arrest and may be useful as a tool to predict re-arrest in post cardiac arrest patients. A rapid increase in StO2 was also seen upon ROSC and may be a better method of identifying ROSC during CPR than pauses for pulse checks or ETCO2 monitoring. PMID:22823984

Frisch, Adam; Suffoletto, Brian P.; Frank, Rachel; Martin-Gill, Christian; Menegazzi, James J.

2014-01-01

70

Out-of-Hospital Perimortem Cesarean Section as Resuscitative Hysterotomy in Maternal Posttraumatic Cardiac Arrest  

Science.gov (United States)

The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early “separation” between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC) in the mother. This treatment, called Perimortem Cesarean Section (PMCS), is now termed as Resuscitative Hysterotomy (RH) to better address the issue of an early Cesarean section (C-section). This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR) maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C) section of a foetus at 36 weeks of gestation after the mother's traumatic cardiac arrest. Despite the negative outcome of the mother, the choice of performing a RH seems to represent up to date the most appropriate intervention to improve the outcome in both mother and foetus. PMID:25530891

Gatti, Francesca; Zerbi, Simone Maria; Colombo, Dario; Landriscina, Mario; Kette, Fulvio

2014-01-01

71

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

Directory of Open Access Journals (Sweden)

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

ZALIKA KLEMENC-KETIS

2011-10-01

72

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)

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.

Rosenqvist Mårten

2009-04-01

73

Clinical profile, management, and outcome in patients with out of hospital cardiac arrest: insights from a 20-year registry  

Directory of Open Access Journals (Sweden)

Full Text Available Ashfaq Ahmad Patel, Abdul Rahman Arabi, Hakam Alzaeem, Jassim Al Suwaidi, Rajvir Singh, Hajar A Al BinaliDepartment of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, QatarBackground: There is limited information regarding the clinical characteristics and outcome of out of hospital cardiac arrest (OHCA in Middle Eastern patients. The aim of this study was to evaluate clinical characteristics, treatment, and outcomes in patients admitted following OHCA at a single center in the Middle East over a 20-year period.Methods: The data used for this hospital-based study were collected for patients hospitalized with OHCA in Doha, Qatar, between 1991 and 2010. Baseline clinical characteristics, in-hospital treatment, and outcomes were studied in comparison with the rest of the admissions.Results: A total of 41,453 consecutive patients were admitted during the study period, of whom 987 (2.4% had a diagnosis of OHCA. Their average age was 57±15 years, and 72.7% were males, 56.5% were Arabs, and 30.9% were South Asians. When compared with the rest of the admissions taken as a reference, patients with OHCA were more likely to have diabetes mellitus (42.8% versus 39.1%, respectively, P=0.02, prior myocardial infarction (21.8% versus 19.2%, P=0.04, and chronic renal failure (7.4% versus 3.9%, P=0.001, but were less likely to have dyslipidemia (16.9% versus 25.4%, P=0.001. Further, 52.6% of patients had preceding symptoms, the most common of which was chest pain (27.2% followed by dyspnea (24.8%. An initially shockable rhythm (ventricular fibrillation or ventricular tachycardia was present in 25.1% of OHCA patients, with ST segment elevation myocardial infarction documented in 30.0%. Severely reduced left ventricular systolic function (ejection fraction ?35% was present in 53.2% of OHCA patients; 42.9% had cardiogenic shock requiring use of inotropes at presentation. An intra-aortic balloon pump was inserted in 3.6% of cases. Antiarrhythmic medications were used in 27.4% and thrombolytic therapy in 13.9%, and 10.8% underwent a percutaneous coronary procedure (coronary angiography ± percutaneous coronary intervention. The in-hospital mortality rate was 59.8%.Conclusion: OHCA was associated with higher incidences of diabetes, prior myocardial infarction, and chronic kidney disease as compared with the remaining admissions. Approximately half of the patients had no preceding symptoms. In-hospital mortality was high (59.8%, but similar to the internationally published data.Keywords: out of hospital cardiac arrest, cardiogenic shock, in-hospital mortality

Patel AA

2014-07-01

74

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

DEFF Research Database (Denmark)

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.

Wissenberg, Mads; Hansen, Carolina Malta

2014-01-01

75

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

DEFF Research Database (Denmark)

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.

Wissenberg, Mads; Hansen, Carolina Malta

2014-01-01

76

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

Science.gov (United States)

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

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

2015-01-01

77

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

DEFF Research Database (Denmark)

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.

Soeholm, Helle; Kirkegaard, Hans

2012-01-01

78

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

DEFF Research Database (Denmark)

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

Folke, Fredrik

2010-01-01

79

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

Science.gov (United States)

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

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

2014-01-01

80

The Scene Time Interval and Basic Life Support Termination of Resuscitation Rule in Adult Out-of-Hospital Cardiac Arrest.  

Science.gov (United States)

We validated the basic life support termination of resuscitation (BLS TOR) rule retrospectively using Out-of-Hospital Cardiac Arrest (OHCA) data of metropolitan emergency medical service (EMS) in Korea. We also tested it by investigating the scene time interval for supplementing the BLS TOR rule. OHCA database of Seoul (January 2011 to December 2012) was used, which is composed of ambulance data and hospital medical record review. EMS-treated OHCA and 19 yr or older victims were enrolled, after excluding cases occurred in the ambulance and with incomplete information. The primary and secondary outcomes were hospital mortality and poor neurologic outcome. After calculating the sensitivity (SS), specificity (SP), and the positive and negative predictive values (PPV and NPV), tested the rule according to the scene time interval group for sensitivity analysis. Of total 4,835 analyzed patients, 3,361 (69.5%) cases met all 3 criteria of the BLS TOR rule. Of these, 3,224 (95.9%) were dead at discharge (SS,73.5%; SP,69.6%; PPV,95.9%; NPV, 21.3%) and 3,342 (99.4%) showed poor neurologic outcome at discharge (SS, 75.2%; SP, 89.9%; PPV, 99.4%; NPV, 11.5%). The cut-off scene time intervals for 100% SS and PPV were more than 20 min for survival to discharge and more than 14 min for good neurological recovery. The BLS TOR rule showed relatively lower SS and PPV in OHCA data in Seoul, Korea. PMID:25552890

Kim, Tae Han; Shin, Sang Do; Kim, Yu Jin; Kim, Chu Hyun; Kim, Jeong Eun

2015-01-01

81

Evolution of insulin sensitivity and its variability in out of hospital cardiac arrest (OHCA) patients treated with hypothermia.  

Science.gov (United States)

IntroductionTherapeutic hypothermia (TH) is often used to treat out of hospital cardiac arrest (OHCA) patients who also often simultaneously receive insulin for stress-induced hyperglycaemia. However, the impact of TH on systemic metabolism and insulin resistance in critical illness is unknown. This study analyses the impact of TH on metabolism, including the evolution of insulin sensitivity (SI) and its variability, in patients with coma after OHCA.MethodsThis study uses a clinically validated, model-based measure of SI. Insulin sensitivity was identified hourly using retrospective data from 200 post-cardiac arrest patients (8,522 hours) treated with TH, shortly after admission to the Intensive Care Unit (ICU). Blood glucose and body temperature readings were taken every one to two hours. Data were divided into three periods: 1) cool (T 37 °C). A maximum of 24 hours each for the cool and warm periods were considered. The impact of each condition on SI is analysed per cohort and per patient for both level and hour-to-hour variability, between periods and in 6-hour blocks.ResultsCohort and per patient median SI levels increase consistently by 35% to 70% and 26% to 59% (P <0.001) respectively from cool to warm. Conversely, cohort and per patient SI variability decreased by 11.1% to 33.6% (P <0.001) for the first 12 hours of treatment. However, SI variability increases between the 18th and 30th hours over the cool-warm transition, before continuing to decrease afterward.ConclusionsOCHA patients treated with TH have significantly lower and more variable SI during the cool period, compared to the later warm period. As treatment continues, SI level rises, and variability decreases consistently except for a large, significant increase during the cool-warm transition. These results demonstrate increased resistance to insulin during mild induced hypothermia. Our study might have important implications for glycaemic control during targeted temperature management. PMID:25349023

Sah Pri, Azurahisham; Chase, James G; Pretty, Christopher G; Shaw, Geoffrey M; Preiser, Jean-Charles; Vincent, Jean-Louis; Oddo, Mauro; Taccone, Fabio S; Penning, Sophie; Desaive, Thomas

2014-10-28

82

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

Science.gov (United States)

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. PMID:25493114

Tiah, Ling; Kajino, Kentaro; Alsakaf, Omer; Bautista, Dianne Carrol Tan; Ong, Marcus Eng Hock; Lie, Desiree; Naroo, Ghulam Yasin; Doctor, Nausheen Edwin; Chia, Michael YC; Gan, Han Nee

2014-01-01

83

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

DEFF Research Database (Denmark)

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

Moesgaard, Jacob; Ravkilde, Jan

2012-01-01

84

Specific Activity Types at the Time of Event and Outcomes of Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study  

OpenAIRE

This study aimed to describe the characteristics of out-of-hospital cardiac arrest (OHCA) according to specific activity types at the time of event and to determine the association between activities and outcomes according to activity type at the time of event occurrence of OHCA. A nationwide OHCA cohort database, compiled from January 2008 to December 2010 and consisting of hospital chart reviews and ambulance run sheet data, was used. Activity group was categorized as one of the following t...

Na, Sang Hoon; Shin, Sang Do; Ro, Young Sun; Lee, Eui Jung; Song, Kyoung Jun; Park, Chang Bae; Kim, Joo Yeong

2013-01-01

85

Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest.  

Science.gov (United States)

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

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

2014-11-25

86

Targeting out-of-hospital cardiac arrest: the effect of heparin administered during cardiopulmonary resuscitation (T-ARREST  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction. Heparin administration during cardiopulmonary resuscitation (CPR may prevent activation of coagulation after successful resuscitation for out-of-hospital cardiac arrest (OHCA. We hypothesize that such an approach is not associated with an increased rate of bleeding, but it has not been evaluated. We performed a pilot randomized clinical study assessing the safety of intra-arrest heparin administration in OHCA patients with suspected acute myocardial infarction (AMI and its impact on their prognosis. Materials and Methods. OHCA patients were randomized during CPR to 10 000 units of intra-arrest intravenous heparin (Group H or to treatment without heparin (Group C. The occurrence of major bleeding and the presence of a favourable neurological result 3 months after OHCA, were analyzed. Results. Out of 88 randomized patients, AMI was subsequently confirmed in 63 of them (71.6 %. There were 30 patients in group H and 33 in group C. No major bleeding event was observed in either group. Return of spontaneous circulation (ROSC, Group H: 40.0%, Group C: 45.4%, p=0.662 and a good neurological result 3 months after OHCA (Group H: 6.7 %, Group C: 9.1 %, p=0.921 did not differ between groups. Conclusions. Intravenous administration of 10 000 units of heparin during CPR for OHCA in patients with supposed AMI was safe. We did not find any improvement in prognosis for our sample of limited size. Though the procedure proved safe, we recommend postponing the administration of heparin until ROSC, assessment of clinical state and recording of a twelve-lead ECG.

JIRÍ KNOR

2011-10-01

87

Outcomes of Out?of?Hospital Cardiac Arrest by Public Location in the Public?Access Defibrillation Era  

Science.gov (United States)

Background The strategy to place public?access automated external defibrillators (AEDs) has not yet been established in real settings. Methods and Results This, prospective, population?based observational study in Osaka, Japan, included consecutive out?of?hospital cardiac arrest (OHCA) patients with resuscitation attempts during 7 years, from January 2005 through December 2011. The trends in the proportion of public?access AED use and 1?month survival with neurologically favorable outcome were evaluated by location. Factors associated with neurologically favorable outcome (defined as cerebral performance category 1 or 2) after ventricular fibrillation were also assessed using multiple logistic regression analysis. A total of 9453 bystander?witnessed OHCAs of cardiac origin were documented and 894 (9.5%) of them occurred at public places. The proportion of public?access AED use significantly increased from 0.0% (0/20) in 2005 to 41.2% (7/17) in 2011 at railway stations and from 0.0% (0/7) to 56.5% (13/23) at sports facilities. Mean time from collapse to shock was 5.0 minutes among those who received shocks with public?access AEDs. The proportion of neurologically favorable outcome was 28.0% (33/118) at railway stations, 51.6% (48/93) at sports facilities, 23.3% (20/86) in public buildings, and 41.9% (13/31) in schools. In multivariate analysis, early defibrillation, irrespective of bystander or emergency medical service (EMS) personnel, was significantly associated with neurologically favorable outcome (adjusted odds ratio for 1?minute increment, 0.89; 95% confidence interval, 0.87 to 0.92). Conclusions This large, population?based OHCA registry demonstrated that earlier shock, irrespective the shock provider (bystander or EMS personnel), contributed to improving outcome, and a public?access defibrillation program was successfully implemented so that shocks with public?access AEDs were delivered to over 40% of bystander?witnessed OHCAs and time to shock was shortened in some kinds of public places. PMID:24755149

Murakami, Yukiko; Iwami, Taku; Kitamura, Tetsuhisa; Nishiyama, Chika; Nishiuchi, Tatsuya; Hayashi, Yasuyuki; Kawamura, Takashi

2014-01-01

88

Prediction of death and neurologic outcome in the emergency department in out-of-hospital cardiac arrest survivors.  

Science.gov (United States)

We reviewed the hospital records of 127 consecutive patients who were resuscitated from cardiac arrest in a retrospective cohort analysis. A cardiac arrest score utilizing time to return of spontaneous circulation, systolic blood pressure at the time of presentation, and initial neurologic exam were calculated. This score was analyzed with 39 other clinical variables for significance with regard to mortality or neurologic survival using multivariate analysis. Combining these variables into a cardiac arrest score (levels 0, 1, 2, 3, from least to most favorable) allowed prediction of neurologic outcomes and mortality from a single variable in an independent fashion (p emergency department arrival. This scoring scheme may aide in selection of patients for early aggressive measures, including triage coronary angiography and angioplasty. PMID:9462599

Thompson, R J; McCullough, P A; Kahn, J K; O'Neill, W W

1998-01-01

89

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

DEFF Research Database (Denmark)

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.

Ostenfeld, Sarah; Lindholm, Matias Greve

2014-01-01

90

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)

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.

Ling Tiah

2014-11-01

91

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)

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.

Søreide Eldar

2010-01-01

92

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

OpenAIRE

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...

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

2013-01-01

93

Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU  

OpenAIRE

Introduction: Therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was adopted early in Norway. Since 2004 the general recommendation has been to cool all unconscious OHCA patients treated in the intensive care unit (ICU), but the decision to cool individual patients was left to the responsible physician. We assessed factors that were associated with use of TH and predicted survival.

Method: We conducted a retrospective observational study of prospecti...

Lindner, Thomas Werner; Langørgen, Jørund; Sunde, Kjetil; Larsen, Alf Inge; Kvaløy, Jan Terje; Heltne, Jon-kenneth; Drægni, Tomas; Søreide, Eldar

2013-01-01

94

Development of the probability of return of spontaneous circulation in intervals without chest compressions during out-of-hospital cardiac arrest: an observational study  

OpenAIRE

Abstract Background One of the factors that limits survival from out-of-hospital cardiac arrest is the interruption of chest compressions. During ventricular fibrillation and tachycardia the electrocardiogram reflects the probability of return of spontaneous circulation associated with defibrillation. We have used this in the current study to quantify in detail the effects of interrupting chest compressions. Methods From an electrocardiogram database we identifi...

Steen Petter; Kramer-Johansen Jo; Kvaløy Jan; Gundersen Kenneth; Eftestøl Trygve

2009-01-01

95

Survival and Neurologic Outcomes of Out-of-Hospital Cardiac Arrest Patients Who Were Transferred after Return of Spontaneous Circulation for Integrated Post-Cardiac Arrest Syndrome Care: The Another Feasibility of the Cardiac Arrest Center  

Science.gov (United States)

It has been proven that safety and efficiency of out-of-hospital cardiac arrest (OHCA) patients is transported to specialized hospitals that have the capability of performing therapeutic hypothermia (TH). However, the outcome of the patients who have been transferred after return of spontaneous circulation (ROSC) has not been well evaluated. We conducted a retrospective observational study between January 2010 to March 2012. There were primary outcomes as good neurofunctional status at 1 month and the secondary outcomes as the survivals at 1 month between Samsung Medical Center (SMC) group and transferred group. A total of 91 patients were enrolled this study. There was no statistical difference between good neurologic outcomes between both groups (38% transferred group vs. 40.6% SMC group, P=0.908). There was no statistical difference in 1 month survival between the 2 groups (66% transferred group vs. 75.6% SMC group, P=0.318). In the univariate and multivariate models, the ROSC to induction time and the induction time had no association with good neurologic outcomes. The good neurologic outcome and survival at 1 month had no significant differences between the 2 groups. This finding suggests the possibility of integrated post-cardiac arrest care for OHCA patients who are transferred from other hospitals after ROSC in the cardiac arrest center. Graphical Abstract PMID:25246751

2014-01-01

96

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)

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.

Krarup, Niels Henrik; Terkelsen, Christian Juhl

2010-01-01

97

A seven-year follow-up of discharged patients after out-of-hospital cardiac arrest with respect to ST-segment elevation myocardial infarction  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction. The aim of this multicentre prospective study was to describe the seven-year survival of patients, from the region of East Bohemia, after out-of-hospital cardiac arrest (OHCA, occurring between 2002 and 2004. The main focus of this study was on the survival of patients with ST-segment elevated myocardial infarction (STEMI. Patients and Methods. A total 718 patients with OHCA were included in the study. Of these patients, 149 were admitted to hospital. The main cohort of our study consisted of 53 patients (41 men; median 59; average 58±13, who survived acute hospitalization. In these patients, STEMI was the main cause of OHCA in 15 cases (28%, whereas without STEMI was found in 38 cases (72%. Patients who survived hospitalization were periodically followed-up at six-monthly intervals. Results. In the first follow-up year, 42 patients survived (79% of 53 patients, in the third year 38 patients (72%, in the fifth year 33 patients (62% and in the seventh year 31 patients (59%. Ninety-four percent of patients were in good neurological condition after the seventh follow-up year. The whole period of seven years was survived by 12 (80% out of 15 patients with STEMI, and by 19 (50% out of 38 patients without STEMI. In patients who survived the seventh year after STEMI, direct percutaneous coronary intervention was performed in 11 cases. Conclusions. Fifty-nine percent of patients discharged from hospital after OHCA survived until the seventh year. The highest rate of survival during this period was seen in patients with STEMI, i.e. in 80%.

MILOSLAV PLESKOT

2012-10-01

98

Chest Compression Injuries Detected via Routine Post-arrest Care in Patients Who Survive to Admission after Out-of-hospital Cardiac Arrest.  

Science.gov (United States)

Abstract Objective. To examine injuries produced by chest compressions in out-of-hospital cardiac arrest (OHCA) patients who survive to hospital admission. Methods. A retrospective cohort study was conducted among 235 consecutive patients who were hospitalized after nontraumatic OHCA in Minnesota between January 2009 and May 2012 (117 survived to discharge; 118 died during hospitalization). Cases were eligible if the patient had received prehospital compressions from an emergency medical services (EMS) provider. One EMS provider in the area was using a mechanical compression device (LUCAS(TM)) as standard equipment, so the association between injury and use of mechanical compression was also examined. Prehospital care information was abstracted from EMS run sheets, and hospital records were reviewed for injuries documented during the post-arrest hospitalization that likely resulted from compressions. Results. Injuries were identified in 31 patients (13%), the most common being rib fracture (9%) and intrathoracic hemorrhage (3%). Among those who survived to discharge, the mean length of stay was not statistically significantly different between those with injuries (13.5 days) and those without (10.8 days; p = 0.23). Crude injury prevalence was higher in those who died prior to discharge, had received compressions for >10 minutes (versus ?10 minutes) and underwent computer tomography (CT) imaging, but did not differ by bystander compressions or use of mechanical compression. After multivariable adjustment, only compression time > 10 min and CT imaging during hospitalization were positively associated with detected injury (OR = 7.86 [95% CI = 1.7-35.9] and 6.30 [95% CI = 2.6-15.5], respectively). Conclusion. In patients who survived OHCA to admission, longer duration of compressions and use of CT during the post-arrest course were associated positively with documented compression injury. Compression-induced injuries detected via routine post-arrest care are likely to be largely insignificant in terms of length of recovery. PMID:25076024

Boland, Lori L; Satterlee, Paul A; Hokanson, Jonathan S; Strauss, Craig E; Yost, Dana

2015-01-01

99

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)

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.

Karlsson, Lena I M; Wissenberg, Mads

2014-01-01

100

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

OpenAIRE

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

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

2013-01-01

101

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

OpenAIRE

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 ...

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

2009-01-01

102

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

Directory of Open Access Journals (Sweden)

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.

Andrade Maria J

2009-12-01

103

Specific activity types at the time of event and outcomes of out-of-hospital cardiac arrest: a nationwide observational study.  

Science.gov (United States)

This study aimed to describe the characteristics of out-of-hospital cardiac arrest (OHCA) according to specific activity types at the time of event and to determine the association between activities and outcomes according to activity type at the time of event occurrence of OHCA. A nationwide OHCA cohort database, compiled from January 2008 to December 2010 and consisting of hospital chart reviews and ambulance run sheet data, was used. Activity group was categorized as one of the following types: paid work activity (PWA), sports/leisure/education (SLE), routine life (RL), moving activity (MA), medical care (MC), other specific activity (OSA), and unknown activity. The main outcome was survival to discharge. Multivariate logistic analysis for outcomes was used adjusted for potential risk factors (reference = RL group). Of the 72,256 OHCAs, 44,537 cases were finally analyzed. The activities were RL (63.7%), PWA (3.1%), SLE (2.7%), MA (2.0%), MC (4.3%), OSA (2.2%), and unknown (21.9%). Survival to discharge rate for total patients was 3.5%. For survival to discharge, the adjusted odds ratios (95% confidence intervals) were 1.42 (1.06-1.90) in the SLE group and 1.62 (1.22-2.15) in PWA group compared with RL group. In conclusion, the SLE and PWA groups show higher survival to discharge rates than the routine life activity group. PMID:23400043

Na, Sang Hoon; Shin, Sang Do; Ro, Young Sun; Lee, Eui Jung; Song, Kyoung Jun; Park, Chang Bae; Kim, Joo Yeong

2013-02-01

104

Assessing outcome of out-of-hospital cardiac arrest due to subarachnoid hemorrhage using brain CT during or immediately after resuscitation (Views : 23 times  

Directory of Open Access Journals (Sweden)

Full Text Available Objectives. The clinical course and outcome of out-of-hospital cardiopulmonary arrest (OHCPA due to subarachnoid hemorrhage (SAH is unclear. The objective of this study is to clarify them. Study design. Single- center, observational study. Setting. We usually perform a brain computed tomography (CT in OHCPA patients who present without a clear etiology (42% of all OHCPA, such as trauma, to determine the cause of OHCPA and to guide treatment. Patients. The study included OHCPA patients without a clear etiology, who were transferred to our center and who underwent a brain CT during resuscitation. Methods of measurement. Patients' records were reviewed; initial cardiac rhythm, existence of a witness and bystander cardiopulmonary resuscitation efforts (CPR were compared with patients' outcomes. Results. Sixty-six patients were enrolled. 72.7% achieved return of spontaneous circulation (ROSC, 71.2% were admitted, 30.3% survived more than 7 days, and 9.1. survived-to-discharge. In 41 witnessed OHCPA, 87.8% obtained ROSC, 85.4% were admitted, and 14.6% survived-to-discharge. All survivors were witnessed. In 25 non-witnessed OHCPA, 48% obtained ROSC and were admitted, and no patients were discharged. Initial cardiac rhythm was ventricular fibrillation (VF, pulseless electrical activity (PEA and asystole in 3.0%, 39.4%, and 47.0%. In 2 VF patients 50.0% survived-to- discharge, and there was no survivor with PEA or asystole.Conclusion. This study shows a high rate of ROSC and admission in OHCPA patients with a SAH, and also reveals their very poor neurological outcome. We conclude that the detection of a SAH in OHCPA patients is important to determine the accurate frequency of SAH in this patient group and to guide appropriate treatment of all OHCPA patients.

