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Sample records for cardiac arrest complicated

  1. Cardiac arrest

    Science.gov (United States)

    ... Article.jsp. Accessed June 16, 2014. Myerburg RJ, Castellanos A. Approach to cardiac arrest and life-threatening ... PA: Elsevier Saunders; 2011:chap 63. Myerburg RJ, Castellanos A. Cardiac arrest and audden aardiac death. In: ...

  2. Opiate Withdrawal Complicated by Tetany and Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Irfanali R. Kugasia

    2014-01-01

    Full Text Available Patients with symptoms of opiate withdrawal, after the administration of opiate antagonist by paramedics, are a common presentation in the emergency department of hospitals. Though most of opiate withdrawal symptoms are benign, rarely they can become life threatening. This case highlights how a benign opiate withdrawal symptom of hyperventilation led to severe respiratory alkalosis that degenerated into tetany and cardiac arrest. Though this patient was successfully resuscitated, it is imperative that severe withdrawal symptoms are timely identified and immediate steps are taken to prevent catastrophes. An easier way to reverse the severe opiate withdrawal symptom would be with either low dose methadone or partial opiate agonists like buprenorphine. However, if severe acid-base disorder is identified, it would be safer to electively intubate these patients for better control of their respiratory and acid-base status.

  3. Main Complications of Mild Induced Hypothermia after Cardiac Arrest: A Review Article

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    Hassan Soleimanpour

    2014-03-01

    Full Text Available The aim of the present study is to assess the complications of mild induced hypothermia (MIH in patients with cardiac arrest. Presently, based on the guidelines of the American heart Association, MIH following successful cardiopulmonary resuscitation (CPR in unconscious adult patients due to ventricular fibrillation (VF with out-of-hospital cardiac arrest (OOHCA is essential and required. However, MIH could be associated with complications in Patients with cardiac arrest. Studies conducted on the precautions and care following cardiac arrest and MIH were included. Valid scientific data bases were used for data collection. The obtained results from different studies revealed that mild MIH could be associated with numerous complications and the knowledge and awareness of the medical staff from the complications is required to guarantee successful therapeutic approaches in MIH following cardiac arrest which is a novel medical facility with different styles and complications. Overall, further future studies are required to improve the quality of MIH, to increase survival and to decrease complications rates.

  4. Sudden Cardiac Arrest

    Science.gov (United States)

    ... Heart Risk Factors & Prevention Heart Diseases & Disorders Atrial Fibrillation (AFib) Sudden Cardiac Arrest (SCA) SCA: Who's At Risk? Prevention of SCA What Causes SCA? SCA Awareness Atrial Flutter Heart Block Heart Failure Sick Sinus Syndrome Substances & Heart Rhythm Disorders Symptoms & ...

  5. Cardiac arrest - cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    Basri Lenjani; Besnik Elshani; Nehat Baftiu; Kelmend Pallaska; Kadir Hyseni; Njazi Gashi; Nexhbedin Karemani; Ilaz Bunjaku; Taxhidin Zaimi; Arianit Jakupi

    2014-01-01

    Objective:To investigate application of cardiopulmonary resuscitation(CPR) measures within the golden minutes inEurope.Methods:The material was taken from theUniversityClinical Center ofKosovo -EmergencyCentre inPristina, during the two(2) year period(2010-2011).The collected date belong to the patients with cardiac arrest have been recorded in the patients' log book protocol at the emergency clinic.Results:During the2010 to2011 in the emergency center of theCUCK inPristina have been treated a total of269 patients with cardiac arrest, of whom159 or59.1% have been treated in2010, and110 patients or40.9% in2011.Of the269 patients treated in the emergency centre,93 or34.6% have exited lethally in the emergency centre, and176 or 65.4% have been transferred to other clinics.In the total number of patients with cardiac arrest, males have dominated with186 cases, or69.1%.The average age of patients included in the survey was56.7 year oldSD±16.0 years.Of the269 patients with cardiac arrest, defibrillation has been applied for93 or34.6% of patients.In the outpatient settings defibrillation has been applied for3 or3.2% of patients.Patients were defibrillated with application of one to four shocks. Of27 cases with who have survived cardiac arrest, none of them have suffered cardiac arrest at home,3 or11.1% of them have suffered cardiac arrest on the street, and24 or88.9% of them have suffered cardiac arrest in the hospital.5 out of27 patients survived have ended with neurological impairment.Cardiac arrest cases were present during all days of the week, but frequently most reported cases have been onMonday with32.0% of cases, and onFriday with24.5% of cases. Conclusions:All survivors from cardiac arrest have received appropriate medical assistance within10 min from attack, which implies that if cardiac arrest occurs near an institution health care(with an opportunity to provide the emergent health care) the rate of survival is higher.

  6. Prolonged cardiac arrest complicating a massive ST-segment elevation myocardial infarction associated with marijuana consumption

    Science.gov (United States)

    Orsini, Jose; Blaak, Christa; Rajayer, Salil; Gurung, Vikash; Tam, Eric; Morante, Joaquin; Shamian, Ben; Malik, Ryan

    2016-01-01

    Recreational substance use and misuse constitute a major public health issue. The annual rate of recreational drug overdose-related deaths is increasing exponentially, making unintentional overdose as the leading cause of injury-related deaths in the United States. Marijuana is the most widely used recreational illicit drug, with approximately 200 million users worldwide. Although it is generally regarded as having low acute toxicity, heavy marijuana usage has been associated with life-threatening consequences. Marijuana is increasingly becoming legal in the United States for both medical and recreational use. Although the most commonly seen adverse effects resulting from its consumption are typically associated with neurobehavioral and gastrointestinal symptoms, cases of severe toxicity involving the cardiovascular system have been reported. In this report, the authors describe a case of cannabis-associated ST-segment elevation myocardial infarction leading to a prolonged cardiac arrest. PMID:27609717

  7. Prolonged cardiac arrest complicating a massive ST-segment elevation myocardial infarction associated with marijuana consumption

    Directory of Open Access Journals (Sweden)

    Jose Orsini

    2016-09-01

    Full Text Available Recreational substance use and misuse constitute a major public health issue. The annual rate of recreational drug overdose-related deaths is increasing exponentially, making unintentional overdose as the leading cause of injury-related deaths in the United States. Marijuana is the most widely used recreational illicit drug, with approximately 200 million users worldwide. Although it is generally regarded as having low acute toxicity, heavy marijuana usage has been associated with life-threatening consequences. Marijuana is increasingly becoming legal in the United States for both medical and recreational use. Although the most commonly seen adverse effects resulting from its consumption are typically associated with neurobehavioral and gastrointestinal symptoms, cases of severe toxicity involving the cardiovascular system have been reported. In this report, the authors describe a case of cannabis-associated ST-segment elevation myocardial infarction leading to a prolonged cardiac arrest.

  8. Prolonged cardiac arrest complicating a massive ST-segment elevation myocardial infarction associated with marijuana consumption.

    Science.gov (United States)

    Orsini, Jose; Blaak, Christa; Rajayer, Salil; Gurung, Vikash; Tam, Eric; Morante, Joaquin; Shamian, Ben; Malik, Ryan

    2016-01-01

    Recreational substance use and misuse constitute a major public health issue. The annual rate of recreational drug overdose-related deaths is increasing exponentially, making unintentional overdose as the leading cause of injury-related deaths in the United States. Marijuana is the most widely used recreational illicit drug, with approximately 200 million users worldwide. Although it is generally regarded as having low acute toxicity, heavy marijuana usage has been associated with life-threatening consequences. Marijuana is increasingly becoming legal in the United States for both medical and recreational use. Although the most commonly seen adverse effects resulting from its consumption are typically associated with neurobehavioral and gastrointestinal symptoms, cases of severe toxicity involving the cardiovascular system have been reported. In this report, the authors describe a case of cannabis-associated ST-segment elevation myocardial infarction leading to a prolonged cardiac arrest. PMID:27609717

  9. Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery

    Directory of Open Access Journals (Sweden)

    Siriphuwanun V

    2014-10-01

    Full Text Available Visith Siriphuwanun,1 Yodying Punjasawadwong,1 Worawut Lapisatepun,1 Somrat Charuluxananan,2 Ketchada Uerpairojkit2 1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Purpose: To determine prognostic factors for death and survival with or without complications in cardiac arrest patients who received cardiopulmonary resuscitation (CPR within 24 hours of receiving anesthesia for emergency surgery. Patients and methods: A retrospective cohort study approved by the Maharaj Nakorn Chiang Mai University Hospital Ethical Committee. Data used were taken from records of 751 cardiac arrest patients who received their first CPR within 24 hours of anesthesia for emergency surgery between January 1, 2003 and October 31, 2011. The reviewed data included patient characteristics, surgical procedures, American Society of Anesthesiologist (ASA physical status classification, anesthesia information, the timing of cardiac arrest, CPR details, and outcomes at 24 hours after CPR. Univariate and polytomous logistic regression analyses were used to determine prognostic factors associated with the outcome variable. P-values of less than 0.05 were considered statistically significant. Results: The outcomes at 24 hours were death (638/751, 85.0%, survival with complications (73/751, 9.7%, and survival without complications (40/751, 5.3%. The prognostic factors associated with death were: age between 13–34 years (OR =3.08, 95% CI =1.03–9.19; ASA physical status three and higher (OR =6.60, 95% CI =2.17–20.13; precardiopulmonary comorbidity (OR =3.28, 95% CI =1.09–9.90; the condition of patients who were on mechanical ventilation prior to receiving anesthesia (OR =4.11, 95% CI =1.17–14.38; surgery in the upper abdominal site (OR =14.64, 95% CI =2.83–75.82; shock prior to cardiac arrest (OR =6.24, 95% CI =2.53–15

  10. Cardiac arrest – cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Basri Lenjani

    2014-01-01

    Conclusions: All survivors from cardiac arrest have received appropriate medical assistance within 10 min from attack, which implies that if cardiac arrest occurs near an institution health care (with an opportunity to provide the emergent health care the rate of survival is higher.

  11. Metoclopramide-induced cardiac arrest

    Directory of Open Access Journals (Sweden)

    Martha M. Rumore

    2011-11-01

    Full Text Available The authors report a case of cardiac arrest in a patient receiving intravenous (IV metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s underlying metoclopramide’s cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and

  12. Sudden Cardiac Arrest (SCA) Risk Assessment

    Science.gov (United States)

    ... Find a Specialist Share Twitter Facebook SCA Risk Assessment Sudden Cardiac Arrest (SCA) occurs abruptly and without ... of all ages and health conditions. Start Risk Assessment The Sudden Cardiac Arrest (SCA) Risk Assessment Tool ...

  13. Hypothermia improves outcome from cardiac arrest.

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    Bernard, S A

    2005-12-01

    Out-of-hospital cardiac arrest is common and patients who are initially resuscitated by ambulance officers and transported to hospital are usually admitted to the intensive care unit (ICU). In the past, the treatment in the ICU consisted of supportive care only, and most patients remained unconscious due to the severe anoxic neurological injury. It was this neurological injury rather than cardiac complications that caused the high rate of morbidity and mortality. However, in the early 1990's, a series of animal experiments demonstrated convincingly that mild hypothermia induced after return of spontaneous circulation and maintained for several hours dramatically reduced the severity of the anoxic neurological injury. In the mid-1990's, preliminary human studies suggested that mild hypothermia could be induced and maintained in post-cardiac arrest patients without an increase in the rate of cardiac or other complications. In the late 1990's, two prospective, randomised, controlled trials were conducted and the results confirmed the animal data that mild hypothermia induced after resuscitation and maintained for 12 - 24 hours dramatically improved neurological and overall outcomes. On the basis of these studies, mild hypothermia was endorsed in 2003 by the International Liaison Committee on Resuscitation as a recommended treatment for comatose patients with an initial cardiac rhythm of ventricular fibrillation. However, the application of this therapy into routine clinical critical care practice has been slow. The reasons for this are uncertain, but may relate to the relative complexity of the treatment, unfamiliarity with the pathophysiology of hypothermia, lack of clear protocols and/or uncertainty of benefit in particular patients. Therefore, recent research in this area has focused on the development of feasible, inexpensive techniques for the early, rapid induction of mild hypothermia after cardiac arrest. Currently, the most promising strategy is a rapid

  14. Impact of emergency percutaneous coronary intervention on outcomes of ST-segment elevation myocardial infarction patients complicated by out-of-hospital cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    LIU Hong-wei; PAN Wei; WANG Lan-feng; SUN Yan-ming; LI Zhu-qin; WANG Zhong-hua

    2012-01-01

    Background Cardiac arrest is one of the most serious complications of acute myocardial infarction (AMI),especially in the out-of-hospital patients.There is no general consensus as to whether percutaneous coronary intervention (PCI) is effective in treating ST-segment elevation myocardial infarction (STEMI) patients complicated by out-of-hospital cardiac arrest (OHCA).In our study,we evaluated the efficacy of PCI in treating STEMI patients complicated by OHCA through observing their clinical conditions in hospital; including total mortality,adverse cardiac events,stroke,acute renal failure,and gastrointestinal bleeding events.Methods A total of 1827 STEMI patients were enrolled in this study,where 81 were STEMI with OHCA.Between the patients with and without OHCA,and the OHCA patients with and without PCI,we compared the clinical characteristics during hospitalization,including total mortality and incidences of adverse cardiac events,and stroke.Results Compared to the patients without OHCA,the OHCA patients had significantly lower systolic blood pressure (P <0.05) and a faster heart rate (P<0.05),and a higher percentage of Killip class IV or Glasgow coma scale (GCS) ≤7 onadmission (P <0.001).And the in-hospital mortality was higher in the OHCA patients (55.6% vs.2.4%,P <0.001).Comparing the OHCA patients without PCI to the patients with PCI,there was no obvious difference of heart rate,blood pressure or the percentage of Killip class IV and GCS ≤7 on admission,but the incidences of cardiogenic shock,stroke were significantly lower in the with-PCI group during hospitalization (P <0.001,P <0.05).And the in-hospital mortality of the OHCA patients receiving PCI was significantly lower (36.7% vs.84.3%,P<0.001).Conclusions During hospitalization,the incidence of adverse events and mortality are higher in the STEMI with OHCA patients,comparing with the STEMI without OHCA.Emergency PCI reduces the incidence of adverse events and decreases mortality

  15. [Out-of-hospital cardiac arrest].

    Science.gov (United States)

    Virkkunen, Ilkka; Hoppu, Sanna; Kämäräinen, Antti

    2011-01-01

    Cardiac arrest as the first symptom of coronary artery disease is not uncommon. Some of previously healthy people with sudden cardiac arrest may be saved by effective resuscitation and post-resuscitative therapy. The majority of cardiac arrest patients experience the cardiac arrest outside of the hospital, in which case early recognition of lifelessness, commencement of basic life support and entry to professional care without delay are the prerequisites for recovery. After the heart has started beating again, the clinical picture of post-resuscitation syndrome must be recognized and appropriate treatment utilized. PMID:22204143

  16. Cognitive and Functional Consequence of Cardiac Arrest.

    Science.gov (United States)

    Perez, Claudia A; Samudra, Niyatee; Aiyagari, Venkatesh

    2016-08-01

    Cardiac arrest is associated with high morbidity and mortality. Better-quality bystander cardiopulmonary resuscitation training, cardiocerebral resuscitation principles, and intensive post-resuscitation hospital care have improved survival. However, cognitive and functional impairment after cardiac arrest remain areas of concern. Research focus has shifted beyond prognostication in the immediate post-arrest period to identification of mechanisms for long-term brain injury and implementation of promising protocols to reduce neuronal injury. These include therapeutic temperature management (TTM), as well as pharmacologic and psychological interventions which also improve overall neurological function. Comprehensive assessment of cognitive function post-arrest is hampered by heterogeneous measures among studies. However, the domains of attention, long-term memory, spatial memory, and executive function appear to be affected. As more patients survive cardiac arrest for longer periods of time, there needs to be a greater focus on interventions that can enhance cognitive and psychosocial function post-arrest. PMID:27311306

  17. Surface Electrocardiogram Predictors of Sudden Cardiac Arrest

    Science.gov (United States)

    Abdelghani, Samy A.; Rosenthal, Todd M.; Morin, Daniel P.

    2016-01-01

    Background: Heart disease is a major cause of death in industrialized nations, with approximately 50% of these deaths attributable to sudden cardiac arrest. If patients at high risk for sudden cardiac arrest can be identified, their odds of surviving fatal arrhythmias can be significantly improved through prophylactic implantable cardioverter defibrillator placement. This review summarizes the current knowledge pertaining to surface electrocardiogram (ECG) predictors of sudden cardiac arrest. Methods: We conducted a literature review focused on methods of predicting sudden cardiac arrest through noninvasive electrocardiographic testing. Results: Several electrocardiographic-based methods of risk stratification of sudden cardiac arrest have been studied, including QT prolongation, QRS duration, fragmented QRS complexes, early repolarization, Holter monitoring, heart rate variability, heart rate turbulence, signal-averaged ECG, T wave alternans, and T-peak to T-end. These ECG findings have shown variable effectiveness as screening tools. Conclusion: At this time, no individual ECG finding has been found to be able to adequately stratify patients with regard to risk for sudden cardiac arrest. However, one or more of these candidate surface ECG parameters may become useful components of future multifactorial risk stratification calculators. PMID:27660578

  18. Ventilation and gas exchange management after cardiac arrest.

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    Sutherasan, Yuda; Raimondo, Pasquale; Pelosi, Paolo

    2015-12-01

    For several decades, physicians had integrated several interventions aiming to improve the outcomes in post-cardiac arrest patients. However, the mortality rate after cardiac arrest is still as high as 50%. Post-cardiac arrest syndrome is associated with high morbidity and mortality due to not only poor neurological outcome and cardiovascular failure but also respiratory dysfunction. To minimize ventilator-associated lung injury, protective mechanical ventilation by using low tidal volume ventilation and driving pressure may decrease pulmonary complications and improve survival. Low level of positive end-expiratory pressure (PEEP) can be initiated and titrated with careful cardiac output and respiratory mechanics monitoring. Furthermore, optimizing gas exchange by avoiding hypoxia and hyperoxia as well as maintaining normocarbia may improve neurological and survival outcome. Early multidisciplinary cardiac rehabilitation intervention is recommended. Minimally invasive monitoring techniques, that is, echocardiography, transpulmonary thermodilution method measuring extravascular lung water, as well as transcranial Doppler ultrasound, might be useful to improve appropriate management of post-cardiac arrest patients. PMID:26670813

  19. Predictors for outcome among cardiac arrest patients

    DEFF Research Database (Denmark)

    Wibrandt-Johansen, Ida Maria; Norsted, Kristine; Schmidt, Henrik;

    2015-01-01

    BackgroundIn the past decade, early treatment of cardiac arrest (CA) victims has been improved in several ways, leading to more optimistic over all prognoses. However, the global survival rate after out-of-hospital CA (OHCA) is still not more than 5-10%. With a better knowledge of the predictors...

  20. Effects of subdiaphragmatic cardiac compression on cardiac arrest during liver transplantation

    Institute of Scientific and Technical Information of China (English)

    WANG Li-xiang; JI Zhi-xin; LIU Ya-hua; ZHOU Man-hong; SHI Hong-zhi; GUO Xiao-dong; SUN Kun; MA Li-zhi; CHEN Xin-guo; SHEN Zhong-yang

    2012-01-01

    Cardiac arrest during upper abdominal surgery such as liver transplantation is a rare but very severe complication.Traditional external cardiac compression has been the mainstay of basic life support in general circumstances.Subdiaphragmatic cardiac compression (SDCC),with no incision in the diaphragm,may be a more effective measure.This maneuver can provide more effective and timely cardiac compression via the already open abdomen in surgery and not add extra trauma.This method can provide a quicker and more effective means of circulation support for intraoperative cardiac arrest patients without adding new injuries.Five cases are reported and all the patients had return of spontaneous circulation (ROSC).This is the first report of the SDCC method.

  1. Maternal Cardiac Arrest: A Practical and Comprehensive Review

    Directory of Open Access Journals (Sweden)

    Farida M. Jeejeebhoy

    2013-01-01

    Full Text Available Cardiac arrest during pregnancy is a dedicated chapter in the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; however, a robust maternal cardiac arrest knowledge translation strategy and emergency response plan is not usually the focus of institutional emergency preparedness programs. Although maternal cardiac arrest is rare, the emergency department is a high-risk area for receiving pregnant women in either prearrest or full cardiac arrest. It is imperative that institutions review and update emergency response plans for a maternal arrest. This review highlights the most recent science, guidelines, and recommended implementation strategies related to a maternal arrest. The aim of this paper is to increase the understanding of the important physiological differences of, and management strategies for, a maternal cardiac arrest, as well as provide institutions with the most up-to-date literature on which they can build emergency preparedness programs for a maternal arrest.

  2. Cardiac perioperative complications in noncardiac surgery

    OpenAIRE

    Radovanović Dragana; Kolak Radmila; Stokić Aleksandar; Radovanović Zoran; Jovanović Gordana

    2008-01-01

    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 ...

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

    Directory of Open Access Journals (Sweden)

    Josip Ivić

    2009-02-01

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

  4. Abulia following an episode of cardiac arrest.

    Science.gov (United States)

    Naik, Vismay Dinesh

    2015-01-01

    The word 'abulia' means a lack of will, initiative or drive. The symptoms of abulia include lack of spontaneous action and speech, reduced emotional responsiveness and social interaction, poor attention and easy distractibility. These symptoms are independent of reduced levels of consciousness or cognitive impairment. We describe a case of a socially active 72-year-old female patient who presented with symptoms of abulia which may have occurred due to damage of the frontosubcortical circuits following an episode of cardiac arrest. The patient's symptoms improved dramatically following treatment with bromocriptine. PMID:26135487

  5. A case of thyroid storm with cardiac arrest

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    Nakashima Y

    2014-05-01

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

  6. Resuscitation, prolonged cardiac arrest, and an automated chest compression device

    DEFF Research Database (Denmark)

    Risom, Martin; Jørgensen, Henrik; Rasmussen, Lars S;

    2010-01-01

    The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest.......The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest....

  7. Out-of-Hospital Cardiac Arrest in Denmark

    DEFF Research Database (Denmark)

    Wissenberg Jørgensen, Mads

    challenges, due to the victim’s physical location, which brings an inherent risk of delay (or altogether absence) of recognition and treatment of cardiac arrest. A low frequency of bystander cardiopulmonary resuscitation and low 30-day survival after out-of-hospital cardiac arrest were identified nearly ten......BACK COVER TEXT Cardiac arrest is an emergency medical condition characterized by the cessation of cardiac mechanical activity; without immediate and decisive treatment, a victim’s chances of survival are minimal. Out-of-hospital cardiac arrest is a particular arrest subgroup that poses additional...... years ago in Denmark. These findings led to several national initiatives to strengthen bystander resuscitation attempts and advance care. Despite these nationwide efforts, it was unknown prior to this project whether these efforts resulted in changes in resuscitation attempts by bystanders and changes...

  8. Sublingual Microcirculation is Impaired in Post-cardiac Arrest Patients

    DEFF Research Database (Denmark)

    G. Omar, Yasser; Massey, Michael; Wiuff Andersen, Lars;

    2013-01-01

    AIM: We hypothesized that microcirculatory dysfunction, similar to that seen in sepsis, occurs in post-cardiac arrest patients and that better microcirculatory flow will be associated with improved outcome. We also assessed the association between microcirculatory dysfunction and inflammatory...... markers in the post-cardiac arrest state. METHODS: We prospectively evaluated the sublingual microcirculation in post-cardiac arrest patients, severe sepsis/septic shock patients, and healthy control patients using Sidestream Darkfield microscopy. Microcirculatory flow was assessed using...... the microcirculation flow index (MFI) at 6 and 24h in the cardiac arrest patients, and within 6h of emergency department admission in the sepsis and control patients. RESULTS: We evaluated 30 post-cardiac arrest patients, 16 severe sepsis/septic shock patients, and 9 healthy control patients. Sublingual...