Noriyuki Suzuki

2010-10-01

105

Development of the probability of return of spontaneous circulation in intervals without chest compressions during out-of-hospital cardiac arrest: an observational study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background One of the factors that limits survival from out-of-hospital cardiac arrest is the interruption of chest compressions. During ventricular fibrillation and tachycardia the electrocardiogram reflects the probability of return of spontaneous circulation associated with defibrillation. We have used this in the current study to quantify in detail the effects of interrupting chest compressions. Methods From an electrocardiogram database we identified all intervals without chest compressions that followed an interval with compressions, and where the patients had ventricular fibrillation or tachycardia. By calculating the mean-slope (a predictor of the return of spontaneous circulation of the electrocardiogram for each 2-second window, and using a linear mixed-effects statistical model, we quantified the decline of mean-slope with time. Further, a mapping from mean-slope to probability of return of spontaneous circulation was obtained from a second dataset and using this we were able to estimate the expected development of the probability of return of spontaneous circulation for cases at different levels. Results From 911 intervals without chest compressions, 5138 analysis windows were identified. The results show that cases with the probability of return of spontaneous circulation values 0.35, 0.1 and 0.05, 3 seconds into an interval in the mean will have probability of return of spontaneous circulation values 0.26 (0.24–0.29, 0.077 (0.070–0.085 and 0.040(0.036–0.045, respectively, 27 seconds into the interval (95% confidence intervals in parenthesis. Conclusion During pre-shock pauses in chest compressions mean probability of return of spontaneous circulation decreases in a steady manner for cases at all initial levels. Regardless of initial level there is a relative decrease in the probability of return of spontaneous circulation of about 23% from 3 to 27 seconds into such a pause.

Steen Petter

2009-02-01

106

Combination of veno-arterial extracorporeal membrane oxygenation and hypothermia for out-of-hospital cardiac arrest due to Taxus intoxication.  

Science.gov (United States)

ABSTRACTA young woman presented with cardiac arrest following ingestion of yew tree leaves of the Taxus baccata species. The toxin in yew tree leaves has negative inotropic and dromotropic effects. The patient had a cardiac rhythm that alternated between pulseless electrical activity with a prolonged QRS interval and ventricular fibrillation. When standard resuscitation therapy including digoxin immune Fab was ineffective, a combination of extracorporeal membrane oxygenation (ECMO) and hypothermia was initiated. The total duration of low flow/no flow was 82 minutes prior to the initiation of ECMO. After 36 hours of ECMO (including 12 hours of electrical asystole), the patient's electrocardiogram had normalized and the left ventricular ejection fraction was 50%. At this time, dobutamine and the ECMO were stopped. The patient had a full neurologic recovery and was discharged from the intensive care unit after 5 days and from the hospital 1 week later. PMID:25358285

Thooft, Aurélie; Goubella, Ahmed; Fagnoul, David; Taccone, Fabio S; Brimioulle, Serge; Vincent, Jean-Louis; De Backer, Daniel

2014-11-01

107

Hyperinvasive approach to out-of hospital cardiac arrest using mechanical chest compression device, prehospital intraarrest cooling, extracorporeal life support and early invasive assessment compared to standard of care. A randomized parallel groups comparative study proposal. “Prague OHCA study”  

OpenAIRE

Abstract Background Out of hospital cardiac arrest (OHCA) has a poor outcome. Recent non-randomized studies of ECLS (extracorporeal life support) in OHCA suggested further prospective multicenter studies to define population that would benefit from ECLS. We aim to perform a prospective randomized study comparing prehospital intraarrest hypothermia combined with mechanical chest compression device, intrahospital ECLS and early invasive investigation and treatment in all patien...

Belohlavek Jan; Kucera Karel; Jarkovsky Jiri; Franek Ondrej; Pokorna Milana; Danda Jiri; Skripsky Roman; Kandrnal Vit; Balik Martin; Kunstyr Jan; Horak Jan; Smid Ondrej; Valasek Jaroslav; Mrazek Vratislav; Schwarz Zdenek

2012-01-01

108

The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation  

OpenAIRE

Abstract Background The LUCAS™ device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO2, compared with results from standard manual cardiopulmonary resuscitation (CPR). Two randomised pilot studies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual CPR. There remains e...

Rubertsson Sten; Silfverstolpe Johan; Rehn Liselott; Nyman Thomas; Lichtveld Rob; Boomars Rene; Bruins Wendy; Ahlstedt Björn; Puggioli Helena; Lindgren Erik; Smekal David; Skoog Gunnar; Kastberg Robert; Lindblad Anna; Halliwell David

2013-01-01

109

Assessing outcome of out-of-hospital cardiac arrest due to subarachnoid hemorrhage using brain CT during or immediately after resuscitation (Views : 23 times)  

OpenAIRE

Objectives. The clinical course and outcome of out-of-hospital cardiopulmonary arrest (OHCPA) due to subarachnoid hemorrhage (SAH) is unclear. The objective of this study is to clarify them. Study design. Single- center, observational study. Setting. We usually perform a brain computed tomography (CT) in OHCPA patients who present without a clear etiology (42% of all OHCPA), such as trauma, to determine the cause of OHCPA and to guide treatment. Patients. The study included OHCPA patients wit...

Noriyuki Suzuki; Yoshihiro Moriwaki; Hiroshi Manaka; Koichi Hamada

2010-01-01

110

Out-of-Hospital therapeutic hypothermia. A Systematic Review  

Directory of Open Access Journals (Sweden)

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.

María Nélida Conejo Pérez

2012-07-01

111

The Study Protocol for the LINC (LUCAS in Cardiac Arrest Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The LUCAS™ device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO2, compared with results from standard manual cardiopulmonary resuscitation (CPR. Two randomised pilot studies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual CPR. There remains evidence from small case series that the device can be potentially beneficial compared with manual chest compressions in specific situations. This multicentre study is designed to evaluate the efficacy and safety of mechanical chest compressions with the LUCAS™ device whilst allowing defibrillation during on-going CPR, and comparing the results with those of conventional resuscitation. Methods/design This article describes the design and protocol of the LINC-study which is a randomised controlled multicentre study of 2500 out-of-hospital cardiac arrest patients. The study has been registered at ClinicalTrials.gov (http://clinicaltrials.gov/ct2/show/NCT00609778?term=LINC&rank=1. Results Primary endpoint is four-hour survival after successful restoration of spontaneous circulation. The safety aspect is being evaluated by post mortem examinations in 300 patients that may reflect injuries from CPR. Conclusion This large multicentre study will contribute to the evaluation of mechanical chest compression in CPR and specifically to the efficacy and safety of the LUCAS™ device when used in association with defibrillation during on-going CPR.

Rubertsson Sten

2013-01-01

112

[Indications for out-of-hospital thromboprophylaxis].  

Science.gov (United States)

In the last decade the performance of an adequate perioperative prophylaxis for venous thromboembolism (VTE) has become an established in-hospital measure. Although new antithrombotic drugs (oral thrombin inhibitors, fondaparinux) could reduce the incidence of perioperative VTE the absolute number remains high. In contrast to the widely accepted in-hospital perioperative prophylaxis, it is still unclear whether prophylaxis has to be prolonged after the hospital stay ("out-of-hospital prophylaxis"). In this review we will demonstrate by evaluation of recent studies and recommendations that a prolonged out-of-hospital prophylaxis for venous thromboembolism can further reduce the incidence of VTE after surgery, mainly orthopaedic surgery, e.g. endoprothetic joint replacement. At present low molecular weight heparins (LMWH) may be most effective and exhibit a low risk for major bleeding. Similar studies with other antithrombotics and other types of surgery are still missing. Finally the medico-legal aspects concerning postoperative in-hospital and extended prophylaxis are discussed. PMID:15182040

Schobersberger, Wolfgang; Spannagel, Uwe; Schwamberger, Helmut; Schnapka, Jörg

2004-04-01

113

Heartstart Scotland: the use of paramedic skills in out of hospital resuscitation  

OpenAIRE

Objective—To assess the frequency with which paramedic skills were used in out of hospital cardiac arrest and the effect of tracheal intubation on outcome.?Design—Retrospective analysis of ambulance service reports and hospital records.?Setting—Scottish Ambulance Service and hospitals admitting acute patients throughout Scotland.?Results—A total of 8651 out of hospital resuscitation attempts were recorded and tracheal intubation was attempted in 3427 (39.6%) arrests. One hundr...

Adams, J.; Sirel, J.; Marsden, K.; Cobbe, S.

1997-01-01

114

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

DEFF Research Database (Denmark)

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

Castrén, M; Bohm, K

2011-01-01

115

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)

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.

Noc, Marko; Fajadet, Jean

2014-01-01

116

"Heartstart Scotland"--initial experience of a national scheme for out of hospital defibrillation.  

OpenAIRE

OBJECTIVE--To determine the outcome of out of hospital defibrillation in Scotland during the year after the introduction of automated external defibrillators in October 1988. DESIGN--Retrospective analysis of ambulance service reports and hospital records. SETTING--Scottish Ambulance Service and acute receiving hospitals throughout Scotland. MAIN OUTCOME MEASURES--Delay from cardiac arrest to first defibrillator shock; vital state on arrival at hospital accident and emergency department; surv...

Cobbe, S. M.; Redmond, M. J.; Watson, J. M.; Hollingworth, J.; Carrington, D. J.

1991-01-01

117

Nurses’ attitude in out-of-hospital cardiopulmonary resuscitation  

Directory of Open Access Journals (Sweden)

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.

Maria Meidani

2008-10-01

118

Successful out-of-hospital defibrillation for ventricular fibrillation complicating solvent abuse.  

OpenAIRE

The Authors describe the case history of a child who suffered a cardiac arrest with ventricular fibrillation after deliberate inhalation of 1,1,1-Trichloroethane in typewriter correction fluid thinners. Successful out-of-hospital defibrillation was carried out and the patient made a full recovery. The literature relating to this particular form of volatile substance abuse is reviewed.

Nee, P. A.; Llewellyn, T.; Pritty, P. E.

1990-01-01

119

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)

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.

Andrea Aguilera-Campos

2012-02-01

120

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)

Full Text Available SciELO Public Health | Language: Spanish Abstract in spanish 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.

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

2012-02-01

121

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)

Full Text Available SciELO Mexico | Language: Spanish Abstract in spanish 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.

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

2012-02-01

122

Refibrillation during out-of-hospital arrest: A frequent event with clinical consequences  

Directory of Open Access Journals (Sweden)

Full Text Available The refibrillation was a frequent event in out-of-hospital cardiac arrest (OHCA. The number of recurrences of ventricular fibrillation (VF is in inverse relationship with survival. In this article we discuss about causes and mechanism of refibrillation. The amiodarone and new technical solution (defibrillators that may allow continuous monitoring of the heart rhythm, while chest compressions continue and recommend defibrillation when refibrillation occurs are promising new strategy to improve outcome of OHCA and recurrent VF.

RUDOLPH W. KOSTER

2010-09-01

123

Refibrillation during out-of-hospital arrest: A frequent event with clinical consequences  

OpenAIRE

The refibrillation was a frequent event in out-of-hospital cardiac arrest (OHCA). The number of recurrences of ventricular fibrillation (VF) is in inverse relationship with survival. In this article we discuss about causes and mechanism of refibrillation. The amiodarone and new technical solution (defibrillators that may allow continuous monitoring of the heart rhythm, while chest compressions continue and recommend defibrillation when refibrillation occurs) are promising new strategy to impr...

Koster, Rudolph W.

2010-01-01

124

Out-of-hospital cardiopulmonary resuscitation in four Serbian university cities: outcome follow-up according to the «Utstein style»  

OpenAIRE

Aims. To investigate the return of spontaneous circulation (ROSC), survival to discharge, six-month and one-year survival of patients with out-of-hospital cardiac arrest in four university cities in Serbia.Methods. A prospective, two-year, multicentre study was designed. Using the Utstein template, we recorded out-of-hospital cardiopulmonary (CPR) and its outcomes, and analyzed the immediate survival (ROSC>20 min.), short-term survival (to discharge), long-term survival (one year after discha...

SLADJANA ANDJELIC; NATASA DJORDJEVIC

2010-01-01

125

Paramedics and technicians are equally successful at managing cardiac arrest outside hospital.  

OpenAIRE

OBJECTIVE--To examine the effect on survival of treatment by ambulance paramedics and ambulance technicians after cardiac arrest outside hospital. DESIGN--Prospective study over two years from 1 April 1992 to 31 March 1994. SETTING--Accident and emergency department of university teaching hospital. SUBJECTS--502 consecutive adult patients with out of hospital cardiopulmonary arrest of cardiac origin. INTERVENTIONS--Treatment by ambulance technicians or paramedics both equipped with semiautoma...

Guly, U. M.; Mitchell, R. G.; Cook, R.; Steedman, D. J.; Robertson, C. E.

1995-01-01

126

Characteristiscs of fatal patient cases out of Riga hospitals  

Directory of Open Access Journals (Sweden)

Full Text Available Health care system becomes less accessible to the people in Latvia. Health insurance is practically destroyed from April, 2010. The aim of our study is to analyze reasons of death of persons who died out of hospital in Riga. We have investigated 130 post mortem examination protocols from Pathology centre of Riga Eastern Clinical university hospital. We have evaluated the information from family doctor and ambulance care medical staff. In our analyzed group 58% of persons were found dead at home without any medical aid but 25% – died in the ambulance car after call to public institutions. Alarming is fact that 43,8% of patients died at 4–5th decade of age. There was also such vulnerably group as homeless people. The most common reasons of death were acute and chronic variations of cardio-vascular and lung curable pathologies. In Latvia there is urgent necessity of costless medical offices for poor and defenceless persons. Patient’s delay in seeking medical help is the decisive phase for late diagnosis of diseases and mortality. It is necessary to renew health insurance system in Latvia. All levels of medical staff and students of medical universities must be involved in providing information on early disease symptoms, diagnosis and treatment options in different media.

Smits A.

2012-10-01

127

Out-of-hospital cardiopulmonary resuscitation in four Serbian university cities: outcome follow-up according to the «Utstein style»  

Directory of Open Access Journals (Sweden)

Full Text Available Aims. To investigate the return of spontaneous circulation (ROSC, survival to discharge, six-month and one-year survival of patients with out-of-hospital cardiac arrest in four university cities in Serbia.Methods. A prospective, two-year, multicentre study was designed. Using the Utstein template, we recorded out-of-hospital cardiopulmonary (CPR and its outcomes, and analyzed the immediate survival (ROSC>20 min., short-term survival (to discharge, long-term survival (one year after discharge, or death following out-of-hospital CPR.Results. During the study period, 591 patients met the inclusion criteria for enrollment and out-of-hospital CPR. The etiology of arrest was cardiac in 33.8% of patients. Cardiac arrest was witnessed by the advanced life support (ALS team in 15.6% of cases. Asystole was the most frequent initial rhythm at time of arrest (46.4%. The highest survival rate (P<0,001 was observed in cases with initial VF and pulseless VT, while patients with asystole and pulseless electrical activity (PEA had the least chance of survival. Within the whole group of patients, ROSC was detected with a frequency of 69.7%. The frequency of patients who died in the field or during admission to hospital was 58.9%, while 28.6% of admitted patients died before discharge. Thirteen percent of patients survived until discharge, and the overall six-month and one-year survival rates were 11.3% and 10%, respectively. No statistical difference in survival rates among the cities was found.Conclusion. The Utstein template should be implemented in the form of an official protocol for out-of-hospital CPR follow-up in all emergency medical services in Serbia.

SLADJANA ANDJELIC

2010-04-01

128

What accounting leaves out of hospital financial management.  

Science.gov (United States)

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

Boles, K E; Glenn, J K

1986-01-01

129

Paediatric out-of-hospital resuscitation in an area with scattered population (Galicia-Spain  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Cardiorespiratory arrest (CRA is a rare event in childhood. Our objective was to determine the characteristics of paediatric CRA and the immediate results of cardiopulmonary resuscitation (CPR in Galicia, a community with a very scattered population. Methods All children (aged from newborn to 16 years old who suffered an out-of-hospital CRA in Galicia and were assisted by the Public Foundation Medical Emergencies of Galicia-061 staff, from June 2002 to February 2005, were included in the study. Data were prospectively recorded following the Utstein's style guidelines. Results Thirty-one cases were analyzed (3.4 CRA annual cases per 100.000 paediatric population. The arrest was respiratory in 16.1% and cardiac in 83.9% of cases. CRA occurred at home in 58.1% of instances. Time CRA to initiation of CPR was shorter than 10 minutes in 32.2% and longer than 20 minutes in 29.0% of cases. 22.6% of children received bystander CPR. The first recorded rhythm was asystole in 67.7% of cases. Bag-mask ventilation was used in 67.7% and in 83.8% oro-tracheal intubation was done. A peripheral venous access was achieved in 67.7% and intraosseous access was used in 16.1% of patients. 93.5% of children were treated with adrenaline. After initial CPR, sustained restoration of spontaneous circulation was achieved in 38.7% of cases. Six children (19.4% survived until hospital discharge. Four of 5 children with respiratory arrest survived, whereas only 2 of 26 children with cardiac arrest survived until hospital discharge. Conclusion Despite the handicap of a highly disseminated population, paediatric CRA characteristics and CPR results in Galicia are comparable to references from other communities. Programs to increase bystander CPR, equip laypeople with basic CPR skills and to update life support knowledge of health staff are needed to improve outcomes.

Cegarra-García María

2007-05-01

130

MUERTE SÚBITA EXTRAHOSPITALARIA POR INFARTO AGUDO DE MIOCARDIO / Out-of-hospital sudden death due to acute myocardial infarction  

Directory of Open Access Journals (Sweden)

Full Text Available The results of cardiopulmonary resuscitation in cases of out-of-hospital cardiac arrest are not very satisfactory in the best health care centers of the world, with a very low percentage of survival. Currently, this topic represents a challenge for practicing doctors; while it is an unresolved subject for others. The case of a patient with sudden death, caused by an extensive acute anterior myocardial infarction, who was assisted and recovered by the family doctor and specialists from the Cardiology and Cardiovascular Surgery Institute, is presented in this article.

Julio César Echarte Martínez

2010-03-01

131

Various aspects of treatment in cardiac arrest prior to hospital arrival  

OpenAIRE

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...

Nordberg, Per

2014-01-01

132

Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.  

Science.gov (United States)

Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome. PMID:25391522

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

2014-11-11

133

Sudden cardiac death: results of resuscitation begun outside hospital.  

Science.gov (United States)

A retrospective review was undertaken to determine the influence of the St John Ambulance life support units on the the incidence of sudden cardiac death during a 12 month period in Auckland. In 65 instances subjects who collapsed with either ventricular fibrillation or cardiac arrest were resuscitated and transported alive to a hospital accident and emergency department in the Auckland area. Twenty patients died within 24 hours of admission and a further 14 died in hospital. There were seven late deaths and 24 survivors (37%). Ten patients are asymptomatic and the remainder are troubled by angina or breathlessness. Only three of the surviving patients have suffered severe cerebral damage as a result of their collapse. PMID:6343935

Agnew, T M; Lauder, I M; Fisher, C A; Crawford, G C

1983-06-22

134

An unusual cause of cardiac arrest in a hospitalized patient  

OpenAIRE

We present an unusual case of 24 year old male who was hospitalized for dental procedure and developed cardiac arrest 2 days after the procedure. The patient presented with swelling of buccal cavity for which a biopsy was taken. Two days after the procedure, apparently normal patient suddenly presented at mid night with VT and VF, which were intractable requiring multiple DC shocks. During this period arterial blood gas analysis revealed severe acidosis. The circumstances led us to suspect po...

Shetty, Ranjan K.; Tumkur, Anil; Bhat, Krishnamurthy; Chacko, Biby

2013-01-01

135

Pulseless electrical activity and successful out-of-hospital resuscitation – long-term survival and quality of life: an observational cohort study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The aim of the study was to evaluate the long-term outcome of patients successfully resuscitated from pre-hospital cardiac arrest with initial pulseless electrical activity (PEA, because the long-term outcome of these patients is unknown. Survival, neurological status one year after cardiac arrest and self-perceived quality of life after five years were assessed. Methods This retrospective study included adult patients resuscitated from PEA between August 2001 and March 2003 in three urban areas in southern Finland. A validated questionnaire was sent to patients while neurological status according to the Cerebral Performance Category (CPC -classification was assessed based on medical database notes recorded during follow-up evaluations. Results Out of 99 included patients in whom resuscitation was attempted, 41 (41% were successfully resuscitated and admitted to hospital. Ten (10% patients were discharged from hospital. Seven were alive after one year and six after five years following cardiac arrest. Five of the seven patients alive one year after resuscitation presented with the same functional level as prior to cardiac arrest. Conclusions Patients with initial PEA have been considered to have poor prognosis, but in our material, half of those who survived to hospital discharge were still alive after 5 years. Their self-assessed quality of life seems to be good with only mild to moderate impairments in activities of daily life.

Saarinen Sini

2012-10-01

136

Acute yellow oleander (Thevetia peruviana) poisoning: cardiac arrhythmias, electrolyte disturbances, and serum cardiac glycoside concentrations on presentation to hospital  

OpenAIRE

OBJECTIVE—To describe the cardiac arrhythmias, electrolyte disturbances, and serum cardiac glycoside levels seen in patients presenting to hospital with acute yellow oleander (Thevetia peruviana) poisoning and to compare these with published reports of digitalis poisoning.?DESIGN—Case series.?SETTING—Medical wards of Anuradhapura District General Hospital, Sri Lanka, and coronary care unit of the Institute of Cardiology, National Hospital of Sri Lanka, Colombo, the national tertiary...

Eddleston, M.; Ariaratnam, Ca; Sjo?stro?m, L.; Jayalath, S.; Rajakanthan, K.; Rajapakse, S.; Colbert, D.; Meyer, Wp; Perera, G.; Attapattu, S.; Kularatne, Sa; Sheriff, MR; Warrell, Da

2000-01-01

137

Implementation of a titrated oxygen protocol in the out-of-hospital setting.  

Science.gov (United States)

Oxygen is one of the most frequently-used therapeutic agents in medicine and the most commonly administered drug by prehospital personnel. There is increasing evidence of harm with too much supplemental oxygen in certain conditions, including stroke, chronic obstructive pulmonary disease (COPD), neonatal resuscitations, and in postresuscitation care. Recent guidelines published by the British Thoracic Society (BTS) advocate titrated oxygen therapy, but these guidelines have not been widely adapted in the out-of-hospital setting where high-flow oxygen is the standard. This report is a description of the implementation of a titrated oxygen protocol in a large urban-suburban Emergency Medical Services (EMS) system and a discussion of the practical application of this out-of-hospital protocol. PMID:24983332

Bosson, Nichole; Gausche-Hill, Marianne; Koenig, William

2014-08-01

138

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

OpenAIRE

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)...

Naderinasab, M.; Tayyebi Meibodi, N.; Nahidi, Y.; Bakhshizadeh, A.

2013-01-01

139

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

DEFF Research Database (Denmark)

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

Damen, Nikki L; Pelle, Aline J

2012-01-01

140

Cardiac transplantation in severely ill patients requiring intensive support in hospital  

OpenAIRE

Sixty four patients were referred for cardiac transplantation from a single cardiac team at this hospital between October 1984 and December 1986. Of these patients, 33 were referred for urgent transplantation, all of whom required intensive treatment in hospital with intravenous infusions of cardiac drugs, intra-aortic balloon counterpulsation, peritoneal dialysis, ventilation, or any combination of these to sustain life. Of these 33 patients, six died while awaiting transplantation, one was ...

Mulcahy, David; Wright, Christine; Mockus, Lorna; Yacoub, Magdi; Fox, Kim

1988-01-01

141

End-of-life hospital referrals by out-of-hours general practitioners: a retrospective chart study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Many patients are transferred from home to hospital during the final phase of life and the majority die in hospital. The aim of the study is to explore hospital referrals of palliative care patients for whom an out-of-hours general practitioner was called. Methods A retrospective descriptive chart study was conducted covering a one-year period (1/Nov/2005 to 1/Nov/2006 in all eight out-of-hours GP co-operatives in the Amsterdam region (Netherlands. All symptoms, sociodemographic and medical characteristics were recorded in 529 charts for palliative care patients. Multivariate logistic regression analysis was performed to identify the variables associated with hospital referrals at the end of life. Results In all, 13% of all palliative care patients for whom an out-of-hours general practitioner was called were referred to hospital. Palliative care patients with cancer (OR 5,1, cardiovascular problems (OR 8,3, digestive problems (OR 2,5 and endocrine, metabolic and nutritional (EMN problems (OR 2,5 had a significantly higher chance of being referred. Patients receiving professional nursing care (OR 0,2 and patients for whom their own general practitioner had transferred information to the out-of-hours cooperative (OR 0,4 had a significantly lower chance of hospital referral. The most frequent reasons for hospital referral, as noted by the out-of-hours general practitioner, were digestive (30%, EMN (19% and respiratory (17% problems. Conclusion Whilst acknowledging that an out-of-hours hospital referral can be the most desirable option in some situations, this study provides suggestions for avoiding undesirable hospital referrals by out-of-hours general practitioners at the end of life. These include anticipating digestive, EMN, respiratory and cardiovascular symptoms in palliative care patients.

De Korte-Verhoef Maria C

2012-08-01

142

REGISTRO DE PARO CARDÍACO EN EL ADULTO Registries of outer hospital cardiac arrest in Bogotta-Colombia  

Directory of Open Access Journals (Sweden)

Full Text Available En nuestro país no hay un registro estandarizado de los eventos cardíacos que requieren reanimación cerebro-cardio-pulmonar (RCCP siguiendo los lineamientos "Utstein". El propósito de este estudio fue determinar la calidad de los registros extrahospitalarios de paro cardíaco en el adulto, en Bogotá-Colombia. Entre enero y marzo de 2005 se realizó un análisis retrospectivo de los casos que correspondieron a paro cardíaco en el adulto atendidos por el "Centro Regulador de Urgencias del Distrito (CRU". El estudio reveló un registro deficiente de los eventos que requirieron RCCP realizados a nivel prehospitalario, e identificó al trauma como causa de paro cardíaco en 22% de los casos, una cifra particularmente elevada si se compara con los reportes mundiales, que oscilan entre 5% y 8%. Recomienda la estandarización del registro de paro cardíaco en el adulto, para lo cual se sugiere utilizar el formato de registro que sigue los lineamientos "Utstein".There is not a standardized registry form of cardiac events requiring cardiopulmonary resuscitation (CPR in our country such as the Utstein style. The purpose of this study was to determine the quality of the registries of out-ofhospital cardiac arrests in Bogotá-Colombia. A retrospective survey of registries of cardiac events assisted by a regulatory center "Centro Regulador de Urgencias del Distrito (CRU" was conducted, between January and March, 2005. The study reveals a poor registry of outof-hospital cardiac arrest in Bogotá-Colombia, and identifies trauma as the cause of cardiac arrest in 22% of cases, a particularly high figure compared with 5-8% registered worldwide. Recommend the standardization of the registry form of out-of-hospital cardiac arrest and suggest to use the "uniform reporting of data following cardiac arrest - the Utstein style". The registry forms are shown in appendix 1-2. Suggestions are welcome.

Ricardo Navarro Vargas

2005-07-01

143

REGISTRO DE PARO CARDÍACO EN EL ADULTO / Registries of outer hospital cardiac arrest in Bogotta-Colombia  

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish En nuestro país no hay un registro estandarizado de los eventos cardíacos que requieren reanimación cerebro-cardio-pulmonar (RCCP) siguiendo los lineamientos "Utstein". El propósito de este estudio fue determinar la calidad de los registros extrahospitalarios de paro cardíaco en el adulto, en Bogotá [...] -Colombia. Entre enero y marzo de 2005 se realizó un análisis retrospectivo de los casos que correspondieron a paro cardíaco en el adulto atendidos por el "Centro Regulador de Urgencias del Distrito (CRU)". El estudio reveló un registro deficiente de los eventos que requirieron RCCP realizados a nivel prehospitalario, e identificó al trauma como causa de paro cardíaco en 22% de los casos, una cifra particularmente elevada si se compara con los reportes mundiales, que oscilan entre 5% y 8%. Recomienda la estandarización del registro de paro cardíaco en el adulto, para lo cual se sugiere utilizar el formato de registro que sigue los lineamientos "Utstein". Abstract in english There is not a standardized registry form of cardiac events requiring cardiopulmonary resuscitation (CPR) in our country such as the Utstein style. The purpose of this study was to determine the quality of the registries of out-ofhospital cardiac arrests in Bogotá-Colombia. A retrospective survey of [...] registries of cardiac events assisted by a regulatory center "Centro Regulador de Urgencias del Distrito (CRU)" was conducted, between January and March, 2005. The study reveals a poor registry of outof-hospital cardiac arrest in Bogotá-Colombia, and identifies trauma as the cause of cardiac arrest in 22% of cases, a particularly high figure compared with 5-8% registered worldwide. Recommend the standardization of the registry form of out-of-hospital cardiac arrest and suggest to use the "uniform reporting of data following cardiac arrest - the Utstein style". The registry forms are shown in appendix 1-2. Suggestions are welcome.

Ricardo, Navarro Vargas.

2005-07-01

144

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

OpenAIRE

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

1997-01-01

145

Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Report of Ten Cases.  

Science.gov (United States)

Abstract Background. Ventricular fibrillation (VF) is considered the out-of-hospital cardiac arrest (OOHCA) rhythm with the highest likelihood of neurologically intact survival. Unfortunately, there are occasions when VF does not respond to standard defibrillatory shocks. Current American Heart Association (AHA) guidelines acknowledge that the data are insufficient in determining the optimal pad placement, waveform, or energy level that produce the best conversion rates from OOHCA with VF. Objective. To describe a technique of double sequential external defibrillation (DSED) for cases of refractory VF (RVF) during OOHCA resuscitation. Methods. A retrospective case series was performed in an urban/suburban emergency medical services (EMS) system with advanced life support care and a population of 900,000. Included were all adult OOHCAs having RVF during resuscitation efforts by EMS providers. RVF was defined as persistent VF following at least 5 unsuccessful single shocks, epinephrine administration, and a dose of antiarrhythmic medication. Once the patient was in RVF, EMS personnel applied a second set of pads and utilized a second defibrillator for single defibrillation with the new monitor/pad placement. If VF continued, EMS personnel then utilized the original and second monitor/defibrillator charged to maximum energy, and shocks were delivered from both machines simultaneously. Data were collected from electronic dispatch and patient care reports for descriptive analysis. Results. From 01/07/2008 to 12/31/2010, a total of 10 patients were treated with DSED. The median age was 76.5 (IQR: 65-82), with median resuscitation time of 51minutes (IQR: 45-62). The median number of single shocks was 6.5 (IQR: 6-11), with a median of 2 (IQR: 1-3) DSED shocks delivered. VF broke after DSED in 7 cases (70%). Only 3 patients (30%) had ROSC in the field, and none survived to discharge. Conclusion. This case series demonstrates that DSED may be a feasible technique as part of an aggressive treatment plan for RVF in the out-of-hospital setting. In this series, RVF was terminated 70% of the time, but no patient survived to discharge. Further research is needed to better understand the characteristics of and treatment strategies for RVF. PMID:25243771

Cabañas, José G; Myers, J Brent; Williams, Jefferson G; De Maio, Valerie J; Bachman, Michael W

2015-01-01

146

The role of nurses in the resuscitation of in-hospital cardiac arrests.  

Science.gov (United States)

Survival rates for in-hospital cardiac arrests are disappointing. Even though such arrests are often witnessed by a nurse, inadequate training may cause these first responders to have to wait for Advanced Cardiac Life Support trained personnel to arrive to perform defibrillation. The introduction of automated external defibrillator (AED) use by nurses was designed to address this problem, but studies have revealed that AED use is associated with a lower rate of survival after in-hospital cardiac arrest compared with no AED use. Interruption to cardiopulmonary resuscitation during the AED advisory mode is the likely reason for these unexpected results. Hence, courses like the Life Support Course for Nurses, which trains nurses to recognise collapse rhythms and to institute manual defibrillation, are extremely important. Barriers to the practice of advanced life support by nurses and recommendations for the prevention and management of in-hospital cardiac arrest are discussed. PMID:21879222

Heng, K W J; Fong, M K; Wee, F C; Anantharaman, V

2011-08-01

147

Factors Related to Hospital Readmission of Elderly Cardiac Patients.  

Science.gov (United States)

Elderly patients with cardiac disease are at high risk for physical deterioration during posthospital recovery and suffer frequent early readmission. Study results found that mental status and posthospital stress were significantly related to early readmission. (Author)

Berkman, Barbara; Abrams, Ruth D.

1986-01-01

148

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

Science.gov (United States)

A review of US poison center data for 2004 showed over 8,000 ingestions of methylphenidate. 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 out-of-hospital management of patients with suspected ingestions of methylphenidate by 1) describing the process by which a specialist in poison information should evaluate an exposure to methylphenidate, 2) identifying the key decision elements in managing cases of methylphenidate ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This review focuses on the ingestion of more than a single therapeutic dose of methylphenidate and the effects of an overdose and 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 (Grade D). 2) In patients without evidence of self-harm, abuse, or malicious intent, poison center personnel should elicit additional information including the time of the ingestion, the precise dose ingested, and the presence of coingestants (Grade D). 3) Patients who are chronically taking a monoamine oxidase inhibitor and who have ingested any amount of methylphenidate require referral to an emergency department (Grade D). 4) Patients experiencing any changes in behavior other than mild stimulation or agitation should be referred to an emergency department. Examples of moderate to severe symptoms that warrant referral include moderate-to-severe agitation, hallucinations, abnormal muscle movements, headache, chest pain, loss of consciousness, or convulsions (Grade D). 5) For patients referred to an emergency department, transportation via ambulance should be considered based on several factors including the condition of the patient and the length of time it will take for the patient to arrive at the emergency department (Grade D). 6) If the patient has no symptoms, and more than 3 hours have elapsed between the time of ingestion and the call to the poison center, referral to an emergency department is not recommended (Grade D). 7) Patients with acute or acute-on-chronic ingestions of less than a toxic dose (see recommendations 8, 9, and 10) or chronic exposures to methylphenidate with no or mild symptoms can be observed at home with instructions to call the poison center back if symptoms develop or worsen. For acute-on-chronic ingestions, the caller should be instructed not to administer methylphenidate to the patient for the next 24 hours. The poison center should consider making a follow-up call at approximately 3 hours after ingestion (Grade D). 8) Patients who ingest more than 2 mg/kg or 60 mg, whichever is less, of an immediate-release formulation (or the equivalent amount of a modified-release formulation that has been chewed) should be referred

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

2007-01-01

149

Ten-year evaluation of cardiac myxoma in Shahid Modarres Hospital  

OpenAIRE

Background: Primary cardiac tumors are rare tumors which should be operated urgently. In this study, cardiac myxoma have been evaluated from diagnosis until dis-charge in a 10 years period and then results including presenting symptoms, approach to the patients were compared with similar study in this center a decade ago. Methods: Patients who underwent operation for myxoma from year 2003 until 2013 in the Shahid Modarres Hospital were included in this study. Results: Eighteen patients ...

Seyed Masoud Majidi Tehrani; Hamid Ghaderi; Mahnoosh Foroughi; Manouchehr Hekmat; Mahmoud Beheshti Monfared; Hassan Tatari; Seyed Mohsen Mirhosseini; Zargham Hossein Ahmadi; Zahra Ansari Aval; Seyedeh Adeleh Mirjafari

2014-01-01

150

Data integration in cardiac surgery health care institution: experience at G. Pasquinucci Heart Hospital  

OpenAIRE

During the last ten years the Hospital Information System (HIS) was developed at the Institute of Clinical Physiology of National Research Council (IFC-CNR), recently reorganized on clinical side into the "Gabriele Monasterio Foundation" (FGM) by joint efforts of CNR, Tuscany Region and Universities. At G.Pasquinucci Heart Hospital (GPH), currently FGM's section in Massa, the HIS was adapted and extended to Cardiac Surgery and Pediatric Cardiology. Data archiving and middleware integration th...

Taddei, Alessandro; Dalmiani, Stefano; Vellani, Antonio; Rocca, E.; Piccini, Giacomo; Carducci, T.; Gori, A.; Borghini, R.; Marcheschi, Paolo; Mazzarisi, Alessandro; Salvatori, Cristina; Macerata, Alberto; Varanini, Maurizio

2008-01-01

151

In-hospital cardiac arrest is associated with use of non-antiarrhythmic QTc-prolonging drugs  

OpenAIRE

Aims: QTc interval-prolonging drugs have been linked to cardiac arrhythmias, cardiac arrest and sudden death. In this study we aimed to quantify the risk of cardiac arrest associated with the use of non-antiarrhythmic QTc-prolonging drugs in an academic hospital setting. Methods: We performed a case–control study in which patients, for whom intervention of the advanced life support resuscitation team was requested for cardiac arrest between 1995 and 2003 in the Aca...

De Bruin, M.L.; Langendijk, P. N. J.; Koopmans, R. P.; Wilde, A.; Leufkens, H. G. M.; Hoes, A. W.

2007-01-01

152

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

Directory of Open Access Journals (Sweden)

Full Text Available Abstract 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.

Chaudhary Isha

2010-06-01

153

Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update.  

Science.gov (United States)

To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia published in Wilderness & Environmental Medicine 2014;25(4):425-445. PMID:25498264

Zafren, Ken; Giesbrecht, Gordon G; Danzl, Daniel F; Brugger, Hermann; Sagalyn, Emily B; Walpoth, Beat; Weiss, Eric A; Auerbach, Paul S; McIntosh, Scott E; Némethy, Mária; McDevitt, Marion; Dow, Jennifer; Schoene, Robert B; Rodway, George W; Hackett, Peter H; Bennett, Brad L; Grissom, Colin K

2014-12-01

154

Key advances in critical care in the out-of-hospital setting: the evolving role of laypersons and technology  

OpenAIRE

During the past decade, critical care in the out-of-hospital setting has transcended the original emphasis on on-scene advanced life support interventions by doctors, paramedics, and nurses. Many of the life-saving efforts and advances in critical care situations have now begun to focus more and more on how, through evolving technology, the average person can save lives and perhaps even spare precious intensive care unit (ICU) resources. A striking example was the recent study conducted at th...

Pepe, Paul E.; Wigginton, Jane G.

2006-01-01

155

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

OpenAIRE

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, Munic...

Edouard Matevossian; Dietrich Doll; Amp Auml Ckl, Jakob S.; Inga Sinicina; et al.

2009-01-01

156

Fighting cardiac arrest: Automated external defibrillator  

OpenAIRE

Ventricular tachyarrhythmias - Ventricular fibrillation (VF) and Ventricular tachycardia (VT) account for most of out-of-hospital sudden cardiac arrests. Defibrillation is the specific therapy for VF/pulseless VT. Time to defibrillation is the most important determinant of survival from these cardiac arrests. Automated external defibrillator (AED) has largely replaced the conventional defibrillator in Basic life support (BLS) programmes for out-of-hospital cardiac arrests. AED use by trained ...

Kumar V; Adhikari K; Singh Y

2003-01-01

157

Cardiocerebral resuscitation: advances in cardiac arrest resuscitation  

Directory of Open Access Journals (Sweden)

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

Erwin Mulia

2011-11-01

158

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

Science.gov (United States)

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

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

2015-01-01

159

Estimating cost savings from regionalizing cardiac procedures using hospital discharge data  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background We examined whether higher procedure volumes for coronary artery bypass graft (CABG surgery or percutaneous coronary interventions (PCI were associated with lower costs per patient, and if so, estimated the financial savings from regionalizing cardiac procedures. Methods Cost regressions with hospital-specific dummy variables measured within-hospital cost reductions associated with increasing hospital volume. We used the regression estimates to predict the change in total costs that would result from moving patients in low-volume hospitals to higher volume facilities. Results A 10% increase in PCI procedure volume lowered costs per patient by 0.7%. For the average hospital performing CABG in 2000, a 10% increase in volume was associated with a 2.8% reduction in average costs. Despite these lower costs, the predicted savings from regionalizing all PCI procedures in the sample from lower to high-volume hospitals amounted to only 1.1% of the entire costs of performing PCI procedures for the sample in 2000. Similarly, the cost savings for CABG were estimated to be only 3.5%. Conclusion Higher volumes were associated with lower costs per procedure. However, the total potential savings from regionalizing cardiac procedures is relatively minor, and may not justify the risks of reducing access to needed services.

Petersen Laura A

2007-06-01

160

Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia.  

Science.gov (United States)

To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. PMID:25443771

Zafren, Ken; Giesbrecht, Gordon G; Danzl, Daniel F; Brugger, Hermann; Sagalyn, Emily B; Walpoth, Beat; Weiss, Eric A; Auerbach, Paul S; McIntosh, Scott E; Némethy, Mária; McDevitt, Marion; Dow, Jennifer; Schoene, Robert B; Rodway, George W; Hackett, Peter H; Bennett, Brad L; Grissom, Colin K

2014-12-01

161

[Out-of-the-hospital care for terminal cancer patients. Clinical and organizational features. Our experience].  

Science.gov (United States)

Home care for terminal oncological patients is, in Italy and in many other highly developed countries, a rapidly expanding part of the health system. At the time of writing it would appear to be the most valid response to the mounting economic and social demands of the population. The present paper has two purposes: 1) to propose an integrated home care operating model for the cancer patient that comprises various operating stages: a) recruitment of patients on the basis of the seriousness of the cancer, life expectancy and socioeconomic conditions of the family; b) interdisciplinary planning of a personalized care project; c) implementation of an integrated care programme at the home of the patient; d) periodic control of the project team; e) periodic professional courses for health personnel; 2) to illustrate our specific clinical expertise in the sector, in 16 months of activity (October 94-February 96) during which we handled on a home basis 27 cancer patients at an advanced stage of the disease; specifically, we describe the main internal-oncological and palliative type problems encountered during the home care period; 3) finally, to highlight in terms of cost/benefit ratio the economic advantages of home compared to the traditional hospitalization care model. PMID:9132628

Marchei, P; Simeoni, F; Bianco, V; Santini, D; Balducci, M; Vecchione, A; Frati, L

1997-01-01

162

Hospital variation in transfusion and infection after cardiac surgery: a cohort study  

OpenAIRE

Abstract Background Transfusion practices in hospitalised patients are being re-evaluated, in part due to studies indicating adverse effects in patients receiving large quantities of stored blood. Concomitant with this re-examination have been reports showing variability in the use of specific blood components. This investigation was designed to assess hospital variation in blood use and outcomes in cardiac surgery patients. Methods We evaluated outcomes in 24,7...

Saint Sanjay; Blumberg Neil; Am, Rogers Mary; Langa Kenneth M; Nallamothu Brahmajee K

2009-01-01

163

Outcome of In-Hospital Cardiac Arrest in Adult General Wards  

OpenAIRE

Objective: Few studies have focused on factors influencing outcomes of patients with in-hospital cardiac arrest (IHCA) in general wards. The goal of this study was to report the outcomes of adult patients with IHCA in the general wards and identified the prognostic factors. Methods: Adult patients with IHCA having received cardiopulmonary resuscitation in general wards from January 2008 to December 2011 were retrospectively reviewed from our registry system. The primary outcome was survival t...

Chia-Te Kung; Hsien-Hung Cheng; Shin-Chiang Hung; Chao-Jui Li; Chu-Feng Liu; Fu-Cheng Chen; Chih-Min Su; Jien-Wei Liu; Hung-Yi Chuang

2014-01-01

164

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

Scientific Electronic Library Online (English)

Full Text Available SciELO South Africa | Language: English Abstract in english 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.

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

2008-07-01

165

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)

166

Outcome of In-Hospital Cardiac Arrest in Adult General Wards  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: Few studies have focused on factors influencing outcomes of patients with in-hospital cardiac arrest (IHCA in general wards. The goal of this study was to report the outcomes of adult patients with IHCA in the general wards and identified the prognostic factors. Methods: Adult patients with IHCA having received cardiopulmonary resuscitation in general wards from January 2008 to December 2011 were retrospectively reviewed from our registry system. The primary outcome was survival to hospital discharge, while the secondary outcome was sustained return of spontaneous circulation (ROSC. Results: A total of 544 general ward patients were analyzed for event variables and resuscitation results. The rate of establishing a ROSC was 40.1% and the rate of survival to discharge was 5.1%. Ventricular tachycardia/ventricular fibrillation (VT/VF was the initial rhythm in 3.9% of patients. Pre-arrest factors including a high Charlson comorbidity index (CCI ? 9 (OR 0.251, 95% CI 0.098 - 0.646, cardiac comorbidity (OR 0.612, 95% CI 0.401 - 0.933, and arrest time on the midnight shift (OR 0.403, 95% CI 0.252 - 0.642 were independently associated with a low possibility of ROSC. The initial VT/VF presenting rhythms (OR 0.135, 95% CI 0.030 - 0.601 were independently associated with a high survival rate, whereas patients with deteriorated disease course were independently associated with a decreased hospital survival (OR 3.902, 95% CI 1.619 - 9.403. Conclusions: We demonstrated that pre-arrest factors can predict patient outcome after IHCA in general wards, including the association of a CCI ? 9 and cardiac comorbidity with poor ROSC, and deteriorated disease course as an independent predictor of a low survival rate.

Chia-Te Kung

2014-10-01

167

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

Directory of Open Access Journals (Sweden)

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.

Wright Desmond

2009-07-01

168

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.)

169

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)

170

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

Directory of Open Access Journals (Sweden)

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

Latasch Leo

2011-10-01

171

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

Scientific Electronic Library Online (English)

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

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

2009-08-01

172

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

Directory of Open Access Journals (Sweden)

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

Pablo Lister

2009-08-01

173

Electrical therapies in cardiac arrest.  

Science.gov (United States)

Recognition and appropriate treatment of ventricular fibrillation or pulseless ventricular tachycardia is an essential skill for healthcare providers. Appropriate defibrillation can improve survival and benefit patient outcome. Similarly, increased public access to automatic electronic defibrillators has been shown to improve out-of-hospital survival for cardiac arrest. When combined with high-quality cardiopulmonary resuscitation, electrical therapies are an important aspect of resuscitation in the patient with cardiac arrest. This article focuses on the use of electrical therapies, including defibrillation, cardiac pacing, and automated external defibrillators, in cardiac arrest. PMID:22107974

Monteleone, Peter P; Borek, Heather A; Althoff, Seth O

2012-02-01

174

High-velocity penetrating thoracic trauma with suspected cardiac involvement in a combat support hospital  

International Nuclear Information System (INIS)

The most common cardiac injuries in the United States are blunt trauma from motor vehicle accidents or low-velocity trauma from stabbings. During military conflict, high-velocity injuries, including gunshot wounds (GSW) and fragment injury from improvised explosive devices (IED), are relatively more common. This is a retrospective review of cases with high-velocity penetrating injury and suspected myocardial involvement during a 6-month period in Baghdad, Iraq, at a United States Army hospital during Operation Iraqi Freedom. Eleven cases survived to admission (GSW in 5, IED in 6). The mean age of the all-male cohort was 27 years (range, 3-54 years). Eight of the 11 patients (73%) were victims of polytrauma. The entrance involved the right ventricle (n=3), right atrium (n=2), left ventricle (n=1), or mediastinum and pericardial reflections (n=5). Echocardiography was performed in all 11 patients. In 7 patients, no foreign body was identifiable, and in 2 patients the foreign body was identified within the pericardial fat pad. Three patients were identified as having a suspected ventricular septal defect, ranging in size from 2 to 8 mm. The most common electrocardiographic abnormality was atrioventricular block and right bundle branch block. In 4 patients, the management of the chest injury was nonsurgical, and in 1 patient the treatment was a chest tube only. Four of the patients underwent median sternotomy, 1 underwent emergent lateral thoracotomy, and 1 underwent an i lateral thoracotomy, and 1 underwent an infradiaphragmatic approach. This case series is too small to draw definitive conclusions; however, a multidisciplinary approach to high-velocity injuries with potential for cardiac involvement augments preoperative assessment for myocardial injury and may allow selective nonoperative management. (author)

175

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

OpenAIRE

Abstract 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 scre...

Chaudhary Isha; Jain Manish; Halder Ashutosh; Kabra Madhulika

2010-01-01

176

[Unexpected out-of-hospital deliveries--experiences from the Gothenburg area. Centralized obstetrical care requires competent ambulance staff].  

OpenAIRE

One hundred and sixty-seven women gave birth before arrival at the hospital during a six-year period in the Göteborg area. Most of these women had given birth before. The actual delivery most often started at term during the night, proceeded normally but rapidly and the neonatal outcome was good. Sixty-two per cent of the women delivered at home. Complicated lacerations or major hemorrhages were uncommon. The distance to the delivery ward was one of the risk factors for prehospital delivery....

Aladdin, Bh; Jacobsson, B.; Sandberg, K.; Lilja, H.

2004-01-01

177

Fighting cardiac arrest: Automated external defibrillator  

Directory of Open Access Journals (Sweden)

Full Text Available Ventricular tachyarrhythmias - Ventricular fibrillation (VF and Ventricular tachycardia (VT account for most of out-of-hospital sudden cardiac arrests. Defibrillation is the specific therapy for VF/pulseless VT. Time to defibrillation is the most important determinant of survival from these cardiac arrests. Automated external defibrillator (AED has largely replaced the conventional defibrillator in Basic life support (BLS programmes for out-of-hospital cardiac arrests. AED use by trained laypersons in the community as part of Public Access Defibrillation (PAD programmes has significantly reduced time to defibrillation and increased survival. AED is now being stipulated for home use in people at high risk of sudden cardiac death. AED placement is also recommended in all areas of hospital. Physicians and Intesivists should strive to familiarize the medical fraternity in our country with AED use so that PAD programmes can be launched in the near future.

Kumar V

2003-01-01

178

Cardiac Complication Rate In Emergent Vascular Procedures Tehran Sina Hospital (2000-2001  

Directory of Open Access Journals (Sweden)

Full Text Available Complications of Coronary artery disease remain the most common cause of morbidity and mortality after vascular surgical procedures. Goldman risk factor analysis has been suggested as peri-operative noninvasive screening method to detect significant coronary artery disease in emergent vascular procedures."nMethods and Materials: In this study, the accuracy of the Goldman scale was assessed with regard to the development of cardiac complications such as asymptomatic ischemic change in ECG, arrhythmia, myocardial infarction and cardiac death. We studied 100 patients that were required emergent vascular procedures from 2000-2001. Data about perioperative complications were extracted and analyzed using SPSS computer program."nResults: Our study indicated there is not statistical correlation between cardiac death, infarction, arrythmia, ECG change, age, sex and cardiac class."nConclusion: We concluded that Goldman scale could not be regarded as a screening method to predict peri-operative cardiac complications in emergent vascular procedures.