  9. Resuscitation of a Pediatric Drowning in Hypothermic Cardiac Arrest.

    Science.gov (United States)

    Dragann, Brendan N; Melnychuk, Eric M; Wilson, Christopher J; Lambert, Richard L; Maffei, Frank A

    2016-01-01

    The prognosis of pediatric patients who require prolonged resuscitation after ice water drowning and hypothermic cardiac arrest remains guarded. We report a case of successful prolonged resuscitation of a pediatric patient in hypothermic cardiac arrest who showed severe metabolic derangements and went on to make a rapid and full neurologic recovery without the use of extracoproreal rewarming or mechanical cardiac support. Many ground and air medical emergency medical service programs have policies against interfacility transfer of patients in hypothermic cardiac arrest, calling into question the need to revise current protocols. PMID:27021675

  10. Combined Application of Circulatory Assist Devices Following Cardiac Arrest in Patients after Cardiac Surgery

    Institute of Scientific and Technical Information of China (English)

    Huang Huanlei; Xiao Xuejun; Wu Ruobin; Ruixin; Cheng Anheng; Zhang Xiaohua; Luo Zhengxiang

    2006-01-01

    Objectives To evaluateretrospectively the potential benefits of combined utilization of various assisted circulation devices in cardiac arrest patients who did not respond to conventional cardiopulmonary cerebral resuscitation (CPCR). Methods Assisted circulation devices,including emergency cardiopulmonary bypass (ECPB), intra-aortic balloon pump (IABP), and left ventricular assist device (LVAD), were applied to 16 adult patients who had cardiac arrest 82 min~56 h after open heart surgery and did not respond to 20 min or longer conventional CPCR. ECPB was applied to 2 patients, ECPB plus IABP to 8 patients, ECPB plus IABP and LVAD to 6 patients. Results One patient recovered fully and one patient died. Of the other 14 patients, 13 resumed spontaneous cardiac rhythm and one did not; none of them could be weaned from ECPB.Further treatment of the 14 patients with combinations of assisted circulation devices enabled 6 patients to recover. One of the 7 recovered patients died of reoccurring cardiac arrest after 11 days; the other 6 were discharged in good condition and were followed up for 3~49 months (mean =22 months). Of the 6 discharged patients one suffered cerebral embolism during LVAD treatment, resulting in mild limitation of mobility of the right limbs; the other 5 never manifested any central nervous system complications. There was no late deaths giving a 37.5% (6/16) long-term survival rate. Conclusions ECPB could effectively reestablish blood circulation and oxygen supply, rectify acidosis,and improve internal milieu. The combined utilization of ECPB, IABP, and LVAD reduces the duration of ECPB, improves the incidence of recovery, and offers beneficial alternatives to refractory cardiac arrest patients.

  11. Cardiac perioperative complications in noncardiac surgery

    Directory of Open Access Journals (Sweden)

    Radovanović Dragana

    2008-01-01

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

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    Introduction: The reported incidences of out-of-hospital cardiac arrests (OHCA) in western countries vary considerably. According to the latest report from Danish Cardiac Arrest Database (DCAD) the incidence rate in Denmark in 2004 was 51/100,000/year. The report states however that this number...... 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...

  13. Complications after cardiac implantable electronic device implantations

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nohr, Ellen Aagaard;

    2013-01-01

    Complications after cardiac implantable electronic device (CIED) treatment, including permanent pacemakers (PMs), cardiac resynchronization therapy devices with defibrillators (CRT-Ds) or without (CRT-Ps), and implantable cardioverter defibrillators (ICDs), are associated with increased patient...

  14. Emergency Neurological Life Support: Resuscitation Following Cardiac Arrest.

    Science.gov (United States)

    Rittenberger, Jon C; Friess, Stuart; Polderman, Kees H

    2015-12-01

    Cardiac arrest is the most common cause of death in North America. Neurocritical care interventions, including targeted temperature management (TTM), have significantly improved neurological outcomes in patients successfully resuscitated from cardiac arrest. Therefore, resuscitation following cardiac arrest was chosen as an emergency neurological life support protocol. Patients remaining comatose following resuscitation from cardiac arrest should be considered for TTM. This protocol will review induction, maintenance, and re-warming phases of TTM, along with management of TTM side effects. Aggressive shivering suppression is necessary with this treatment to ensure the maintenance of a target temperature. Ancillary testing, including electrocardiography, computed tomography and/or magnetic resonance imaging of the brain, continuous electroencephalography monitoring, and correction of electrolyte, blood gas, and hematocrit changes, are also necessary to optimize outcomes. PMID:26438463

  15. The psychosocial outcome of anoxic brain injury following cardiac arrest

    OpenAIRE

    Wilson, Michelle

    2012-01-01

    Aim of the study The psychosocial outcome of anoxic brain injury following cardiac arrest is a relatively under researched, but clinically important area. The aim of the current study was to add to the limited existing literature exploring the psychosocial outcome for cardiac arrest survivors, but specifically explore if there is a greater impact on psychosocial outcome in individuals experiencing anoxic brain injury as a result. Methods A range of self report measures were used to c...

  16. Heart Attack or Sudden Cardiac Arrest: How Are They Different?

    Science.gov (United States)

    ... for Heart360 Cardiovascular Conditions • Conditions Home • Arrhythmia and Atrial Fibrillation • Cardiac ArrestCardiac Rehab • Cardiomyopathy • Cardiovascular Conditions of Childhood • Cholesterol • Congenital Heart Defects • Diabetes • Heart Attack • Heart Failure (HF) • Heart Valve Problems and Disease • High Blood ...

  17. Cardiac arrest after anesthetic management in a patient with hereditary sensory autonomic neuropathy type IV

    Directory of Open Access Journals (Sweden)

    Ergül Yakup

    2011-01-01

    Full Text Available Hereditary sensory autonomic neuropathy type IV is a rare disorder with an autosomal recessive transmission and characterized by self-mutilation due to a lack in pain and heat sensation. Recurrent hyperpyrexia and anhydrosis are seen in patients as a result of a lack of sweat gland innervation. Self-mutilation and insensitivity to pain result in orthopedic complications and patients undergone recurrent surgical interventions with anesthesia. However, these patients are prone to perioperative complications such as hyperthermia, hypothermia, and cardiac complications like bradycardia and hypotension. We report a 5-year-old boy with hereditary sensory autonomic neuropathy type IV, developing hyperpyrexia and cardiac arrest after anesthesia.

  18. Current Pharmacological Advances in the Treatment of Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Andry Papastylianou

    2012-01-01

    Full Text Available Cardiac arrest is defined as the sudden cessation of spontaneous ventilation and circulation. Within 15 seconds of cardiac arrest, the patient loses consciousness, electroencephalogram becomes flat after 30 seconds, pupils dilate fully after 60 seconds, and cerebral damage takes place within 90–300 seconds. It is essential to act immediately as irreversible damage can occur in a short time. Cardiopulmonary resuscitation (CPR is an attempt to restore spontaneous circulation through a broad range of interventions which are early defibrillation, high-quality and uninterrupted chest compressions, advanced airway interventions, and pharmacological interventions. Drugs should be considered only after initial shocks have been delivered (when indicated and chest compressions and ventilation have been started. During cardiopulmonary resuscitation, no specific drug therapy has been shown to improve survival to hospital discharge after cardiac arrest, and only few drugs have a proven benefit for short-term survival. This paper reviews current pharmacological treatment of cardiac arrest. There are three groups of drugs relevant to the management of cardiac arrest: vasopressors, antiarrhythmics, and other drugs such as sodium bicarbonate, calcium, magnesium, atropine, fibrinolytic drugs, and corticosteroids.

  19. Drug therapy in cardiac arrest: a review of the literature.

    Science.gov (United States)

    Lundin, Andreas; Djärv, Therese; Engdahl, Johan; Hollenberg, Jacob; Nordberg, Per; Ravn-Fischer, Annika; Ringh, Mattias; Rysz, Susanne; Svensson, Leif; Herlitz, Johan; Lundgren, Peter

    2016-01-01

    The aim of this study was to review the literature on human studies of drug therapy in cardiac arrest during the last 25 years. In May 2015, a systematic literature search was performed in PubMed, Embase, the Cochrane Library, and CRD databases. Prospective interventional and observational studies evaluating a specified drug therapy in human cardiac arrest reporting a clinical endpoint [i.e. return of spontaneous circulation (ROSC) or survival] and published in English 1990 or later were included, whereas animal studies, case series and reports, studies of drug administration, drug pharmacology, non-specified drug therapies, preventive drug therapy, drug administration after ROSC, studies with primarily physiological endpoints, and studies of traumatic cardiac arrest were excluded. The literature search identified a total of 8936 articles. Eighty-eight articles met our inclusion criteria and were included in the review. We identified no human study in which drug therapy, compared with placebo, improved long-term survival. Regarding adrenaline and amiodarone, the drugs currently recommended in cardiac arrest, two prospective randomized placebo-controlled trials, were identified for adrenaline, and one for amiodarone, but they were all underpowered to detect differences in survival to hospital discharge. Of all reviewed studies, only one recent prospective study demonstrated improved neurological outcome with one therapy over another using a combination of vasopressin, steroids, and adrenaline as the intervention compared with standard adrenaline administration. The evidence base for drug therapy in cardiac arrest is scarce. However, many human studies on drug therapy in cardiac arrest have not been powered to identify differences in important clinical outcomes such as survival to hospital discharge and favourable neurological outcome. Efforts are needed to initiate large multicentre prospective randomized clinical trials to evaluate both currently recommended and

  20. Increased risk of sudden cardiac arrest in obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Warnier, Miriam Jacoba; Blom, Marieke Tabo; Bardai, Abdennasser;

    2013-01-01

    . METHODS: A community-based case-control study was performed, with 1310 cases of SCA of the ARREST study and 5793 age, sex and SCA-date matched non-SCA controls from the PHARMO database. Only incident SCA cases, age older than 40 years, that resulted from unequivocal cardiac causes......BACKGROUND: We aimed to determine whether (1) patients with obstructive pulmonary disease (OPD) have an increased risk of sudden cardiac arrest (SCA) due to ventricular tachycardia or fibrillation (VT/VF), and (2) the SCA risk is mediated by cardiovascular risk-profile and/or respiratory drug use...

  1. Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

    DEFF Research Database (Denmark)

    Westhall, Erik; Rossetti, Andrea O; van Rootselaar, Anne-Fleur;

    2016-01-01

    OBJECTIVE: To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. METHODS: In this cohort study, 4 EEG specialists...... patients. EEGs were recorded in 103 patients at a median 77 hours after cardiac arrest; 37% had a highly malignant EEG and all had a poor outcome (specificity 100%, sensitivity 50%). Any malignant EEG feature had a low specificity to predict poor prognosis (48%) but if 2 malignant EEG features were present...

  2. Anaphylactic shock and cardiac arrest caused by thiamine infusion

    DEFF Research Database (Denmark)

    Juel, Jacob; Pareek, Manan; Langfrits, Christian Sigvald;

    2013-01-01

    intoxication and developed cardiac arrest due to anaphylactic shock following intravenous thiamine infusion. The patient was successfully resuscitated after 15 min and repeated epinephrine administrations. He was discharged in good health after 14 days. This case report emphasises both the importance...

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

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik;

    2015-01-01

    BACKGROUND: There is insufficient knowledge of out-of-hospital cardiac arrest (OHCA) in the very young. OBJECTIVES: This nationwide study sought to examine age-stratified OHCA characteristics and the role of parental socioeconomic differences and its contribution to mortality in the young...

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

    NARCIS (Netherlands)

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

    2015-01-01

    With increasing rates of in-hospital cardiac arrest, improving resuscitation outcomes is essential. Mechanical chest compressors seem to be related to improved outcome in out-of hospital cardiac arrest; however, the literature on its use in in-hospital cardiac arrest is scarce. We used the Medline p

  5. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Lippert, Freddy K.; Folke, Fredrik;

    2013-01-01

    resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29 111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n = 7390) and those with cardiac arrests witnessed by emergency medical services personnel (n......IMPORTANCE Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many associated with improved survival. OBJECTIVE To examine...... temporal changes in bystander resuscitation attempts and survival during a 10-year period in which several national initiatives were taken to increase rates of bystander resuscitation and improve advanced care. DESIGN, SETTING, AND PARTICIPANTS Patients with out-of-hospital cardiac arrest for which...

  6. A Unique Case of Cardiac Arrest following K2 Abuse

    Directory of Open Access Journals (Sweden)

    Saif Ibrahim

    2014-01-01

    Full Text Available Sudden cardiac death (SCD accounts for up to 450,000 deaths every year in the United States (Zipes et al. (2006. Most cases of sudden cardiac death occur in subjects with no prior history of heart disease (Myerburg et al. (1998. The incidence of sudden death in a general population has been shown to increase contemporaneously with substance abuse (Phillips et al. (1999. The causative association of sudden death with cocaine, methadone, and volatile agents is well established (Adgey et al. (1995 and Isner et al. (1986. We describe a case of out-of-hospital cardiac arrest temporally related to abuse of the synthetic cannabinoid street drug known as K2. To our knowledge, there are no previously documented cases of sudden cardiac death associated with synthetic cannabinoids although they have been linked to myocardial infarction in teenagers despite normal coronary angiography (Mir et al. (2011.

  7. The inflammatory marker suPAR after cardiac arrest

    DEFF Research Database (Denmark)

    Rundgren, Malin; Lyngbaek, Stig; Fisker, Helle;

    2015-01-01

    BACKGROUND: Soluble urokinase plasminogen activator receptor (suPAR) is released in response to inflammatory stimuli, and plasma levels are associated with long-term outcomes. The ischemia/reperfusion injury caused by cardiac arrest (CA) and resuscitation triggers an inflammatory response...... analysis shoved an AUC of 0.76 at 6 hours. In the subgroup of CA of cardiac cause, the AUC was 0.84. CONCLUSION: suPAR levels at 6 and 36 hours after CA were significantly higher in nonsurviving patients compared with survivors; however, the overlap in suPAR levels between the outcome groups...

  8. Complications of cardiac catheterization: one centre's experience.

    OpenAIRE

    Morton, B C; Beanlands, D. S.

    1984-01-01

    Data on complication rates in a cardiac catheterization laboratory were prospectively gathered over a 6-year period. During this time 7960 catheterizations were performed. Death occurred in seven (0.1%) of the cases. The difference between the mortality rates for procedures performed with and without systemically administered heparin (0.04% and 0.2% respectively) was barely statistically significant (p less than 0.05). A significant complication occurred in 1.5% of the cases; however, most di...

  9. Hyperoxia toxicity after cardiac arrest: What is the evidence?

    OpenAIRE

    Llitjos, Jean-François; Mira, Jean-Paul; Duranteau, Jacques; Cariou, Alain

    2016-01-01

    This review gives an overview of current knowledge on hyperoxia pathophysiology and examines experimental and human evidence of hyperoxia effects after cardiac arrest. Oxygen plays a pivotal role in critical care management as a lifesaving therapy through the compensation of the imbalance between oxygen requirements and supply. However, growing evidence sustains the hypothesis of reactive oxygen species overproduction-mediated toxicity during hyperoxia, thus exacerbating organ failure by vari...

  10. Anaphylactic shock and cardiac arrest caused by thiamine infusion

    OpenAIRE

    Juel, Jacob; Pareek, Manan; Langfrits, Christian Sigvald; Jensen, Svend Eggert

    2013-01-01

    Parenteral thiamine has a very high safety profile. The most common adverse effect is local irritation; however, anaphylactic or anaphylactoid reactions may occur, mostly related to intravenous administration. We describe a 44-year-old man, a chronic alcoholic, who was admitted with alcohol intoxication and developed cardiac arrest due to anaphylactic shock following intravenous thiamine infusion. The patient was successfully resuscitated after 15 min and repeated epinephrine administrations....

  11. 重度乳酸性酸中毒并心脏骤停一例诊治分析%Characteristics of Severe Lactic Acidosis Complicated with Cardiac Arrest and the Related Literature Review

    Institute of Scientific and Technical Information of China (English)

    刘红升; 苏琴; 曹阳; 姚咏明; 赵晓东

    2015-01-01

    目的:探讨重度乳酸性酸中毒(lactic acidosis, LA)的临床特征及治疗方法,以提高救治成功率。方法对我院收治的重度 LA 并心脏骤停1例的临床资料进行回顾性分析。结果本例因腹泻3 d、剧烈上腹痛1 h 以急性心肌梗死(心梗)急诊入院。有糖尿病史,长期口服二甲双胍,未定期检测血糖。入院后出现腰背剧痛,经相关检查排除急性心梗、主动脉夹层,查血乳酸脱氢酶277.0 U/ L,乳酸17 mmol/ L,血气分析示代谢性酸中毒,入院诊断为糖尿病、重度 LA。入院1 h 后发生心脏骤停,经积极复苏抢救,病情逐步缓解,1个月后临床治愈出院。结论重度 LA 可以剧烈胸腹部疼痛为主要表现,甚至发生心脏骤停,及时诊断及正确评估病情对预后极为重要,积极液体复苏及有效呼吸支持、早期血液透析是救治成功的保证。%Objective To investigate the clinical features and the treatment of severe lactic acidosis (LA) and to im-prove the success rate. Methods We carried out a retrospective analysis of clinical data of a patient suffering from cardiac ar-rest with severe LA and a review of the related literature review was made. Results The patient suffered from diarrhea for 3 d, severe abdominal pain for 1 h and was admitted into our hospital for acute myocardial infarction. The patient had a history of diabetes and diabetic nephropathy and took a long-term oral metformin without testing blood sugar regularly. Relevant exam-inations ruled out acute myocardial infarction and aortic dissection, and then, and the blood lactate dehydrogenase was 277. 0 U/ L, and lactic acid was 17 mmol/ L and blood gas analysis revealed metabolic acidosis. Above all, the patient was di-agnosed with diabetes and severe LA. The patient suffered sudden cardiac arrest one hour after admission, then the condition was alleviated gradually after active recovery treatment, and in the end the patient was clinically cured and was

  12. Hyperoxia toxicity after cardiac arrest: What is the evidence?

    Science.gov (United States)

    Llitjos, Jean-François; Mira, Jean-Paul; Duranteau, Jacques; Cariou, Alain

    2016-12-01

    This review gives an overview of current knowledge on hyperoxia pathophysiology and examines experimental and human evidence of hyperoxia effects after cardiac arrest. Oxygen plays a pivotal role in critical care management as a lifesaving therapy through the compensation of the imbalance between oxygen requirements and supply. However, growing evidence sustains the hypothesis of reactive oxygen species overproduction-mediated toxicity during hyperoxia, thus exacerbating organ failure by various oxidative cellular injuries. In the cardiac arrest context, evidence of hyperoxia effects on outcome is fairly conflicting. Although prospective data are lacking, retrospective studies and meta-analysis suggest that hyperoxia could be associated with an increased mortality. However, data originate from retrospective, heterogeneous and inconsistent studies presenting various biases that are detailed in this review. Therefore, after an original and detailed analysis of all experimental and clinical studies, we herein provide new ideas and concepts that could participate to improve knowledge on oxygen toxicity and help in developing further prospective controlled randomized trials on this topic. Up to now, the strategy recommended by international guidelines on cardiac arrest (i.e., targeting an oxyhemoglobin saturation of 94-98 %) should be applied in order to avoid deleterious hypoxia and potent hyperoxia. PMID:27003426

  13. Witnessed arrest, but not delayed bystander cardiopulmonary resuscitation improves prehospital cardiac arrest survivial

    OpenAIRE

    Vukmir, R

    2004-01-01

    Methods: This prospective, randomised, double blinded clinical intervention trial enrolled 874 prehospital cardiopulmonary arrest patients encountered in a prehospital urban, suburban, and rural regional emergency medical service (EMS) area. This group underwent conventional advanced cardiac life support intervention followed by empiric early administration of sodium bicarbonate (1 mEq/l), monitoring conventional resuscitation parameters. Survival was measured as presence of vital signs on em...

  14. Isolation Syndrome after Cardiac Arrest and Therapeutic Hypothermia.

    Science.gov (United States)

    Forgacs, Peter B; Fridman, Esteban A; Goldfine, Andrew M; Schiff, Nicholas D

    2016-01-01

    Here, we present the first description of an isolation syndrome in a patient who suffered prolonged cardiac arrest and underwent a standard therapeutic hypothermia protocol. Two years after the arrest, the patient demonstrated no motor responses to commands, communication capabilities, or visual tracking at the bedside. However, resting neuronal metabolism and electrical activity across the entire anterior forebrain was found to be normal despite severe structural injuries to primary motor, parietal, and occipital cortices. In addition, using quantitative electroencephalography, the patient showed evidence for willful modulation of brain activity in response to auditory commands revealing covert conscious awareness. A possible explanation for this striking dissociation in this patient is that altered neuronal recovery patterns following therapeutic hypothermia may lead to a disproportionate preservation of anterior forebrain cortico-thalamic circuits even in the setting of severe hypoxic injury to other brain areas. Compared to recent reports of other severely brain-injured subjects with such dissociation of clinically observable (overt) and covert behaviors, we propose that this case represents a potentially generalizable mechanism producing an isolation syndrome of blindness, motor paralysis, and retained cognition as a sequela of cardiac arrest and therapeutic hypothermia. Our findings further support that highly-preserved anterior cortico-thalamic integrity is associated with the presence of conscious awareness independent from the degree of injury to other brain areas. PMID:27375420

  15. The utility of cardiac sonography and capnography in predicting outcome in cardiac arrest

    OpenAIRE

    Nelson, Bret P; Patel, Vaishali R.; Norris, Marlaina M.; Richardson, Barbara K.

    2008-01-01

    Emergency physicians and intensivists are increasingly utilizing capnography and bedside echocardiography during medical resuscitations. These techniques have shown promise in predicting outcomes in cardiac arrest, and no cases of return of spontaneous circulation in the setting of sonographic cardiac standstill and low end-tidal carbon dioxide have been reported. This case report illustrates an example of such an occurrence. Our aims are to report a case of return of spontaneous circulation ...

  16. Experience with bretylium tosylate by a hospital cardiac arrest team.

    Science.gov (United States)

    Holder, D A; Sniderman, A D; Fraser, G; Fallen, E L

    1977-03-01

    The effect of bretylium tosylate (BT) was determined in 27 consecutive cases of resistant ventricular fibrillation (VF) encountered by a hospital cardiac arrest team. The VF was sustained and completely resistant to multiple injections of lidocaine, sequential DC shocks at 400 watt-sec and one or a combination of intravenous propranolol, diphenylhydantoin or procainamide. Following 30 min of sustained cardiac massage, BT (5 mg/kg i.v.) was administered. In 20 patients, VF was terminated within 9-12 min after DC shock. Eight of these patients failed to recover while 12 (44%) of all patients resuscitated survived to be discharged from hospital. Eleven out of 20 (55%) of all patients who had a cardiac arrest outside the CCU were survivors; only one out of seven in the CCU were successfully resuscitated. While receiving maintanance BT post-resuscitation (5 mg/kg i.m. q 8-12 hrs x 48 hrs), half the patients developed hypotension and three required vasopressors and/or fluid replacement. The data indicate that BT is a useful agent in patients with sustained VF refractory to repeated lidocaine injections, some other antiarrhythmic agents, and multiple DC shocks. PMID:837490

  17. [Ethics of organ retrieval after controlled cardiac arrest].

    Science.gov (United States)

    Kinnaert, P

    2011-01-01

    The article tells the evolution of the terminology concerning non heart beating donors during the two last decades and describes summarily the procedure of organ retrieval after controlled cardiac arrest. We then consider the various ethical problems created by this practice. We discuss in detail therapeutic withdrawal, the treatment of the donor during the agonal period, death certification, the doctor's conflict of interests, the presence of the family at the time of death, the quality of the organs and organ retrieval after euthanasia. PMID:22279852

  18. Cardiac arrest caused by multiple recurrent pulmonary embolism

    DEFF Research Database (Denmark)

    Hannig, Kjartan Eskjaer; Husted, Steen Elkjaer; Grove, Erik Lerkevang

    2011-01-01

    Pulmonary embolism is a common condition with a high mortality. We describe a previously healthy 68-year-old male who suffered three pulmonary embolisms during a short period of time, including two embolisms while on anticoagulant treatment. This paper illustrates three important points. (1) The ...... and may be life-saving in patients with cardiac arrest suspected to be caused by pulmonary embolism.......) The importance of optimal anticoagulant treatment in the prevention of pulmonary embolism reoccurrence. (2) The benefit of immediate accessibility to echocardiography in the handling of haemodynamically unstable patients with an unknown underlying cause. (3) Thrombolytic treatment should always be considered...

  19. Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

    Science.gov (United States)

    Rossetti, Andrea O.; van Rootselaar, Anne-Fleur; Wesenberg Kjaer, Troels; Horn, Janneke; Ullén, Susann; Friberg, Hans; Nielsen, Niklas; Rosén, Ingmar; Åneman, Anders; Erlinge, David; Gasche, Yvan; Hassager, Christian; Hovdenes, Jan; Kjaergaard, Jesper; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wanscher, Michael; Wetterslev, Jørn; Wise, Matt P.; Cronberg, Tobias

    2016-01-01

    Objective: To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. Methods: In this cohort study, 4 EEG specialists, blinded to outcome, evaluated prospectively recorded EEGs in the Target Temperature Management trial (TTM trial) that randomized patients to 33°C vs 36°C. Routine EEG was performed in patients still comatose after rewarming. EEGs were classified into highly malignant (suppression, suppression with periodic discharges, burst-suppression), malignant (periodic or rhythmic patterns, pathological or nonreactive background), and benign EEG (absence of malignant features). Poor outcome was defined as best Cerebral Performance Category score 3–5 until 180 days. Results: Eight TTM sites randomized 202 patients. EEGs were recorded in 103 patients at a median 77 hours after cardiac arrest; 37% had a highly malignant EEG and all had a poor outcome (specificity 100%, sensitivity 50%). Any malignant EEG feature had a low specificity to predict poor prognosis (48%) but if 2 malignant EEG features were present specificity increased to 96% (p EEG was found in 1% of the patients with a poor outcome. Conclusions: Highly malignant EEG after rewarming reliably predicted poor outcome in half of patients without false predictions. An isolated finding of a single malignant feature did not predict poor outcome whereas a benign EEG was highly predictive of a good outcome. PMID:26865516

  20. Student perceptions of sudden cardiac arrest: a qualitative inquiry.

    Science.gov (United States)

    McDonough, Annette; Callan, Krista; Egizio, Katelyn; Kenney, Kaye; Gray, Gillian; Mundry, Gillian; Re, Gillian

    Sudden cardiac arrest (SCA) is the number one cause of death in young athletes in high school and university settings. Survival and outcomes of SCA is dependent on appropriate recognition of symptoms and immediate cardiopulmonary resuscitation (CPR), along with a shock from an automatic external defibrillator (AED). The three aims of the authors' study presented in this article were: to describe university students' perceptions and beliefs about sudden cardiac arrest, to describe university students' understanding of an AED and their level of preparedness to recognize and respond to a life threatening emergency event, and to identify university students' experiences of responding to handling life-threatening emergency events. Qualitative methodology was employed using semi-structured interviews and thematic analysis. Three major themes emerged from data analysis: confusion, uncertainty, and fear/uncomfortableness. These themes characterised participant's perceptions about SCA. The authors concluded that a lack of understanding of what SCA is and participants' inability to respond to an emergency event was evident. PMID:22585265

  1. An unusual cause of cardiac arrest in a hospitalized patient

    Directory of Open Access Journals (Sweden)

    K Ranjan Shetty

    2013-01-01

    Full Text Available 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 poisoning as one of the cause for his medical condition. We looked for commonly available toxins. One of the commonly available toxins is hand sanitizer which contains Isopropyl alcohol, glycerin and perfume. Due to prolonged cardiac arrest and intractable arrhythmia patient had sustained hypoxic brain injury. Patient remained hemodynamically stable for next 9 days although his CNS status did not improve. Patient succumbed to sepsis on 9 th day. Healthcare professionals should be aware of such possibilities and treat the patients at the earliest and put a check on the easy availability of IPA based hand sanitizers.

  2. Variation in Out-of-Hospital Cardiac Arrest Management

    Directory of Open Access Journals (Sweden)

    Jason M. Jones

    2016-01-01

    Full Text Available Objective. To evaluate variation in airway management strategies in one suburban emergency medical services system treating patients experiencing out-of-hospital cardiac arrest (OHCA. Method. Retrospective chart review of all adult OHCA resuscitation during a 13-month period, specifically comparing airway management decisions. Results. Paramedics demonstrated considerable variation in their approaches to airway management. Approximately half of all OHCA patients received more than one airway management attempt (38/77 [49%], and one-quarter underwent three or more attempts (25/77 [25%]. One-third of patients arrived at the emergency department with a different airway device than initially selected (25/77 [32%]. Conclusion. This study confirmed our hypothesis that paramedics’ selection of ventilation strategies in cardiac arrest varies considerably. This observation raises concern because airway management diverts time and energy from interventions known to improve outcomes in OHCA management, such as cardiopulmonary resuscitation and defibrillation. More research is needed to identify more focused airway management strategies for prehospital care providers.

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

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper; Søholm, Helle;

    2014-01-01

    AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopres......AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level......-score of Sequential Organ Failure Assessment (SOFA). The population was stratified by use of dopamine as first line intervention (D-group) or use of dopamine+norepinephrine/epinephrine (DA-group). Primary endpoint was 30-day mortality and secondary endpoint was in-hospital cause of death. RESULTS: Patients in the DA......-group carried a 49% all-cause 30-day mortality rate compared to 23% in the D-group, plog-rankCause of death...

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

    Directory of Open Access Journals (Sweden)

    Skrifvars Markus B

    2012-11-01

    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.

  5. Cardiac arrest during gamete release in chum salmon regulated by the parasympathetic nerve system.

    Directory of Open Access Journals (Sweden)

    Yuya Makiguchi

    Full Text Available Cardiac arrest caused by startling stimuli, such as visual and vibration stimuli, has been reported in some animals and could be considered as an extraordinary case of bradycardia and defined as reversible missed heart beats. Variability of the heart rate is established as a balance between an autonomic system, namely cholinergic vagus inhibition, and excitatory adrenergic stimulation of neural and hormonal action in teleost. However, the cardiac arrest and its regulating nervous mechanism remain poorly understood. We show, by using electrocardiogram (ECG data loggers, that cardiac arrest occurs in chum salmon (Oncorhynchus keta at the moment of gamete release for 7.39+/-1.61 s in females and for 5.20+/-0.97 s in males. The increase in heart rate during spawning behavior relative to the background rate during the resting period suggests that cardiac arrest is a characteristic physiological phenomenon of the extraordinarily high heart rate during spawning behavior. The ECG morphological analysis showed a peaked and tall T-wave adjacent to the cardiac arrest, indicating an increase in potassium permeability in cardiac muscle cells, which would function to retard the cardiac action potential. Pharmacological studies showed that the cardiac arrest was abolished by injection of atropine, a muscarinic receptor antagonist, revealing that the cardiac arrest is a reflex response of the parasympathetic nerve system, although injection of sotalol, a beta-adrenergic antagonist, did not affect the cardiac arrest. We conclude that cardiac arrest during gamete release in spawning release in spawning chum salmon is a physiological reflex response controlled by the parasympathetic nervous system. This cardiac arrest represents a response to the gaping behavior that occurs at the moment of gamete release.

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

    Directory of Open Access Journals (Sweden)

    Niković Vuk

    2013-01-01

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

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

    DEFF Research Database (Denmark)

    Kragholm, Kristian; Wissenberg, Mads; Mortensen, Rikke Normark;

    2015-01-01

    BACKGROUND: Data on long-term function of out-of-hospital cardiac arrest survivors are sparse. We examined return to work as a proxy of preserved function without major neurologic deficits in survivors. METHODS AND RESULTS: In Denmark, out-of-hospital cardiac arrests have been systematically repo...

  8. Complement activation and its prognostic role in post-cardiac arrest patients

    DEFF Research Database (Denmark)

    Jenei, Z M; Zima, E; Csuka, D;

    2014-01-01

    of therapeutic hypothermia predicted 30-day mortality regardless of age, sex and the APACHE II score. Complement activation occurs in post-cardiac arrest patients, and its extent correlates with 30-day survival. The C3a/C3 ratio might prove useful for estimating the prognosis of comatose post-cardiac arrest...

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

    DEFF Research Database (Denmark)

    Bagai, Akshay; McNally, Bryan F; Al-Khatib, Sana M;

    2013-01-01

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

  10. Dexmedetomidine Related Bradycardia Leading to Cardiac Arrest in a Dog

    Directory of Open Access Journals (Sweden)

    C. Y. Chen2, K-S. Chen1,2, K. M. Chang2, W. M. Lee1,2, S. C. Chang1,2 and H. C. Wang1,2

    2012-10-01

    Full Text Available A 2-year-old, mixed breed female dog (16 kg underwent an exploratory laparotomy following ultrasonographic diagnosis of foreign body and a segment of small intestine intussusceptions. The patient was classified as an ASA II. Ketamine (1mg/kg, IV, and dexmedetomidine (2.5 µg/kg, IV, and morphine (0.6 mg/kg, SC were given as anesthetic premedication. Propofol (0.1 mg/kg, IV titrated to a total amount of 4 ml (2.5 mg/ kg was given for intubation. Asystole was occurred. Cardiac resuscitation was then conducted immediately. Atipamezole (0.1 ml was injected, but showed no response on ECG. Atropine (0.02 mg/kg was then injected, and a second dosage was given. Two-three mins later, the heart rate at 84 beats/min. The NIBP showed 203/132 with MAP 153 mmHg, and the SpO2 showed 95% after the cardiac function was regained. Dexmedetomidine related bradycardia leading to cardiac arrest has been suggested in this case.

  11. An infant with out-of-hospital cardiac arrest secondary to enteroviral myocarditis surviving up to cardiac transplantation.

    Science.gov (United States)

    McGovern, Eimear; Ryan, Ethel; McMahon, Colin J

    2016-01-01

    We report the case of a 13-day-old infant with enteroviral myocarditis surviving an out-of-hospital cardiac arrest. She underwent orthotopic cardiac transplantation three months later. A year after the transplantation, she is alive and well. Enteroviral infection is common in neonates with high mortality in cases of enteroviral myocarditis. Cardiac transplantation is a treatment option for infants who fail to recover and remain dependent on inotropic support. This is the first report of an infant with out-of-hospital cardiac arrest secondary to enteroviral myocarditis surviving up to cardiac transplantation.

  12. Near death experiences, cognitive function and psychological outcomes of surviving cardiac arrest.

    Science.gov (United States)

    Parnia, S; Spearpoint, K; Fenwick, P B

    2007-08-01

    Cardiac arrest is associated with a number of cognitive processes as well as long term psychological outcomes. Recent studies have indicated that approximately 10-20% of cardiac arrest survivors report cognitive processes, including the ability to recall specific details of their resuscitation from the period of cardiac arrest. In addition it has been demonstrated that these cognitive processes are consistent with the previously described near death experience and that those who have these experiences are left with long term positive life enhancing effects. There have also been numerous studies that have indicated that although the quality of life for cardiac arrest survivors is generally good, some are left with long term cognitive impairments as well as psychological sequelae such as post-traumatic stress disorder. This paper will review near death experiences, cognitive function and psychological outcomes in survivors of cardiac arrest.

  13. Prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest

    DEFF Research Database (Denmark)

    Ottesen, Michael Mundt; Dixen, Ulrik; Torp-Pedersen, Christian;

    2003-01-01

    OBJECTIVE: To study prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest. DESIGN: Structured interview of 250 consecutive patients with acute coronary syndrome and relatives of 48 patients with witnessed cardiac arrest. The following courses of action......-four per cent of the patients admitted with cardiac arrest expressed no prior symptoms. Two-thirds of patients with typical symptoms interpreted it as cardiac-still only half took action within 20 min. Fifty per cent of patients who called a physician were delayed by wrong advice or misinterpretation. One...

  14. Anaphylactic shock and cardiac arrest caused by thiamine infusion.

    Science.gov (United States)

    Juel, Jacob; Pareek, Manan; Langfrits, Christian Sigvald; Jensen, Svend Eggert

    2013-01-01

    Parenteral thiamine has a very high safety profile. The most common adverse effect is local irritation; however, anaphylactic or anaphylactoid reactions may occur, mostly related to intravenous administration. We describe a 44-year-old man, a chronic alcoholic, who was admitted with alcohol intoxication and developed cardiac arrest due to anaphylactic shock following intravenous thiamine infusion. The patient was successfully resuscitated after 15 min and repeated epinephrine administrations. He was discharged in good health after 14 days. This case report emphasises both the importance of recognising the symptoms of anaphylaxis and the fact that facilities for treating anaphylaxis and cardiopulmonary resuscitation should be available when thiamine or for that matter, any drug is given in-hospital. PMID:23853017

  15. Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

    Science.gov (United States)

    Rossetti, Andrea O.; van Rootselaar, Anne-Fleur; Wesenberg Kjaer, Troels; Horn, Janneke; Ullén, Susann; Friberg, Hans; Nielsen, Niklas; Rosén, Ingmar; Åneman, Anders; Erlinge, David; Gasche, Yvan; Hassager, Christian; Hovdenes, Jan; Kjaergaard, Jesper; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wanscher, Michael; Wetterslev, Jørn; Wise, Matt P.; Cronberg, Tobias

    2016-01-01

    Objective: To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. Methods: In this cohort study, 4 EEG specialists, blinded to outcome, evaluated prospectively recorded EEGs in the Target Temperature Management trial (TTM trial) that randomized patients to 33°C vs 36°C. Routine EEG was performed in patients still comatose after rewarming. EEGs were classified into highly malignant (suppression, suppression with periodic discharges, burst-suppression), malignant (periodic or rhythmic patterns, pathological or nonreactive background), and benign EEG (absence of malignant features). Poor outcome was defined as best Cerebral Performance Category score 3–5 until 180 days. Results: Eight TTM sites randomized 202 patients. EEGs were recorded in 103 patients at a median 77 hours after cardiac arrest; 37% had a highly malignant EEG and all had a poor outcome (specificity 100%, sensitivity 50%). Any malignant EEG feature had a low specificity to predict poor prognosis (48%) but if 2 malignant EEG features were present specificity increased to 96% (p < 0.001). Specificity and sensitivity were not significantly affected by targeted temperature or sedation. A benign EEG was found in 1% of the patients with a poor outcome. Conclusions: Highly malignant EEG after rewarming reliably predicted poor outcome in half of patients without false predictions. An isolated finding of a single malignant feature did not predict poor outcome whereas a benign EEG was highly predictive of a good outcome. PMID:26865516

  16. In-hospital Cardiac Arrest at Cork University Hospital.

    Science.gov (United States)

    O'Sullivan, E; Deasy, C

    2016-01-01

    We describe the incidence and outcomes of in-hospital cardiac arrest (IHCA) at Cork University Hospital over a one year time period (2011), prior to the implementation of national early warning scoring (NEWS) systems. There were 43 217 coded CUH admissions, in 2011, to 518 in-patient beds. The Hospital In-Patient Enquiry Database was used to identify adults (>/= 18 years) who sustained IHCA. Available Utstein variables were collected. Fifty-two patients were found to be incorrectly coded IHCA. 17 of 63 (27.0%) IHCA survived to discharge. IHCA with shockable rhythm had significantly higher survival. IHCA survival was significantly lower on wards versus any other hospital location. Median days of stay prior to arrest were significantly different between survivors and non-survivors. All survivors (n = 17) had intact neurological outcome post-event. Our outcomes from IHCA are poorest on hospital wards when compared to other areas of the hospital. Those that survive have excellent function and one-year survival.

  17. Early Recognition of Foreign Body Aspiration as the Cause of Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Muhammad Kashif

    2016-01-01

    Full Text Available Foreign body aspiration (FBA is uncommon in the adult population but can be a life-threatening condition. Clinical manifestations vary according to the degree of airway obstruction, and, in some cases, making the correct diagnosis requires a high level of clinical suspicion combined with a detailed history and exam. Sudden cardiac arrest after FBA may occur secondary to asphyxiation. We present a 48-year-old male with no history of cardiac disease brought to the emergency department after an out-of-hospital cardiac arrest (OHCA. The patient was resuscitated after 15 minutes of cardiac arrest. He was initially managed with therapeutic hypothermia (TH. Subsequent history suggested FBA as a possible etiology of the cardiac arrest, and fiberoptic bronchoscopy demonstrated a piece of meat and bone lodged in the left main stem bronchus. The foreign body was removed with the bronchoscope and the patient clinically improved with full neurological recovery. Therapeutic hypothermia following cardiac arrest due to asphyxia has been reported to have high mortality and poor neurological outcomes. This case highlights the importance of early identification of FBA causing cardiac arrest, and we report a positive neurological outcome for postresuscitation therapeutic hypothermia following cardiac arrest due to asphyxia.

  18. Multimodal Imaging after Sudden Cardiac Arrest in an 18-Year-Old Athlete

    Science.gov (United States)

    Rehman, Mobeen Ur; Atalay, Michael K.; Broderick, Ryan J.

    2015-01-01

    We report the case of a previously healthy 18-year-old male athlete who twice presented with sudden cardiac arrest. Our use of electrocardiography, echocardiography, cardiac magnetic resonance, coronary angiography, coronary computed tomographic angiography, and nuclear stress testing enabled the diagnoses of apical hypertrophic cardiomyopathy and anomalous origin of the right coronary artery. We discuss the patient's treatment and note the useful role of multiple cardiovascular imaging methods in cases of sudden cardiac arrest. PMID:26664308

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

    DEFF Research Database (Denmark)

    Weeke, P; Jensen, Aksel Karl Georg; Folke, F;

    2012-01-01

    Treatment with some types of antidepressants has been associated with sudden cardiac death. It is unknown whether the increased risk is due to a class effect or related to specific antidepressants within drug classes. All patients in Denmark with an out-of-hospital cardiac arrest (OHCA) were.......17-12.2). An association between cardiac arrest and antidepressant use could be documented in both the SSRI and TCA classes of drugs....

  20. Hospital discharge diagnoses of ventricular arrhythmias and cardiac arrest were useful for epidemiologic research

    DEFF Research Database (Denmark)

    De Bruin, M L; van Hemel, N M; Leufkens, H G M;

    2005-01-01

    OBJECTIVE: We investigated the validity of hospital discharge diagnosis regarding ventricular arrhythmias and cardiac arrest. METHODS: We identified patients whose record in the PHARMO record linkage system database showed a code for ventricular or unspecified cardiac arrhythmias according to cod...... according to ICD-9-CM as paroxysmal ventricular tachycardia, ventricular fibrillation, ventricular flutter, ventricular premature beats, or cardiac arrest) have a high PPV and are useful for selecting events in epidemiological studies on drug-induced arrhythmias....

  1. Multiscale Entropy Analysis of EEG for Assessment of Post-Cardiac Arrest Neurological Recovery Under Hypothermia in Rats

    OpenAIRE

    Kang, Xiaoxu; Jia, Xiaofeng; Geocadin, Romergryko G.; Thakor, Nitish V.; Maybhate, Anil

    2009-01-01

    Neurological complications after cardiac arrest (CA) can be fatal. Although hypothermia has been shown to be beneficial, understanding the mechanism and establishing neurological outcomes remains challenging because effects of CA and hypothermia are not well characterized. This paper aims to analyze EEG (and the α-rhythms) using multiscale entropy (MSE) to demonstrate the ability of MSE in tracking changes due to hypothermia and compare MSE during early recovery with long-term neurological ex...

  2. Use of Sodium Bicarbonate in Cardiac Arrest: Current Guidelines and Literature Review.

    Science.gov (United States)

    Velissaris, Dimitrios; Karamouzos, Vassilios; Pierrakos, Charalampos; Koniari, Ioanna; Apostolopoulou, Christina; Karanikolas, Menelaos

    2016-04-01

    The aim of the review was to summarize the literature over the last 25 years regarding bicarbonate administration in out-of-hospital cardiac arrest. A PubMed search was conducted using the terms "bicarbonates" and "cardiac arrest", limited to human studies and reviews published in English (or at least with a meaningful abstract in English) in the last 25 years. Clinical and experimental data raised questions regarding the safety and effectiveness of sodium bicarbonate (SB) administration during cardiac arrest. Earlier advanced cardiac life support (ACLS) guidelines recommended routine bicarbonate administration as part of the ACLS algorithm, but recent guidelines no longer recommend its use. The debate in the literature is ongoing, but at the present time, SB administration is only recommended for cardiac arrest related to hypokalemia or overdose of tricyclic antidepressants. Several studies challenge the assumption that bicarbonate administration is beneficial for treatment of acidosis in cardiac arrest. At the present time, there is a trend against using bicarbonates in cardiac arrest, and this trend is supported by guidelines published by professional societies and organizations. PMID:26985247

  3. Therapeutic Hypothermia and Out-of-Hospital Cardiac Arrest in a Child with Hypertrophic Obstructive Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Nancy Spurkeland

    2015-01-01

    Full Text Available Neurologic outcomes following pediatric cardiac arrest are consistently poor. Early initiation of cardiopulmonary resuscitation has been shown to have positive effects on both survival to hospital discharge, and improved neurological outcomes after cardiac arrest. Additionally, the use of therapeutic hypothermia may improve survival in pediatric cardiac arrest patients admitted to the intensive care unit. We report a child with congenital hypertrophic obstructive cardiomyopathy and an out-of-hospital cardiac arrest, in whom the early initiation of effective prolonged cardiopulmonary resuscitation and subsequent administration of therapeutic hypothermia contributed to a positive outcome with no gross neurologic sequelae. Continuing efforts should be made to promote and employ high-quality cardiopulmonary resuscitation, which likely contributed to the positive outcome of this case. Further research will be necessary to develop and solidify national guidelines for the implementation of therapeutic hypothermia in selected subpopulations of children with OHCA.