Ahmadi H

2003-06-01

179

Repair of a Complex Congenital Cardiac Defect  

Medline Plus

Full Text Available ... from Children's Hospital Boston's cardiac OR, see cardiac surgeons repair a complex congenital cardiac defect. Each year ... Emile Bacha. I'm one of the cardiac surgeons at Children's Hospital Boston and associate professor of ...

180

Cardiac arrest in children  

Directory of Open Access Journals (Sweden)

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.

Tress Erika

2010-01-01

181

Hypothermia and pediatric cardiac arrest  

Directory of Open Access Journals (Sweden)

Full Text Available The survival outcome following pediatric cardiac arrest still remains poor. Survival to hospital discharge ranges anywhere from 0 to 38% when considering both out-of-hospital and in-hospital arrests, with up to 50% of the survivors having neurologic injury. The use of mild induced hypothermia has not been definitively proven to improve outcomes following pediatric cardiac arrest. This may be due to the lack of consensus regarding target temperature, best method of cooling, optimal duration of cooling and identifying the patient population who will receive the greatest benefit. We review the current applications of induced hypothermia in pediatric patients following cardiac arrest after searching the current literature through Pubmed and Ovid journal databases. We put forth compiled recommendations/guidelines for initiating hypothermia therapy, its maintenance, associated monitoring and suggested adjunctive therapies to produce favorable neurologic and survival outcomes.

Schlunt Michelle

2010-01-01

182

Determinants of distance walked during the six-minute walk test in patients undergoing cardiac surgery at hospital discharge  

Science.gov (United States)

Introduction The aim of this study was to identify the determinants of distance walked in six-minute walk test (6MWD) in patients undergoing cardiac surgery at hospital discharge. Methods The assessment was performed preoperatively and at discharge. Data from patient records were collected and measurement of the Functional Independence Measure (FIM) and the Nottingham Health Profile (NHP) were performed. The six-minute walk test (6MWT) was performed at discharge. Patients undergoing elective cardiac surgery, coronary artery bypass grafting or valve replacement were eligible. Patients older than 75 years who presented arrhythmia during the protocol, with psychiatric disorders, muscular or neurological disorders were excluded from the study. Results Sixty patients (44.26% male, mean age 51.53?±?13 years) were assessed. In multivariate analysis the following variables were selected: type of surgery (P?=?0.001), duration of cardiopulmonary bypass (CPB) (P?=?0.001), Functional Independence Measure - FIM (0.004) and body mass index - BMI (0.007) with r?=?0.91 and r2?=?0.83 with P?MWD?=?Surgery (89.42)?+?CPB (1.60)?+?MIF (2.79 ) - BMI (7.53) - 127.90. Conclusion In this study, the determinants of 6MWD in patients undergoing cardiac surgery were: the type of surgery, CPB time, functional capacity and body mass index. PMID:24885130

2014-01-01

183

Influence of diabetes, high blood pressure and smoking habit to hospital admission of patients with cardiac heart failure  

Directory of Open Access Journals (Sweden)

Full Text Available Heart failure is a result of many cardiac diseases and the reason for about 20 percent of hospital admissions of elderly patients aged over 65.The objective of the study was establish influence of diabetes mellitus, high blood pressure and smoking to hospitalization of patients with heart failure. We performed a retrospective observational study of patients with CHF admitted to Cardiology Department of the Cantonal Hospital Zenica between April 2005 and April 2001. Age, sex and risk factors for diabetes mellitus, high blood pressure and smoking were evaluated. A total of 754 patients were treated , 78 (9% of them having been with CHF: 35(44,87% men and 43 (55,12% women, without significant sex differences. Diabetes was presented at 32 (41% patients with CHF, 7(9% men and 25 (32 % women (p>0,05. 32(41% of patients with CHF suffered from diabetes mellitus,7 (9% men and 25 (32% women, 48(61% were smokers, and 42 (54% patients had high blood pressure. Diabetes mellitus, high blood pressure and smoking were significant factors for hospitalization of patients with CHF in this study whereas diabetes mellitus was a significant risk factor for female patinets. These data correspond to the data from the world references and once again they outline significance of treating risk factors for arteriosclerosis and hear failure.

A. Maci?-Džankovi?

2007-02-01

184

Hypothermia and cardiac arrest: the promise of intra-arrest cooling  

OpenAIRE

Over the past several years, the implementation of therapeutic hypothermia has provided an exciting opportunity toward improving survival from out-of-hospital cardiac arrest. There are compelling data to support the prompt use of therapeutic hypothermia for initial survivors from out-of-hospital cardiac arrest, but animal data have suggested that initiation of therapeutic hypothermia during the intra-arrest period may significantly improve outcomes even further. In the first feasibility study...

Band, Roger A.; Abella, Benjamin S.

2008-01-01

185

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)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

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

2013-09-01

186

Can linked emergency department data help assess the out-of-hospital burden of acute lower respiratory infections? A population-based cohort study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background There is a lack of data on the out-of-hospital burden of acute lower respiratory infections (ALRI in developed countries. Administrative datasets from emergency departments (ED may assist in addressing this. Methods We undertook a retrospective population-based study of ED presentations for respiratory-related reasons linked to birth data from 245,249 singleton live births in Western Australia. ED presentation rates Results ED data from metropolitan WA, representing 178,810 births were available for analysis. From 35,136 presentations, 18,582 (52.9% had an International Classification of Diseases (ICD code for ALRI and 434 had a symptom code directly relating to an ALRI ICD code. A further 9600 presentations had a non-specific diagnosis. From the combined 19,016 ALRI presentations, the highest rates were in non-Aboriginal children aged 6–11 months (81.1/1000 child-years and Aboriginal children aged 1–5 months (314.8/1000. Croup and bronchiolitis accounted for the majority of ALRI ED presentations. Of Aboriginal births, 14.2% presented at least once to ED before age 5 years compared to 6.5% of non-Aboriginal births. Male sex and maternal age Conclusions ED data can give an insight into the out-of-hospital burden of ALRI. Presentation rates to ED for ALRI were high, but are minimum estimates due to current limitations of the ED datasets. Recommendations for improvement of these data are provided. Despite these limitations, ALRI, in particular bronchiolitis and croup are important causes of presentation to paediatric EDs.

Moore Hannah C

2012-08-01

187

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)

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.

Gasse, Christiane; Laursen, Thomas M

2014-01-01

188

The association of willingness-to-pay and patient attributes: a cost-volume-profit analysis of cardiac catheter unit services in Ramallah Hospital, Palestine.  

Science.gov (United States)

The purpose of this study is to examine the association of willingness-to-pay and patient attributes in relation to the multi-service cost-volume-profit structure of a cardiac catheter unit in Ramallah Hospital. This article contributes to the literature by providing primary evidence on patient willingness-to-pay, by identifying the specific break-even parameters of three hospital cardiac catheter unit service types (diagnosis, balloon, and pacemaker), and by demonstrating the cross-subsidization of patient income groups that is inherent in the existing hospital rate structure. Our results provide information useful for (1) evidence-based policy making with respect to hospital rate setting and cross-subsidies of patient income groups; (2) the advancement of hospital management, by demonstrating the estimated variable and fixed cost parameters and the impact of patient revenue mix on the profitability of cardiac catheter unit services; and (3) the advancement of theory, by documenting the relationship of patient demand and the cost of supply in a multi-patient-group, multi-service hospital setting. PMID:19891208

Jabr, Samer F K; Younis, Mustafa Mike Z; Forgione, Dana A

2009-01-01

189

Coronary angioplasty for acute myocardial infarction in a hospital without cardiac surgery.  

OpenAIRE

We evaluated, retrospectively, the hospital records of 100 consecutive patients with acute myocardial infarction who underwent emergency coronary angiography and percutaneous transluminal coronary angioplasty between January 1984 and August 1990. Intracoronary streptokinase (250,000 to 1 million units) was administered to 46 of these patients. Reperfusion was achieved in 82 patients, 8 of whom died in the hospital within 30 days. Angioplasty failed in 18 patients. Six were managed medically a...

Iannone, L. A.; Anderson, S. M.; Phillips, S. J.

1993-01-01

190

Koronarangiografi bør overvejes efter hjertestop uden for hospital  

DEFF Research Database (Denmark)

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.

Moesgaard, Jacob; LØfgren, Bo

2011-01-01

191

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

192

Psychiatric Co-Morbidity and Its Associated Factors in Patients with Non Cardiac Chest Pain: A Study from a Tertiary Care Hospital, Kolkata  

OpenAIRE

Background: Chest pain is a common symptom for patients to attend hospital outdoor all over the world. Majority of the chest pain is due to non-cardiac causes. Both organic and psychiatric causes contribute to the causes of non-cardiac chest pain. Objectives: To find out the socio-demographic profile of the study population, types of psychiatric disorders present in the study population and to find out the association between the presence of psychiatric disorder in the study population with t...

Abhik Sinha; Sukhendu Mondal; Asish Mukhopadhyay; Sarmila Mallik; Ashis Debnath; Kantibhushan Choudhury

2013-01-01

193

Recognizing the Deteriorating Patient Prior to Cardiac Arrest: Predictive Criteria and Risk Factors  

Directory of Open Access Journals (Sweden)

Full Text Available Cardiac arrest is a common end point of various pathophysiological pathways. Out-of-hospital and in-hospital cardiac arrests have a similarly poor survival, although differences exist in terms of pathogenetic mechanisms and prognostic factors. There is time to recognize the deteriorating patient, especially in hospital. Early warning scores and systems that rely on physiological parameters present a window of opportunity for recognizing the deteriorating patient for early intervention. In order to prevent cardiac arrests and improve the subsequent survival, it is necessary to implement a rapid and effective chain of survival and to move from a reactive approach to a proactive one.

Mine Durusu Tanr?över

2011-04-01

194

Patients Dismissed From the Hospital With a Diagnosis of Noncardiac Chest Pain: Cardiac Outcomes and Health Care Utilization  

OpenAIRE

OBJECTIVE: To determine the proportion of patients with noncardiac chest pain (NCCP) who see a gastroenterologist, the type and frequency of gastrointestinal (GI) and cardiac tests performed, and the frequency of cardiac death.

Leise, Michael D.; Locke, G. Richard; Dierkhising, Ross A.; Zinsmeister, Alan R.; Reeder, Guy S.; Talley, Nicholas J.

2010-01-01

195

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)

196

Impact of 'fire drill' training and dedicated obstetric resuscitation code in improving fetomaternal outcome following cardiac arrest in a tertiary referral hospital setting in Singapore.  

Science.gov (United States)

Cardiac arrest in pregnancy is a rare but catastrophic obstetric emergency, with a quoted incidence of 1:20,000 pregnancies. Speedy multidisciplinary interventions are crucial for good maternal and foetal outcomes. A perimortem caesarean section (PMCS) initiated within 4 min of onset of cardiac arrest to minimise the effect of aortocaval compression on cardiopulmonary resuscitation (CPR) has been recommended as a key intervention, which is likely to improve survival of both mother and foetus. Sudden collapse is uncommon in pregnant women and their management is more challenging than in a non-pregnant patient. This article aims to emphasise the significance of early identification and management of impending or established maternal cardiac arrest. We propose that a focus on effective and good-quality CPR, utilising key interventions such as early airway control, left uterine displacement and a timely decision for a PMCS with multidisciplinary input is more likely to result in good maternal and foetal survival and neurological outcomes. We also discuss the role of 'fire drill' obstetric training for key staff and the use of a dedicated hospital-wide resuscitation code for managing collapse in obstetric patients in improving survival and outcomes. We present four cases of maternal cardiac arrest managed with PMCS in our hospital, highlighting the evolution in management and with improved outcomes following changes to our resuscitation guidelines, training and workflows. PMID:25472736

Pandian, Radha; Mathur, Manisha; Mathur, Deepak

2014-12-01

197

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

Scientific Electronic Library Online (English)

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

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

2010-06-01

198

The effect of therapeutic hypothermia after cardiac arrest  

OpenAIRE

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 ...

Georgia Mavrogianni; Sevasti Petraki; Konstadina Xidou; Vasiliki Avramopoulou; John Kontzinos

2013-01-01

199

Análise das complicações hospitalares relacionadas ao cateterismo cardíaco / Analysis of in-hospital complications related to cardiac catheterization  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese INTRODUÇÃO: As complicações relacionadas ao cateterismo cardíaco são os principais limitantes desta técnica, e podem variar desde eventos adversos leves e transitórios até eventos graves, como infarto do miocárdio ou morte. OBJETIVO: Avaliar a incidência de complicações imediatas do cateterismo card [...] íaco diagnóstico em adultos, conforme um modelo de categorização das complicações em tipo e gravidade. MÉTODO: Estudo de coorte prospectivo em um centro de referência. As características dos pacientes foram registradas, e estes foram acompanhados até a alta hospitalar. As complicações foram categorizadas em nove modalidades: alérgica, isquêmica, vascular, arrítmica, vaso-vagal, pirogênica, neurológica, embólica e congestivas, e estratificadas em leves (intercorrências), moderadas (resolvidas em até 24 horas) ou graves (necessitou internação ou intervenção). Os fatores preditivos de complicações foram identificados por análise multivariada. RESULTADOS: Foram incluídos 1916 indivíduos, sendo 59,4% do sexo masculino e com média de idade de 58,3±11,1 anos. Complicações ocorreram em 175 pacientes (190 eventos), sendo que 62,5% foram intercorrências leves, 24% moderadas e 13,5% graves. Foi registrado apenas um óbito (0,05% dos indivíduos). As complicações vasculares foram as mais incidentes (35,6%), seguidas das vagais (18,3%), isquêmicas (15,4%) e alérgicas (14,4%). Os fatores de risco para complicações pela análise multivariada foram uso de anticoagulante (3,59; 1,67-7,74; p=0,006) e duração prolongada do exame (1,03; 1,02-1,04; p Abstract in english BACKGROUND: The major limitations of cardiac catheterization are the occurrence of complications related to its invasive nature. Complications can vary from mild and transitory reactions to severe adverse events like myocardial infarction or death. OBJECTIVE: To assess the incidence, type and severi [...] ty of complications related to cardiac catheterization in adults using a comprehensive system previously described. METHODS: We conducted a prospective cohort study in a tertiary reference center, and patient characteristics and in-hospital outcomes were registered in a dedicated database. Complications were categorized in nine types: allergic, ischemic, vascular, arrythmic, vagal, pyrogenic, neurological, embolic and congestive, and stratified in mild, moderate (resolved in 24 hours) or severe (needed hospitalization or another intervention). The predictive factors of complications were assessed by multivariate analysis. RESULTS: We included 1916 individuals, 59% male and with a mean age of 58±11 years. Complications occurred in 175 patients (190 events), and 63% were mild, 24% moderate e 13% severe. There was one (0.05%) death in the entire cohort. Vascular complications were the most common type (36%), followed by vagal (18%), ischemic (15%) and allergic (14%). Risk factors for complications by multivariate analysis were anticoagulant use (OR=3.59; CI=1.67-7.74; p=0.006) and prolonged examination time (OR=1.03; CI=1.02-1.04; p

Géderson, Rossato; Alexandre Schaan de, Quadros; Rogério, Sarmento-Leite; Carlos Antonio M., Gottschall.

2007-03-01

200

Response interval is important for survival until admission after prehospital cardiac arrest  

DEFF Research Database (Denmark)

An increasing distance to the nearest hospital must be expected as a result of centralization of acute care at a small number of hospitals. This may have important consequences in emergency situations, such as prehospital or out-of-hospital cardiac arrest (OHCA) where the aim is to obtain return of spontaneous circulation (ROSC), i.e. successful resuscitation. The aim of this study was to describe the impact of response interval on sustained ROSC, i.e. ROSC at hospital admission, after OHCA with presumed cardiac aetiology.

Do, Hien Quoc; Nielsen, SØren Loumann

2010-01-01

201

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

Directory of Open Access Journals (Sweden)

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

Bignami Elena

2009-01-01

202

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)

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.

GONZALO GÓMEZ C

2009-10-01

203

Regional cardiac resuscitation systems of care  

Directory of Open Access Journals (Sweden)

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.

NICHOL GRAHAM

2010-09-01

204

Cardiac Malpositions  

Energy Technology Data Exchange (ETDEWEB)

Cardiac Malposition refers to any position of the heart other than a left-sided heart in a situs solitus individual. Associated cardiac malformations are so complex that even angiocardiographic and autopsy studies may not afford an accurate information. Although the terms and classifications used to describe the internal cardiac anatomy and their arterial connections in cardiac malpositions differ and tend to be confusing, common agreement exists on the need for a segmental approach to diagnosis. Authors present 18 cases of cardiac malpositions in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul National University Hospital between 1971 and 1979. Authors analyzed the clinical, radiographic, operative and autopsy findings with the emphasis on the angiocardiographic findings. The results are as follows: 1. Among 18 cases with cardiac malpositions, 6 cases had dextrocardia with situs inversus, 9 cases had dextrocardia with situs solitus and 3 cases had levocardia with situs inversus. 2. There was no genuine exception to visceroatrial concordance rule. 3. Associated cardiac malpositions were variable and complex with a tendency of high association of transposition and double outlet varieties with dextrocardia in situs solitus and levocardia in situs inversus. Only one in 6 cases of dextrocardia with situs inversus had pure transposition. 4. In two cases associated pulmonary atresia was found at surgery which was not predicted by angiocardiography. 5. Because many of the associated complex lesions can be corrected surgically provided the diagnosis is accurate, the selective biplane angiocardiography with or without cineradiography is essential.

Yoo, Shi Joon; Im, Chung Gie; Yeon, Kyung Mo; Hasn, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1979-06-15

205

Supporting lay bystanders during out-of-hospital cardiac arrest : comparison of video calls and audio calls for instructions and supervision  

OpenAIRE

Akuttmedisinske situasjoner krever rask, god og effektiv kommunikasjon. Publikum har i økende grad mulighet for videokonferanse via vanlige mobiltelefoner. Kan legfolk i fremtiden få bedre hjelp fra medisinsk nødnummer (113) hvis de kan vise levende bilder fra akuttmedisinske situasjoner via mobiltelefonen? Dette er hovedspørsmålet i dette doktorgradsarbeidet utført ved Nasjonalt senter for samhandling og telemedisin og Akuttmedisinsk klinikk ved Universitetssykehuset Nord-Norge. 180 el...

Bolle, Stein Roald

2011-01-01

206

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

Science.gov (United States)

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

207

Uso de Hipotermia en el Paro Cardiorrespiratorio Extrahospitalario: Reporte de un Caso / Use of Hypothermia in Out of Hospital Pediatric Arrest: A Case report  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish La hipotermia moderada mejora la mortalidad y el pronóstico neurológico en el paro cardíaco en adultos y en recién nacidos con asfixia neonatal. El efecto de la hipotermia en niños con paro cardiorrespiratorio (PCR) no se conoce. Objetivo: Describir el uso de la Hipotermia terapéutica en el PCR en u [...] na paciente pediátrica, y actualizar el conocimiento en dicha materia. Caso clínico: Preescolar sexo femenino, 4 años de edad que presentó un PCR extra hospitalario en la que se uso como neuroprotección hipotermia moderada (34 °C) durante 48 horas en la unidad de cuidados intensivos pediátricos, lo que permitió su alta en una condición neurológica satisfactoria, estimada por la escala Pediatric Cerebral Performance Category (PCPC) de 2, similar a su condición basal. También se revisa el uso de hipotermia en cuidado intensivo pediátrico, los métodos para inducir hipotermia y potenciales efectos secundarios de esta terapia. Abstract in english Moderate hypothermia decreases mortality and improves neurological outcome in adults as well as newborns affected with Neonatal Asphyxia. The effect of hypothermia among children with cardiac arrest (CRA) is not known. Objective: Case description of the use of therapeutic hypothermia in a pediatric [...] patient with cardiac arrest. Clinical Case: Four-year-old girl who presented extra-hospitalary CRA, where modérate hypothermia (34 degrees Celsius) was used for neurological protection in a PICU. The patient was discharged in satisfactory neurological condition, as rated through a Pediatric Cerebral Performance Category (PCPC) Test assessment, with a score of 2, similar to her baseline evaluation. Use of Hypothermia in PICU is discussed, as well as methods to induce this state and potential side effects of the treatment.

RAÚL, BUSTOS B; GONZALO, SOTO G; AMPARO, SÁNCHEZ Z; MARIANA, MONTOYA S.

2009-12-01

208

Optimizing Neurologically Intact Survival from Sudden Cardiac Arrest: A Call to Action  

Science.gov (United States)

The U.S. national out-of-hospital and in-hospital cardiac arrest survival rates, although improving recently, have remained suboptimal despite the collective efforts of individuals, communities, and professional societies. Only until very recently, and still with inconsistency, has focus been placed specifically on survival with pre-arrest neurologic function. The reality of current approaches to sudden cardiac arrest is that they are often lacking an integrative, multi-disciplinary approach, and without deserved funding and outcome analysis. In this manuscript, a multidisciplinary group of authors propose practice, process, technology, and policy initiatives to improve cardiac arrest survival with a focus on neurologic function. PMID:25493121

Goodloe, Jeffrey M.; Wayne, Marvin; Proehl, Jean; Levy, Michael K.; Yannopoulos, Demetris; Thigpen, Ken; O’Connor, Robert E.

2014-01-01

209

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 ...

210

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 ...

211

Dying to get out of the asylum: mortality and madness in four mental hospitals in Victorian Canada, c. 1841-1891.  

Science.gov (United States)

This article examines the status of lunatic cadavers during the second half of the nineteenth century. The first section summarizes cause of death data of over three thousand patients who were admitted to the four principal lunatic asylums in the province of Ontario (Canada). The results illuminate the alleged causes of death, revealing, among other factors, the impact of tuberculosis and general paralysis of the insane. The data also suggest that there was a steady increase in life chances of those entering the mental hospital over the five decades under study. The second section of the article investigates the tension between medical schools and asylum superintendents as educational requirements for nineteenth-century medical education necessitated more and more material for dissection, elevating the status of alienists as gatekeepers to cadavers. The article then concludes by reflecting on what implications these findings have for our understanding of the Victorian lunatic asylum. PMID:24362277

Wright, David; Jacklin, Laurie; Themeles, Tom

2013-01-01

212

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)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish 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.

GONZALO, GÓMEZ C; JOSÉ, HOLA B.

2009-10-01

213

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

Directory of Open Access Journals (Sweden)

Full Text Available 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 cardiac surgery. Methods: 474 pts from June 2003 through September 2004 had TSH and T4 measured. 365 pts were euthyroid (Group 1, 41 pts had SCHT (Group 2. Groups were compared by demographics and EuroSCORE (ES risk profiles. Operative and hospital outcomes were compared as was follow-up mortality up to 96 months. Results: There were more females in Group 2, p = 0.04, more pts with CHF and number of NYHA III-IV pts (p < 0.05. More pts in Group 2 had elevated s-crea (p < 0.0001 and atrial fibrillation (p = 0.007. Comparing the Groups by EuroSCORE (ES showed higher risk scores in Group 2 pts (Additive ES 6.8 vs 8.5 and Logistic ES 12.3% vs 18.1%, p = 0.01 and 0.03. Hospital mortality was higher in Group 2 (12.2% vs 4.1%, p = 0.04 and the number of pts needing extended care was higher in Group 2 (p = 0.01. Follow up mortality was doubled in Group 2 pts up to 96 months compared to Group 1 (p < 0.0001. Conclusions: Presentation characteristics and risk scores are different and worse in SCHT pts compared with euthyroid pts. Hospital and follow-up mortality are increased in SCHT pts.

Aarne Jyrala

2012-09-01

214

Cardiac Malpositions  

International Nuclear Information System (INIS)

Cardiac Malposition refers to any position of the heart other than a left-sided heart in a situs solitus individual. Associated cardiac malformations are so complex that even angiocardiographic and autopsy studies may not afford an accurate information. Although the terms and classifications used to describe the internal cardiac anatomy and their arterial connections in cardiac malpositions differ and tend to be confusing, common agreement exists on the need for a segmental approach to diagnosis. Authors present 18 cases of cardiac malpositions in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul National University Hospital between 1971 and 1979. Authors analyzed the clinical, radiographic, operative and autopsy findings with the emphasis on the angiocardiographic findings. The results are as follows: 1. Among 18 cases with cardiac malpositions, 6 cases had dextrocardia with situs inversus, 9 cases had dextrocardia with situs solitus and 3 cases had levocardia with situs inversus. 2. There was no genuine exception to visceroatrial concordance rule. 3. Associated cardiac malpositions were variable and complex with a tendency of high association of transposition and double outlet varieties with dextrocardia in situs solitus and levocardia in situs inversus. Only one in 6 cases of dextrocardia with situs inversus had pure transposition. 4. In two cases associated pulmonary atresia was found at surgery which was not predia was found at surgery which was not predicted by angiocardiography. 5. Because many of the associated complex lesions can be corrected surgically provided the diagnosis is accurate, the selective biplane angiocardiography with or without cineradiography is essential.