  4. Near-death experiences in cardiac arrest survivors.

    Science.gov (United States)

    French, Christopher C

    2005-01-01

    Near-death experiences (NDEs) have become the focus of much interest in the last 30 years or so. Such experiences can occur both when individuals are objectively near to death and also when they simply believe themselves to be. The experience typically involves a number of different components including a feeling of peace and well-being, out-of-body experiences (OBEs), entering a region of darkness, seeing a brilliant light, and entering another realm. NDEs are known to have long-lasting transformational effects upon those who experience them. An overview is presented of the various theoretical approaches that have been adopted in attempts to account for the NDE. Spiritual theories assume that consciousness can become detached from the neural substrate of the brain and that the NDE may provide a glimpse of an afterlife. Psychological theories include the proposal that the NDE is a dissociative defense mechanism that occurs in times of extreme danger or, less plausibly, that the NDE reflects memories of being born. Finally, a wide range of organic theories of the NDE has been put forward including those based upon cerebral hypoxia, anoxia, and hypercarbia; endorphins and other neurotransmitters; and abnormal activity in the temporal lobes. Finally, the results of studies of NDEs in cardiac arrest survivors are reviewed and the implications of these results for our understanding of mind-brain relationships are discussed.

  5. Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest

    OpenAIRE

    Gerard O’Connor; Gareth Fitzpatrick; Ayman El-Gammal; Peadar Gilligan

    2015-01-01

    More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI) or pulmonary embolism (PE). Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR). We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scena...

  6. Sudden cardiac arrest in a patient with epilepsy induced by chronic inflammation on the cerebral surface

    Institute of Scientific and Technical Information of China (English)

    Yuxi Liu; Weicheng Hao; Xiaoming Yang; Yimin Wang; Yu Su

    2012-01-01

    The present study analyzed a patient with epilepsy due to chronic inflammation on the cerebral surface underwent sudden cardiac arrest. Paradoxical brain discharge, which occurred prior to epileptic seizures, induced a sudden cardiac arrest. However, when the focal brain pressure was relieved, cardiac arrest disappeared. A 27-year-old male patient underwent pre-surgical video-electroencephalogram monitoring for 160 hours. During monitoring, secondary tonic-clonic seizures occurred five times. A burst of paradoxical brain discharges occurred at 2-19 seconds (mean 8 seconds) prior to epileptic seizures. After 2-3 seconds, sudden cardiac arrest occurred and lasted for 12-22 seconds (average 16 seconds). The heart rate subsequently returned to a normal rate. Results revealed arachnoid pachymenia and adhesions, as well as mucus on the focal cerebral surface, combined with poor circulation and increased pressure. Intracranial electrodes were placed using surgical methods. Following removal of the arachnoid adhesions and mucus on the local cerebral surface, paradoxical brain discharge and epileptic seizures occurred three times, but sudden cardiac arrest was not recorded during 150-hour monitoring. Post-surgical histological examination indicated meningitis. Experimental findings suggested that paradoxical brain discharge led to cardiac arrest instead of epileptic seizures; the insult was associated with chronic inflammation on the cerebral surface, which subsequently led to hypertension and poor blood circulation in focal cerebral areas.

  7. Survival in patients without acute ST elevation after cardiac arrest and association with early coronary angiography

    DEFF Research Database (Denmark)

    Dankiewicz, J; Nielsen, N; Annborn, M;

    2015-01-01

    PURPOSE: To investigate whether early coronary angiography (CAG) after out-of-hospital cardiac arrest of a presumed cardiac cause is associated with improved outcomes in patients without acute ST elevation. METHODS: The target temperature management after out-of-hospital cardiac arrest (TTM) trial...... early CAG was not significantly associated with survival. CONCLUSIONS: In this post hoc observational study of a large randomized trial, early coronary angiography for patients without acute ST elevation after out-of-hospital cardiac arrest of a presumed cardiac cause was not associated with improved...... showed no difference in all-cause mortality or neurological outcome between an intervention of 33 and 36 °C. In this post hoc analysis, 544 patients where the admission electrocardiogram did not show acute ST elevation were included. Early CAG was defined as being performed on admission or within...

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

    DEFF Research Database (Denmark)

    Nielsen, Niklas; Wetterslev, Jørn; Cronberg, Tobias;

    2013-01-01

    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...... (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......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...

  9. Incidence of out-of-hospital cardiac arrest.

    Science.gov (United States)

    Rea, Thomas D; Pearce, Rachel M; Raghunathan, Trivellore E; Lemaitre, Rozenn N; Sotoodehnia, Nona; Jouven, Xavier; Siscovick, David S

    2004-06-15

    Estimates of the incidence of out-of-hospital primary cardiac arrest (CA) have typically relied solely upon emergency medical service or death certificate records and have not investigated incidence in clinical subgroups. Overall and temporal patterns of CA incidence were investigated in clinically defined groups using systematic methods to ascertain CA. Estimates of incidence were derived from a population-based case-control study in a large health plan from 1986 to 1994. Subjects were enrollees aged 50 to 79 years who had had CA (n = 1,275). A stratified random sample of enrollees who had not had CA was used to estimate the population at risk with various clinical characteristics (n = 2,323). Poisson's regression was used to estimate incidence overall and for 3-year time periods (1986 to 1988, 1989 to 1991, and 1992 to 1994). The overall CA incidence was 1.89/1,000 subject-years and varied up to 30-fold across clinical subgroups. For example, incidence was 5.98/1,000 subject-years in subjects with any clinically recognized heart disease compared with 0.82/1,000 subject-years in subjects without heart disease. In subgroups with heart disease, incidence was 13.69/1,000 subject-years in subjects with prior myocardial infarction and 21.87/1,000 subject-years in subjects with heart failure. Risk decreased by 20% from the initial to the final time period, with a greater decrease observed in those with (25%) compared with those without (12%) clinical heart disease. Thus, CA incidence varied considerably across clinical groups. The results provide insights regarding absolute and population-attributable risk in clinically defined subgroups, information that may aid strategies aimed at reducing mortality from CA. PMID:15194012

  10. Sudden cardiac arrest as a presentation of Brugada syndrome unmasked by thyroid storm

    NARCIS (Netherlands)

    Korte, Anna K M; Derde, Lennie; van Wijk, Jeroen; Tjan, David H

    2015-01-01

    An 18-year-old man suffered a sudden cardiac arrest with ventricular fibrillation and was successfully resuscitated. He had neither a medical nor family history of cardiac disease/sudden death, but was known to have Graves' disease, for which he was treated with radioactive iodine. Recently, block-a

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

    Directory of Open Access Journals (Sweden)

    Jeffrey M. Goodloe

    2014-11-01

    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.

  12. A novel program focused on women survivors who were enrolled in a cardiac arrest pathway.

    Science.gov (United States)

    Herzog, Eyal; Tamis, Jacqueline; Aziz, Emad F; Shapiro, Janet M

    2013-03-01

    The number of cases of out-of-hospital cardiac arrest is estimated to be 300,000/year in the United States. Two landmark studies published in 2002 demonstrated that therapeutic hypothermia decreased mortality and improved neurological outcome after out-of-hospital cardiac arrest. Our institutional pathway for the management of survivors of cardiac arrest stresses teamwork involving multiple disciplines, including cardiology, critical care, nursing, neurology, infectious diseases, physical therapy, social work, and pastoral care. Involvement of the patients' families is critical in the understanding of the process and in the decision making and goals of care when neurological prognosis is poor. In a unique approach, we have included the survivors in the process. Our approach to quality improvement includes a yearly conference incorporating the voices of survivors and families. This conference serves as a means to review our experience, educate clinicians, involve all healthcare providers in the outcome, and provide a model of communication and professionalism to trainees. During review of our experience, we noted the small number of women undergoing therapeutic hypothermia, accounting for only 21% of all patients undergoing this therapy after cardiac arrest. This led to a conference that focused on cardiac disease and cardiac arrest in women.

  13. Management of survivors of cardiac arrest - the importance of genetic investigation.

    Science.gov (United States)

    Schwartz, Peter J; Dagradi, Federica

    2016-09-01

    Management of survivors of cardiac arrest is largely based on a traditional approach. However, during the past decade, arrhythmias of genetic origin have increasingly been recognized as contributing to many more cases than previously appreciated. This realization is forcing physicians managing the survivors of cardiac arrest also to consider family members. In this Perspectives article, we examine the appropriate management approaches for survivors of cardiac arrests related to channelopathies, cardiomyopathies, or ischaemic heart disease, and for their families. Important implications for families of individuals who have experienced sudden cardiac death as part of sudden infant death syndrome or during sport activity are also discussed. Congenital long QT syndrome provides a paradigm of the logical sequence of the steps that should be performed. When a diagnosis of the cause of the cardiac arrest is certain or probable, every effort should be made to identify the genetic basis of disease, because this approach will enable the identification and early protection of similarly affected family members. Accordingly, the availability in hospitals of at least one cardiologist with cardiovascular genetics expertise would improve the management of survivors of cardiac arrest as well as of their families. PMID:27383078

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

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Hansen, Carolina Malta; Folke, Fredrik;

    2014-01-01

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

  15. Association between prehospital physician involvement and survival after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Hamilton, Annika; Steinmetz, Jacob; Wissenberg, Mads;

    2016-01-01

    involvement and 30-day survival. METHODS: Observational study including persons registered with first-time OHCA of any cause in the Danish Cardiac Arrest Registry during 2005-2012. We used logistic regression analysis to assess the association between 30-day survival and involvement of a physician at any time......AIM: Sudden out-of-hospital cardiac arrest (OHCA) is an important public health problem. While several interventions are known to improve survival, the impact of physician-delivered advanced cardiac life support for OHCA is unclear. We aimed to assess the association between prehospital physician...

  16. Recovery of brain function after cardiac arrest, case report and review.

    Science.gov (United States)

    Nekoui, A; Tresierra, del Carmen Escalante; Abdolmohammadi, S; Charbonneau, S; Blaise, G

    2016-01-01

    Cerebral hypoxia during cardiac arrest is the leading cause of mortality and morbidity in survival victims. To reduce cerebral damage, studies focus on finding effective treatments during the resuscitation period. Our report focuses on a 36-year-old police officer who had had two cardiac arrests (one at home and one at the hospital). After acute treatment, his cardiac and brain functions recovered impressively. Neuropsychological results were normal except for mild anomia. He also reported some retrograde memory loss. Surprisingly, he also reported an improvement in a very specific capacity, his episodic memory. We here review the possible causes and mechanisms that may have affected his memory abilities.

  17. Cardiac Arrest following a Myocardial Infarction in a Child Treated with Methylphenidate

    DEFF Research Database (Denmark)

    Munk, Kim; Gormsen, Lise Kirstine; Kim, Won Yong;

    2015-01-01

    -years, did not report any cases of myocardial infarction in current users of methylphenidate, and the risk of serious adverse cardiac events was not found to be increased. We present a case with an 11-year-old child, treated with methylphenidate, who suffered cardiac arrest and was diagnosed with a remote...... myocardial infarction. This demonstrates that myocardial infarction can happen due to methylphenidate exposure in a cardiac healthy child, without cardiovascular risk factors....

  18. 心脏骤停后综合征%Post-cardiac arrest syndrome

    Institute of Scientific and Technical Information of China (English)

    文俊; 高路; 常文毅

    2013-01-01

    Post-cardiac arrest syndrome (PCAS) is one of the most common medical emergencies in children.The fatality rate and disability rate are extremely high.Pathogenesis of PCAS remains incompletely clear,and clinical manifestation is complicated.The treatment is mainly limited to supportive care.In recent years,the phases of PCAS are defined according to the pathophysiological changes and clinical prognosis.Investigators also made some advances in the fields of pathophysiological changes and clinical treatment of brain damage and myocardial damage.For the treatment of PCAS,early therapeutic hypothermia,glucose control and seizure control,and reasonable cardiopulmonary support are promoted.In this article,we reviewed the advances in the above fields and the latest advance on the management of PCAS in foreign countries.%心脏骤停后综合征(post-cardiac arrest syndrome,PCAS)是儿童时期常见的危重症,致死率及致残率极高,其发病机制未完全阐明,临床表现复杂多样,治疗上主要是对症支持治疗.近年来根据病理生理改变及临床预后对PCAS进行分期,并在PCAS脑损伤、心肌损伤病理生理改变及临床治疗等领域取得了一些进展.在PCAS的救治上,提倡早期亚低温治疗、控制血糖、控制惊厥和合理的心肺支持.该文就上述领域的研究作一综述,并介绍国外治疗PCAS的最新治疗策略.

  19. Acute right ventricular myocardial injury and sudden cardiac arrest in a patient with persistent spontaneous coronary vasospasm

    Institute of Scientific and Technical Information of China (English)

    Hung Ming-Yow; Li Ju-Chi; Hao Wen-Rui; Wu Cheng-Hsueh; Hung Ming-Jui

    2011-01-01

    Coronary vasospasm is a rare diagnosis resulting in sudden arrhythmic cardiac arrest. We report a case of a healthy,non-smoking elderly woman resuscitated from arrhythmic cardiac arrest. She had persistent spontaneous coronaxy vasospasm, leading to right ventricular myocardial injury and failure, and shock. She responded quickly to intravenous normal saline bolus infusion, but had irreversible neurological sequelae. Additionally, she had atrial fibrillation preceding ischemic ventricular fibrillation, a rare finding in coronary vasospasm-related cardiac arrest. We suggest immediate coronary angiography of patients in sudden arrhythmic cardiac arrest with acute right ventricular failure for a prompt,accurate diagnosis and appropriate management of the coronary vasospasm.

  20. Intraoperative cardiac arrest during anesthesia:a retrospective study of 218 274 anesthetics undergoing non-cardiac surgery in a US teaching hospital

    Institute of Scientific and Technical Information of China (English)

    AN Jian-xiong; Li-Ming Zhang; Erin A.Sullivan; GUO Qu-lian; John P.Williams

    2011-01-01

    Background Patient safety has been gained much more attention in recent years.The authors reviewed patients who had cardiac arrest in the operating rooms undergoing noncardiac surgery between January 1989 and December 2001 at the University of Pittsburgh Medical Center,USA.The main objectives of the study were to determine the incidence of intraoperative cardiac arrest,to identify possible causes of cardiac arrest and to explore amenable modifications.Methods With approval by the University of Pittsburgh Institutional Review Board,patients experienced cardiac arrest during surgery were retrieved from medical records,surgical operation and anesthesia records and pathological reports by searching the Medical Archival Retrieval System (MARS),a hospital electronic searching system.Cases of cardiac arrest were collected over a period of thirteen years from the Pre byteria University Hospital (PUH),USA.Results We found 23 cases of intraoperative cardiac arrests occurred in 218 274 anesthesia cases (1.1 per 10 000).Fourteen patients (60.8%) died in the operating room,leading to a mortality rate from all causes of 0.64 per 10 000 anesthetics.Immediate overall survival rate after arrest was 39% (9/23).Half of the patients (12/23) were emergency cases with 41% survival rate (5/12).One fourth of the arrests were trauma patients (6/23).Most arrest patients (87%,20/23) were American Society of Anesthesiologists Physical Status (ASA PS) Ⅳ and Ⅴ,while only three patients were ASA PS-Ⅰ,Ⅱ and Ⅲ,respectively.One case was attributable to an anesthesia-related cardiac arrest and recovered after successful resuscitation.Conclusions Most intraoperative cardiac arrests were not due to anesthesia-related causes.Anesthesia-related cardiac arrests might have a higher survival rate when compared to other possible causes of cardiac arrest in the operating room.

  1. Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Gerard O’Connor

    2015-01-01

    Full Text Available More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI or pulmonary embolism (PE. Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR. We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scenario in which recombinant tissue Plasminogen Activator (rtPA may be beneficial in cardiac arrest. In addition to the strong clinical suspicion of pulmonary embolism as the causative agent of the patient’s cardiac arrest, the extremely low end-tidal CO2 suggested a massive PE. The absence of dilatation of the right heart on subxiphoid ultrasound argued against the diagnosis of PE, but not conclusively so. In the context of the circulatory collapse induced by cardiac arrest, this aspect was relegated in terms of importance. The second dose of rtPA utilised in this case resulted in return of spontaneous circulation (ROSC and did not result in haemorrhage or an adverse effect.

  2. Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest.

    Science.gov (United States)

    O'Connor, Gerard; Fitzpatrick, Gareth; El-Gammal, Ayman; Gilligan, Peadar

    2015-01-01

    More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI) or pulmonary embolism (PE). Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR). We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scenario in which recombinant tissue Plasminogen Activator (rtPA) may be beneficial in cardiac arrest. In addition to the strong clinical suspicion of pulmonary embolism as the causative agent of the patient's cardiac arrest, the extremely low end-tidal CO2 suggested a massive PE. The absence of dilatation of the right heart on subxiphoid ultrasound argued against the diagnosis of PE, but not conclusively so. In the context of the circulatory collapse induced by cardiac arrest, this aspect was relegated in terms of importance. The second dose of rtPA utilised in this case resulted in return of spontaneous circulation (ROSC) and did not result in haemorrhage or an adverse effect. PMID:26664765

  3. Sudden Cardiac Arrest due to Brugada Syndrome: a Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    R Soleimanirad

    2013-04-01

    Full Text Available Brugada Syndrome is a rare cause of sudden cardiac arrest and has a unique ECG pattern. In fact, with ST-segment elevation down sloping in the right precordial leads (v1-v3, RBBB pattern in lateral leads and J-point elevation is revealed. We must notice and avoid trigger factors of this syndrome during general anesthesia. Patient is a 39 old man who attended to emergency department with sudden cardiac arrest and resuscitate. He was transferred to ICU for management of hypoxic ischemic encephalopathy. Complementary studies concluded the diagnosis of Brugada syndrome. We must consider Brugada syndrome within patients with family history of sudden cardiac arrest. Moreover, we must avoid trigger factors of this syndrome such as fever, bradicardia and electrolyte abnormality (specialy Na, Ca abnormalities during general anesthesia and if they appear, we should treat them.

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

    DEFF Research Database (Denmark)

    Alfsen, David; Møller, Thea Palsgaard; Egerod, Ingrid;

    2015-01-01

    the dispatchers' recognition of OHCA, focusing on the communication during the emergency call. The purpose of this study is to identify factors affecting medical dispatchers' recognition of OHCA during emergency calls in a qualitative analysis of calls. METHODS: An investigator triangulated inductive thematic...... analysis of recordings of out-of-hospital cardiac arrest emergency calls from December 2012. Participants were the callers (bystanders) and the emergency medical dispatchers. Data were analysed using a hermeneutic approach. RESULTS: Based on the concept of data saturation, 13 recordings of not recognised...... cardiac arrest and 8 recordings of recognised cardiac arrests were analysed. Three main themes, six subthemes and an embedded theme emerged from the analysis: caller's physical distance (caller near patient, caller not near patient), caller's emotional distance (keeping calm, losing control), caller...

  5. Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams

    DEFF Research Database (Denmark)

    Andersen, P.O.; Jensen, Michael Kammer; Lippert, A.;

    2010-01-01

    for improving team performance in multi-professional cardiac arrest teams, and to describe barriers to the use and implementation of such NTSs by using a qualitative method. Methods: Individual semi-structured interviews were conducted with 11 Danish Advanced Life Support instructors during the period April...... 2006 to November 2006. Interviews were focussed on barriers and recommendations for teamwork in the cardiac arrest team, optimal policy for improvement of resuscitation training and clinical practice, use of cognitive aids and adoption of European Resuscitation Council (ERC) Guidelines 2005. Interviews...... management. Important barriers that were identified were inexperienced team leaders, task overload and hierarchic structure in the teams' inability to maintain focus on chest compressions. Conclusion: Interview participants pointed out that NTSs of teams could improve the treatment of cardiac arrest...

  6. Spontaneous subarachnoid hemorrhage as a differential diagnosis of pre-hospital cardiac arrest

    Directory of Open Access Journals (Sweden)

    Sohil Pothiawala

    2012-01-01

    Full Text Available Spontaneous subarachnoid hemorrhage is the most common neurological disorder leading to pre-hospital cardiac arrest. ECG changes in SAH may mimic myocardial infarction or ischemia, and thus lead to delayed treatment of the primary problem. Early identification of SAH-induced cardiac arrest with the use of computed tomography scan of the brain obtained immediately after resuscitation will aid emergency physicians make further decisions. The overall prognosis of patients who are resuscitated is extremely poor. But, prompt neurosurgical referral and multidisciplinary intensive care management can improve the survival rate and the functional outcome. Thus, physicians should consider SAH as a differential diagnosis in patients presenting with pre-hospital cardiac arrest.

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

    Directory of Open Access Journals (Sweden)

    Marcus EH Ong

    2010-04-01

    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

  8. Surviving Sudden Cardiac Arrest: A Pilot Qualitative Survey Study of Survivors.

    Science.gov (United States)

    Sawyer, Kelly N; Brown, Frances; Christensen, Roxanne; Damino, Colleen; Newman, Mary M; Kurz, Michael C

    2016-06-01

    Research describing survivors of sudden cardiac arrest (SCA) has centered on quantifying functional ability, perceived quality of life, and neurocognitive assessment. Many gaps remain, however, regarding survivors' psychosocial perceptions of life in the aftermath of cardiac arrest. An important influence upon those perceptions is the presence of support and its role in a survivor's life. An Internet-based pilot survey study was conducted to gather data from SCA survivors and friends and/or family members (FFMs) representing their support system. The survey was distributed to members of the Sudden Cardiac Arrest Foundation (SCAF) via the Internet by SCAF leadership. Questions included both discrete multiple-choice and open-ended formats. Inductive thematic analyses were completed by three independent researchers trained in qualitative research methodology to identify primary themes consistent among study participants until thematic saturation was achieved. No statistical inferences were made. A total of 205 surveys were returned over the 5-month study period (July to November 2013); nine were received blank, leaving 196 surveys available for review. Major themes identified for survivors (N = 157) include the significance of and desire to share experiences with others; subculture identification (unique experience from those suffering a heart attack); and the need to seek a new normal, both personally and inter-personally. Major themes identified for FFMs (N = 39) include recognition of loved one's memory loss; a lack of information at discharge, including expectations after discharge; and concern for the patient experiencing another cardiac arrest. This pilot, qualitative survey study suggests several common themes important to survivors, and FFMs, of cardiac arrest. These themes may serve as a basis for future patient-centered focus groups and the development of patient-centered guidelines for patients and support persons of those surviving cardiac arrest

  9. Surviving Sudden Cardiac Arrest: A Pilot Qualitative Survey Study of Survivors.

    Science.gov (United States)

    Sawyer, Kelly N; Brown, Frances; Christensen, Roxanne; Damino, Colleen; Newman, Mary M; Kurz, Michael C

    2016-06-01

    Research describing survivors of sudden cardiac arrest (SCA) has centered on quantifying functional ability, perceived quality of life, and neurocognitive assessment. Many gaps remain, however, regarding survivors' psychosocial perceptions of life in the aftermath of cardiac arrest. An important influence upon those perceptions is the presence of support and its role in a survivor's life. An Internet-based pilot survey study was conducted to gather data from SCA survivors and friends and/or family members (FFMs) representing their support system. The survey was distributed to members of the Sudden Cardiac Arrest Foundation (SCAF) via the Internet by SCAF leadership. Questions included both discrete multiple-choice and open-ended formats. Inductive thematic analyses were completed by three independent researchers trained in qualitative research methodology to identify primary themes consistent among study participants until thematic saturation was achieved. No statistical inferences were made. A total of 205 surveys were returned over the 5-month study period (July to November 2013); nine were received blank, leaving 196 surveys available for review. Major themes identified for survivors (N = 157) include the significance of and desire to share experiences with others; subculture identification (unique experience from those suffering a heart attack); and the need to seek a new normal, both personally and inter-personally. Major themes identified for FFMs (N = 39) include recognition of loved one's memory loss; a lack of information at discharge, including expectations after discharge; and concern for the patient experiencing another cardiac arrest. This pilot, qualitative survey study suggests several common themes important to survivors, and FFMs, of cardiac arrest. These themes may serve as a basis for future patient-centered focus groups and the development of patient-centered guidelines for patients and support persons of those surviving cardiac arrest.

  10. Endothelial activation/injury and associations with severity of post-cardiac arrest syndrome and mortality after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Johansson, Pär I; Hassager, Christian;

    2016-01-01

    BACKGROUND: Post-cardiac arrest syndrome (PCAS) is characterized by whole-body ischemia triggering systemic inflammation and damage of the endothelium. This study investigated the relationship between systemic inflammation, endothelial damage and severity of PCAS and the association between...... endothelial damage and outcome after out-of-hospital cardiac arrest (OHCA). METHODS: In this post hoc study, we analyzed 163 comatose patients included at a single center in the target temperature management (TTM) trial, randomly assigned to TTM at 33°C or 36°C for 24h. Endothelial biomarkers (syndecan-1......, thrombomodulin, sE-selectin, sVE-cadherin) and the inflammatory biomarker interleukin-6 (IL-6) were measured at admission (baseline) and 24, 48 and 72h after OHCA. Severity of PCAS was assessed by Sequential Organ Failure Assessment score. Mortality at 30-days was evaluated by Cox regression analysis. RESULTS...

  11. Cardiac arrest in intensive care unit: Case report and future recommendations

    Directory of Open Access Journals (Sweden)

    Mohammad A

    2010-01-01

    Full Text Available Initiation of hemofiltration in a patient in septic shock can cause hemodynamic compromise potentially leading to cardiac arrest. We propose that the standard ′4Hs and 4Ts′ approach to the differential diagnosis of a cardiac arrest should be supplemented in critically ill patients with anaphylaxis and human and technical errors involving drug administration (the 5 th H and T. To illustrate the point, we report a case where norepinephrine infused through a central venous catheter (CVC was being removed by the central venovenous hemofiltration (CVVH catheter causing the hemodynamic instability. CVVH has this potential of interfering with the systemic availability of drugs infused via a closely located CVC.

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

    DEFF Research Database (Denmark)

    Wichmann, Janine; Folke, Fredrik; Torp-Pedersen, Christian;

    2013-01-01

    Cardiovascular disease is the number one cause of death globally and air pollution can be a contributing cause. Acute myocardial infarction and cardiac arrest are frequent manifestations of coronary heart disease. The objectives of the study were to investigate the association between 4 657 out......-of-hospital cardiac arrests (OHCA) and hourly and daily outdoor levels of PM(10), PM(2.5), coarse fraction of PM (PM(10-2.5)), ultrafine particle proxies, NO(x), NO(2), O(3) and CO in Copenhagen, Denmark, for the period 2000-2010. Susceptible groups by age and sex was also investigated. A case-crossover design...

  13. Prehospital therapeutic hypothermia after cardiac arrest--from current concepts to a future standard.

    Science.gov (United States)

    Kämäräinen, Antti; Hoppu, Sanna; Silfvast, Tom; Virkkunen, Ilkka

    2009-01-01

    Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting. The purpose of this review was to evaluate current clinical studies on prehospital induction of mild hypothermia after cardiac arrest. Most reported studies present data on cooling rates, safety and feasibility of different methods, but are inconclusive as regarding to outcome effects. PMID:19821967

  14. Prehospital therapeutic hypothermia after cardiac arrest - from current concepts to a future standard

    Directory of Open Access Journals (Sweden)

    Hoppu Sanna

    2009-10-01

    Full Text Available Abstract Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting. The purpose of this review was to evaluate current clinical studies on prehospital induction of mild hypothermia after cardiac arrest. Most reported studies present data on cooling rates, safety and feasibility of different methods, but are inconclusive as regarding to outcome effects.

  15. Prehospital therapeutic hypothermia after cardiac arrest - from current concepts to a future standard

    Science.gov (United States)

    Kämäräinen, Antti; Hoppu, Sanna; Silfvast, Tom; Virkkunen, Ilkka

    2009-01-01

    Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting. The purpose of this review was to evaluate current clinical studies on prehospital induction of mild hypothermia after cardiac arrest. Most reported studies present data on cooling rates, safety and feasibility of different methods, but are inconclusive as regarding to outcome effects. PMID:19821967

  16. Cardiac arrest after sugammadex administration in a patient with variant angina: a case report

    Science.gov (United States)

    Kim, Yong Han; Kang, Eunsu; Lee, Byeong-Cheol; Lee, Sujung

    2016-01-01

    A 76-year-old man with no notable medical history was scheduled for a robot-assisted radical prostatectomy. After the operation, he was given sugammadex. Two minutes later, ventricular premature contraction bigeminy began, followed by cardiac arrest. Cardiac arrest occurred three times and cardiopulmonary resuscitation was done. The patient recovered after the third cardiopulmonary resuscitation and was transferred to the intensive care unit. Coronary angiography was done on postoperative day 1. The patient was diagnosed with variant angina and discharged uneventfully on postoperative day 8.

  17. F-MARC: promoting the prevention and management of sudden cardiac arrest in football.

    Science.gov (United States)

    Kramer, Efraim Benjamin; Dvorak, J; Schmied, C; Meyer, T

    2015-05-01

    Sudden cardiac death is the most common cause of unnatural death in football. To prevent and urgently manage sudden cardiac arrest on the football field-of-play, F-MARC (FIFA Medical and Research Centre) has been fully committed to a programme of research, education, standardisation and practical implementation. This strategy has detected football players at medical risk during mandatory precompetition medical assessments. Additionally, FIFA has (1) sponsored internationally accepted guidelines for the interpretation of an athlete's ECG, (2) developed field-of-play-specific protocols for the recognition, response, resuscitation and removal of a football player having sudden cardiac arrest and (3) introduced and distributed the FIFA medical emergency bag which has already resulted in the successful resuscitation of a football player who had a sudden cardiac arrest on the field-of-play. Recently FIFA, in association with the Institute of Sports and Preventive Medicine in Saarbrücken, Germany, established a worldwide Sudden Death Registry with a view to documenting fatal events on the football field-of-play. These activities by F-MARC are testimony to FIFA's continued commitment to minimising sudden cardiac arrest while playing football. PMID:25878076

  18. POST-OPERATIVE VENTRICULAR TACHYCARDIA LEADING TO CARDIAC ARREST IN AN ASAG- I PATIENT OF CHOLECYSTECTOMY: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Pradip

    2014-03-01

    Full Text Available We here present our experience with ventricular tachycardia (VT leading to cardiac arrest in a patient with American Society of Anesthesiologists grade-I (ASA-I 11 hours after cholecystectomy. Excessive fluid overload and hypoxemia due to lung congestion may lead to cardiac arrest in this case. Immediate diagnosis and appropriate intervention saved the life of the patient.

  19. Importance of the First Link Description and Recognition of an Out-of-Hospital Cardiac Arrest in an Emergency Call

    NARCIS (Netherlands)

    J. Berdowski; F. Beekhuis; A.H. Zwinderman; J.G.P. Tijssen; R.W. Koster

    2009-01-01

    Background-The content of emergency calls for suspected cardiac arrest is rarely analyzed. This study investigated the recognition of a cardiac arrest by dispatchers and its influence on survival rates. Methods and Results-During 8 months, voice recordings of 14 800 consecutive emergency calls were

  20. Efficacy analysis of intravenous thrombolysis after cardiopulmonary resuscitation for patients with acute myocardial infarction and cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    张晓丽

    2014-01-01

    Objective To explore the clinical value of intravenous thrombolysis in the treatment of patients with acute myocardial infarction(AMI)and cardiac arrest after cardiopulmonary resuscitation.Methods 120 patients with AMI and cardiac arrest admitted in our hospital from Mar2009 to Mar 2013 were divided into thrombolytic group(n=50)and control group(n=70)according to the

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

    DEFF Research Database (Denmark)

    Hansen, Carolina Malta; Wissenberg, Mads; Weeke, Peter;

    2013-01-01

    BACKGROUND: Despite wide dissemination, use of automated external defibrillators (AEDs) in community settings is limited. We assessed how AED accessibility affected coverage of cardiac arrests in public locations. METHODS AND RESULTS: We identified cardiac arrests in public locations (1994-2011) ...

  2. Early and Late Neurological Complications after Cardiac Transplantation

    Directory of Open Access Journals (Sweden)

    Mehmet Balkanay

    2011-08-01

    Full Text Available The clinical use of cyclosporine as an immunosuppressant improved the recipient’s life span and revolutionized the field of cardiac transplantation. But most of the immunesuppressant drugs including cyclosporine may cause neurological and many other side effects. In this article we present three cases, from 58 patients, undergoing cardiac transplantation at our hospital from 1989 to 2008 in whom developed transient neurological complications.

  3. Pyruvate stabilizes electrocardiographic and hemodynamic function in pigs recovering from cardiac arrest.

    Science.gov (United States)

    Cherry, Brandon H; Nguyen, Anh Q; Hollrah, Roger A; Williams, Arthur G; Hoxha, Besim; Olivencia-Yurvati, Albert H; Mallet, Robert T

    2015-12-01

    Cardiac electromechanical dysfunction may compromise recovery of patients who are initially resuscitated from cardiac arrest, and effective treatments remain elusive. Pyruvate, a natural intermediary metabolite, energy substrate, and antioxidant, has been found to protect the heart from ischemia-reperfusion injury. This study tested the hypothesis that pyruvate-enriched resuscitation restores hemodynamic, metabolic, and electrolyte homeostasis following cardiac arrest. Forty-two Yorkshire swine underwent pacing-induced ventricular fibrillation and, after 6 min pre-intervention arrest, 4 min precordial compressions followed by transthoracic countershocks. After defibrillation and recovery of spontaneous circulation, the pigs were monitored for another 4 h. Sodium pyruvate or NaCl were infused i.v. (0.1 mmol·kg(-1)·min(-1)) throughout precordial compressions and the first 60 min recovery. In 8 of the 24 NaCl-infused swine, the first countershock converted ventricular fibrillation to pulseless electrical activity unresponsive to subsequent countershocks, but only 1 of 18 pyruvate-treated swine developed pulseless electrical activity (relative risk 0.17; 95% confidence interval 0.13-0.22). Pyruvate treatment also lowered the dosage of vasoconstrictor phenylephrine required to maintain systemic arterial pressure at 15-60 min recovery, hastened clearance of excess glucose, elevated arterial bicarbonate, and raised arterial pH; these statistically significant effects persisted up to 3 h after sodium pyruvate infusion, while infusion-induced hypernatremia subsided. These results demonstrate that pyruvate-enriched resuscitation achieves electrocardiographic and hemodynamic stability in swine during the initial recovery from cardiac arrest. Such metabolically based treatment may offer an effective strategy to support cardiac electromechanical recovery immediately after cardiac arrest. PMID:26088865

  4. Distinct properties and metabolic mechanisms of postresuscitation myocardial injuries in ventricular fibrillation cardiac arrest versus asphyxiation cardiac arrest in a porcine model

    Institute of Scientific and Technical Information of China (English)

    Wu Caijun; Li Chunsheng; Zhang Yi; Yang Jun

    2014-01-01

    Background The two most prevalent causes of sudden cardiac death are ventricular fibrillation cardiac arrest (VFCA) and asphyxiation cardiac arrest (ACA).Profound postresuscitation myocardial dysfunction has been demonstrated in both VFCA and ACA animal models.Our study aimed to characterize the two porcine models of cardiac arrest and postresuscitation myocardial metabolism dysfunction.Methods Thirty-two pigs were randomized into two groups.The VFCA group (n=16) were subject to programmed electrical stimulation and the ACA group (n=16) underwent endotracheal tube clamping to induce cardiac arrest (CA).Once induced,CA remained untreated for a period of 8 minutes.Two minutes following initiation of cardiopulmonary resuscitation (CPR),defibrillation was attempted until return of spontaneous circulation (ROSC) was achieved or animals died.To assess myocardial metabolism,18F-FluoroDeoxyGlucose Positron Emission Tomography was performed at baseline and 4 hours after ROSC.Results ROSC was 100% successful in VFCA and 50% successful in ACA.VFCA had better mean arterial pressure and cardiac output after ROSC than ACA.Arterial blood gas analysis indicated more detrimental metabolic disturbances in ACA compared with VFCA after ROSC (ROSC 0.5 hours,pH:7.01±0.06 vs.7.21±0.03,P<0.01; HCO3-:(15.83±2.31 vs.20.11±1.83) mmol/L,P<0.01; lactate:(16.22±1.76 vs.5.84±1.44) mmol/L,P<0.01).Myocardial metabolism imaging using Positron Emission Tomography demonstrated that myocardial injuries after ACA were more severe and widespread than after VFCA at 4 hours after ROSC (the maximum standardized uptake value of the whole left ventricular:1.00±0.17 vs.1.93±0.27,P<0.01).Lower contents of myocardial energy metabolism enzymes (Na+-K+-ATPase enzyme activity,Ca2+-ATPase enzyme activity,superoxide dismutase and phosphodiesterase) were found in ACA relative to VFCA.Conclusions Compared with VFCA,ACA causes more severe myocardium injury and metabolism hindrance,therefore they

  5. Time-differentiated target temperature management after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Kirkegaard, Hans; Rasmussen, Bodil S; de Haas, Inge;

    2016-01-01

    24 or 48 hours. Inclusion criteria are: age older than 17 and below 80 years; presumed cardiac origin of arrest; and Glasgow Coma Score (GCS) <8, on admission. The primary outcome is neurological outcome at 6 months using the Cerebral Performance Category score (CPC) by an assessor blinded to...

  6. Cardiac arrest during treatment of Pneumocystis carinii pneumonia with intravenous pentamidine isethionate

    DEFF Research Database (Denmark)

    Balslev, U; Berild, D; Nielsen, T L

    1992-01-01

    A 27-year-old man, HIV-positive for 4 years, developed ventricular fibrillation and cardiac arrest during treatment of Pneumocystis carinii pneumonia with intravenous pentamidine isethionate. The dosage was 4 mg/kg/day for 18 days. Nephrotoxicity occurred and raised serum potassium. The plasma...

  7. Sinus bradycardia during hypothermia in comatose survivors of out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Thomsen, Jakob Hartvig; Hassager, Christian; Bro-Jeppesen, John;

    2015-01-01

    BACKGROUND: Bradycardia is a common finding in patients undergoing therapeutic hypothermia (TH) following out-of-hospital cardiac arrest (OHCA), presumably as a normal physiological response to low body temperature. We hypothesized that a normal physiological response with sinus bradycardia (SB) ...

  8. Willingness to Perform Chest Compression Only in Witnessed Cardiac Arrest Victims versus Cardiopulmonary Resuscitation in Iran

    Directory of Open Access Journals (Sweden)

    Nesreen Yaghmour

    2015-03-01

    Full Text Available Background: Performing immediate bystander Cardio Pulmonary Resuscitation (CPR is the most important factor that determines survival from cardiac arrest. Recommended mouth to mouth ventilation maneuver during CPR has led to lower rate of CPR performance in the population. Objectives: The present survey aimed to evaluate the willingness of nurses at Shiraz University of Medical Sciences for performing CPR versus chest-compression-only CPR. Patients and Methods: During a CPR course, we performed a survey on 25 nurses from Shiraz University of Medical Sciences, Iran. This survey included age and gender of the participants. In the first question, they were asked about their willingness to perform CPR with mouth to mouth breathing for witnessed cardiac arrest victims. In the second question, they were asked about their willingness to perform chest compression only for cardiac arrest victims. Results: Among the participating nurses, 96% were female with a mean age of 31 years. Only 40% were willing to perform CPR that requires mouth to mouth ventilation. On the other hand, 92% were willing to perform chest compression only without mouth to mouth ventilation. The mean age of the nurses who would do CPR was lower compared to those who would not. Conclusions: In this survey, we demonstrated that eliminating mouth to mouth ventilation maneuver could lead to markedly higher willingness to perform CPR for witnessed cardiac arrest victims in CPR trained nursing personnel. Our study is in agreement with other studies advocating that chest-compression-only CPR could lead to higher bystander resuscitation efforts.

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

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper; Horsted, Tina I;

    2008-01-01

    AIMS: To assess the impact of therapeutic hypothermia on cognitive function and quality of life in comatose survivors of out of Hospital Cardiac arrest (OHCA). METHODS: We prospectively studied comatose survivors of OHCA consecutively admitted in a 4-year period. Therapeutic hypothermia was imple...

  10. Long-term neuropsychological outcomes in children and adolescents after cardiac arrest

    NARCIS (Netherlands)

    L. van Zellem (Lennart); C.M.P. Buysse (Corinne); M.J. Madderom (Marlous); J.S. Legerstee (Jeroen); F.K. Aarsen (Femke); D. Tibboel (Dick); E.M.W.J. Utens (Elisabeth)

    2015-01-01

    textabstractPurpose: Research into neuropsychological functioning of survivors of cardiac arrest (CA) in childhood is scarce. We sought to assess long-term neuropsychological functioning in children and adolescents surviving CA. Methods: Neuropsychological follow-up study involving all consecutive c

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

    DEFF Research Database (Denmark)

    Do, Hien Quoc; Nielsen, Søren Loumann; Rasmussen, Lars Simon

    2010-01-01

    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...

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

    DEFF Research Database (Denmark)

    Weeke, Peter; Folke, Fredrik; Gislason, Gunnar H;

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Francesca Gatti

    2014-01-01

    Full Text Available 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.

  14. Activation of mitochondrial STAT-3 and reduced mitochondria damage during hypothermia treatment for post-cardiac arrest myocardial dysfunction.

    Science.gov (United States)

    Huang, Chien-Hua; Tsai, Min-Shan; Chiang, Chih-Yen; Su, Yu-Jen; Wang, Tzung-Dau; Chang, Wei-Tien; Chen, Huei-Wen; Chen, Wen-Jone

    2015-11-01

    While therapeutic hypothermia improves the outcomes of individuals in cardiac arrest, the hemodynamic responses and mechanisms which underlie hypothermia-induced cardioprotection are not fully understood. Therefore, we investigated the mechanism by which induced hypothermia preserves cardiac function and protects against mitochondrial damage following cardiac arrest. Cardiac arrest was induced in adult male Wistar rats by asphyxiation for 8.5 min. Following resuscitation, the animals were randomly assigned to a hypothermia (32 °C) or normothermia (37 °C) group. Monitoring results showed that cardiac output at the fourth hour after resuscitation was significantly better in rats treated with hypothermia when compared to rats treated with normothermia (P mitochondrial permeability transition pores occurred less frequently in the hypothermic group. While complex I/III activity in the electron transport reaction was damaged after cardiac arrest and resuscitation, the degree of injury was ameliorated by hypothermia treatment (P mitochondrial integrity and electron transport activity.

  15. Anxiety and depression among out-of-hospital cardiac arrest survivors

    DEFF Research Database (Denmark)

    Lilja, G; Nilsson, G; Nielsen, N;

    2015-01-01

    . Subjective cognitive problems were associated with an increased risk for psychological distress. Since psychological distress affects long-term prognosis of cardiac patients in general it should be addressed during follow-up of survivors with OHCA due to a cardiac cause. ClinicalTrials.gov NCT01020916/NCT......AIM: Survivors of out-of-hospital cardiac arrest (OHCA) may experience psychological distress but the actual prevalence is unknown. The aim of this study was to investigate anxiety and depression within a large cohort of OHCA-survivors. METHODS: OHCA-survivors randomized to targeted temperature...

  16. Prolonged Intraoperative Cardiac Resuscitation Complicated by Intracardiac Thrombus in a Patient Undergoing Orthotopic Liver Transplantation.

    Science.gov (United States)

    Kim, Sang; DeMaria, Samuel; Cohen, Edmond; Silvay, George; Zerillo, Jeron

    2016-09-01

    We report the case of successful resuscitation after prolonged cardiac arrest during orthotopic liver transplantation. After reperfusion, the patient developed ventricular tachycardia, complicated by intracardiac clot formation and massive hemorrhage. Transesophageal echocardiography demonstrated stunned and nonfunctioning right and left ventricles, with developing intracardiac clots. Treatment with heparin, massive transfusion and prolonged cardiopulmonary resuscitation ensued for 51 minutes. Serial arterial blood gases demonstrated adequate oxygenation and ventilation during cardiopulmonary resuscitation. Cardiothoracic surgery was consulted for potential use of extracorporeal membrane oxygenation, however, the myocardial function improved and the surgery was completed without further intervention. On postoperative day 6, the patient was extubated without neurologic or cardiac impairment. The patient continues to do well 2 years posttransplant, able to perform independent daily activities of living and his previous job. This case underscores the potential for positive outcomes with profoundly prolonged, effective advanced cardiovascular life support in patients who experience postreperfusion syndrome. PMID:27233818

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

    DEFF Research Database (Denmark)

    Weeke, Peter; Folke, Fredrik; Gislason, Gunnar H;

    2012-01-01

    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......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......: 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...

  18. Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database

    DEFF Research Database (Denmark)

    Andersen, Peter Oluf; Maaløe, Rikke; Andersen, Henning Boje

    2010-01-01

    Background Critical incident reports can identify areas for improvement in resuscitation practice. The Danish Patient Safety Database is a mandatory reporting system and receives critical incident reports submitted by hospital personnel. The aim of this study is to identify, analyse and categorize...... critical incidents related to cardiac arrests reported to the Danish Patient Safety Database. Methods The search terms “cardiac arrest” and “resuscitation” were used to identify reports in the Danish Patient Safety Database. Identified critical incidents were then classified into categories. Results One...... (n = 14; 11%), insufficient monitoring (n = 14; 11%), and medication error (n = 8; 7%). Conclusion Critical incidents related to cardiac arrest occur due to logistical, technical, teamworking and knowledge problems. These findings should be considered when planning education and implementing...

  19. Case series: CT scan in cardiac arrest and imminent cardiogenic shock

    International Nuclear Information System (INIS)

    Imaging a patient having a cardiac arrest on the examination table is not a common occurrence. Altered hemodynamics resulting from pump failure causes stasis of blood in the dependent organs of the body, which is manifested on imaging by dependent contrast pooling and layering. Often a patient with imminent cardiogenic shock also shows a similar dependent contrast pooling and layering, which is a marker of the worsening clinical condition. We report the contrast-enhanced CT scan features in four cases, two of whom had cardiac arrest during imaging, while the other two developed cardiogenic shock soon after the examination. Dependent contrast pooling and layering were found in all of them, with faint or no opacification of the left cardiac chambers. Contrast pooling was noted in the dependent lumbar veins, hepatic veins, hepatic parenchyma, and the right renal vein, as well as in the dependent part of the IVC and the right heart chambers

  20. In-Hospital Cardiac Arrest: An Update on Pulseless Electrical Activity and Asystole.

    Science.gov (United States)

    Attin, Mina; Tucker, Rebecca G; Carey, Mary G

    2016-09-01

    Nonshockable rhythms, including pulseless electrical activity (PEA) and asystole, precede more than 70% of in-hospital cardiac arrests (I-HCA). Compared with shockable rhythms (ventricular fibrillation and ventricular tachycardia), nonshockable rhythms have higher mortality and morbidity. Therefore, investigating the underlying mechanisms of these arrhythmias to improve the quality of care and outcome for patients who suffer cardiac arrest is a priority. As the first responders to I-HCA, nurses must have the proper knowledge and training to provide timely and efficient cardiopulmonary resuscitation therapy. This article provides an overview of nonshockable cardiac arrhythmias preceding I-HCA as a means of addressing the gap between science and clinical practice. PMID:27484665

  1. Cardiac and systemic haemodynamic complications of liver cirrhosis

    DEFF Research Database (Denmark)

    Henriksen, Jens H; Møller, Søren

    2009-01-01

    Cardiovascular complications of liver cirrhosis include cardiac dysfunction and abnormalities in the central-, splanchnic,- and peripheral circulation. Vasodilatation prevails, but vascular beds with various degrees of reduced and increased haemodynamic resistance are the results of massive...... by physical and pharmacological strain. Cardiac failure is an important cause of mortality after liver transplantation and stressful procedures as insertions of transjugular intrahepatic portal systemic shunt (TIPS), peritoneal venous shunting, and other types of surgery. Improvement of liver function has...... been shown to reverse the cardiovascular complications. The clinical significance is an important topic for future research. At present, no specific treatment can be recommended, and the cardiac failure in cirrhosis should be treated as in non-cirrhotic patients with sodium restriction, diuretics...