215

Simple training programme for ambulance personnel in the management of cardiac arrest in the community.  

OpenAIRE

The extended training for ambulance personnel in Nottinghamshire includes a period of training in cardiac resuscitation by defibrillation, and defibrillators are now part of the standard equipment of vehicles used on the accident and emergency service. Comparison of recent results with previous attempts in the City of Nottingham to provide a service for out of hospital cardiac arrest has shown that an elementary training course and the provision of defibrillators on emergency vehicles enables...

Rowley, J. M.; Garner, C.; Handy, M.; Hampton, J. R.

1985-01-01

216

Cerebral tissue oxygen saturation during therapeutic hypothermia in post-cardiac arrest patients  

OpenAIRE

Aim of the study: This observational study was performed to assess the cerebral tissue oxygen saturation during and after therapeutic hypothermia in comatose patients after out-of-hospital cardiac arrest. Methods: We performed a prospective observational study on the cerebral tissue oxygen saturation (SctO2) in post-cardiac arrest patients treated with therapeutic hypothermia (TH) between March 2011 and April 2012. SctO2 (measured by near-infrared spectroscopy) was non-invasively and...

Meex, Ingrid; Dens, Jo; Jans, Frank; Boer, Willem; Vanhengel, Kristof; Vundelinckx, Guy; Heylen, Rene; Deyne, Cathy

2013-01-01

217

[Cardiac abscesses].  

Science.gov (United States)

The paper analyzes the experience in treating 75 patients with cardiac abscesses of various sites. Abscesses complicated the natural history of infectious endocarditis in all patients. The clinical features of cardiac abscesses are shown to be related to the stage of the destructive process. Echocardiography, follow-up analysis of ECH, PhCG and overall clinical data are demonstrated to play a role in their diagnosis. The paper discusses the specific features of surgical intervention into the heart if abscesses are present. Out of 75 patients who have been operated on for abscessing infectious endocarditis, 53 have had an operation and survived. PMID:1285970

Shevchenko, Iu L; Matveev, S A; Shikhverdiev, N N; Zhuravlev, V P; Gridasov, V F; Khubulava, G G

1992-01-01

218

Psychiatric Co-Morbidity and Its Associated Factors in Patients with Non Cardiac Chest Pain: A Study from a Tertiary Care Hospital, Kolkata  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Chest pain is a common symptom for patients to attend hospital outdoor all over the world. Majority of the chest pain is due to non-cardiac causes. Both organic and psychiatric causes contribute to the causes of non-cardiac chest pain. Objectives: To find out the socio-demographic profile of the study population, types of psychiatric disorders present in the study population and to find out the association between the presence of psychiatric disorder in the study population with the relevant socio-demographic variables. Material and Method : This is a hospital based descriptive cross sectional study done on 88 diagnosed patients of noncardiac chest pain in the Department Of Psychiatry ,Calcutta National Medical College in the time period of January to July 2011 .Data were collected with the help of predesigned pretested proforma and analysed by SPSS 16.0 . Results: The study revealed that the mean age of the study population was 35.91 years .Most (37.5% of the study population were having middle school education. Regarding psychiatric co morbidities present 58( 65.9%of the study population had psychiatric disorder in some form . Of these 58 (65.9% patients majority (44.9% were having panic disorders followed by depressive disorders (36.2%. Presence of psychiatric disorder was significantly more in married people (p= 0.011, nuclear family (p =0.002, people from rural areas (p=0.001, lower socioeconomic status (p=0.014. Conclusion: No significant association of presence of psychiatric disorder with religion, sex, educational status or occupation was found. [Natl J of Med Res 2013; 3(1.000: 9-12

Abhik Sinha

2013-02-01

219

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english Background: Heart failure (HF) is one of the most common causes for hospital admission. Aim: To evaluate clinical predictors of mortality and prolonged hospital stay among patients admitted for HF in Chilean hospitals. Patients and Methods: Prospective registry of 14 centers. Patients admitted for H [...] F in functional class III and IV were included. Epidemiological, clinical data, functional class, decompensation cause, electrocardiogram, echocardiogram, treatment and evolution were registered. The endpoint was hospital death and hospital stay greater than 10 days. Results: Data from 646 patients (mean age 69±13 years, 56% men) was collected. The main etiologies of HF were hypertensive in 29.6%, ischemic in 27.1% and valvular in 20%. Mean hospital stay was 10±9 days and mortality was 5.6%. Independent predictors of death and prolonged hospital stay were serum sodium

Pablo, Castro G; Hugo, Verdejo P; José Luis, Vukasovic R; Eduardo, Garcés; Ilse, González.

1083-10-01

220

Fibrilación auricular en el postoperatorio de cirugía cardíaca: Prevalencia y tiempo de internación Atrial fibrillation in postoperative cardiac surgery: Prevalence and hospitalized period  

Directory of Open Access Journals (Sweden)

Full Text Available La fibrilación auricular es el trastorno del ritmo más frecuente luego de la cirugía cardíaca. En estudios previos se ha asociado a prolongación de la internación, aumento en los costos e incremento en la mortalidad. El objetivo de este estudio fue conocer la prevalencia de fibrilación auricular en el postoperatorio de cirugía cardíaca y determinar el efecto en el tiempo de estadía hospitalaria. Se analizaron retrospectivamente las historias clínicas de pacientes sometidos a cirugía cardíaca consecutivamente (de revascularización miocárdica, valvulares o ambas entre enero 2006 y noviembre 2008. El punto final evaluado en el postoperatorio fue la presencia de fibrilación auricular. Se dividió a la muestra en dos grupos según tuvieran o no fibrilación auricular, y se compararon las variables clínicas y el tiempo de estadía hospitalaria. Ciento setenta y dos pacientes fueron operados en este período. Se excluyeron del análisis siete pacientes por falta de datos. La edad media fue 64.2 ± 9.5 años, con predominio del sexo masculino. La fibrilación auricular fue la complicación más frecuente (23.6%. El tiempo promedio de internación fue 6.7 ± 4.6 días. No hubo diferencias relevantes al comparar la estadía hospitalaria entre los grupos con o sin fibrilación auricular, 7.5 ± 4.1 días vs. 6.5 ± 4.7 días respectivamente, p = 0.21. La presencia de fibrilación auricular no prolongó la hospitalización. Probablemente una estrategia de prevención indiscriminada no sería costo-efectiva.Atrial fibrillation is the most common heart rhythm disorder after cardiac surgery. In previous studies it has been associated with prolonged hospitalization, increased costs and mortality. This study aimed to determine the prevalence of postoperative atrial fibrillation in cardiac surgery and its impact on the hospitalization period. Medical records of consecutive patients undergoing cardiac surgery (coronary artery bypass graft, valvular, or both between January 2006 and November 2008 were included and retrospectively analyzed. Primary outcome was the presence of postoperative atrial fibrillation. The sample was divided into two groups, with and without atrial fibrillation in the postoperative. The clinical variables and length of hospital stay were compared between both groups. A total of 172 patients underwent surgery in this period. Seven patients were excluded from analysis due to lack of data. The mean age was 64.2 ± 9.5 years, and they were predominantly male. Atrial fibrillation was the most common complication (23.6%. The average length hospital stay was 6.7 ± 4.6 days. There were no significant differences between both groups, with atrial fibrillation (7.5 ± 4.1 days, and without (6.5 ± 4.7 days, p = 0.21. The presence of atrial fibrillation did not prolong hospitalization. Probably, such strategy of prevention would not be cost-effective.

Alejandro E. Contreras

2010-08-01

221

Nursing assistance at the hospital discharge after cardiac surgery: integrative review / Assistência de enfermagem na alta hospitalar em pós-operatório de cirurgia cardíaca: revisão integrativa  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese O estudo objetivou analisar evidências disponíveis na literatura sobre a assistência de enfermagem na alta hospitalar em pós-operatório de cirurgia cardíaca. Os dados foram coletados das bases eletrônicas LILACS, SciELO, MEDLINE, através dos DeCS cirurgia torácica, alta hospitalar, cuidados de enfer [...] magem, no período de 2001 a 2011. Foram selecionados dez artigos que revelaram a necessidade de desenvolver um plano de alta de enfermagem com foco na prevenção das complicações e no enfrentamento das limitações físicas decorrentes da cirurgia cardíaca. Destarte, a alta hospitalar deve ser pensada desde o momento da admissão, com ações de cuidado planejadas envolvendo paciente e familiar. Abstract in english The study aimed to analyze the available evidence in the literature on nursing care in the hospital post-cardiac surgery. Data were collected from electronic databases LILACS, SciELO, MEDLINE, via DeCS thoracic surgery, hospital, nursing care, in the period 2001 to 2011. Ten articles were selected t [...] hat showed the need to develop a plan of nursing discharge focusing on prevention of complications and coping with physical limitations resulting from heart surgery. Thus, the discharge should be considered from the time of admission, with carefully planned actions involving patient and family.

Daniela Fraga de, Jesus; Patrícia Figueiredo, Marques.

2013-12-01

222

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

Directory of Open Access Journals (Sweden)

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

Pablo Castro G

2006-09-01

223

Availability and Utilization of Cardiac Resuscitation Centers  

Science.gov (United States)

Introduction The American Heart Association (AHA) recommends regionalized care following out-of-hospital cardiac arrest (OHCA) at cardiac resuscitation centers (CRCs). Key level 1 CRC criteria include 24/7 percutaneous coronary intervention (PCI) capability, therapeutic hypothermia capability, and annual volume of ?40 patients resuscitated from OHCA. Our objective was to characterize the availability and utilization of resources relevant to post-cardiac arrest care, including level 1 CRCs in California. Methods We combined data from the AHA, the California Office of Statewide Health Planning and Development (OSHPD), and surveys to identify CRCs. We surveyed emergency department directors and nurse managers at all 24/7 PCI centers identified by the AHA to determine their post-OHCA care capabilities. The survey included questions regarding therapeutic hypothermia use and specialist availability and was pilot-tested prior to distribution. Cases of OHCA were identified in the 2011 OSHPD Patient Discharge Database using a “present on admission” diagnosis of cardiac arrest (ICD-9-CM code 427.5). We defined key level 1 CRC criteria as 24/7 PCI capability, therapeutic hypothermia, and annual volume ?40 patients admitted with a “present on admission” diagnosis of cardiac arrest. Our primary outcome was the proportion of hospitals meeting these criteria. Descriptive statistics and 95% CI are presented. Results Of the 333 acute care hospitals in California, 31 (9.3%, 95% CI 6.4–13%) met level 1 CRC criteria. These hospitals treated 25% (1937/7780; 95% CI 24–26%) of all admitted OHCA patients in California in 2011. Of the 125 hospitals identified as 24/7 PCI centers by the AHA, 54 (43%, 95% CI 34–52%) admitted ?40 patients following OHCA in 2011. Seventy (56%, 95% CI 47–65%) responded to the survey; 69/70 (99%, 95% CI 92–100%) reported having a therapeutic hypothermia protocol in effect by 2011. Five percent of admitted OHCA patients (402/7780; 95% CI 4.7–5.7%) received therapeutic hypothermia and 18% (1372/7780; 95% CI 17–19%) underwent cardiac catheterization. Conclusion Approximately 10% of hospitals met key criteria for AHA level 1 CRCs. These hospitals treated one-quarter of patients resuscitated from OHCA in 2011. The feasibility of regionalized care for OHCA requires detailed evaluation prior to widespread implementation. PMID:25493115

Mumma, Bryn E.; Diercks, Deborah B.; Holmes, James F.

2014-01-01

224

Availability and Utilization of Cardiac Resuscitation Centers  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: The American Heart Association (AHA recommends regionalized care following out-of-hospital cardiac arrest (OHCA at cardiac resuscitation centers (CRCs. Key level 1 CRC criteria include 24/7 percutaneous coronary intervention (PCI capability, therapeutic hypothermia capability, and annual volume of ?40 patients resuscitated from OHCA. Our objective was to characterize the availability and utilization of resources relevant to post-cardiac arrest care, including level 1 CRCs in California. Methods: We combined data from the AHA, the California Office of Statewide Health Planning and Development (OSHPD, and surveys to identify CRCs. We surveyed emergency department directors and nurse managers at all 24/7 PCI centers identified by the AHA to determine their post-OHCA care capabilities. The survey included questions regarding therapeutic hypothermia use and specialist availability and was pilot-tested prior to distribution. Cases of OHCA were identified in the 2011 OSHPD Patient Discharge Database using a “present on admission” diagnosis of cardiac arrest (ICD-9-CM code 427.5. We defined key level 1 CRC criteria as 24/7 PCI capability, therapeutic hypothermia, and annual volume ?40 patients admitted with a “present on admission” diagnosis of cardiac arrest. Our primary outcome was the proportion of hospitals meeting these criteria. Descriptive statistics and 95% CI are presented. Results: Of the 333 acute care hospitals in California, 31 (9.3%, 95% CI 6.4-13% met level 1 CRC criteria. These hospitals treated 25% (1937/7780; 95% CI 24-26% of all admitted OHCA patients in California in 2011. Of the 125 hospitals identified as 24/7 PCI centers by the AHA, 54 (43%, 95% CI 34-52% admitted ?40 patients following OHCA in 2011. Seventy (56%, 95% CI 47-65% responded to the survey; 69/70 (99%, 95% CI 92-100% reported having a therapeutic hypothermia protocol in effect by 2011. Five percent of admitted OHCA patients (402/7780; 95% CI 4.7-5.7% received therapeutic hypothermia and 18% (1372/7780; 95% CI 17-19% underwent cardiac catheterization. Conclusion: Approximately 10% of hospitals met key criteria for AHA level 1 CRCs. These hospitals treated one-quarter of patients resuscitated from OHCA in 2011. The feasibility of regionalized care for OHCA requires detailed evaluation prior to widespread implementation. [West J Emerg Med. 2014;15(7:–0.

Bryn E. Mumma

2014-11-01

225

An ANN-based HRV classifier for cardiac health prognosis.  

Science.gov (United States)

A multi-layer artificial neural network (ANN)-based heart rate variability (HRV) classifier has been proposed, which gives the cardiac health status as the output based on HRV of the patients independently of the cardiologists' view. The electrocardiogram (ECG) data of 46 patients were recorded in the out-patient department (OPD) of a hospital and HRV was evaluated using self-designed autoregressive-model-based technique. These patients suspected to be suffering from cardiac abnormalities were thoroughly examined by experienced cardiologists. On the basis of symptoms and other investigations, the attending cardiologists advised them to be classified into four categories as per the severity of cardiac health. Out of 46, the HRV data of 28 patients were used for training and data of 18 patients were used for testing of the proposed classifier. The cardiac health classification of each tested patient with the proposed classifier matches with the medical opinion of the cardiologists. PMID:25161107

Sunkaria, Ramesh Kumar; Kumar, Vinod; Saxena, Suresh Chandra; Singhal, Achala M

2014-01-01

226

Prehospital cooling in cardiac arrest - the next frontier?  

Directory of Open Access Journals (Sweden)

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.

Søreide Eldar

2009-10-01

227

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

Directory of Open Access Journals (Sweden)

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

Gastão L. F. Soares-Filho

2009-03-01

228

[An epidemiological study of cardiac emergency cases in the province of Florence and the Southeast Florence Hospital area].  

Science.gov (United States)

The national data provided by ANMCO in 1978 show a total of 2.5 m heart cases in Italy, including 1.5 m instances of ischaemic cardiopathy, and an annual incidence of 105,000 new cases of myocardial infarct. An assessment was made of the 1976 and 1977 pattern of "cardiological emergency cases" (ISTAT codes 402, 410-14, 427-29, 441, 450, 519, 997) in the province of Florence and two of its social and health consortia: 39 (municipalities of Dicomano, Londa, Pelago, Pontassieve, Rufina, S. Godenzo), and 51 (municipalities of Borgata Ripoli, Greve, Impruneta, S. Casciano, Tavarnelle). The records of the S. Maria Nuova, Florence Hospital were used for in-patient data, since this is the only hospital in the province with automatic filing by discharge diagnosis according to the ISTAT code. Mortality in emergency cases in the two consortia m and the province fell from 14.68% and 17.17% to 11.20% and 18.11% respectively in the two years. In both populations, the highest incidence was between 70 and 74 yr of age in 1976, and between 65 and 69 yr in 1977. In the case of infarct, mortality moved from 18.75 to 7.58% (consortia) and from 22.40% to 20.93% (province), with maximum incidences in 1976 between 70 and 74 yr (consortia and province), and in 1977 between 65 and 69 yr (province) and between 55 and 59 yr (consortia). Admissions were greatest in number on Mondays (peak hours: 11 a.m. to 4 p.m.) whereas no difference was noted between one month and another. The Hospital Resuscitation Centre, which serves the two consortia, received 45 emergency cases in 1977, including 25 infarct patients. Total mortality was 13.33% (infarct 20%). The slight numeric discrepancy between in the latter data and those held in the computer suggests that the ISTAT code may not be easy to use and not always employed by physicians in a rational manner. PMID:7219745

De Marinis, A; Buoncristiano, U; Pagni, E; Piacentino, V; Pailli, F; Santoro, G; Vergassola, R

1980-05-01

229

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 ...

230

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

Science.gov (United States)

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 participants were rehospitalized during the study and did not use the application once discharged. Seven participants completed 1–30 days and four patients completed >31 days. For those 11 patients, medication reminders were utilized 37% (1–30-day group) and 53% (>31-day group) of the time, education material was read 44% (1–30) and 53% (>31) of the time, and physical activity was reported 25% (1–30) and 42% (>31) of the time. Findings demonstrated that patients with stable health utilized the application, even if only minimally. Patients with decreased breath sounds by physical exam and who reported their health as fair to poor on the day of discharge were less likely to utilize the application. Acceptability of the application to report health status varied among the stable patients. PMID:25574165

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

2014-01-01

231

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)

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.

J.B. López-Messa

2012-09-01

232

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

Scientific Electronic Library Online (English)

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

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

2012-09-01

233

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

Science.gov (United States)

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

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

2014-06-30

234

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

Directory of Open Access Journals (Sweden)

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.

McCabe Chris

2010-11-01

235

Evaluation of clinical and demographic characteristics and their association with length of hospital stay in patients admitted to cardiac intensive care unit with the diagnosis of acute heart failure  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: Despite increasing incidence, data regarding clinical and demographic characteristics of patients with acute heart failure (AHF admitted to cardiac intensive care unit (ICU are inconclusive. The aim of this study was to assess the presentation characteristics and factors determining the length of hospital stay in this particular patient population.Methods: We conducted a single-center, prospective study involving 150 patients hospitalized to cardiac ICU with the primary diagnosis of AHF. Chi-square and Student t tests were used for the analysis of categorical and continuous variables, respectively. Linear regression analysis (LRA was used to determine the factors affecting the length of hospital stay. Results: Forty-nine percent of the patients had new-onset AHF and 25% had preserved left ventricular ejection fraction (LVEF. In 25.3% of all patients and 46.6% of the patients with new-onset HF the precipitating factor was acute coronary syndrome. Atrial fibrillation and valvular heart disease as precipitating factors were more common in patients with preserved EF, when compared to low EF group. LRA showed that presence of anemia [?=1.62; 95% CI 0.08-3.15; p=0.039] and severe mitral regurgitation (?=2.55; 95% CI 0.06-5.05; p=0.045 and systolic blood pressure (?=-0.03; 95% CI -0.06 - -0.002; p=0.039 and blood urea nitrogen (?=0.034; 95% CI 0.006 - 0.06; p=0.016 were the independent predictors of length of stay. Conclusion: Underlying cardiovascular risk factors, comorbidities and precipitating pathologies were diverse and highlighted the inhomogeneous characteristics of AHF syndromes. However, in-hospital mortality was high and initial clinical presentation characteristics were significantly associated with in-hospital outcome.

Sami ?ahin

2012-02-01

236

Optimizing Neurologically Intact Survival from Sudden Cardiac Arrest: A Call to Action  

Directory of Open Access Journals (Sweden)

Full Text Available The U.S. national out-of-hospital and in-hospital cardiac arrest survival rates, although improving recently, have remained suboptimal despite the collective efforts of individuals, communities, and professional societies. Only until very recently, and still with inconsistency, has focus been placed specifically on survival with pre-arrest neurologic function. The reality of current approaches to sudden cardiac arrest is that they are often lacking an integrative, multi-disciplinary approach, and without deserved funding and outcome analysis. In this manuscript, a multidisciplinary group of authors propose practice, process, technology, and policy initiatives to improve cardiac arrest survival with a focus on neurologic function. [West J Emerg Med. 2014;15(7:-0.

Jeffrey M. Goodloe

2014-11-01

237

Implant Evaluation of an Insertable Cardiac Monitor Outside the Electrophysiology Lab Setting  

Science.gov (United States)

Background To date, insertable cardiac monitors (ICM) have been implanted in the hospital without critical evaluation of other potential settings. Providing alternatives to in-hospital insertion may increase access to ICM, decrease waiting times for patients awaiting diagnosis, and reduce hospital resources. Methods This was a prospective, non-randomized, clinical trial involving nine clinical sites throughout the United States designed to assess the feasibility of ICM implants in a non-hospital setting. Other than the Reveal® ICM, implant supplies and techniques were left to physician discretion in patients who met indications. Patients were followed up to 90 days post-implant. The primary objective was to characterize the number of procedure-related adverse events that required surgical intervention within 90 days. Results Sixty-five patients were implanted at nine out-of-hospital sites. The insertion procedure was well tolerated by all patients. There were no deaths, systemic infections or endocarditis. There were two (3%) procedure-related adverse events requiring device explant and four (6%) adverse events not requiring explant. ICM use led to 16 diagnoses (24.6%) with 9 patients proceeding to alternate cardiac device implants during the course of the 90-day follow up. Conclusion Out-of-hospital ICM insertion can be accomplished with comparable procedural safety and represents a reasonable alternative to the in-hospital setting. Clinicaltrials.gov registration number: NCT01168427 PMID:23977071

Pachulski, Roman; Cockrell, James; Solomon, Hemant; Yang, Fang; Rogers, John

2013-01-01

238

The effect of therapeutic hypothermia after cardiac arrest  

Directory of Open Access Journals (Sweden)

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.

Georgia Mavrogianni

2013-07-01

239

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. ...

240

Epidemiology of arrhythmias and sudden cardiac death in Asia.  

Science.gov (United States)

Cardiac arrhythmias are cardiac rhythm disorders that comprise an important epidemiological and public health problem. Cardiac arrhythmias are significantly associated with increased risks of cardiovascular complications and sudden death, consequently leading to decreased quality of life, disability, high mortality, and healthcare expense. Atrial fibrillation (AF) is the most common sustained arrhythmia, and has been further increasing with the aging of society. Although the prevalence is relatively lower in Asians than in Westerners, the prognostic impacts on stroke and mortality in Asians are comparable. Sudden cardiac death (SCD) occurs in approximately 40 cases per 100,000 persons annually in each country of Asia. Most cases are caused by myocardial infarction and ventricular fibrillation in out-of-hospital cardiac arrest cases, but the proportion of myocardial infarction is lower in Asia than in Western countries. The primary electrophysiological disorders related to channelopathies, such as long QT syndrome, short QT syndrome, Brugada syndrome, early repolarization syndrome, and catecholaminergic polymorphic ventricular tachycardia, are estimated to be responsible for 10% of SCDs. Implantable cardioverter-defibrillator implantation has become established as an effective secondary prevention for SCD, and numbers have been increasing annually worldwide. New insights into arrhythmic diseases have been emerging from epidemiological, clinical, and genetic research, and contribute to improvements in diagnosis and prognosis.? PMID:24067274

Murakoshi, Nobuyuki; Aonuma, Kazutaka

2013-01-01

241

Sudden cardiac death: Role of therapeutic hypothermia  

Directory of Open Access Journals (Sweden)

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.

Matthias Derwall

2012-05-01

242

Out of the woods.  

Science.gov (United States)

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

Jacobson, J L

1992-01-01

243

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)

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.

Radmehr H

2001-08-01

244

Cardiac Arrest from Postpartum Spontaneous Coronary Artery Dissection  

Directory of Open Access Journals (Sweden)

Full Text Available We present the case of a 32-year-old woman who presented to the emergency department with a witnessed cardiac arrest. She was otherwise healthy with no cardiac risk factors and had undergone an uneventful repeated cesarean section 3 days priorly. The patient underwent defibrillation, out of ventricular fibrillation to a perfusing sinus rhythm, and was taken to the catheterization laboratory where coronary angiography findings showed spontaneous dissection of the left anterior descending artery. The patient received a total of 6 stents during her hospital stay and was eventually discharged in good condition. Spontaneous coronary artery dissection is a rare entity with a predilection for pregnant or postpartum women. Early diagnosis and treatment are key for survival, and when identified early, mortality is good. [West J Emerg Med. 2011;12(4:567–570.