  2. Sudden cardiac arrest in sports - need for uniform registration

    DEFF Research Database (Denmark)

    Solberg, E E; Borjesson, M; Sharma, S;

    2015-01-01

    , the importance of gender, ethnicity and age of the athlete, as well as the type and level of sporting activity. A precise instruction for autopsy practice in the case of a SCD of athletes is given, including the role of molecular samples and evaluation of possible doping. Rational decisions about cardiac...

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

    Directory of Open Access Journals (Sweden)

    Deborah Caruso, MD

    2014-11-01

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

  4. Cardiac ryanodine receptor gene (hRyR2) mutation underlying catecholaminergic polymorphic ventricular tachycardia in a Chinese adolescent presenting with sudden cardiac arrest and cardiac syncope

    Institute of Scientific and Technical Information of China (English)

    Ngai-Shing Mok; Ching-Wan Lam; Nai-Chung Fong; Yim-Wo Hui; Yuen-Choi Choi; Kwok-Yin Chan

    2006-01-01

    @@ Sudden cardiac death (SCD) in children and adolescents is uncommon and yet it is devastating for both victim's family and the society.Recently, it was increasingly recognized that SCD in young patients with structurally normal heart may be caused by inheritable primary electrical diseases due to the malfunction of cardiac ion channels, a disease entity known as the ion channelopathies.Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a specific form of ion channelopathy which can cause cardiac syncope or SCD in young patients by producing catecholamine-induced bi-directional ventricular tachycardia (BiVT), polymorphic VT and ventricular fibrillation (VF) during physical exertion or emotion.1-7 We reported here an index case of CPVT caused by cardiac ryanodine receptor gene (hRyR2)mutation which presented as cardiac syncope and sudden cardiac arrest in a Chinese adolescent female.

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

    Directory of Open Access Journals (Sweden)

    Hypes C

    2014-10-01

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

  6. Cardiac Arrest Secondary to Bilateral Pulmonary Emboli following Arteriovenous Fistula Thrombectomy: A Case Report with Review of the Literature

    Directory of Open Access Journals (Sweden)

    Avni Shah

    2012-01-01

    Full Text Available Number of patients with End Stage Renal Disease (ESRD is growing worldwide. Hemodialysis remains the main modality of renal replacement therapy for ESRD patients. A patent hemodialysis access (arteriovenous fistula or arteriovenous graft plays a key role in successful delivery of hemodialysis. Common vascular access issues encountered by patients and nephrologists are thrombosis and infection. The thrombosed access is declotted by various percutaneous techniques these days by multiple outpatient access centers in a timely fashion. Thrombolysis can give rise to various complications, a few of which can be life threatening. A young hemodialysis patient underwent percutaneous thrombolysis of his clotted arteriovenous fistula. Outpatient access thrombectomy was complicated immediately afterwards with cardiac arrest requiring cardiac resuscitation in the recovery room. The patient was admitted to intensive care unit after life sustaining care. Work up revealed multiple pulmonary emboli to both lung fields on CT scan of the chest. Patient was anticoagulated and discharged from the hospital. Thrombolysis of clotted hemodialysis access is associated commonly with occurrences of pulmonary embolic which are usually asymptomatic. Massive pulmonary embolization due to access thrombolysis is rare. Nephrologists and radiologists should be aware of this dangerous complication particularly in patients with preexisting cardiopulmonary disease.

  7. [Drowning versus cardiac ischemia: Cardiac arrest of an 11-year-old boy at a swimming lake].

    Science.gov (United States)

    Födinger, A; Wöss, C; Semsroth, S; Stadlbauer, K H; Wenzel, V

    2015-11-01

    This report describes a case of sudden cardiac arrest and subsequent attempted cardiopulmonary resuscitation of an 11-year-old child on the shores of a swimming lake. Reports of eyewitnesses excluded the obviously suspected diagnosis of a drowning accident. The result of the autopsy was sudden cardiac death due to a congenital coronary anomaly (abnormal left coronary artery, ALCA). Favored by vigorous physical activity, this anomaly can lead to malignant arrhythmias because the ectopic coronary artery with its intramural course through the aortic wall is compressed during every systole. This pathology was not known to the boy or his family; in fact he liked sports but had suffered of a syncope once which was not followed up. Without a strong suspicion it is difficult to diagnose a coronary artery anomaly and it is often missed even in college athletes. Tragically, sudden cardiac arrest may be the first symptom of an undiagnosed abnormal coronary artery. Following syncope or chest pain during exercise with a normal electrocardiogram (ECG) cardiac imaging, such as computed tomography (CT) or angiography should be initiated in order to enable surgical repair of an abnormal coronary artery.

  8. Double-valve Libman-Sacks endocarditis causing ventricular fibrillation cardiac arrest.

    Science.gov (United States)

    Tanawuttiwat, Tanyanan; Dia, Muhyaldeen; Hanif, Tabassum; Mihailescu, Mihaela

    2011-01-01

    Libman-Sacks endocarditis is a well-known and rather common cardiac manifestation of systemic lupus erythematosus. Transesophageal and transthoracic echocardiography are the definitive imaging methods used to evaluate cardiac valvular involvement in this disease. Valvular masses (vegetations) and valvular thickening are 2 common morphologic echocardiographic patterns. Libman-Sacks lesions are typically characterized by single-valve involvement and their small size of 1 to 4 mm.Herein, we present the unusual case of a 22-year-old woman with newly diagnosed systemic lupus erythematosus who had large, sterile vegetations of Libman-Sacks endocarditis that involved the mitral and aortic valves. This compromised coronary blood flow and resulted in ventricular fibrillation cardiac arrest. The vegetations were surgically excised, and the patient's cardiac function recovered. We discuss the treatment of the patient and that of Libman-Sacks endocarditis.

  9. A case of Ventricular Tachycardia and Cardiac Arrest Associated with Sertraline and Mirtazapine Combination.

    Directory of Open Access Journals (Sweden)

    Murad Atmaca

    2014-03-01

    Full Text Available A 67-year-old male suffering from depressive symptomatology was admitted to the inpatient clinic at Firat University School of Medicine; and his psychiatric evaluation revealed major depressive episode according to DSM-IV. He developed chest discomfort, chest pain and shortness of breath of acute onset accompanying pulseless ventricular tachycardia (VT leading to cardiac arrest following sertraline and mirtazapine combination treatment. He died after two days in the Intensive Care Unit. The present case suggests that psychiatrists should be aware of unexpected cardiac events, especially when they use combination treatments.

  10. Advantages of a cohort study on cardiac arrest conducted by nurses

    Directory of Open Access Journals (Sweden)

    Cássia Regina Vancini Campanharo

    2015-10-01

    Full Text Available AbstractOBJECTIVEIdentifying factors associated to survival after cardiac arrest.METHODAn experience report of a cohort study conducted in a university hospital, with a consecutive sample comprised of 285 patients. Data were collected for a year by trained nurses. The training strategy was conducted through an expository dialogue lecture. Collection monitoring was carried out by nurses via telephone calls, visits to the emergency room and by medical record searches. The neurological status of survivors was evaluated at discharge, after six months and one year.RESULTSOf the 285 patients, 16 survived until hospital discharge, and 13 remained alive after one year, making possible to identify factors associated with survival. There were no losses in the process.CONCLUSIONCohort studies help identify risks and disease outcomes. Considering cardiac arrest, they can subsidize public policies, encourage future studies and training programs for CPR, thereby improving the prognosis of patients.

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

    DEFF Research Database (Denmark)

    Søholm, Helle; Bro-Jeppesen, John; Lippert, Freddy K;

    2014-01-01

    BACKGROUND: Survival after out-of-hospital cardiac arrest (OHCA) has increased in recent years, and new data are therefore needed to avoid unsubstantiated statements when debating futility of resuscitation attempts following OHCA in nursing home (NH)-residents. We aimed to investigate the outcome...... of 2541 consecutive OHCA-patients were recorded, 245 (10%) of who were current NH-residents. NH-patients were older, more frequently female, had more witnessed arrests, fewer shockable primary rhythm and assumed cardiac aetiology, but shorter time to the return of spontaneous circulation (ROSC) compared...... to OHCA in non-nursing homes (non-NH). Overall 30-day survival rate was 9% in NH and 18% in non-NH, parrests 79 (32%) patients were admitted to hospital compared to 937 (41%) from non-NH (p

  12. Radiologic manifestations of extra-cardiac complications of infective endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Colen, Teran W.; Gunn, Martin; Cook, Erin; Dubinsky, Theodore [University of Washington Medical Center, Department of Radiology, 1959 NE Pacific Ave, Box 357115, Seattle, WA (United States)

    2008-11-15

    Infective endocarditis (IE) is a disease with high morbidity and a mortality rate of 9-30%, even with appropriate diagnosis and therapy. Septic emboli, caused by IE, can affect any organ or tissue in the body with an arterial supply and occur in 12-40% of IE cases. The most common extra-cardiac organ system involved in IE is the central nervous system. Other organs frequently involved are the lungs (especially in right-sided IE), spleen, kidneys, liver, and the musculoskeletal system. In addition, the arterial system itself is susceptible to the development of potentially fatal mycotic aneurysms. As extra-cardiac complications often antedate the clinical diagnosis of IE, it is important that the diagnosis is suggested when characteristic findings are encountered during imaging. In addition, imaging is often used to monitor the extent of complications in patients with a known diagnosis of IE. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Edouard Matevossian

    2009-04-01

    Full Text Available Edouard Matevossian1, Dietrich Doll4, Jakob Säckl1, Inga Sinicina5, Jürgen Schneider2, Gerhard Simon3, Norbert Hüser11Department of Surgery, 2Department of Anesthesiology and Intensive-Care Medicine; 3Department of Radiology, Technische Universität of Munich, Germany; 4Department of Visceral, Vascular and Thoracic Surgery, Philips University of Marburg, Marburg, Germany; 5Institute of Clinical Forensic Medicine, Ludwig-Maximilian University of Munich, Munich, GermanyAbstract: Saving more human lives through more effective reanimation measures is the goal of the new international guidelines on cardiopulmonary resuscitation as the decisive aspect for survival after cardiovascular arrest is that basic resuscitation should start immediately. According to the updated guidelines, the greatest efficacy in cardiac massage is only achieved when the right compression point, an adequate compression depth, vertical pressure, the correct frequency, and equally long phases of compression and decompression are achieved. The very highest priority is placed on restoring continuous circulation. Against this background, standardized continuous chest compression with active decompression has contributed to a favorable outcome in this case. The hydraulically operated and variably adjustable automatic Lund University Cardiac Arrest System (LUCAS device (Jolife, Lund, Sweden undoubtedly meets these requirements. This case report describes a 44-year-old patient who – approximately 15 min after the onset of clinical death due to apparent ventricular fibrillation – received cardiopulmonary resuscitation, initially by laypersons and then by the emergency medical team (manual chest compressions followed by situation-adjusted LUCAS compressions. Sinus rhythm was restored after more than 90 min of continuous resuscitation, with seven defibrillations. Interventional diagnostic workup did not reveal a causal morphological correlate for the condition on coronary

  14. Emergency coronary angiography in comatose cardiac arrest patients:do real-life experiences support the guidelines?

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper; Wanscher, Michael;

    2012-01-01

    To describe the use of emergency coronary angiography (CAG) and primary percutaneous coronary intervention (PCI) and the association with short- and long-term survival in consecutive comatose survivors after out-of-hospital cardiac arrest (OHCA)....

  15. Use of cold intravenous fluid to induce hypothermia in a comatose child after cardiac arrest due to a lightning strike.

    Science.gov (United States)

    Kim, Young-Min; Jeong, Ju-Hwan; Kyong, Yeon-Young; Kim, Han-Joon; Kim, Ji-Hoon; Park, Jeong-Ho; Park, Kyu-Nam

    2008-11-01

    We report a case in which mild hypothermia was induced successfully using a cold intravenous fluid infusion in a 12-year-old boy who was comatose following 21 min of cardiac arrest caused by a lightning strike. PMID:18805616

  16. Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia : Dutch nationwide retrospective cohort study

    NARCIS (Netherlands)

    Kieboom, J. K.; Verkade, H. J.; Burgerhof, J. G.; Bierens, J. J.; van Rheenen, P. F.; Kneyber, M. C.; Albers, M. J.

    2015-01-01

    OBJECTIVES To evaluate the outcome of drowned children with cardiac arrest and hypothermia, and to determine distinct criteria for termination of cardiopulmonary resuscitation in drowned children with hypothermia and absence of spontaneous circulation. DESIGN Nationwide retrospective cohort study. S

  17. Cerebral perfusion in cardiac surgery : with special reference to circulatory arrest during profound hypothermia

    OpenAIRE

    Astudillo Ley, Rafael

    1998-01-01

    Thirty-nine pediatric and 82 adult patients were studied during cardiac surgery with cardio pulmonary bypass (CPB) performed with moderate hypothermia or with deep hypothermia and circulatory arrest (DHCA) with or-without retrograde cerebral perfusion (RCP). Cerebral blood flow (CBF) was estimated from Doppler measurements of the blood velocity in the middle cerebral artery (MCAv). Arterio-venous (jugular bulb) differences of blood lactate and oxygen were used to study cereb...

  18. Advantages of a cohort study on cardiac arrest conducted by nurses

    OpenAIRE

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

    2015-01-01

    AbstractOBJECTIVEIdentifying factors associated to survival after cardiac arrest.METHODAn experience report of a cohort study conducted in a university hospital, with a consecutive sample comprised of 285 patients. Data were collected for a year by trained nurses. The training strategy was conducted through an expository dialogue lecture. Collection monitoring was carried out by nurses via telephone calls, visits to the emergency room and by medical record searches. The neurological status of...

  19. Willingness to Perform Chest Compression Only in Witnessed Cardiac Arrest Victims versus Cardiopulmonary Resuscitation in Iran

    OpenAIRE

    Nesreen Yaghmour; Mohammad Reza Movahed

    2015-01-01

    Background: Performing immediate bystander Cardio Pulmonary Resuscitation (CPR) is the most important factor that determines survival from cardiac arrest. Recommended mouth to mouth ventilation maneuver during CPR has led to lower rate of CPR performance in the population. Objectives: The present survey aimed to evaluate the willingness of nurses at Shiraz University of Medical Sciences for performing CPR versus chest-compression-only CPR. Patients and Methods: During a CPR course, we...

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

    OpenAIRE

    McClung, Christian D.; Alexander J. Anshus

    2015-01-01

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

  1. Efficacy of Mild Hypothermia for the Treatment of Patients with Cardiac Arrest

    Institute of Scientific and Technical Information of China (English)

    Yu Gao; Kang-Li Hui; Yu-Jie Wang; Lin Wu; Man-Lin Duan; Jian-Guo Xu; De-Xin Li

    2015-01-01

    Background:Therapeutic hypothermia has been recommended for the treatment of cardiac arrest patients who remain comatose after the return of spontaneous circulation.The aim of this study was to evaluate the effectiveness and safety of mild hypothermia on patients with cardiac arrest by conducting a meta-analysis.Methods:The relevant trials were searched in Cochrane Library,PubMed,Web of Science,Embase,CNKI and Wan Fang Data from the date of their establishment to October 2014.Thereafter,the studies retrieved were screened based on predefined inclusion and exclusion criteria.Data were extracted,and the quality of the included studies was evaluated.A meta-analysis was conducted using the Cochrane Collaboration Review Manager 5.2 software.Results:Six randomized controlled trials involving 531 cases were included,among which 273 cases were assigned to the treatment group and the other 258 cases to the control group.The meta-analysis indicated that mild hypothermia therapy after cardiac arrest produced significant differences in survival rate (relative risk [RR] =1.23,95% confidence interval [CI]:1.02-1.48,P =0.03) and neurological function (RR =1.33,95% CI:1.08-1.65,P =0.007) after 6 months compared with normothermia therapy.However,no significant differences were observed in the survival to the hospital discharge (RR =1.35,95% CI:0.87-2.10,P =0.18),favorable neurological outcome at hospital discharge (RR =1.53,95% CI:0.95-2.45,P =0.08) and adverse events.Conclusions:The meta-analysis demonstrated that mild hypothermia can improve the survival rate and neurological function of patients with cardiac arrest after 6 months.On the other hand,regarding the survival to hospital discharge,favorable neurological outcome at hospital discharge,and adverse events,our meta-analysis produced nonsignificant results.

  2. Prehospital therapeutic hypothermia after cardiac arrest - from current concepts to a future standard

    OpenAIRE

    Hoppu Sanna; Kämäräinen Antti; Silfvast Tom; Virkkunen Ilkka

    2009-01-01

    Abstract Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting. The purpose of this review was to evaluate current clinical studies o...

  3. Sudden cardiac arrest following ventricular fibrillation attributed to anabolic steroid use in an adolescent.

    Science.gov (United States)

    Lichtenfeld, Jana; Deal, Barbara J; Crawford, Susan

    2016-06-01

    Anabolic androgenic steroids are synthetic derivatives of testosterone that promote the growth of skeletal muscles and have many recognised cardiovascular effects. We report the clinical presentation and pathological findings of an adolescent male whose sudden cardiac arrest following ventricular fibrillation was attributed to anabolic androgenic steroid use. The age of our patient reflects the usage of anabolic androgenic steroids among younger athletes and highlights the need for increased awareness among practitioners.

  4. Sudden cardiac arrest following ventricular fibrillation attributed to anabolic steroid use in an adolescent.

    Science.gov (United States)

    Lichtenfeld, Jana; Deal, Barbara J; Crawford, Susan

    2016-06-01

    Anabolic androgenic steroids are synthetic derivatives of testosterone that promote the growth of skeletal muscles and have many recognised cardiovascular effects. We report the clinical presentation and pathological findings of an adolescent male whose sudden cardiac arrest following ventricular fibrillation was attributed to anabolic androgenic steroid use. The age of our patient reflects the usage of anabolic androgenic steroids among younger athletes and highlights the need for increased awareness among practitioners. PMID:26980272

  5. Factors associated with the clinical outcomes of paediatric out-of-hospital cardiac arrest in Japan

    OpenAIRE

    Nagata, Takashi; Abe, Takeru; Noda, Eiichiro; Hasegawa, Manabu; Hashizume, Makoto; Hagihara, Akihito

    2014-01-01

    Objectives To better understand and predict clinical outcomes of paediatric out-of-hospital cardiac arrest (OHCA). Design A population-based, observational study. Setting The National Japan Utstein Registry. Participants 2900 children aged 5–17 years who experienced OHCA and received resuscitation by emergency responders. Signal detection analysis using 17 variables was applied to identify factors associated with OHCA outcomes; the primary endpoint was cerebral performance category (CPC) 1 or...

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

    OpenAIRE

    Kim JH; Uhm TH

    2014-01-01

    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 ...

  7. Risk factors for cardiac complications after spine surgery

    OpenAIRE

    Guyot, Juan P.; Cizik, Amy; Bransford, Richard; Bellabarba, Carlo; Lee, Michael J.

    2010-01-01

    Study design:  Registry study using prospectively collected data Objective:  To determine risk factors for cardiac complications in spine surgery. Methods:  The Spine End Results Registry 2003–2004 is an exhaustive database of 1,592 patients who underwent spine surgery at the University of Washington Medical Center or Harborview Medical Center. Detailed information regarding patient demographic, medical comorbidity, surgical invasiveness and adverse outcomes were prospectively recorded. The p...

  8. [Recent treatment of postischaemic anoxic brain damage after cardiac arrest by using therapeutic hypothermia].

    Science.gov (United States)

    Andjelić, Sladjana

    2008-01-01

    Organ injury caused by ischaemia and anoxia during prolonged cardiac arrest is compounded by reperfusion injury that occurs when spontaneous circulation is restored. Mild hypothermia (32-35 degrees C) is neuroprotective through several mechanisms, including suppression of apoptosis, reduced production of excitotoxins and free radicals, and anti-inflammatory actions. Experimental studies show that hypothermia is more effective the earlier it is started after return of spontaneous circulation (ROSC). Two randomised clinical trials show improved survival and neurological outcome in adults who remained comatose after initial resuscitation from prehospital VF cardiac arrest, and who were cooled after ROSC. Different strategies can be used to induce hypothermia. Optimal timing of therapeutic hypothermia for cardiac ischaemia is unknown. In patients who failed to respond to standard cardiopulmonary resuscitation, intra-arrest cooling using ice-cold intravenous (i.v.) fluid improved the chance of survival. Recently, fasudil, a Rho kinase inhibitor, was reported to prevent cerebral ischaemia in vivo by increasing cerebral blood flow and inhibiting inflammatory responses. In future, two different kinds of protective therapies, BCL-2 overexpression and hypothermia,will both inhibit aspects of apoptotic cell death cascades, and that combination treatment can prolong the temporal "therapeutic window" for gene therapy. PMID:19069351

  9. Recent treatment of postischaemic anoxic brain damage after cardiac arrest by using therapeutic hypothermia

    Directory of Open Access Journals (Sweden)

    Anđelić Slađana

    2008-01-01

    Full Text Available Organ injury caused by ischemia and anoxia during prolonged cardiac arrest is compounded by reperfusion injury that occurs when spontaneous circulation is restored. Mild hypothermia (32-35ºC is neuroprotective through several mechanisms, including suppression of apoptosis, reduced production of excitotoxins and free radicals, and anti-inflammatory actions. Experimental studies show that hypothermia is more effective the earlier it is started after return of spontaneous circulation (ROSC. Two randomized clinical trials show improved survival and neurological outcome in adults who remained comatose after initial resuscitation from prehospital VF cardiac arrest, and who were cooled after ROSC. Different strategies can be used to induce hypothermia. Optimal timing of therapeutic hypothermia for cardiac ischemia is unknown. In patients who failed to respond to standard cardiopulmonary resuscitation, intra-arrest cooling using ice-cold intravenous (i.v. fluid improved the chance of survival. Recently, fasudil, a Rho kinase inhibitor, was reported to prevent cerebral ischaemia in vivo by increasing cerebral blood flow and inhibiting inflammatory responses. In future, two different kinds of protective therapies, BCL-2 overexpression and hypothermia, will both inhibit aspects of apoptotic cell death cascades, and that combination treatment can prolong the temporal 'therapeutic window' for gene therapy.