Dick Kuo

2011-05-01

245

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)

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

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

2005-01-01

246

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)

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

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

2005-01-01

247

Automated external defibrillators and secondary prevention of sudden cardiac death among children and adolescents.  

Science.gov (United States)

Sudden cardiac death is devastating at any age, but it is especially so among children and adolescents. This report discusses the outcomes for patients with out-of hospital cardiac arrest (OHCA) and describes public access defibrillation programs in general and those directed at children and adolescents. In addition, the relatively new concept of cardiopulmonary resuscitation (CPR)–automated external defibrillator (AED) programs directed at schools is discussed. Although limited data are available, some of the preliminary data suggest improved OHCA outcomes associated with CPR-AED programs implemented in schools. These early data provide hope for the future potential reduction in the incidence of sudden cardiac deaths in the school setting, not only among children and adolescents, but also among adults. PMID:22302278

Kovach, Joshua; Berger, Stuart

2012-03-01

248

Cardiac perioperative complications in noncardiac surgery  

Directory of Open Access Journals (Sweden)

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.

Radovanovi? Dragana

2008-01-01

249

Detection of chest pain of non-cardiac origin at the emergency room by a new non-invasive device avoiding unnecessary admission to hospital  

OpenAIRE

Recent advances in the treatment of acute coronary syndromes has raised awareness that prompt presentation for chest pain may be life saving. Most patients presenting with chest discomfort have a non-ischaemic ECG on presentation, but are routinely admitted to hospital because of diagnostic uncertainty for occult MI or ischaemia.

Gorenberg, M.; Marmor, A.; Rotstein, H.

2005-01-01

250

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)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] 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

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

2004-06-01

251

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 ... in no significant distress. His weight is 6.5 kg, but he's not growing well. The echo -- ...

252

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 ...

253

Cardiac cephalgia  

OpenAIRE

The purpose of this review was to provide a critical evaluation of medical literature on so-called “cardiac cephalgia” or “cardiac cephalalgia”. The 2004 International Classification of Headache Disorders codes cardiac cephalgia to 10.6 in the group of secondary headaches attributed to disorder of homoeostasis. This headache is hardly recognizable and is associated to an ischaemic cardiovascular event, of which it may be the only manifestation in 27% of cases. It usually occurs after ...

Bini, Annamaria; Evangelista, Andrea; Castellini, Paola; Lambru, Giorgio; Ferrante, Tullia; Manzoni, Gian Camillo; Torelli, Paola

2009-01-01

254

Hyponatremia Presenting as Cardiac Conduction Defect  

OpenAIRE

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.

Pawan Suri, Kaiser Habeeb

2009-01-01

255

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)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

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

2010-06-01

256

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)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

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

257

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  

Directory of Open Access Journals (Sweden)

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.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 arterial 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.

Newton Almeida Lima Junior

2012-06-01

258

Incidence, predisposing factors, management and survival following cardiac arrest due to subarachnoid haemorrhage: a review of the literature  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction The prevalence of cardiac arrest among patients with subarachnoid haemorrhage [SAH], and the prevalence of SAH as the cause following out-of-hospital cardiac arrest [OHCA] or in-hospital cardiac arrest [IHCA] is unknown. In addition it is unclear whether cardiopulmonary resuscitation [CPR] and post-resuscitation care management differs, and to what extent this will lead to meaningful survival following cardiac arrest [CA] due to SAH. Aim We reviewed the literature in order to describe; 1.The prevalence and predisposing factors of CA among patients with SAH 2.The prevalence of SAH as the cause of OHCA or IHCA and factors characterising CPR 3.The survival and management of SAH patients with CA. Material and methods The following sources, PubMed, CinAHL and The Cochrane DataBase were searched using the following Medical Subheadings [MeSH]; 1. OHCA, IHCA, heart arrest and 2. subarachnoid haemorrhage. Articles containing relevant data based on the abstract were reviewed in order to find results relevant to the proposed research questions. Manuscripts in other languages than English, animal studies, reviews and case reports were excluded. Results A total of 119 publications were screened for relevance and 13 papers were included. The prevalence of cardiac or respiratory arrest among all patients with SAH is between 3-11%, these patients commonly have a severe SAH with coma, large bleeds and evidence of raised intracerebral pressure on computed tomography scans compared to those who did not experience a CA. The prevalence of patients with SAH as the cause of the arrest among OHCA cases vary between 4 to 8% among those who die before hospital admission, and between 4 to 18% among those who are admitted. The prevalence of SAH as the cause following IHCA is low, around 0.5% according to one recent study. In patients with OHCA survival to hospital discharge is poor with 0 to 2% surviving. The initial rhythm is commonly asystole or pulseless electrical tachycardia. In IHCA the survival rate is variable with 0-27% surviving. All survivors experience brief cardiac arrests with short latencies to ROSC. Conclusion Cardiac arrest is a fairly common complication following severe SAH and these patients are encountered both in the pre-hospital and in-hospital setting. Survival is possible if the arrest occurs in the hospital and the latency to ROSC is short. In OHCA the outcome seems to be uniformly poor despite initially successful resuscitation.

Skrifvars Markus B

2012-11-01

259

10 year review of cardiac tumours in childhood  

OpenAIRE

OBJECTIVE--To review the commonest types of cardiac tumours in childhood, their different presentations, and management. DESIGN--A retrospective study of patients with cardiac tumours. SETTING--Cardiac department of a teaching hospital. PATIENTS--Six patients with an age range between one day to three years presented over a period of 10 years. MAIN OUTCOME MEASURES--To determine different presentations, management, and prognosis of cardiac tumours. RESULTS--Three patients presented with an ar...

Webb, David W.; Clarke, Antonia; Thomas, Rod; Osborne, John P.

1994-01-01

260

Myocardial stunning after resuscitation from cardiac arrest following spinal anaesthesia  

OpenAIRE

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...

Kurhekar, Pranjali Madhav; Yachendra, Vsg; Babu, Simi P.; Govindasamy, Raghavelu

2014-01-01

261

Validation of a computer case definition for sudden cardiac death in opioid users  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background To facilitate the use of automated databases for studies of sudden cardiac death, we previously developed a computerized case definition that had a positive predictive value between 86% and 88%. However, the definition has not been specifically validated for prescription opioid users, for whom out-of-hospital overdose deaths may be difficult to distinguish from sudden cardiac death. Findings We assembled a cohort of persons 30-74 years of age prescribed propoxyphene or hydrocodone who had no life-threatening non-cardiovascular illness, diagnosed drug abuse, residence in a nursing home in the past year, or hospital stay within the past 30 days. Medical records were sought for a sample of 140 cohort deaths within 30 days of a prescription fill meeting the computer case definition. Of the 140 sampled deaths, 81 were adjudicated; 73 (90% were sudden cardiac deaths. Two deaths had possible opioid overdose; after removing these two the positive predictive value was 88%. Conclusions These findings are consistent with our previous validation studies and suggest the computer case definition of sudden cardiac death is a useful tool for pharmacoepidemiologic studies of opioid analgesics.

Kawai Vivian K

2012-08-01

262

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

Directory of Open Access Journals (Sweden)

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 ...

Hypes C

2014-10-01

263

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)

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.

Hansen, Carolina Malta; Wissenberg, M.

2013-01-01

264

Lack of agreement between esophageal doppler cardiac output measurements and continuous pulse contour analysis during off-pump cardiac surgery  

OpenAIRE

Objective: Transesophageal echo-Doppler cardiac output as well as arterial pulse contour analyses cardiac output are increasingly used for cardiac output monitoring. No data are available whether both techniques may be used interchangeably in patients undergoing cardiac surgery. Design: Prospective, observational study Setting: Operating rooms of a university affiliated hospital. Patients: 30 patients undergoing elective coronary artery bypass grafting surgery.Interventions: NoneMeasurements:...

Groesdonk, H. V.; Ender, J.; Kiefer, H.; Fassl, J.; Paarmann, H.

2010-01-01

265

Cardiac Paragangliomas.  

Science.gov (United States)

Cardiac paraganglioma is a rare entity. We review the clinical data from 158 patients reported in 132 isolated papers, and discuss clinical presentations, imaging findings, pathology, location, therapy, and outcomes. PMID:25331372

Wang, Ji-Gang; Han, Jing; Jiang, Tao; Li, Yu-Jun

2014-10-20

266

Cardiac MRI  

Science.gov (United States)

... involve contrast agent). Rate This Content: Next >> Featured Video New pediatric imaging facility aims to improve treatment for congenital heart disease 10/14/2014 February 2, 2012 Cardiac MRI ...

267

Cardiac Amyloidosis  

Science.gov (United States)

... to standard blood tests) are often monitored in cardiac amyloidosis, N-terminal pro-brain natriuretic peptide (or the related brain natriuretic peptide) and troponin. These tests measure different aspects of heart function, ...

268

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)

269

Out of shadow / Peeter Linnap  

Index Scriptorium Estoniae

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

Linnap, Peeter, 1960-

2007-01-01

270

Frequency and Timing of Nonconvulsive Status Epilepticus in Comatose Post-Cardiac Arrest Subjects Treated with Hypothermia  

Science.gov (United States)

Background Therapeutic hypothermia (TH) improves outcomes in comatose patients resuscitated from cardiac arrest. However, nonconvulsive status epilepticus (NCSE) may cause persistent coma. The frequency and timing of NCSE after cardiac arrest is unknown. Methods Review of consecutive subjects treated with TH and receiving continuous EEG (cEEG) monitoring between 8/1/2009 and 11/16/2010. Demographic data, survival, and functional outcome were prospectively recorded. Each cEEG file was analyzed using standard definitions to define NCSE. Data were analyzed using descriptive and non-parametric statistics. Results Mean age of the 101 subjects was 57 years (SD 15) with most subjects being male (N = 55, 54%) and experiencing out-of-hospital cardiac arrest (N = 78; 77%). Ventricular fibrillation was the initial cardiac rhythm in 39 (38%). All subjects received TH. Thirty subjects (30%) awoke at a median of 41 h (IQR 30, 61) after cardiac arrest. A total of 29/30 (97%) subjects surviving to hospital discharge were awake. Median interval from arrest to placement of cEEG was 9 h (IQR 6, 12), at which time the mean temperature was 33.9°C. NCSE occurred in 12 (12%) subjects. In 3/12 (25%) subjects, NCSE was present when the cEEG recording began. In 4 subjects, NCSE occurred within 8 h of cEEG recording. One (8%) subject with NCSE survived in a vegetative state. Conclusions NCSE is common in comatose post-cardiac arrest subjects receiving TH. Most seizures occur within the first 8 h of cEEG recording and within the first 12 h after resuscitation from cardiac arrest. Outcomes are poor in those who experience NCSE. PMID:21638118

Rittenberger, Jon C.; Popescu, Alexandra; Brenner, Richard P.; Guyette, Francis X.; Callaway, Clifton W.

2011-01-01

271

Cardiac CT  

Energy Technology Data Exchange (ETDEWEB)

Computed tomography of the heart has become a highly accurate diagnostic modality that is attracting increasing attention. This extensively illustrated book aims to assist the reader in integrating cardiac CT into daily clinical practice, while also reviewing its current technical status and applications. Clear guidance is provided on the performance and interpretation of imaging using the latest technology, which offers greater coverage, better spatial resolution, and faster imaging. The specific features of scanners from all four main vendors, including those that have only recently become available, are presented. Among the wide range of applications and issues to be discussed are coronary artery bypass grafts, stents, plaques, and anomalies, cardiac valves, congenital and acquired heart disease, and radiation exposure. Upcoming clinical uses of cardiac CT, such as plaque imaging and functional assessment, are also explored. (orig.)

Dewey, Marc [Charite - Universitaetsmedizin Berlin (Germany). Inst. fuer Radiologie

2011-07-01

272

Cardiac echinococcosis  

Directory of Open Access Journals (Sweden)

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.

Ivanovi?-Krsti? Branislava A.

2002-01-01

273

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

Directory of Open Access Journals (Sweden)

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.

Landoni Giovanni

2009-01-01

274

Characterization of Out of Lesson and Out Of School Physical  

Directory of Open Access Journals (Sweden)

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.

Krzysztof WARCHO?

275

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

DEFF Research Database (Denmark)

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.)

Nielsen, Niklas; Wetterslev, JØrn

2013-01-01

276

Coping to Cardiac Surgery – preview note  

OpenAIRE

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 style...

Juliane Umann; Laura Azevedo Guido; Graciele Fernanda da Costa Linch

2008-01-01

277

Cardiac catheterisation in nonagenarians: Single center experience  

OpenAIRE

Objective To explore the treatment, procedure related risks, and outcomes of patients older than 90 years of age undergoing cardiac catheterization. Methods We retrospectively studied 32 patients ? 90 years (93.0 ± 1.2 years) who underwent cardiac catheterisation in a tertiary specialist hospital (0.2% of 14,892 procedures during three years). The results were compared to a patient cohort younger than 90 years of age. Results Baseline characteristics revealed a higher prevalence of diab...

Marc-Alexander Ohlow; Aly Hassan; Ulrich Lotze; Bernward Lauer

2012-01-01

278

Depression and its treatment in cardiac patients.  

OpenAIRE

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

Fernandez, F.

1993-01-01

279

Robotic cardiac surgery: an anaesthetic challenge.  

Science.gov (United States)

Robotic cardiac surgery with the da Vinci robotic surgical system offers the benefits of a minimally invasive procedure, including a smaller incision and scar, reduced risk of infection, less pain and trauma, less bleeding and blood transfusion requirements, shorter hospital stay and decreased recovery time. Robotic cardiac surgery includes extracardiac and intracardiac procedures. Extracardiac procedures are often performed on a beating heart. Intracardiac procedures require the aid of peripheral cardiopulmonary bypass via a minithoracotomy. Robotic cardiac surgery, however, poses challenges to the anaesthetist, as the obligatory one-lung ventilation (OLV) and CO2 insufflation may reduce cardiac output and increase pulmonary vascular resistance, potentially resulting in hypoxaemia and haemodynamic compromise. In addition, surgery requires appropriate positioning of specialised cannulae such as an endopulmonary vent, endocoronary sinus catheter, and endoaortic clamp catheter under the guidance of transoesophageal echocardiography. Therefore, cardiac anaesthetists should have a working knowledge of these systems, OLV and haemodynamic support. PMID:24958894

Wang, Gang; Gao, Changqing

2014-08-01

280

[Cardiac arrest management: any news? When the literature does not meet clinical practice].  

Science.gov (United States)

The percentage of patients transported alive to hospital after an out-of-hospital cardiac arrest has increased in recent years thanks to growing population education. In 2010 the International Liaison Committee on Resuscitation (ILCOR) has published new guidelines for the management of cardiac arrest. These guidelines present several new features, but cardiac compression remains the mainstay of optimal cardiopulmonary resuscitation. Use of atropine and endotracheal drugs are no longer recommended, and early ultrasound evaluation and intraosseous vascular access are new methods now standardized. The best chances of improving patient prognosis are in the period immediately after return of spontaneous circulation (ROSC). It is well known that most patients who experience cardiac arrest without an obvious extra-cardiac cause, show significant underlying coronary artery disease. Hence, the importance of widespread and early use of primary percutaneous coronary intervention. An early percutaneous coronary intervention was found to be crucial not only in increasing survival, but also in improving neurological outcome at discharge. The ILCOR consensus statement suggests that therapeutic hypothermia should be considered as the standard treatment for comatose patients resuscitated from cardiac arrest. This was supported by the evidence that moderate hypothermia is the only treatment for post-ROSC as it is associated with a significant increase in survival. For this reason, it should be started as early as possible, preferably in the pre-hospital setting. Despite the bulk of available literature on the early treatment of cardiac arrest, the studies carried out in Italy indicate that most post-ROSC patients are undertreated or untreated. This results in poor resource utilization with a high social and personal impact that involves both the patients and their families. Teamwork activities addressing the chain of survival become a fundamental tool for the treatment of resuscitated patients. Given the crucial importance of the time elapsing from collapse to cardiopulmonary resuscitation in terms of final prognosis, efforts should be made to promote the "culture of cardiopulmonary resuscitation" not only among health professionals, but also among the general population. PMID:22825343

Grieco, Niccolò; Manzoni, Paola

2012-09-01

281

Cardiac Calcification  

Directory of Open Access Journals (Sweden)

Full Text Available There is a spectrum of different types of cardiac"ncalcifications with the importance and significance"nof each type of cardiac calcification, especially"ncoronary artery calcification. Radiologic detection of"ncalcifications within the heart is quite common. The"namount of coronary artery calcification correlates"nwith the severity of coronary artery disease (CAD."nCalcification of the aortic or mitral valve may indicate"nhemodynamically significant valvular stenosis."nMyocardial calcification is a sign of prior infarction,"nwhile pericardial calcification is strongly associated"nwith constrictive pericarditis. A spectrum of different"ntypes of cardiac calcifications (linear, annular,"ncurvilinear,... could be seen in chest radiography and"nother imaging modalities. So a carful inspection for"ndetection and reorganization of these calcifications"nshould be necessary. Numerous modalities exist for"nidentifying coronary calcification, including plain"nradiography, fluoroscopy, intravascular ultrasound,"nMRI, echocardiography, and conventional, helical and"nelectron-beam CT (EBCT. Coronary calcifications"ndetected on EBCT or helical CT can be quantifie,"nand a total calcification score (Cardiac Calcification"nScoring may be calculated. In an asymptomatic"npopulation and/or patients with concomitant risk"nfactors like diabetes mellitus, determination of the"npresence of coronary calcifications identifies the"npatients at risk for future myocardial infarction and"ncoronary artery disease. In patients without coronary"ncalcifications, future cardiovascular events could"nbe excluded. Therefore, detecting and recognizing"ncalcification related to the heart on chest radiography"nand other imaging modalities such as fluoroscopy, CT"nand echocardiography may have important clinical"nimplications.

Morteza Joorabian

2011-05-01

282

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

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Continued breathing following ventricular fibrillation has here-to-fore not been described. Methods We analyzed the spontaneous ventilatory activity during the first several minutes of ventricular fibrillation (VF in our isoflurane anesthesized swine model of out-of-hospital cardiac arrest. The frequency and type of ventilatory activity was monitored by pneumotachometer and main stream infrared capnometer and analyzed in 61 swine during the first 3 to 6 minutes of untreated VF. Results During the first minute of VF, the air flow pattern in all 61 swine was similar to those recorded during regular spontaneous breathing during anesthesia and was clearly different from the patterns of gasping. The average rate of continued breathing during the first minute of untreated VF was 10 breaths per minute. During the second minute of untreated VF, spontaneous breathing activity either stopped or became typical of gasping. During minutes 2 to 5 of untreated VF, most animals exhibited very slow spontaneous ventilatory activity with a pattern typical of gasping; and the pattern of gasping was crescendo-decrescendo, as has been previously reported. In the absence of therapy, all ventilatory activity stopped 6 minutes after VF cardiac arrest. Conclusion In our swine model of VF cardiac arrest, we documented that normal breathing continued for the first minute following cardiac arrest.

Zuercher Mathias

2010-08-01

283

Predictive value of EuroSCORE on long term outcome in cardiac surgery patients: a single institution study  

OpenAIRE

Objectives: To assess the value of the European system for cardiac operative risk evaluation (EuroSCORE), a validated model for prediction of in-hospital mortality after cardiac surgery, in predicting long term event-free survival.

Maria, R.; Mazzoni, M.; Parolini, M.; Gregori, D.; Bortone, F.; Arena, V.; Parodi, O.

2005-01-01

284

Comparison of Plasma Cardiac Troponin I and Cardiac Enzymes in Haemodialysis Patients of Gorgan (South East of Iran)  

OpenAIRE

The objectives of this study were to evaluate the effect of haemodialysis on plasma Cardiac Troponin I and cardiac enzymes before and after the dialysis process. Twenty two patients with Chronic Renal Failure (CRF) disease who were haemodialyzed at 5th Azar hospital of Gorgan Dialysis Center were recruited for this study (2005). The patients do not have coronary heart disease. Plasma cardiac enzymes showed no significant difference in the post dialysis group when compared with predialys...

Abdoljalal Marjani; Abdolvahab Moradi; Gholamreza Veghari

2007-01-01

285

Risk factors for surgical-site infection after cardiac surgery  

OpenAIRE

Objective: Surgical site infection is a serious complication inpatients undergoing heart surgery because in addition to highmorbitity rates, length of hospital stay and hospital costs areincreased. This study aims to identify pre-, peri- and postoperativerisk factors related to surgical-site infection after cardiac surgery.Methods: The study comprised 1053 patients undergoing cardiacsurgery, with sternotomy, performed consecutively, between June1 and October 31, 1999, by three cardiac surgery...

Fermina Mendonça Borges; Renato Satovschi Grinbaum; Jacyr Pasternak; Eduardo Alexandrino Servolo de Medeiros

2005-01-01

286

Do medical outpatients want 'out of hours' clinics?  

Directory of Open Access Journals (Sweden)

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.

Partridge Martyn R

2005-06-01

287

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)

Full Text Available SciELO Costa Rica | Language: Spanish Abstract in spanish 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.

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

2013-03-01

288

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

Directory of Open Access Journals (Sweden)

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

Hugo Arguedas-Jiménez

2013-03-01

289

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)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese 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.

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

2014-04-01

290

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)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish 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.

Magdalena, Canals Aracil; Alba, Riesgo García.

2013-10-01

291

Non-cardiac chest pain and benign palpitations in the cardiac clinic.  

OpenAIRE

OBJECTIVES--To assess the characteristics of consecutive patients referred from general practice with the presenting disorder of chest pain or palpitations, and to determine the outcome at six months and three years. SETTING--A single consultant teaching hospital cardiac clinic receiving new referrals from a health district. DESIGN--94 consecutive referrals by general practitioners to a cardiac clinic with the presenting disorder of chest pain or palpitations were assessed at first attendance...

Mayou, R.; Bryant, B.; Forfar, C.; Clark, D.

1994-01-01

292

Ventilatory targets after cardiac arrest.  

Science.gov (United States)

The mortality of postcardiac arrest patients has gradually reduced in years but it still is as high as 50%, despite advancements in the diagnostic and therapeutic approaches, i.e. revascularization and therapeutic moderate hypothermia. However, recent evidence suggests that other therapeutic interventions aimed to minimize progressive deterioration of the brain and other organs function might be helpful to reduce in-hospital mortality and improve neurologic outcome as well as quality of life after cardiac arrest. In this article, we discuss the role of ventilator management on the prognosis after cardiac arrest. We performed a meta-analysis showing that in adult patients not only hypoxia but also hyperoxia was associated with higher in-hospital mortality, while hypercapnia and hypocapnia worse neurologic outcome. In pediatric patients, hypoxia and hyperoxia were not associated with higher in-hospital mortality, while hypocapnia and hypercabia with higher in-hospital mortality worse neurologic outcome. We propose a general bundle for ventilator treatment after cardiac arrest, including: 1) therapeutic hypothermia for 12-24 hours; 2) mean arterial pressure ?65-75 mmHg; 3) PaO2 between 60-200 mmHg and PCO2 between 30 and 50 mmHg; 4) protective MV with tidal volume of 6-8 mL/kg and positive end expiratory pressure of between 5-10 cmH2O; 5) monitoring of respiratory mechanics, extravascular lung water, hemodynamics, non-invasive transcranial Doppler and intracranial pressure monitoring; and 6) others supportive care, i.e. blood sugar and seizures control. PMID:24642487

Sutherasan, Y; Vargas, M; Brunetti, I; Pelosi, P

2015-01-01

293

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

294

Critical appraisal of cardiac implantable electronic devices: complications and management  

Directory of Open Access Journals (Sweden)

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 

Padeletti L

2011-09-01

295

Time series analysis as input for clinical predictive modeling: Modeling cardiac arrest in a pediatric ICU  

OpenAIRE

Abstract Background Thousands of children experience cardiac arrest events every year in pediatric intensive care units. Most of these children die. Cardiac arrest prediction tools are used as part of medical emergency team evaluations to identify patients in standard hospital beds that are at high risk for cardiac arrest. There are no models to predict cardiac arrest in pediatric intensive care units though, where the risk of an arrest is 10 times higher than for standard ho...

Kennedy Curtis E; Turley James P

2011-01-01

296

Cardiac pacemaker  

International Nuclear Information System (INIS)

The construction of a cardiac pacemaker is described which is characterized by particularly small dimensions, small weight and long life duration. The weight is under 100g, the specific weight under 1.7. Mass inertia forces which occur through acceleration and retardation processes, thus remain below the threshold values, above which one would have to reckon with considerable damaging of the surrounding body tissue. The maintaining of small size and slight weight is achieved by using an oscillator on COSMOS basis, where by considerably lower energy consumption, amongst others the lifetimes of the batteries used - a lithium anode with thionyl chloride electrolyte - is extended to over 5 years. The reliability can be increased by the use of 2 or more batteries. The designed dimension are 20x60x60 mm3. (ORU/LH)

297

Controlled Cardiac Computed Tomography  

OpenAIRE

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...

Ge Wang; Ying Liu; Chenglin Wang; Erwei Bai

2006-01-01

298

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

Directory of Open Access Journals (Sweden)

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

Juan Stuardo Yazlle Rocha

1989-10-01

299

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

Science.gov (United States)

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. PMID:22915942

Padeletti, Luigi; Mascioli, Giosuè; Perini, Alessandro Paoletti; Grifoni, Gino; Perrotta, Laura; Marchese, Procolo; Bontempi, Luca; Curnis, Antonio

2011-01-01

300

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)

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.

Edgar A. Méndez

2002-12-01

301

Myocardial stunning after resuscitation from cardiac arrest following spinal anaesthesia  

Science.gov (United States)

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 subarachnoid block. Return of spontaneous circulation (ROSC) was achieved within 2 minutes with cardiopulmonary resuscitation (CPR) and defibrillation for pulseless ventricular tachycardia. Patient developed delayed pulmonary oedema, which was probably due to myocardial stunning. In the present case, inadequate preloading could have precipitated bradycardia progressing to cardiac arrest which, after resuscitation led to reversible myocardial dysfunction. We conclude that early vasopressor infusion, titrated fluids and echocardiography should be considered in immediate post cardiac arrest phase following spinal anaesthesia. PMID:24963188

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

2014-01-01

302

Long term follow up of severely ill patients who underwent urgent cardiac transplantation.  

OpenAIRE

OBJECTIVE--To assess long term survival (> 5 years) and quality of life in severely ill patients referred for urgent cardiac transplantation. SETTING--Tertiary referral centres: before transplantation at the National Heart Hospital (late 1984 to end 1986); after transplantation at Harefield Hospital. SUBJECTS--Eighteen patients (15 men; three women) who had required intensive support in hospital before cardiac transplantation and were alive at short term follow up. INTERVENTIONS--Intravenous ...

Mulcahy, D.; Fitzgerald, M.; Wright, C.; Sparrow, J.; Pepper, J.; Yacoub, M.; Fox, K. M.

1993-01-01

303

[Cardiac rehabilitation in the region of Veneto].  

Science.gov (United States)

In Italy there has been a progressive shifting of the legislative and fiscal activity from a national level to a regional one. In the Venetian district a series of documents, also concerning the cardiac rehabilitation, has been produced. A document elaborated in 1999 contains a detailed account of eligibility criteria for cardiac rehabilitation as well as of structural and organizational requirements. Other documents contain the updated price lists for admission episode (DRG 462) or days of stay in hospital and diurnal hospital activity, according to the type of structure which supplies the service. For outpatients, cardiac rehabilitation is identified by the code 93.36 and the ticket fare is 19,50 Euro. In the enclosure no.6 of the Sanitary Regional Plan, still under definitive approval, it is stated that for each Intensive Therapy there will be a functional connector with a cardiac rehabilitation service which, except for few Centers, will carry on its activity with outpatients. At present the regional Cardiac Rehabilitation includes 3 complex units (for in- and outpatients) and 13 simple units (for outpatients only), with a total of 3031 patients rehabilitated in 2004. PMID:16499310

Carlon, Roberto

2005-06-01

304

Out-of-hours primary care. Implications of organisation on costs  

OpenAIRE

Abstract Background To perform out-of-hours primary care, Dutch general practitioners (GPs) have organised themselves in large-scale GP cooperatives. Roughly, two models of out-of-hours care can be distinguished; GP cooperatives working separate from the hospital emergency department (ED) and GP cooperatives integrated with the hospital ED. Research has shown differences in care utilisation between these two models; a significant shift in the integrated model from utilisation...

Wesseling Geertjan; Bwe, Voss Gemma; Jha, Ament Andre; Jt, Uden Caro; Ag, Winkens Ron; Cp, Schayck Onno; Fjm, Crebolder Harry

2006-01-01

305

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

Directory of Open Access Journals (Sweden)

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.

Nikovi? Vuk

2013-01-01

306

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

Directory of Open Access Journals (Sweden)

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.

Satoko Fukuike

2014-11-01

307

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)

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.

Wibrandt, Ida; Norsted, Kristine

2015-01-01

308

Cardiac myxosarcoma with thoracic spinal metastasis.  

Science.gov (United States)

Echocardiography revealed a left atrial tumor in a 59-year-old man with back pain that concurrently worsened with left foot drop and loss of the left ankle reflex soon after admission to our hospital. Magnetic resonance imaging of the spine revealed an epidural tumor extending from Th5 with spinal cord compression. The patient was immediately treated by emergency Th4-5 laminectomy and epidural decompression. One month later, a cardiac tumor excised via the left atrial approach was histopathologically diagnosed as myxosarcoma, and the Th5 tumor was consistent with this finding. This is the first report to describe spinal metastasis of cardiac myxosarcoma. PMID:23677508

Kimura, Mitsuhiro; Kikuchi, Chizuo; Takahashi, Yoshiki; Kanazawa, Hiroshi; Nakazawa, Satoshi

2014-07-01

309

The economics of cardiac biomarker testing in suspected myocardial infarction.  

Science.gov (United States)

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

Goodacre, Steve; Thokala, Praveen

2014-08-27

310

Southern hospitality.  

Science.gov (United States)

Self Memorial Hospital's hostesses are the embodiment of a patient-oriented service philosophy instituted by Bob Borland when he created the $5-million-a-year Hospitality Services department. PMID:10117979

Parsons, H

1992-03-01

311

Mediastinitis after cardiac transplantation  

Directory of Open Access Journals (Sweden)

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.

Noedir A. G. Stolf

2000-05-01

312

Mixoid cardiac liposarcoma  

International Nuclear Information System (INIS)

Patien with myxoid cardiac liposarcoma was subjected to control. Tumor was suspected according to roentgen and tomographic studies. The patient was operated. Difficulties at the preoperation stage of diagnosis of initial cardiac malignant tumors are indicated

313

Cardiac Risk Assessment  

Science.gov (United States)

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

314

Catastrophic Cardiac Amyloidosis  

OpenAIRE

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

Mohammed Mukhaini; Prashanth Panduranga

2011-01-01

315

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)

316

Cardiac tumours in children  

OpenAIRE

Abstract Cardiac tumours are benign or malignant neoplasms arising primarily in the inner lining, muscle layer, or the surrounding pericardium of the heart. They can be primary or metastatic. Primary cardiac tumours are rare in paediatric practice with a prevalence of 0.0017 to 0.28 in autopsy series. In contrast, the incidence of cardiac tumours during foetal life has been reported to be approximately 0.14%. The vast majority of primary cardiac tumours in children are benign, whils...

Parsons Jonathan M; Vujanic Gordon M; Wilson Dirk G; Uzun Orhan; De Giovanni Joseph V

2007-01-01

317

Cardiac MRI in Athletes  

OpenAIRE

Cardiac magnetic resonance imaging (CMR) is often used in athletes to image cardiac anatomy and function and is increasingly requested in the context of screening for pathology that can cause sudden cardiac death (SCD). In this thesis, patterns of cardiac adaptation to sports are investigated with CMR. Chapter 2 describes our finding that left-right ratios are preserved across all sports categories, and that these ratios are similar to those found in non-athletic controls. The ratio of ve...

Luijkx, T.

2012-01-01

318

Infection control in cardiac surgery.  

Science.gov (United States)

This report relates the results of a multifaceted, 4 year program directed toward reduction of infection in patients undergoing cardiac operations and extracorporeal circulation in a large teaching hospital. Retrospective analysis of all superficial and deep wound infections and prosthetic valve infections for the period of 1966 to 1970 and a prospective study of the period of 1970 to 1974 were made. The multifaceted program begun in 1970 consisted of (1) renovation of a cardiac operating room with incorporation of a high flow, vertical unidirectional ventilation system, (2) change in the gown and draping material for improvement of barriers to bacteriologic shedding, (3) frequent steam sterilization of prosthetic valves, (4) routine use of an antistaphylococcal agent in patients receiving valve replacement, and (5) an unannounced bacteriologic monitoring program of the cardiac operating room personnel. Studies of airborne particulates and bacteria and adequacy of skin preparation and hair removal also were conducted. The studies showed that (1) a high-flow HEPA filtered vertical ventilation system and altered operating room clothing reduced the concentration of airborne particles and the concentration of bacteria at the wound by a factor of 10 compared to conventional operating rooms, (2) the incidence of markedly contaminated scrubbed and unscrubbed hands decreased, (3) shedders and carriers were identified, and (4) current patient skin preparation and hair removal practices were satisfactory. The results of the program were a reduction of the deep wound infection rate from 2.9 to 0.6 percent (p less than 0.01) and a concomitant total wound infection decrease from 6.6 to 3.3 percent. Prosthetic valve infection rates decreased fourfold, from 5.6 to 1.4 percent. It is concluded that careful attention to possible endogenous sources of infection from the patient and a multifaceted program directed to exogenous sources of infection can lower infection rates in cardiac surgical patients. PMID:1246694

Clark, R E; Amos, W C; Higgins, V; Bemberg, K F; Weldon, C S

1976-01-01

319

Coping to Cardiac Surgery – preview note  

Directory of Open Access Journals (Sweden)

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.

Graciele Fernanda da Costa Linch

2008-11-01

320

Coping to Cardiac Surgery – preview note  

Directory of Open Access Journals (Sweden)

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.

Juliane Umann

2008-11-01

321

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

Directory of Open Access Journals (Sweden)

Full Text Available JUSTIFICATIVA E OBJETIVOS: A incidência e causas de parada cardíaca (PC durante a anestesia variam e são difíceis de comparar diante dos diversos métodos usados nos estudos. A pesquisa teve como objetivo estudar todas as PC ocorridas no intra e pós-operatório, durante um período de sete anos, de 1996 a 2002, em hospital de ensino de atendimento terciário para determinar incidência e causas da PC. MÉTODO: A incidência prospectiva de PC ocorrida durante a anestesia em 40.941 pacientes consecutivos foi identificada, utilizando-se um Banco de Dados. Todos os casos de PC e óbito foram revisados por uma Comissão, para determinar o fator desencadeante da PC ou óbito. A incidência de PC foi calculada em relação à idade, sexo, estado físico, segundo a classificação da ASA, tipo de atendimento, fatores desencadeantes, como alteração do estado físico do paciente e complicações cirúrgicas e anestésicas, tipo de anestesia e evolução para óbito. RESULTADOS: Ocorreram 138 PC (33,7:10.000, sendo a maioria em recém-nascidos, crianças até um ano e idosos, no sexo masculino (65,2%, em pacientes com estado físico ASA III ou superior, em atendimento de emergência e durante anestesia geral. Alterações do estado físico foram o principal fator de PC (23,9:10.000, seguidas de complicações cirúrgicas isoladamente (4,64:10.000 ou associadas a alterações do estado físico (2,44:10.000 e da anestesia isoladamente (1,71:10.000 ou associadas a alterações do estado físico (0,98:10.000. O risco de óbito relacionado à anestesia como fator principal ou contributivo foi igual para ambos (0,49:10.000. As principais causas da mortalidade associada à anestesia foram os problemas ventilatórios (45,4%, eventos relacionados à medicação empregada (27,3%, aspiração pulmonar (18,2% e hidratação excessiva (9,1%. CONCLUSÕES: A incidência de PC durante a anestesia ainda continua elevada. A maioria das PC e óbitos associados à anestesia foi relacionada ao manuseio das vias aéreas e à administração de medicamentos e anestésicos.JUSTIFICATIVA Y OBJETIVOS: La incidencia y causas de parada cardíaca (PC durante la anestesia varían y son difíciles de comparar delante de los diversos métodos usados en los estudios. El objetivo de la pesquisa fue de como estudiar todas las PC ocurridas en el intra y pos-operatorio, durante un período de siete años, de 1996 a 2002, en un hospital de enseñanza de servicio terciario para determinar incidencia y causas de la PC. MÉTODO: La incidencia prospectiva de PC ocurrida durante la anestesia en 40.941 pacientes consecutivos fue identificada, utilizándose un Banco de datos. Todos los casos de PC y fallecimiento fueron revisados por una Comisión, para determinar el factor desencadenante de la PC o fallecimiento. La incidencia de la PC fue calculada con relación a la edad, sexo, estado físico, según la clasificación de la ASA, tipo de servicio, factores desencadenantes, como alteración del estado físico del paciente y complicaciones quirúrgicas y anestésicas, tipo de anestesia y evolución para fallecimiento. RESULTADOS: Ocurrieron 138 PC (33,7:10.000, siendo la mayoría en recién nacidos, niños hasta un año de edad y ancianos, en el sexo masculino (65,2%, en pacientes con estado físico ASA III o superior, en servicio de emergencia y durante anestesia general. Alteraciones del estado físico fueron el principal factor de PC (23,9:10.000, seguidas de complicaciones quirúrgicas aisladamente (4,64:10.000 o asociadas a alteraciones del estado físico (2,44:10.000 y de la anestesia aisladamente (1,71:10.000 o asociadas a alteraciones del estado físico (0,98:10.000. El riesgo de fallecimiento relacionado a la anestesia como factor principal o contributivo fue igual para ambos (0,49:10.000. Las principales causas de la mortalidad asociada a la anestesia fueron los problemas ventilatorios (45,4%, eventos relacionados a la medicación usada (27,3%, aspiración pulmonar (18,2% e hidratación excesiva (9,1%. CONCLUSIONES: La incidencia de PC dur

Leandro Gobbo Braz

2004-12-01

322

Innervation of the human cardiac conduction system at birth.  

OpenAIRE

OBJECTIVE--To study the pattern of innervation of the conduction system of the neonatal heart in humans. DESIGN--A prospective analysis based on immunohistochemical and enzyme histochemical examination of newborn human hearts. SETTING--A general district hospital. MAIN OUTCOME MEASURES--Fresh necropsy tissue. MATERIAL--Hearts of three neonatal humans with no cardiac anomaly, freshly taken at necropsy. METHODS--Serial sectioning to obtain a three dimensional reconstruction of the cardiac condu...

Chow, L. T.; Chow, S. S.; Anderson, R. H.; Gosling, J. A.

1993-01-01

323

Measures to reduce cognitive deficits after cardiac surgery  

OpenAIRE

Cognitive deficits can be detected even months after cardiac surgery particularly if the heart lung machine (HLM) was used. Since the number of older patients undergoing cardiac operations is increasing, frequency of cognitive deficits increases as well. This leads to longer hospital stay, lower rehabilitation potential and last but not least a higher mortality. Genesis of postoperative cognitive deficits (POCD) is multifactorial. Operative techniques and materials contribute to micro- and ma...

Holinski, Sebastian

2013-01-01

324

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

Science.gov (United States)

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

Yew, K L

2012-12-01

325

Controlled Cardiac Computed Tomography  

Directory of Open Access Journals (Sweden)

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.

Ge Wang

2006-04-01

326

Controlled Cardiac Computed Tomography  

Directory of Open Access Journals (Sweden)

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.

2006-01-01

327

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

Scientific Electronic Library Online (English)

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

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

2011-06-01

328

Burnout in nurses working with cardiac patients  

OpenAIRE

The burnout syndrome has been described as a frequent job-related health problem in nurses. This syndrome is characterized by emotional fatigue, low personal accomplishment and depersonalization. Its prevalence has not been specifically explored in nurses attending cardiac patients. We designed a prevalence study including nursing staff in a cardiologic hospital (ward and ICU). In addition to sociolaboral data, information regarding the dimensions of the Maslach Burnout Inventory were recorde...

María Josefa Díaz-Muñoz Crespo

2005-01-01

329

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.

330

Assessing depression in cardiac patients: what measures should be considered?  

Science.gov (United States)

It is highly recommended to promptly assess depression in heart disease patients as it represents a crucial risk factor which may result in premature deaths following acute cardiac events and a more severe psychopathology, even in cases of subsequent nonfatal cardiac events. Patients and professionals often underestimate or misjudge depressive symptomatology as cardiac symptoms; hence, quick, reliable, and early mood changes assessments are warranted. Failing to detect depressive signals may have detrimental effects on these patients' wellbeing and full recovery. Choosing gold-standard depression investigations in cardiac patients that fit a hospitalised cardiac setting well is fundamental. This paper will examine eight well established tools following Italian and international guidelines on mood disorders diagnosis in cardiac patients: the Hospital Anxiety and Depression Scale (HADS), the Cognitive Behavioural Assessment Hospital Form (CBA-H), the Beck Depression Inventory (BDI), the two and nine-item Patient Health Questionnaire (PHQ-2, PHQ-9), the Depression Interview and Structured Hamilton (DISH), the Hamilton Rating Scale for Depression (HAM-D/HRSD), and the Composite International Diagnostic Interview (CIDI). Though their strengths and weaknesses may appear to be homogeneous, the BDI-II and the PHQ are more efficient towards an early depression assessment within cardiac hospitalised patients. PMID:24649359

Ceccarini, M; Manzoni, G M; Castelnuovo, G

2014-01-01

331

Magnetocardiography and cardiac risk.  

Science.gov (United States)

Risk evaluation is a challenging problem in clinical cardiology. Recently, the development of new therapeutic strategies for malignant cardiac arrhythmias and ischemia has urged the need for more accurate screening methods of risk patients The purpose of this review is to summarize the current scientific evidence on the applicability of a new method, high-resolution magnetocardiography (HR-MCG), in identification of cardiac patients at risk of malignant ventricular arrhythmias and ischemic episodes. In recent years different methods for recognizing the electromagnetic abnormalities indicating the increased risk have been used with promising results. At present, the following conclusions can be made: 1) MCG can reliably identify patients prone to malignant ventricular arrhythmias after myocardial infarction as well as in cardiomyopathy, in long QT syndrome, and in operated congenital heart disease. 2) Several analysis methods seem to work: high-pass filtering, relative smoothness score and magnetic field map trajectory plots. 3) Detection and localization of acute and chronic ischemia seems technically feasible and may be one of the most important new clinical applications of the method. 4) Larger clinical series are needed to optimize these techniques and to evaluate their feasibility in the clinics. 5) Prognostic studies should also be started as soon as possible. There are already many multichannel MCG measurement systems available in hospitals to enable clinical studies.ZUSAMMENFASSUNG: Die Risikoabschätzung stellt in der klinischen Kardiologie ein schwieriges Problem dar. Kürzlich hat die Entwicklung neuer Strategien bei malignen kardialen Arrhythmien und der Ischämie die, Notwendigkeit an exakteren Untersuchungsmethoden bei Risikopatienten unterstrichen. Diese Ubersicht soll dem Zweck dienen, die derzeitige wissenschaftliche Anwendbarkeit einer neuen Methode, der hochauflösenden Magnetokardiographie (HR-MCG) bei Herzpatienten nachzuweisen, bei denen ein Risiko des Auftretens maligner Kammerarrhythmien und ischämischen Episoden beseht. Im Verlauf der letzten Jahre sind mit vielversprechenden Resultaten verschiedene Methoden zum Nachweis elektromagnetischer Störungen entwickelt worden, die auf ein erhöhtes Risiko hinweisen. Momentan können daraus die folgenden Schlussfolgerungen gezogen werden: 1) Die MCG kann das erhöhte Risiko bei den Patienten zuverlässig aufzeigen, die einen Herzinfarkt durchgemacht haben oder an einer Kardiomyopathie, einem langen QT-Syndrom oder einer operierten, kongenitalen Herzerkrankung leiden. 2) Es scheinen verschiedene Auswertungsmethoden zu funktionieren: Hochpassfiltrierung, Relative Smoothness Score und Magnetkarten-Trajektaufzeichnungen. 3) Nachweis und Lokalisation der akuten und chronischen Ischämie erscheinen technisch möglich zu sein und können eine der wichtigsten neuen klinischen Untersuchungsmethoden darstellen. 4) Umfangreichere klinische Studien sind erforderlich, um die Optimierung dieser Methoden zu erreichen und ihre Eignung unter klinischen Bedingungen aufzuzeigen. 5) So bald als möglich sollten ausserdem prognostische Studien eingeleitet werden. Es existieren in Krankenhäusern bereits einige Multikanal-MCG-Messgeräte, die sich zur Durchführung klinischer Studien eignen. PMID:19484514

Mäkijärvi, M

1997-09-01

332

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

Directory of Open Access Journals (Sweden)

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.

Wiborg Karsten R

2011-10-01

333

Device-related atypical pressure ulcer after cardiac surgery.  

Science.gov (United States)

Medical devices must be closely monitored to prevent harm to patients. Pressure ulcers secondary to medical devices present a significant health burden in terms of length of stay in hospital and cost. Intensivists, anaesthetists and other professionals involved in managing critically ill patients following cardiac surgery need to be aware that pressure ulcers may develop in atypical sites and present at a later stage of the hospital stay. This case report highlights the important issue of device-related pressure ulcers in the cardiac surgical intensive care setting, particularly when the clinical status of the patient may preclude routine assessment and prophylaxis. An algorithm for preventing such pressure ulcers is suggested. PMID:25139595

Glasgow, D; Millen, I S; Nzewi, O C; Varadarajaran, B

2014-08-01

334

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

OpenAIRE

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

Westerdahl Elisabeth; Möller Margareta

2010-01-01

335

A decade (1982 to 1992) of pediatric cardiac transplantation and the impact of FK 506 immunosuppression  

OpenAIRE

The decade from 1982 through 1992 witnessed tremendous growth in pediatric cardiac transplantation. At Children's Hospital of Pittsburgh 66 cardiac transplants were performed during this period (age range 7 hours to 18 years). The cause of cardiomyopathy was congenital (n = 30), cardiomyopathy (n = 29), myocarditis (n = 2), doxorubicin toxicity (n = 2), ischemic (n = 1), valvular (n = 1), and cardiac angiosarcoma (n = 1). Nine children (14 %) required mechanical circulatory support before tra...

Armitage, John M.; Fricker, Frederick J.; Nido, Pedro Del; Starzl, Thomas E.; Hardesty, Robert L.; Griffith, Bartley P.

1993-01-01

336

Cardiac mitochondria and arrhythmias  

OpenAIRE

Despite a high prevalence of sudden cardiac death throughout the world, the mechanisms that lead to ventricular arrhythmias are not fully understood. Over the last 20 years, a growing body of evidence indicates that cardiac mitochondria are involved in the genesis of arrhythmia. In this review, we have attempted to describe the role that mitochondria play in altering the heart's electrical function by introducing heterogeneity into the cardiac action potential. Specifically, we have focused o...

Brown, David A.; O Rourke, Brian

2010-01-01

337

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

OpenAIRE

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

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

2015-01-01

338

Abordagem do paciente reanimado, pós-parada cardiorrespiratória Care of patient resuscitated from cardiac arrest  

Directory of Open Access Journals (Sweden)

Full Text Available JUSTIFICATIVA E OBJETIVOS: A parada cardiorrespiratória (PCR ocorrida em ambulatório tem elevada mortalidade, sendo a sobrevida entre 5% e 35%. Dos pacientes que são reanimados uma percentagem elevada permanece com déficits neurológicos, resultantes das lesões ocorridas, tanto no período de ausência de circulação ou durante a reperfusão. No entanto a compreensão dos mecanismos da lesão cerebral não tem traduzido na melhoria do prognóstico. A hipotermia terapêutica após a reanimação parece ser uma opção válida associada à diminuição destas seqüelas neurológicas. O objetivo deste estudo foi rever a evidência científica relativa à abordagem do paciente reanimado após PCR. CONTEÚDO: Descrição e abordagem dos principais fatores de risco associados à lesão neurológica após PCR, bem como dos seus critérios de prognóstico.Feita pesquisa não sistemática na base de dados PubMed dos artigos referentes à abordagem terapêutica dos pacientes reanimados de parada cardíaca. As referências bibliográficas dos artigos de revisão foram igualmente analisadas. Elaboradas normas práticas para essa abordagem. CONCLUSÕES: Os pacientes que sobrevivem à PCR têm elevado risco de permanecer com lesões neurológicas graves. A hipotermia terapêutica e o controle das variáveis fisiológicas, com otimização da perfusão cerebral, podem melhorar o seu prognóstico.BACKGROUND AND OBJECTIVES: Out-of-hospital cardiac arrest is a major cause of death with survival rates as low as 5% to 35%. A large number of patients who survive resuscitation will face significant neurological damage, as a result of the ischemia that occurs both during cardiac arrest and reperfusion. However understanding of the mechanisms responsible for brain damage has not resulted in prognostic improvement. Therapeutic hypothermia after resuscitation may be a valid option associated to reduction of neurological damage. The purpose of this study was to review scientific evidence related to a therapy for patients resuscitated from cardiac arrest. CONTENTS: Description and analysis of the main risk factors associated with neurological damage after resuscitation from cardiac arrest as well as prognostic criteria was carried out. A non-systematic search was conducted in the PubMed data base for papers on a therapeutic approach for patients resuscitated from cardiac arrest. Bibliographic references of reviewed papers were also analyzed. Practical rules were drafted for such an approach. CONCLUSIONS: Patients resuscitated from cardiac arrest face a high level of risk of neurological damage. Therapeutic hypothermia and control of physiological parameters to optimise brain perfusion, may improve prognosis.