  10. Prediction of the potential clinical outcomes for post-resuscitated patients after cardiac arrest

    Science.gov (United States)

    Hong, Sungmin; Kwon, Bojun; Yun, Il Dong; Lee, Sang Uk; Kim, Kyuseok; Kim, Joonghee

    2013-02-01

    Cerebral injuries after cardiac arrest are serious causes for morbidity. Many previous researches in the medical society have been proposed to prognosticate the functional recoveries of post-resuscitated patients after cardiac arrest, but the validity of suggested features and the automation of prognostication have not been made yet. This paper presents the automatic classification method which predicts the potential clinical outcomes of post-resuscitated patients who suffered from cardiac arrest. The global features and the local features are adapted from the researches from the medical society. The global features, which are consisted of the percentage of the partial volume under the uniformly increasing thresholds, represent the global tendency of apparent diffusion coefficient value in a DWI. The local features are localized and measured on the refined local apparent diffusion coefficient minimal points. The local features represent the ischemic change of small areas in a brain. The features are trained and classified by the random forest method, which have been widely used in the machine learning society for classification. The validity of features is automatically evaluated during the classification process. The proposed method achieved the 0.129 false-positive rate while maintaining the perfect true-positive rate. The area-under-curve of the proposed method was 0.9516, which showed the feasibility and the robustness of the proposed method.

  11. Simultaneous measurement of cerebral and muscle tissue parameters during cardiac arrest and cardiopulmonary resuscitation

    Science.gov (United States)

    Nosrati, Reyhaneh; Ramadeen, Andrew; Hu, Xudong; Woldemichael, Ermias; Kim, Siwook; Dorian, Paul; Toronov, Vladislav

    2015-03-01

    In this series of animal experiments on resuscitation after cardiac arrest we had a unique opportunity to measure hyperspectral near-infrared spectroscopy (hNIRS) parameters directly on the brain dura, or on the brain through the intact pig skull, and simultaneously the muscle hNIRS parameters. Simultaneously the arterial blood pressure and carotid and femoral blood flow were recorded in real time using invasive sensors. We used a novel hyperspectral signalprocessing algorithm to extract time-dependent concentrations of water, hemoglobin, and redox state of cytochrome c oxidase during cardiac arrest and resuscitation. In addition in order to assess the validity of the non-invasive brain measurements the obtained results from the open brain was compared to the results acquired through the skull. The comparison of hNIRS data acquired on brain surface and through the adult pig skull shows that in both cases the hemoglobin and the redox state cytochrome c oxidase changed in similar ways in similar situations and in agreement with blood pressure and flow changes. The comparison of simultaneously measured brain and muscle changes showed expected differences. Overall the results show feasibility of transcranial hNIRS measurements cerebral parameters including the redox state of cytochrome oxidase in human cardiac arrest patients.

  12. Bystander-initiated chest compression-only CPR is better than standard CPR in out-of-hospital cardiac arrest

    OpenAIRE

    Cabrini, L; Biondi-Zoccai, G; Landoni, G; Greco, M.; Vinciguerra, F; Greco, T; Ruggeri, L; Sayeg, J; Zangrillo, A

    2010-01-01

    Introduction Out-of-hospital cardiac arrest has a low survival rate to hospital discharge. Recent studies compared a simplified form of CPR, based on chest compression alone versus standard CPR including ventilation. We performed systematic review and meta-analysis of randomized controlled trials, focusing on survival at hospital discharge. Methods We extensively searched the published literature on out-of hospital CPR for non traumatic cardiac arrest in different databases. Results We identi...

  13. The Extent of Myocardial Injury During Prolonged Targeted Temperature Management After Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Grejs, Anders Morten; Gjedsted, Jakob; Thygesen, Kristian;

    2016-01-01

    AIM: The aim of this study is to evaluate the extent of myocardial injury by cardiac biomarkers during prolonged targeted temperature management of 24 hours vs 48 hours after out-of-hospital cardiac arrest. METHODS: This randomized Scandinavian multicenter study compares the extent of myocardial...... injury quantified by area under the curve (AUC) of cardiac biomarkers during prolonged targeted temperature management at 33°C ± 1°C of 24 hours and 48 hours, respectively. Through a period of 2.5 years, 161 comatose out-of-hospital cardiac arrest patients were randomized to targeted temperature...... targeted temperature management at 24 hours was significantly lower than that of 2428 μg/L/h (IQR 1163-10,906) within targeted temperature management at 48 hours, P hospital cardiac arrest survivors showed no difference between the extents of myocardial...

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

    Directory of Open Access Journals (Sweden)

    Kim JH

    2014-09-01

    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

  15. Cardiac arrest upon induction of anesthesia in children with cardiomyopathy: an analysis of incidence and risk factors.

    LENUS (Irish Health Repository)

    Lynch, Johanne

    2012-02-01

    INTRODUCTION: It is thought that patients with cardiomyopathy have an increased risk of cardiac arrest on induction of anesthesia, but there is little available data. The purpose of this study was to identify the incidence and potential risk factors for cardiac arrest upon induction of anesthesia in children with cardiomyopathy in our institution. METHODS: A retrospective chart review was performed. Eligible patients included patients admitted between 1998 and 2008 with the International Statistical Classification of Disease code for cardiomyopathy (ICD-9 code 425) who underwent airway intervention for sedation or general anesthesia in the operating room, cardiac diagnostic and interventional unit (CDIU) or intensive care unit. Patients undergoing emergency airway intervention following cardiovascular collapse were excluded. For each patient, we recorded patient demographics, disease severity, anesthesia location, and anesthetic technique. RESULTS: One hundred and twenty-nine patients with cardiomyopathy underwent a total of 236 anesthetic events, and four cardiac arrests were identified. One was related to bradycardia (HR<60), two were attributed to bradycardia in association with severe hypotension (systolic blood pressure<45), and the fourth arrest was related to isolated severe hypotension. Two occurred in the operating suite and two in the CDIU. There was no resulting mortality. One patient progressed to heart transplantation. Multiple combinations of anesthetic drugs were used for induction of anesthesia. CONCLUSION: We performed a review of the last 10 years of anesthesia events in children with cardiomyopathy. We report four cardiac arrests in two patients and 236 anesthetic events (1.7%). To the best of our knowledge, this is the largest review of these patients to date but is limited by its retrospective nature. The low cardiac arrest incidence prevents the identification of risk factors and the development of a cardiac arrest risk predictive clinical

  16. Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    Mojtaba Chardoli; Farhad Heidari; Helaleh Rabiee; Mahdi Sharif-Alhoseini; Hamid Shokoohi; Vafa Rahimi-Movaghar

    2012-01-01

    Objective: To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA) cardiac arrest and predicting the resuscitation outcomes.Methods: In this prospective interventional study,patients presenting with PEA cardiac arrest were randomized into two groups.In Group A,ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity,right ventricle dilation,left ventricle function,pericardial effusion/tamponade and ⅣC size along with the advanced cardiac life support (ACLS) protocol.Patients in Group B solely underwent ACLS protocol without applying echocardiography.The presence or absence of mechanical ventricular activity (MVA) and evidences of PEA reversible causes were recorded.The return of spontaneous circulation (ROSC) and death were evaluated in both groups.Results: One hundred patients with the mean age of (58±6.1) years were enrolled in this study.Fifty patients (Group A) had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR).Among them,7 patients (14%) had pericardial effusion,11 (22%) had hypovolemia,and 39 (78%) were revealed the presence of MVA.In the pseudo PEA subgroup (presence of MVA),43% had ROSC (positive predictive value) and in the true PEA subgroup with cardiac standstill (absence of MVA),there was no recorded ROSC (negative predictive value).Among patients in Group B,no reversible etiology was detected.There was no significant difference in resuscitation results between Groups A and B observed (P=0.52).Conclusion: Bedside echocardiography can identify some reversible causes of PEA.However,there are no significant changes in survival outcome between the echo group and those with traditional CPR.

  17. Development of a theoretical guide for nursing care in cardiac arrest

    Directory of Open Access Journals (Sweden)

    Aliandra Bittencourt da Silva

    2013-11-01

    Full Text Available This study aimed to identify the knowledge on cardiorespiratory arrest among nurses in a hospital of Vale do Paraíba, São Paulo, Brazil, and develop a theoretical guide for care of this emergency. We prepared an instrument of data collection based on relevant literature and the 2010 AHA Guidelines for CPR, from August to October 2012. The sample consisted of 41 nurses who deliver care activities in various units of the hospital. The study showed that professional participants said they were able to act in cardiopulmonary resuscitation, however, there were limitations of knowledge about the theme. Given the above, we developed a theoretical guide for cardiac arrest care based on scientific literature and covering questions submitted by nurses.

  18. Influence of Chest Compressions on Circulation during the Peri-Cardiac Arrest Period in Porcine Models.

    Directory of Open Access Journals (Sweden)

    Jun Xu

    Full Text Available Starting chest compressions immediately after a defibrillation shock might be harmful, if the victim already had a return of spontaneous circulation (ROSC and yet was still being subjected to external compressions at the same time. The objective of this study was to study the influence of chest compressions on circulation during the peri-cardiac arrest period.Prospective, randomized controlled study.Animal experimental center in Peking Union Medical Collage Hospital, Beijing, China.Healthy 3-month-old male domestic pigs.44 pigs (28±2 kg were randomly assigned to three groups: Group I (non-arrested with compressions (n = 12; Group II (arrested with compressions only (n = 12; Group III (ROSC after compressions and defibrillation (n = 20. In Groups I and II, compressions were performed to a depth of 5cm (Ia and IIa, n = 6 or a depth of 3cm (Ib and IIb, n = 6 respectively, while in Group III, the animals which had just achieved ROSC (n = 18 were compressed to a depth of 5cm (IIIa, n = 6, a depth of 3cm (IIIb, n = 6, or had no compressions (IIIc, n = 6. Hemodynamic parameters were collected and analyzed.Hemodynamics were statistically different between Groups Ia and Ib when different depths of compressions were performed (p < 0.05. In Group II, compressions were beneficial and hemodynamics correlated with the depth of compressions (p < 0.05. In Group III, compressions that continued after ROSC produced a reduction in arterial pressure (p < 0.05.Chest compressions might be detrimental to hemodynamics in the early post-ROSC stage. The deeper the compressions were, the better the effect on hemodynamics during cardiac arrest, but the worse the effect on hemodynamics after ROSC.

  19. Protective and biogenesis effects of sodium hydrosulfide on brain mitochondria after cardiac arrest and resuscitation.

    Science.gov (United States)

    Pan, Hao; Xie, Xuemeng; Chen, Di; Zhang, Jincheng; Zhou, Yaguang; Yang, Guangtian

    2014-10-15

    Mitochondrial dysfunction plays a critical role in brain injury after cardiac arrest and cardiopulmonary resuscitation (CPR). Recent studies demonstrated that hydrogen sulfide (H2S) donor compounds preserve mitochondrial morphology and function during ischemia-reperfusion injury. In this study, we sought to explore the effects of sodium hydrosulfide (NaHS) on brain mitochondria 24h after cardiac arrest and resuscitation. Male Sprague-Dawley rats were subjected to 6min cardiac arrest and then resuscitated successfully. Rats received NaHS (0.5mg/kg) or vehicle (0.9% NaCl, 1.67ml/kg) 1min before the start of CPR intravenously, followed by a continuous infusion of NaHS (1.5mg/kg/h) or vehicle (5ml/kg/h) for 3h. Neurological deficit was evaluated 24h after resuscitation and then cortex was collected for assessments. As a result, we found that rats treated with NaHS revealed an improved neurological outcome and cortex mitochondrial morphology 24h after resuscitation. We also observed that NaHS therapy reduced intracellular reactive oxygen species generation and calcium overload, inhibited mitochondrial permeability transition pores, preserved mitochondrial membrane potential, elevated ATP level and ameliorated the cytochrome c abnormal distribution. Further studies indicated that NaHS administration increased mitochondrial biogenesis in cortex at the same time. Our findings suggested that administration of NaHS 1min prior CPR and followed by a continuous infusion ameliorated neurological dysfunction 24h after resuscitation, possibly through mitochondria preservation as well as by promoting mitochondrial biogenesis.

  20. EMuRgency: Addressing cardiac arrest with socio-technical innovation in a smart learning region

    Directory of Open Access Journals (Sweden)

    Sabina Jeschke

    2013-08-01

    Full Text Available This paper introduces the EMuRgency project. The project has the goal to increase awareness and competences regarding the problem of cardiac arrest in the Euregio Meuse-Rhine (EMR and to use socio-technical innovations to transfer it into a smart learning region. Based on the conscious competence framework solutions for stakeholders on different levels of the framework are introduced, namely a public display network, mobile learning apps and a volunteer notification system. Finally, a future research outlook is given.

  1. Successful emergency splenectomy during cardiac arrest due to cytomegalovirus-induced atraumatic splenic rupture

    DEFF Research Database (Denmark)

    Glesner, Matilde Kanstrup; Madsen, Kristian Rørbæk; Nielsen, Jesper Meng Rahn;

    2015-01-01

    A 27-year-old woman was admitted to the emergency department with fever and a petechial rash on suspicion of meningitis. Shortly after arriving she developed cardiac arrest. Blood work up showed severe lactate acidosis, anaemia and thrombocytopenia. A focused assessment with sonography in trauma...... for 14 days with ganciclovir and meropenem and discharged on recovery. Atraumatic splenic rupture caused by viral infection is a rare condition although well described. In the case of our patient, thrombocytopenia added to the severity of the splenic rupture. A multidisciplinary team approach...

  2. The role of the immuno-inflammatory response in patients after cardiac arrest

    OpenAIRE

    Samborska-Sablik, Anna; Sablik, Zbigniew; Gaszynski, Wojciech

    2011-01-01

    Introduction The aim of the research was to assess whether concentrations of inflammatory markers in blood of patients after cardiac arrest (CA) are related to their clinical state and survival. Material and methods Forty-six patients, aged 63 ±12 years, 21 of them after out-of-hospital CA and 25 after in-hospital CA, were enrolled in the study. Twenty-five patients survived and were discharged from hospital (CA-S); 21 died during hospitalization (CA-D). The clinical state of the patients was...

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

    Directory of Open Access Journals (Sweden)

    Christian D. McClung

    2015-10-01

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

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

    DEFF Research Database (Denmark)

    Holler, Nana G; Mantoni, Teit; Nielsen, Søren L;

    2007-01-01

    from the Danish Causes of Death Registry and the Danish Civil Registration System. We conducted a search to find out whether patients were still alive on 31 January 2005. RESULTS: Resuscitation was indicated and attempted in 1095 cases and 95 patients (8.7%) survived to discharge. Of these 75% had...... an initial rhythm of VF, 13% had asystole, 10% had PEA and 2% were unknown. Survival was 87% after one year and survival after 10 years was 46% with a significantly lower survival for patients over 60 years. CONCLUSION: Long-term survival after out-of-hospital cardiac arrest in a physician-staffed emergency...

  5. Medical attention proposal for patients under the iodo therapy in cardiac arrest cases

    International Nuclear Information System (INIS)

    This research has like aim to present a proposition about how to attend the patients which are under the iodo therapy, and the possibility they can show a cardiac arrest during their hospitalization. The physical medical department with the nurse group and the team of ICU (Intensive Care Unit) looked for to establish basic norms of radiological protection in order to avoid the radiation and contamination of all workers involved with one patient, without changing the routine of attendance service. We analyzed all rules of service including the attendance the hospital room and mainly if it is necessary to lead the patient to the ICU. (authors). 4 refs

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

    LENUS (Irish Health Repository)

    Masterson, Siobhán

    2011-05-01

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

  7. Cardiac arrest in an 18-year-old man caused by anomalous right coronary artery origin.

    Science.gov (United States)

    Cronin, Heather; Curtin, Ronan

    2016-01-01

    An 18-year-old man presented to hospital following an out of hospital ventricular fibrillation cardiac arrest, with successful resuscitation at the scene. The incident happened during a competitive football match in which the man was playing. In the course of an extensive work up, a CT coronary angiogram demonstrated an anomalous right coronary artery (RCA) origin in the left coronary sinus. The RCA followed an initial intramural and subsequent interarterial course between the ascending aorta and pulmonary artery trunk. Cardiac MRI showed a small subendocardial area of delayed gadolinium enhancement in the inferoseptal wall, consistent with a small infarct. Treatment involved elective coronary artery bypass of the RCA with a right internal mammary artery graft. The patient made a full recovery. An implantable cardioverter-defibrillator was not inserted and he was advised not to return to competitive sports. PMID:26961556

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

    DEFF Research Database (Denmark)

    Søholm, Helle; Hassager, Christian; Lippert, Freddy;

    2015-01-01

    associated with outcome. RESULTS: Of a total of 2,527 attempted resuscitations in out-of-hospital cardiac arrest patients, 40% (n=1,015) were successfully resuscitated and admitted to the hospital. The strongest independent factors associated with successful resuscitation were shockable primary rhythm...... (multivariate OR=1.14; 95% CI 0.91 to 1.44), and employment status (multivariate OR=1.17; 95% CI 0.89 to 1.56) were not independently associated with outcome. The number of patients with a high comorbidity burden (Charlson comorbidity index ≥3) increased during the study period (P trend ...STUDY OBJECTIVE: Out-of-hospital cardiac arrest has an overall poor prognosis. We sought to identify what temporal trends and influencing factors existed for this condition in one region. METHODS: We studied consecutive out-of-hospital cardiac arrest patients from 2007 to 2011 with attempted...

  9. Spontaneous defibrillation after cessation of resuscitation in out-of-hospital cardiac arrest: a case of Lazarus phenomenon.

    Science.gov (United States)

    Kämäräinen, Antti; Virkkunen, Ilkka; Holopainen, Leevi; Erkkilä, Elja-Pekka; Yli-Hankala, Arvi; Tenhunen, Jyrki

    2007-12-01

    This report describes a case of out-of-hospital cardiac arrest with spontaneous defibrillation and subsequent return of circulation after cessation of resuscitative efforts. A 47-year-old man was found in cardiac arrest and resuscitation was initiated. As no response was achieved, the efforts were withdrawn and final registered cardiac rhythm was ventricular fibrillation. Fifteen minutes later the patient was found to be normotensive and breathing spontaneously. The patient made a poor neurological recovery and died 3 months after the arrest. The authors are unable to give an explanation to the event, but suspect the effect of adrenaline combined with mild hypothermia to have contributed to the self-defibrillation of the myocardium. PMID:17629389

  10. Biallelic PPA2 Mutations Cause Sudden Unexpected Cardiac Arrest in Infancy.

    Science.gov (United States)

    Guimier, Anne; Gordon, Christopher T; Godard, François; Ravenscroft, Gianina; Oufadem, Myriam; Vasnier, Christelle; Rambaud, Caroline; Nitschke, Patrick; Bole-Feysot, Christine; Masson, Cécile; Dauger, Stéphane; Longman, Cheryl; Laing, Nigel G; Kugener, Béatrice; Bonnet, Damien; Bouvagnet, Patrice; Di Filippo, Sylvie; Probst, Vincent; Redon, Richard; Charron, Philippe; Rötig, Agnès; Lyonnet, Stanislas; Dautant, Alain; de Pontual, Loïc; di Rago, Jean-Paul; Delahodde, Agnès; Amiel, Jeanne

    2016-09-01

    Sudden unexpected death in infancy occurs in apparently healthy infants and remains largely unexplained despite thorough investigation. The vast majority of cases are sporadic. Here we report seven individuals from three families affected by sudden and unexpected cardiac arrest between 4 and 20 months of age. Whole-exome sequencing revealed compound heterozygous missense mutations in PPA2 in affected infants of each family. PPA2 encodes the mitochondrial pyrophosphatase, which hydrolyzes inorganic pyrophosphate into two phosphates. This is an essential activity for many biosynthetic reactions and for energy metabolism of the cell. We show that deletion of the orthologous gene in yeast (ppa2Δ) compromises cell viability due to the loss of mitochondria. Expression of wild-type human PPA2, but not PPA2 containing the mutations identified in affected individuals, preserves mitochondrial function in ppa2Δ yeast. Using a regulatable (doxycycline-repressible) gene expression system, we found that the pathogenic PPA2 mutations rapidly inactivate the mitochondrial energy transducing system and prevent the maintenance of a sufficient electrical potential across the inner membrane, which explains the subsequent disappearance of mitochondria from the mutant yeast cells. Altogether these data demonstrate that PPA2 is an essential gene in yeast and that biallelic mutations in PPA2 cause a mitochondrial disease leading to sudden cardiac arrest in infants. PMID:27523598

  11. Oxygenation, Ventilation, and Airway Management in Out-of-Hospital Cardiac Arrest: A Review

    Directory of Open Access Journals (Sweden)

    Tomas Henlin

    2014-01-01

    Full Text Available Recently published evidence has challenged some protocols related to oxygenation, ventilation, and airway management for out-of-hospital cardiac arrest. Interrupting chest compressions to attempt airway intervention in the early stages of OHCA in adults may worsen patient outcomes. The change of BLS algorithms from ABC to CAB was recommended by the AHA in 2010. Passive insufflation of oxygen into a patent airway may provide oxygenation in the early stages of cardiac arrest. Various alternatives to tracheal intubation or bag-mask ventilation have been trialled for prehospital airway management. Simple methods of airway management are associated with similar outcomes as tracheal intubation in patients with OHCA. The insertion of a laryngeal mask airway is probably associated with worse neurologically intact survival rates in comparison with other methods of airway management. Hyperoxemia following OHCA may have a deleterious effect on the neurological recovery of patients. Extracorporeal oxygenation techniques have been utilized by specialized centers, though their use in OHCA remains controversial. Chest hyperinflation and positive airway pressure may have a negative impact on hemodynamics during resuscitation and should be avoided. Dyscarbia in the postresuscitation period is relatively common, mainly in association with therapeutic hypothermia, and may worsen neurological outcome.

  12. Oxygenation, ventilation, and airway management in out-of-hospital cardiac arrest: a review.

    Science.gov (United States)

    Henlin, Tomas; Michalek, Pavel; Tyll, Tomas; Hinds, John D; Dobias, Milos

    2014-01-01

    Recently published evidence has challenged some protocols related to oxygenation, ventilation, and airway management for out-of-hospital cardiac arrest. Interrupting chest compressions to attempt airway intervention in the early stages of OHCA in adults may worsen patient outcomes. The change of BLS algorithms from ABC to CAB was recommended by the AHA in 2010. Passive insufflation of oxygen into a patent airway may provide oxygenation in the early stages of cardiac arrest. Various alternatives to tracheal intubation or bag-mask ventilation have been trialled for prehospital airway management. Simple methods of airway management are associated with similar outcomes as tracheal intubation in patients with OHCA. The insertion of a laryngeal mask airway is probably associated with worse neurologically intact survival rates in comparison with other methods of airway management. Hyperoxemia following OHCA may have a deleterious effect on the neurological recovery of patients. Extracorporeal oxygenation techniques have been utilized by specialized centers, though their use in OHCA remains controversial. Chest hyperinflation and positive airway pressure may have a negative impact on hemodynamics during resuscitation and should be avoided. Dyscarbia in the postresuscitation period is relatively common, mainly in association with therapeutic hypothermia, and may worsen neurological outcome.