João Carlos Ramos Gonçalves Pereira

2008-06-01

339

Abordagem do paciente reanimado, pós-parada cardiorrespiratória / Care of patient resuscitated from cardiac arrest  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: A parada cardiorrespiratória (PCR) ocorrida em ambulatório tem elevada mortalidade, sendo a sobrevida entre 5% e 35%. Dos pacientes que são reanimados uma percentagem elevada permanece com déficits neurológicos, resultantes das lesões ocorridas, tanto no período de ausênci [...] a de circulação ou durante a reperfusão. No entanto a compreensão dos mecanismos da lesão cerebral não tem traduzido na melhoria do prognóstico. A hipotermia terapêutica após a reanimação parece ser uma opção válida associada à diminuição destas seqüelas neurológicas. O objetivo deste estudo foi rever a evidência científica relativa à abordagem do paciente reanimado após PCR. CONTEÚDO: Descrição e abordagem dos principais fatores de risco associados à lesão neurológica após PCR, bem como dos seus critérios de prognóstico.Feita pesquisa não sistemática na base de dados PubMed dos artigos referentes à abordagem terapêutica dos pacientes reanimados de parada cardíaca. As referências bibliográficas dos artigos de revisão foram igualmente analisadas. Elaboradas normas práticas para essa abordagem. CONCLUSÕES: Os pacientes que sobrevivem à PCR têm elevado risco de permanecer com lesões neurológicas graves. A hipotermia terapêutica e o controle das variáveis fisiológicas, com otimização da perfusão cerebral, podem melhorar o seu prognóstico. Abstract in english BACKGROUND AND OBJECTIVES: Out-of-hospital cardiac arrest is a major cause of death with survival rates as low as 5% to 35%. A large number of patients who survive resuscitation will face significant neurological damage, as a result of the ischemia that occurs both during cardiac arrest and reperfus [...] ion. However understanding of the mechanisms responsible for brain damage has not resulted in prognostic improvement. Therapeutic hypothermia after resuscitation may be a valid option associated to reduction of neurological damage. The purpose of this study was to review scientific evidence related to a therapy for patients resuscitated from cardiac arrest. CONTENTS: Description and analysis of the main risk factors associated with neurological damage after resuscitation from cardiac arrest as well as prognostic criteria was carried out. A non-systematic search was conducted in the PubMed data base for papers on a therapeutic approach for patients resuscitated from cardiac arrest. Bibliographic references of reviewed papers were also analyzed. Practical rules were drafted for such an approach. CONCLUSIONS: Patients resuscitated from cardiac arrest face a high level of risk of neurological damage. Therapeutic hypothermia and control of physiological parameters to optimise brain perfusion, may improve prognosis.

João Carlos Ramos Gonçalves, Pereira.

2008-06-01

340

Alternative models of cardiac rehabilitation: A systematic review.  

Science.gov (United States)

The traditional hospital-based model of cardiac rehabilitation faces substantial challenges, such as cost and accessibility. These challenges have led to the development of alternative models of cardiac rehabilitation in recent years. The aim of this study was to identify and critique evidence for the effectiveness of these alternative models. A total of 22 databases were searched to identify quantitative studies or systematic reviews of quantitative studies regarding the effectiveness of alternative models of cardiac rehabilitation. Included studies were appraised using a Critical Appraisal Skills Programme tool and the National Health and Medical Research Council's designations for Level of Evidence. The 83 included articles described interventions in the following broad categories of alternative models of care: multifactorial individualized telehealth, internet based, telehealth focused on exercise, telehealth focused on recovery, community- or home-based, and complementary therapies. Multifactorial individualized telehealth and community- or home-based cardiac rehabilitation are effective alternative models of cardiac rehabilitation, as they have produced similar reductions in cardiovascular disease risk factors compared with hospital-based programmes. While further research is required to address the paucity of data available regarding the effectiveness of alternative models of cardiac rehabilitation in rural, remote, and culturally and linguistically diverse populations, our review indicates there is no need to rely on hospital-based strategies alone to deliver effective cardiac rehabilitation. Local healthcare systems should strive to integrate alternative models of cardiac rehabilitation, such as brief telehealth interventions tailored to individual's risk factor profiles as well as community- or home-based programmes, in order to ensure there are choices available for patients that best fit their needs, risk factor profile, and preferences. PMID:23943649

Clark, Robyn A; Conway, Aaron; Poulsen, Vanessa; Keech, Wendy; Tirimacco, Rosy; Tideman, Phillip

2015-01-01

341

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

Directory of Open Access Journals (Sweden)

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.

Grace Sherry L

2012-08-01

342

Genoplivning med automatisk ekstern defibrillator på hospital  

DEFF Research Database (Denmark)

Early defibrillation is a determinant of survival in cardiac arrest. We report a Danish case of successful in-hospital resuscitation using an automated external defibrillator (AED). This case illustrates important aspects of implementation of in-hospital use of an AED, i.e. location of the AED, education of the staff, systematic registration and data collection and technical aspects of AED use. If in-hospital AED implementation is carefully executed, its use may provide a safe and effective way of obtaining early defibrillation. Udgivelsesdato: 2009-Jan-26

LØfgren, Bo; Wahlgreen, Claus

2009-01-01

343

Hospital fundamentals.  

Science.gov (United States)

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

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

2014-07-01

344

Diagnosis of traumatic cardiac contusion  

International Nuclear Information System (INIS)

Cardiac contusion following blunt chest trauma remains a diagnostic problem because of a lack of sensitive diagnostic tests. This study evaluated thallous chloride Tl 201 single-photon-emission computed tomography in a series of 48 patients following blunt chest trauma. Of the 48 patients, 23 had normal scans. None of these patients proved to have serious arrhythmias during three days of continuous monitoring. Of 25 patients with abnormal or ambiguous studies, five (20%) developed serious arrhythmias requiring therapy. Single-photon-emission computed tomography scanning thus was sensitive in indicating that group of patients at risk of serious arrhythmias, and may therefore prove to be a useful screening test to determine the need for hospitalization and arrhythmia monitoring following blunt chest trauma

345

Comparison of Plasma Cardiac Troponin I and Cardiac Enzymes in Haemodialysis Patients of Gorgan (South East of Iran  

Directory of Open Access Journals (Sweden)

Full Text Available The objectives of this study were to evaluate the effect of haemodialysis on plasma Cardiac Troponin I and cardiac enzymes before and after the dialysis process. Twenty two patients with Chronic Renal Failure (CRF disease who were haemodialyzed at 5th Azar hospital of Gorgan Dialysis Center were recruited for this study (2005. The patients do not have coronary heart disease. Plasma cardiac enzymes showed no significant difference in the post dialysis group when compared with predialysis. Plasma levels of Cardiac Troponin I in 12 haemodialyzed patients were significantly increased in the postdialysis group when compared with predialysis, whereas plasma level of Cardiac Troponin I in 10 haemodialyzed patients were undetectable ( less than 0.1 ?g L-1. The observation of meaningful increasing level of plasma Cardiac Troponin I in the haemodialyzed patients after the process of dialysis shows that Cardiac Troponin I is highly specific marker for Acute Myocardial Infarction (AMI when compared with other cardiac enzymes and is particularly useful for detecting AMI in chronic renal failure and haemodialysis patients which can prevent sudden cardiovascular abnormality and sudden silent myocardial infarction in these patients.

Abdoljalal Marjani

2007-01-01

346

Cardiac imaging to investigate suspected cardiac pain in the post-treadmill era.  

Science.gov (United States)

Symptomatic cardiovascular disease is one of the leading causes of hospital admissions in the UK; along with emergency attendances, over 100,000 patients are investigated using treadmill testing via rapid access chest pain clinics each year. With the introduction of new technologies, clinicians have a wide choice of investigations including nuclear perfusion scanning, dobutamine stress echocardiography, cardiac computed tomography and stress cardiac magnetic resonance imaging. These imaging modalities have their strengths and weaknesses, which depend not only on the pre-test likelihood of significant coronary artery disease but also the clinical characteristics of the patient. This article will review the differing imaging modalities, the patient experience, accuracy, prognostic data and future prospects for cardiac computed tomography and magnetic resonance imaging. PMID:25301906

Gosling, Oliver E; Morgan-Hughes, Gareth; Bellenger, Nick G

2014-10-01

347

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

DEFF Research Database (Denmark)

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.

Jakobsen, Carl-Johan; Bhavsar, Rajesh

2012-01-01

348

Automatic Implantable Cardiac Defibrillator  

Medline Plus

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

349

[Progress in cardiac pacing].  

Science.gov (United States)

This article contains a discussion of the most recent developments in cardiac resynchronization therapy, of the feasibility of performing magnetic resonance imaging in patients with cardiac pacemakers, and of the current and future status of leadless pacing. Finally, the most significant scientific articles published in the last year are reviewed. PMID:21276495

Sancho-Tello de Carranza, María-José; Ruiz-Mateas, Francisco; Fidalgo-Andrés, María Luisa; Buendía-Fuentes, Francisco

2011-01-01

350

The Chinese version of the cardiac depression scale: Mokken scaling  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Myocardial infarction is a major cause of death and morbidity in many countries, including China. The aim of this study was to analyse a Mandarin Chinese translation of the Cardiac Depression Scale for a hierarchy of items according to the criteria of Mokken scaling. Findings Data from 438 Chinese participants who completed the Chinese translation of the Cardiac Depression Scale were analysed using the Mokken scaling procedure and the 'R' statistical programme using the diagnostics available in these programmes. Correlations between Mandarin Chinese items and Chinese translations of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory were also analysed. Fifteen items from the Mandarin Chinese Cardiac Depression Scale were retained in a weak but reliable Mokken scale; invariant item ordering was evident but of low accuracy and the Mokken scaled items of the Chinese Cardiac Depression Scale correlated with the Hospital Anxiety and Depression Scale and the Beck Depression Inventory. Conclusions Items from the Mandarin Chinese Cardiac Depression Scale form a Mokken scale and this offers further insight into how the items of the Cardiac Depression Scale relate to the measurement of depression in people with a myocardial infarction.

Watson Roger

2012-03-01

351

Fast tracking in paediatric cardiac anaesthesia : an update.  

Directory of Open Access Journals (Sweden)

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

Lake Carol

2002-01-01

352

Cardiac Hegemony of Senescence.  

Science.gov (United States)

Cardiac senescence and age-related disease development have gained general attention and recognition in the past decades due to increased accessibility and quality of health care. The advancement in global civilization is complementary to concerns regarding population aging and development of chronic degenerative diseases. Cardiac degeneration has been rigorously studied. The molecular mechanisms of cardiac senescence are on multiple cellular levels and hold a multilayer complexity level, thereby hampering development of unambiguous treatment protocols. In particular, the synergistic exchange of the senescence phenotype through a senescence secretome between myocytes and stem cells appears complicated and is of great future therapeutic value. The current review article will highlight hallmarks of senescence, cardiac myocyte and stem cell senescence, and the mutual exchange of senescent secretome. Future cardiac cell therapy approaches require a comprehensive understanding of myocardial senescence to improve therapeutic efficiency as well as efficacy. PMID:24349878

Siddiqi, Sailay; Sussman, Mark A

2013-12-01

353

Biomaterials for cardiac regeneration  

CERN Document Server

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 ...

Ruel, Marc

2015-01-01

354

The cardiac patient during Ramadan and Hajj.  

Science.gov (United States)

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

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

2014-10-01

355

The cardiac patient during Ramadan and Hajj  

Science.gov (United States)

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

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

2014-01-01

356

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

OpenAIRE

The aim of the present work is to identify the risk factors for maternal cardiac complications and for adverse neonatal outcome in women with heart disease in pregnancy. Prospective observational study was carried out at a tertiary referral hospital in South India. Data was collected from 144 women going through 146 pregnancies and delivered after 24 weeks of gestation, over a period of 7 years. Logistic regression analysis was done to identify the risk factors for maternal and the neonatal c...

Sheela, C. N.; Shashikala Karanth; Patil, Chandrakanth B.

2011-01-01

357

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

DEFF Research Database (Denmark)

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.

Winkel, Bo Gregers; Holst, Anders Gaarsdal

2011-01-01

358

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)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] 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.

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

1201-12-01

359

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)

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.

Jaime Retamal

2011-09-01

360

Out-of-plane photons in SPECT  

Energy Technology Data Exchange (ETDEWEB)

This paper reports on photons originating from planes adjacent to the slice of interest which introduce considerable qualitative and quantitative error to Single Photon Emission Computerized Tomography (SPECT) images. Typically, images are reconstructed on a slice-by-slice basis and do not take into account out-of-plane radiation that may contribute to the projections. Scatter is a three dimensional (3-D) phenomenon, and full quantitative compensation requires a 3-D reconstruction. The extent of out-of-plane contributions and a method to compensate for these photons has been examined. Simulations using accurate Monte Carlo models were performed to acquire projection data. Analysis of these projections showed that as much as 12% of the total counts corresponding to a 1.8 cm thick slice of interest were due to out-of-plane non-scatter and that out-of-plane scatter could comprise up to 16% of a projection pixel's total count. Reconstructions were obtained by maximum-likelihood expectation maximization (MLEM) methods that accounted for the out-of-plane phenomena. These reconstructions gave an improvement in count quantitation, noise and contrast as compared to when only in-plan compensation was performed. These findings require 3-D reconstructions with out-of-plane compensation in order to obtain reliable quareliable quantitative SPECT images.

Munley, M.T.; Floyd, C.E. Jr.; Tourassi, G.D.; Bowsher, J.E.; Coleman, R.E. (Duke Univ., Durham, NC (United States). Dept. of Radiology)

1991-04-01

361

Out-of-plane photons in SPECT  

International Nuclear Information System (INIS)

This paper reports on photons originating from planes adjacent to the slice of interest, introduce considerable qualitative and quantitative error to Single Photon Emission Computerized Tomography (SPECT) images. Typically, images are reconstructed on a slice-by-slice basis and do not take into account out-of-plane radiation that may contribute to the projections. Scatter is a three dimensional (3-D) phenomenon, and full quantitative compensation requires a 3-D reconstruction. The extent of out-of-plane contributions and a method to compensate for these photons has been examined. Simulations using accurate Monte Carlo models were performed to acquire projection data. Analysis of these projections showed that as much as 12% of the total counts corresponding to a 1.8 cm thick slice of interest were due to out-of-plane non-scatter and that out-of-plane scatter could comprise up to 16% of a projection pixel's total count. Reconstructions were obtained by maximum-likelihood expectation maximization (MLEM) methods that accounted for the out-of-plane phenomena. These reconstructions gave an improvement in count quantitation, noise and contrast as compared to when only in-plane compensation was performed. These findings require 3-D reconstructions with out-of-plane compensation in order to obtain reliable quantitative SPECT images

362

Predictors of low cardiac output in decompensated severe heart failure  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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

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

363

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)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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 rol

Nájela Hassan, Saloum; Magali Roseira, Boemer.

1999-12-01

364

Minimally invasive paediatric cardiac surgery.  

Science.gov (United States)

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

Bacha, Emile; Kalfa, David

2014-01-01

365

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)

366

Economic and biological costs of cardiac imaging  

Directory of Open Access Journals (Sweden)

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.

Picano Eugenio

2005-05-01

367

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.)

368

A Case of Recurrent Cardiac Arrest and Light Chain Cardiac Amyloidosis  

Science.gov (United States)

Introduction: Light chain amyloidosis is a clonal plasma cell disorder characterized by monoclonal light chain deposition in body organs. The diagnostic challenge belies the variable, often elusive nature of amyloid disease presentation. Cardiac involvement in particular may be seen in up to 50% of cases, and is associated with poor prognosis. We present a case of light chain cardiac amyloidosis, with multi-system derangements, leading to recurrent cardiac arrest despite resuscitative efforts. Case Report: A 59-year-old man with a history of end-stage renal disease presented with the complaint of sudden onset of shortness of breath. Atrial fibrillation with rapid ventricular response was noted. While undergoing treatment, complications arose on 3 separate occasions at which time the patient experienced a precipitous fall in heart rate, cardiac arrest, and successful resuscitation. An echocardiogram was performed which revealed a 25% reduction in ejection fraction and new left ventricular septal thickening in comparison to an evaluation 3 months prior. Cardiac catheterization was unremarkable for coronary artery disease. Over the course of hospitalization, there was progressive muscle weakness. Nerve conduction studies were performed, revealing diffuse axonal sensorimotor neuropathy. The link between diffuse polyneuropathy, autonomic instability, persistent hypotension requiring intravenous vasoactive support, and recurrent asystole remained unclear. Amyloidosis workup with immunofixation electrophoresis revealed free kappa light chain excess. Before further workup, the patient went into asystole, unresponsive to resuscitative efforts. Post-mortem findings suggest cardiac arrest due to amyloidosis of the heart secondary to multiple myeloma. Of note, amyloid deposits were found focally in blood vessels of the kidney and peripheral nerves. Discussion: Early detection of cardiac involvement is crucial as illustrated above. Advanced echocardiographic techniques including speckle tracking plus strain imaging, may lead to earlier, amyloid-specific identification. Gadolinium-enhanced cardiac MRI has also been employed, with futility reserved for infiltrative cardiac disease states without renal insufficiency. Potentially, utilizing the above imaging studies, in association with cardiac biomarkers such as NT-pro BNP, may lead to the development of prognostication tools to identify patient's at high risk for death. Goal for early detection and institution of prognosis models are aimed at early implementation of treatment strategies including heart transplantation, high-dose chemotherapy, and autologous stem cell support. For patients with a myriad of symptoms and suspicion of amyloidosis, we encourage early lab and imaging studies, because any delay in diagnosis and initiation of treatment is inevitably too late.

Azuma, Steven

2014-01-01

369

Lack of agreement between esophageal doppler cardiac output measurements and continuous pulse contour analysis during off-pump cardiac surgery  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: Transesophageal echo-Doppler cardiac output as well as arterial pulse contour analyses cardiac output are increasingly used for cardiac output monitoring. No data are available whether both techniques may be used interchangeably in patients undergoing cardiac surgery. Design: Prospective, observational study Setting: Operating rooms of a university affiliated hospital. Patients: 30 patients undergoing elective coronary artery bypass grafting surgery.Interventions: NoneMeasurements: 900 paired cardiac output measurements were obtained by pulse contour analysis following transpulmonary thermodilution equilibration by the PiCCO system (PiCCO, Pulsion, Munich, Germany and by the HemoSonic esophageal doppler monitor (HemoSonic 100; Arrow International, Reading, PA. Measurements were performed within the first hour after induction of anesthesia. Results: Bland-Altman analysis of the complete data set showed a mean difference (bias of - 0.12 l/min (95% CI -0.06 to -0.18 with limits of agreement + 1.8 l/min to -1.6 l/min (upper 95% CI 1.78 to 1.98; lower 95% CI -1.74 to -1.54, the percentage error was + 37% to -44.5%. Transesophageal echo-Doppler cardiac output closely correlated (r = 0.75, p < 0.0001 with pulse-contour analyses cardiac output. Conclusions: Several studies have shown the accuracy of calibrated pulse contour cardiac output measurements in patients undergoing cardiac surgery. Thus, the present data question the reliability of transesophageal echo-Doppler derived cardiac output measurements in this setting and may have implications for using transesophageal echo-Doppler during goal-directed hemodynamic optimization.

H. V. Groesdonk

2010-03-01

370

Nursing process for the patient submitted to cardiac cateterism  

Directory of Open Access Journals (Sweden)

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.

Rosane B. Lourenci

2006-08-01

371

Molecular Basis of Cardiac Myxomas  

Directory of Open Access Journals (Sweden)

Full Text Available Cardiac tumors are rare, and of these, primary cardiac tumors are even rarer. Metastatic cardiac tumors are about 100 times more common than the primary tumors. About 90% of primary cardiac tumors are benign, and of these the most common are cardiac myxomas. Approximately 12% of primary cardiac tumors are completely asymptomatic while others present with one or more signs and symptoms of the classical triad of hemodynamic changes due to intracardiac obstruction, embolism and nonspecific constitutional symptoms. Echocardiography is highly sensitive and specific in detecting cardiac tumors. Other helpful investigations are chest X-rays, magnetic resonance imaging and computerized tomography scan. Surgical excision is the treatment of choice for primary cardiac tumors and is usually associated with a good prognosis. This review article will focus on the general features of benign cardiac tumors with an emphasis on cardiac myxomas and their molecular basis.

Pooja Singhal

2014-01-01

372

Cardiac output measurement instruments controlled by microprocessors  

International Nuclear Information System (INIS)

The nuclear medicine and biophysics laboratory of the Necker-Enfants malades University Hospital Centre has built a microprocessor controlled Cardiac flowmetre. The principle of the cardiac output measurement from a radiocardiogram is well established. After injection of a radioactive indicator upstream from the heart cavities the dilution curve is obtained by the use of a gamma-ray precordial detector. This curve normally displays two peaks due to passage of the indicator into the right and left sides of the heart respectively. The output is then obtained from the stewart Hamilton principle once recirculation is eliminated. The graphic method used for the calculation however is long and tedious. The decreasing fraction of the dilution curve is projected in logarithmic space in order to eliminate recirculation by determining the mean straight line from which the decreasing exponential is obtained. The principle of the use of microprocessors is explained (electronics, logics)

373

Early administration of levosimendan is associated with improved kidney function after cardiac surgery ¿ a retrospective analysis.  

Science.gov (United States)

BackgroundSeveral animal studies suggest beneficial effects on kidney function upon administration of levosimendan. As recent data from clinical studies are heterogeneous, we sought to investigate whether levosimendan is associated with improved postoperative kidney function in cardiac surgery patients with respect to timing of its administration.MethodsRetrospective, single centre, observational analysis at a university hospital in Berlin, Germany. All adult patients without preoperative renal dysfunction that underwent coronary artery bypass grafting and/or valve reconstruction/replacement between 01/01/2007 and 31/12/2011 were considered for analyses.ResultsOut of 1.095 included patients, 46 patients were treated with levosimendan due to a severely reduced left ventricular systolic function preoperatively (LVEF¿levosimendan was given immediately after anaesthesia induction, creatinine plasma levels (p¿=¿0.009 for nonparametric analysis of longitudinal data in a two-factorial design) and incidence of postoperative renal dysfunction (67.9% vs. 94.4%; p¿=¿0.033) were significantly reduced in contrast to a later start of treatment. In addition, duration of renal replacement therapy was significantly shorter (79 [35;332] vs. 272 [132;703] minutes; p¿=¿0.046) in that group.ConclusionsPostoperative kidney dysfunction is a common condition in patients under going cardiac surgery. Patients with severely reduced left ventricular function and/or clinical signs of a low cardiac output syndrome who preoperatively presented with a normal kidney function may benefit from an early start of levosimendan administration, i.e. immediately after anaesthesia.Trial registrationClinicaltrials.gov-ID: NCT01918618. PMID:25399779

Balzer, Felix; Treskatsch, Sascha; Spies, Claudia; Sander, Michael; Kastrup, Mark; Grubitzsch, Herko; Wernecke, Klaus-Dieter; Braun, Jan P

2014-11-18

374

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... slide, you're looking at discharges from the hospital for cardiovascular disease, you'll see that although ... at the top bar, represents admissions to the hospital for cardiovascular disease compared to many other causes ...

375

Automatic Implantable Cardiac Defibrillator  

Medline Plus

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

376

Sudden cardiac death  

Directory of Open Access Journals (Sweden)

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

Aran?elovi? Aleksandra ?.

2004-01-01

377

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available Automatic Implantable Cardiac Defibrillator February 19, 2009 Halifax Health Medical Center, Daytona Beach, FL Welcome to Halifax ... and understands all of the implications of any changes because any change can have an effect, adversely, ...

378

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 ...

379

Perioperative Cardiac Arrests  

Directory of Open Access Journals (Sweden)

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

JURAJ SPRUNG

2008-10-01

380

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... cardiac disease here in the United States. So where are we right now, Dr. Stoner, with heart ... so that as we get to the place where the heart becomes weaker, we have the situation ...

381

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... the next slide we'll also appreciate the volume of cardiac disease compared to other diseases. If ... And then, depending on the recommendations for that specific device, eventually that goes over a couple of ...

382

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... of an automated implantable cardiac defibrillator. The surgery will be performed by Dr. Hanscy Seide and moderated ... person to live a normal life and eventually will die of heart failure. That's the second way ...

383

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 ...

384

Automatic Implantable Cardiac Defibrillator  

Medline Plus

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

385

Sudden Cardiac Arrest  

Science.gov (United States)

... courses, businesses, airports, airplanes, casinos, convention centers, hotels, sports venues, and schools. Rate This Content: Next >> April 1, 2011 Sudden Cardiac Arrest Clinical Trials Clinical trials are research studies that explore whether a medical strategy, treatment, or ...

386