  13. Detection of ROSC in Patients with Cardiac Arrest During Chest Compression Using NIRS: A Pilot Study.

    Science.gov (United States)

    Yagi, Tsukasa; Nagao, Ken; Kawamorita, Tsuyoshi; Soga, Taketomo; Ishii, Mitsuru; Chiba, Nobutaka; Watanabe, Kazuhiro; Tani, Shigemasa; Yoshino, Atsuo; Hirayama, Atsushi; Sakatani, Kaoru

    2016-01-01

    Return of spontaneous circulation (ROSC) during chest compression is generally detected by arterial pulse palpation and end-tidal CO2 monitoring; however, it is necessary to stop chest compression during pulse palpation, and to perform endotracheal intubation for monitoring end-tidal CO2. In the present study, we evaluated whether near-infrared spectroscopy (NIRS) allows the detection of ROSC during chest compression without interruption. We monitored cerebral blood oxygenation in 19 patients with cardiac arrest using NIRS (NIRO-200NX, Hamamatsu Photonics, Japan). On arrival at the emergency room, the attending physicians immediately assessed whether a patient was eligible for this study after conventional advanced life support (ALS) and employed NIRS to measure cerebral blood oxygenation (CBO) in the bilateral frontal lobe in patients. We found cerebral blood flow waveforms in synchrony with chest compressions in all patients. In addition, we observed abrupt increases of oxy-hemoglobin concentration and tissue oxygen index (TOI), which were associated with ROSC detected by pulse palpation. The present findings indicate that NIRS can be used to assess the quality of chest compression in patients with cardiac arrest as demonstrated by the detection of synchronous waveforms during cardiopulmonary resuscitation (CPR). NIRS appears to be applicable for detection of ROSC without interruption of chest compression and without endotracheal intubation. PMID:26782207

  14. Hypothermia ameliorates gastrointestinal ischemic injury sustained in a porcine cardiac arrest model

    Institute of Scientific and Technical Information of China (English)

    LU Yi; WANG Shuo; LI Chun-sheng

    2012-01-01

    Background During cardiac arrest,the gastrointestinal tract is sensitive to ischemia.Protection of the gastrointestinal tract is a critical factor in determining prognosis following cardiopulmonary resuscitation (CPR).This study seeks to determine the extent of gastrointestinal tract injury and the potential protective effect of inducing hypothermia following a porcine cardiac arrest model and CPR.Methods Ventricular fibrillation was induced by programmed electrical stimulation in 16 male domestic pigs (n=8 per group).Four minutes after ventricular fibrillation,CPR was performed.Pigs that successfully restored spontaneous circulation then received intravenous infusions of saline at either 4C or room temperature to produce hypothermic and control conditions respectively.Serum diamine oxidase and gastrointestinal adenosine triphosphate enzyme activity were determined and histopathology of the gastrointestinal tract was performed by light microscopy and electron microscopy.Results Significant injury of the gastrointestinal tract after CPR was found.Na+-K+ and Ca2+ adenosine triphosphate enzyme activity in the gastric tissue were significantly high in animals receiving hypothermia treatment compared to controls.Hypothermia also significantly reduced serum diamine oxidase after CPR compared to the control group.Moreover,severe injury sustained by the gastrointestinal tissue was significantly ameliorated under hypothermic conditions compared to controls.Conclusions Gastrointestinal injury and abnormal energy metabolism are strikingly evident following CPR.Hypothermia,which is induced by an infusion of 4C saline,can rapidly reduce internal body temperature,improve energy metabolism,and ameliorate injury to the gastrointestinal mucosa after CPR.

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

    Directory of Open Access Journals (Sweden)

    McCabe Chris

    2010-11-01

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

  16. Evaluation of coronary blood flow velocity during cardiac arrest with circulation maintained through mechanical chest compressions in a porcine model

    Directory of Open Access Journals (Sweden)

    Wagner Henrik

    2011-12-01

    Full Text Available Abstract Background Mechanical chest compressions (CCs have been shown capable of maintaining circulation in humans suffering cardiac arrest for extensive periods of time. Reports have documented a visually normalized coronary blood flow during angiography in such cases (TIMI III flow, but it has never been actually measured. Only indirect measurements of the coronary circulation during cardiac arrest with on-going mechanical CCs have been performed previously through measurement of the coronary perfusion pressure (CPP. In this study our aim was to correlate average peak coronary flow velocity (APV to CPP during mechanical CCs. Methods In a closed chest porcine model, cardiac arrest was established through electrically induced ventricular fibrillation (VF in eleven pigs. After one minute, mechanical chest compressions were initiated and then maintained for 10 minutes upon which the pigs were defibrillated. Measurements of coronary blood flow in the left anterior descending artery were made at baseline and during VF with a catheter based Doppler flow fire measuring APV. Furthermore measurements of central (thoracic venous and arterial pressures were also made in order to calculate the theoretical CPP. Results Average peak coronary flow velocity was significantly higher compared to baseline during mechanical chests compressions and this was observed during the entire period of mechanical chest compressions (12 - 39% above baseline. The APV slowly declined during the 10 min period of mechanical chest compressions, but was still higher than baseline at the end of mechanical chest compressions. CPP was simultaneously maintained at > 20 mmHg during the 10 minute episode of cardiac arrest. Conclusion Our study showed good correlation between CPP and APV which was highly significant, during cardiac arrest with on-going mechanical CCs in a closed chest porcine model. In addition APV was even higher during mechanical CCs compared to baseline. Mechanical

  17. Cardiac arrest teams and time of day: effects on surviving in-hospital resuscitation

    Directory of Open Access Journals (Sweden)

    Christ M

    2014-06-01

    Full Text Available Martin Christ, Wolfgang Dierschke, Katharina Isabel von Auenmueller, Marc van Bracht, Martin Grett, Hans-Joachim Trappe Department of Cardiology and Angiology, Marienhospital Herne, Ruhr – University Bochum, Herne, Germany Objectives: Little is known about the factors that influence survival following in-hospital resuscitation, but previous investigations have suggested that in-hospital resuscitations outside of regular working hours are associated with worse survival rates. Material and methods: In-hospital cardiac arrest teams at our hospital were instructed to complete a questionnaire following every emergency call between July 2011 and June 2013. Data on all resuscitation attempts were collected and analyzed. Results: A total of 65 in-hospital resuscitations were recorded in 42 males (64.6% and 23 females (35.4% (mean age 72.0±14.3 years. A total of 54 (83.1% cardiac arrests were witnessed; seven (10.8% showed a shockable rhythm at the time of the first ECG. Resuscitation attempts lasted 29.3±41.3 minutes, and 4.1±3.1 mg epinephrine was given. Return of spontaneous circulation could be achieved in 38 patients (58.5%; 29 (44.6% survived the first day, 23 (35.4% the seventh day, and 15 patients (23.1% were discharged alive. Significantly more in-hospital resuscitations were obtained for those performed during non-regular working hours (P<0.001, with higher neuron-specific enolase levels at 72 hours after resuscitation during nonregular working hours (P=0.04. Patients who were discharged alive were significantly younger (P=0.01, presented more often with an initial shockable rhythm (P=0.04, and had a shorter duration of resuscitation (P<0.001 with the need of a lower dose of epinephrine (P<0.001. Discussion: Survival rates following in-hospital resuscitation were poor at any time, but appear to depend less on time-dependent effects of the quality of resuscitation and more on time-dependent effects of recognition of cardiac arrests

  18. Temporal trends in survival after out-of-hospital cardiac arrest in patients with and without underlying chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Møller, Sidsel G.; Rajan, Shahzleen; Folke, Fredrik;

    2016-01-01

    AIM: Survival after out-of-hospital cardiac arrest (OHCA) has tripled during the past decade in Denmark as a likely result of improvements in cardiac arrest management. This study analyzed whether these improvements were applicable for patients with chronic obstructive pulmonary disease (COPD). M...

  19. Out-of-hospital cardiac arrests in an urban/rural area during 1991 and 1996 : have emergency medical service changes improved outcome?

    NARCIS (Netherlands)

    Absalom, AR; Bradley, P; Soar, J

    1999-01-01

    Survival after out-of-hospital cardiac arrest is influenced by pre-hospital emergency medical care. This study compares outcome of cardiac arrest victims presenting to an emergency department serving a mixed urban/rural area (Norfolk, UK) in 1991 with 1996. Between these years the regional emergency

  20. Neurological and cardiac complications in a cohort of children with end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Jumana H Albaramki

    2016-01-01

    Full Text Available Adult patients with chronic kidney disease are at risk of major neurologic and cardiac complications. The purpose of this study is to review the neurological and cardiac complications in children with end-stage renal disease (ESRD. A retrospective review of medical records of children with ESRD at Jordan University Hospital was performed. All neurological and cardiac events were recorded and analyzed. Data of a total of 68 children with ESRD presenting between 2002 and 2013 were reviewed. Neurological complications occurred in 32.4%; seizures were the most common event. Uncontrolled hypertension was the leading cause of neurological events. Cardiac complications occurred in 39.7%, the most common being pericardial effusion. Mortality from neurological complications was 45%. Neurological and cardiac complications occurred in around a third of children with ESRD with a high mortality rate. More effective control of hypertension, anemia, and intensive and gentle dialysis are needed.

  1. The effect of targeted temperature management on coagulation parameters and bleeding events after out-of-hospital cardiac arrest of presumed cardiac cause

    DEFF Research Database (Denmark)

    Jacob, Marrit; Hassager, Christian; Bro-Jeppesen, John;

    2015-01-01

    AIMS: Targeted temperature management (TTM) is part of the standard treatment of comatose patients after out-of-hospital cardiac arrest (OHCA) to attenuate neurological injury. In other clinical settings, hypothermia promotes coagulopathy leading to an increase in bleeding and thrombosis tendency...

  2. Impact of a novel, resource appropriate resuscitation curriculum on Nicaraguan resident physician’s management of cardiac arrest

    Science.gov (United States)

    2016-01-01

    Purpose: Project Strengthening Emergency Medicine, Investing in Learners in Latin America (SEMILLA) created a novel, language and resource appropriate course for the resuscitation of cardiac arrest for Nicaraguan resident physicians. We hypothesized that participation in the Project SEMILLA resuscitation program would significantly improve the physician’s management of simulated code scenarios. Methods: Thirteen Nicaraguan resident physicians were evaluated while managing simulated cardiac arrest scenarios before, immediately, and at 6 months after participating in the Project SEMILLA resuscitation program. This project was completed in 2014 in Leon, Nicaragua. The Cardiac Arrest Simulation Test (CASTest), a validated scoring system, was used to evaluate performance on a standardized simulated cardiac arrest scenario. Mixed effect logistic regression models were constructed to assess outcomes. Results: On the pre-course simulation exam, only 7.7% of subjects passed the test. Immediately post-course, the subjects achieved a 30.8% pass rate and at 6 months after the course, the pass rate was 46.2%. Compared with pre-test scores, the odds of passing the CASTest at 6 months after the course were 21.7 times higher (95% CI 4.2 to 112.8, PSEMILLA resuscitation course and retain these skills. PMID:27378010

  3. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies

    NARCIS (Netherlands)

    J. Berdowski; R.A. Berg; J.G.P. Tijssen; R.W. Koster

    2010-01-01

    Aim: The aim of this investigation was to estimate and contrast the global incidence and outcome of out-of-hospital cardiac arrest (OHCA) to provide a better understanding of the variability in risk and survival of OHCA. Methods: We conducted a review of published English-language articles about inc

  4. Brain stem death as the vital determinant for resumption of spontaneous circulation after cardiac arrest in rats.

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    Alice Y W Chang

    Full Text Available BACKGROUND: Spontaneous circulation returns to less than half of adult cardiac arrest victims who received in-hospital resuscitation. One clue for this disheartening outcome arises from the prognosis that asystole invariably takes place, after a time lag, on diagnosis of brain stem death. The designation of brain stem death as the point of no return further suggests that permanent impairment of the brain stem cardiovascular regulatory machinery precedes death. It follows that a crucial determinant for successful revival of an arrested heart is that spontaneous circulation must resume before brain stem death commences. Here, we evaluated the hypothesis that maintained functional integrity of the rostral ventrolateral medulla (RVLM, a neural substrate that is intimately related to brain stem death and central circulatory regulation, holds the key to the vital time-window between cardiac arrest and resumption of spontaneous circulation. METHODOLOGY/PRINCIPAL FINDINGS: An animal model of brain stem death employing the pesticide mevinphos as the experimental insult in Sprague-Dawley rats was used. Intravenous administration of lethal doses of mevinphos elicited an abrupt cardiac arrest, accompanied by elevated systemic arterial pressure and anoxia, augmented neuronal excitability and enhanced microvascular perfusion in RVLM. This period represents the vital time-window between cardiac arrest and resumption of spontaneous circulation in our experimental model. Animals with restored spontaneous circulation exhibited maintained neuronal functionality in RVLM beyond this critical time-window, alongside resumption of baseline tissue oxygen and enhancement of local blood flow. Intriguingly, animals that subsequently died manifested sustained anoxia, diminished local blood flow, depressed mitochondrial electron transport activities and reduced ATP production, leading to necrotic cell death in RVLM. That amelioration of mitochondrial dysfunction and

  5. Evaluation of intensified prehospital treatment in out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Frandsen, F; Nielsen, J R; Gram, L;

    1991-01-01

    with doctors collaborating (advanced EMS) were used, and 11 (13%) patients were discharged. The intermediate EMS system was used in another area with 45,000 inhabitants/population density of 340/km2, and in this area 20 (18%) patients were discharged. Among the survivors a psychological assessment in form...... of a test for dementia was assessed in long-term survivors (n = 30) together with 28 patients surviving acute myocardial infarction and 11 control persons. The results of the investigation demonstrate that the more intensive the prehospital treatment of out-of-hospital cardiac arrest, the more patients...... survive and the more patients survive with good cerebral function. However, the ambulances with specially trained paramedics were only effective in the area with 340 inhabitants/km2....

  6. Risk Factor Analyses for the Return of Spontaneous Circulation in the Asphyxiation Cardiac Arrest Porcine Model

    Institute of Scientific and Technical Information of China (English)

    Cai-Jun Wu; Zhi-Jun Guo; Chun-Sheng Li; Yi Zhang; Jun Yang

    2015-01-01

    Background:Animal models of asphyxiation cardiac arrest (ACA) are frequently used in basic research to mirror the clinical course of cardiac arrest (CA).The rates of the return of spontaneous circulation (ROSC) in ACA animal models are lower than those from studies that have utilized ventricular fibrillation (VF) animal models.The purpose of this study was to characterize the factors associated with the ROSC in the ACA porcine model.Methods:Forty-eight healthy miniature pigs underwent endotracheal tube clamping to induce CA.Once induced,CA was maintained untreated for a period of 8 min.Two minutes following the initiation of cardiopulmonary resuscitation (CPR),defibrillation was attempted until ROSC was achieved or the animal died.To assess the factors associated with ROSC in this CA model,logistic regression analyses were performed to analyze gender,the time of preparation,the amplitude spectrum area (AMSA) from the beginning of CPR and the pH at the beginning ofCPR.A receiver-operating characteristic (ROC) curve was used to evaluate the predictive value of AMSA for ROSC.Results:ROSC was only 52.1% successful in this ACA porcine model.The multivariate logistic regression analyses revealed that ROSC significantly depended on the time of preparation,AMSA at the beginning of CPR and pH at the beginning of CPR.The area under the ROC curve in for AMSA at the beginning of CPR was 0.878 successful in predicting ROSC (95% confidence intervals:0.773~0.983),and the optimum cut-off value was 15.62 (specificity 95.7% and sensitivity 80.0%).Conclusions:The time of preparation,AMSA and the pH at the beginning of CPR were associated with ROSC in this ACA porcine model.AMSA also predicted the likelihood of ROSC in this ACA animal model.

  7. Risk Factor Analyses for the Return of Spontaneous Circulation in the Asphyxiation Cardiac Arrest Porcine Model

    Directory of Open Access Journals (Sweden)

    Cai-Jun Wu

    2015-01-01

    Full Text Available Background: Animal models of asphyxiation cardiac arrest (ACA are frequently used in basic research to mirror the clinical course of cardiac arrest (CA. The rates of the return of spontaneous circulation (ROSC in ACA animal models are lower than those from studies that have utilized ventricular fibrillation (VF animal models. The purpose of this study was to characterize the factors associated with the ROSC in the ACA porcine model. Methods: Forty-eight healthy miniature pigs underwent endotracheal tube clamping to induce CA. Once induced, CA was maintained untreated for a period of 8 min. Two minutes following the initiation of cardiopulmonary resuscitation (CPR, defibrillation was attempted until ROSC was achieved or the animal died. To assess the factors associated with ROSC in this CA model, logistic regression analyses were performed to analyze gender, the time of preparation, the amplitude spectrum area (AMSA from the beginning of CPR and the pH at the beginning of CPR. A receiver-operating characteristic (ROC curve was used to evaluate the predictive value of AMSA for ROSC. Results: ROSC was only 52.1% successful in this ACA porcine model. The multivariate logistic regression analyses revealed that ROSC significantly depended on the time of preparation, AMSA at the beginning of CPR and pH at the beginning of CPR. The area under the ROC curve in for AMSA at the beginning of CPR was 0.878 successful in predicting ROSC (95% confidence intervals: 0.773∼0.983, and the optimum cut-off value was 15.62 (specificity 95.7% and sensitivity 80.0%. Conclusions: The time of preparation, AMSA and the pH at the beginning of CPR were associated with ROSC in this ACA porcine model. AMSA also predicted the likelihood of ROSC in this ACA animal model.

  8. Assessment of nonpenetrating captive bolt stunning followed by electrical induction of cardiac arrest in veal calves.

    Science.gov (United States)

    Bartz, B; Collins, M; Stoddard, G; Appleton, A; Livingood, R; Sobcynski, H; Vogel, K D

    2015-09-01

    The purpose of this study was to evaluate the impact of nonpenetrating captive bolt stunning followed by electrical induction of cardiac arrest on veal calf welfare, veal quality, and blood yield. Ninety calves from the same farm were randomly assigned to 1 of 2 treatment groups in a balanced unpaired comparison design. The first treatment group (the "head-only" method-application of the pneumatic nonpenetrating stun to the frontal plate of the skull at the intersection of 2 imaginary lines extending from the lateral canthus to the opposite poll [CONTROL]) was stunned with a nonpenetrating captive bolt gun ( = 45). The second group ( = 45) was stunned with a nonpenetrating captive bolt gun followed by secondary electrical induction of cardiac arrest (the "head/heart" method-initial application of the pneumatic nonpenetrating captive bolt stun followed by 1 s application of an electrical stun to the ventral region of the ribcage directly caudal to the junction of the humerus and scapula while the stunned calf was in lateral recumbence [HEAD/HEART]). Stunning efficacy was the indicator of animal welfare used in this study. All calves were instantly rendered insensible by the initial stun and did not display common indicators of return to consciousness. For meat quality evaluation, all samples were collected from the 12th rib region of the longissimus thoracis. Meat samples were evaluated for color, drip loss, ultimate pH, cook loss, and Warner-Bratzler shear force. The L* values (measure of meat color lightness) were darker ( 0.05) observed in a* (redness) and b* (yellowness) values between treatments. No differences ( > 0.05) were observed in drip loss, ultimate pH, cook loss, and Warner-Bratzler shear force. The blood yield from the CONTROL group (7,217.9 ± 143.5 g) was greater ( veal calves. PMID:26440354

  9. Multiscale entropy analysis of EEG for assessment of post-cardiac arrest neurological recovery under hypothermia in rats.

    Science.gov (United States)

    Kang, Xiaoxu; Jia, Xiaofeng; Geocadin, Romergryko G; Thakor, Nitish V; Maybhate, Anil

    2009-04-01

    Neurological complications after cardiac arrest (CA) can be fatal. Although hypothermia has been shown to be beneficial, understanding the mechanism and establishing neurological outcomes remains challenging because effects of CA and hypothermia are not well characterized. This paper aims to analyze EEG (and the alpha-rhythms) using multiscale entropy (MSE) to demonstrate the ability of MSE in tracking changes due to hypothermia and compare MSE during early recovery with long-term neurological examinations. Ten Wistar rats, upon post-CA resuscitation, were randomly subjected to hypothermia (32 degrees C-34 degrees C, N = 5) or normothermia (36.5 degrees C-37.5 degrees C, N = 5). EEG was recorded and analyzed using MSE during seven recovery phases for each experiment: baseline, CA, and five early recovery phases (R1-R5). Postresuscitation neurological examination was performed at 6, 24, 48, and 72 h to obtain neurological deficit scores (NDSs). Results showed MSE to be a sensitive marker of changes in alpha-rhythms. Significant difference (p < 0.05) was found between the MSE for two groups during recovery, suggesting that MSE can successfully reflect temperature modulation. A comparison of short-term MSE and long-term NDS suggested that MSE could be used for predicting favorability of long-term outcome. These experiments point to the role of cortical rhythms in reporting early neurological response to ischemia and therapeutic hypothermia. PMID:19174339

  10. Impact of a novel, resource appropriate resuscitation curriculum on Nicaraguan resident physician’s management of cardiac arrest

    Directory of Open Access Journals (Sweden)

    Breena R. Taira

    2016-06-01

    Full Text Available Purpose: Project Strengthening Emergency Medicine, Investing in Learners in Latin America (SEMILLA created a novel, language and resource appropriate course for the resuscitation of cardiac arrest for Nicaraguan resident physicians. We hypothesized that participation in the Project SEMILLA resuscitation program would significantly improve the physician’s management of simulated code scenarios. Methods: Thirteen Nicaraguan resident physicians were evaluated while managing simulated cardiac arrest scenarios before, immediately, and at 6 months after participating in the Project SEMILLA resuscitation program. This project was completed in 2014 in Leon, Nicaragua. The Cardiac Arrest Simulation Test (CASTest, a validated scoring system, was used to evaluate performance on a standardized simulated cardiac arrest scenario. Mixed effect logistic regression models were constructed to assess outcomes. Results: On the pre-course simulation exam, only 7.7% of subjects passed the test. Immediately post-course, the subjects achieved a 30.8% pass rate and at 6 months after the course, the pass rate was 46.2%. Compared with pre-test scores, the odds of passing the CASTest at 6 months after the course were 21.7 times higher (95% CI 4.2 to 112.8, P<0.001. Statistically significant improvement was also seen on the number of critical items completed (OR=3.75, 95% CI 2.71-5.19, total items completed (OR=4.55, 95% CI 3.4-6.11, and number of “excellent” scores on a Likert scale (OR=2.66, 95% CI 1.85-3.81. Conclusions: Nicaraguan resident physicians demonstrate improved ability to manage simulated cardiac arrest scenarios after participation in the Project SEMILLA resuscitation course and retain these skills.

  11. Effects of Intraosseous Tibial vs. Intravenous Vasopressin in a Hypovolemic Cardiac Arrest Model

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    Justin Fulkerson, MSN

    2016-03-01

    Full Text Available Introduction: This study compared the effects of vasopressin via tibial intraosseous (IO and intravenous (IV routes on maximum plasma concentration (Cmax, the time to maximum concentration (Tmax, return of spontaneous circulation (ROSC, and time to ROSC in a hypovolemic cardiac arrest model. Methods: This study was a randomized prospective, between-subjects experimental design. A computer program randomly assigned 28 Yorkshire swine to one of four groups: IV (n=7, IO tibia (n=7, cardiopulmonary resuscitation (CPR + defibrillation (n=7, and a control group that received just CPR (n=7. Ventricular fibrillation was induced, and subjects remained in arrest for two minutes. CPR was initiated and 40 units of vasopressin were administered via IO or IV routes. Blood samples were collected at 0.5, 1, 1.5, 2, 2.5, 3, and 4 minutes. CPR and defibrillation were initiated for 20 minutes or until ROSC was achieved. We measured vasopressin concentrations using highperformance liquid chromatography. Results: There was no significant difference between the IO and IV groups relative to achieving ROSC (p=1.0 but a significant difference between the IV compared to the CPR+ defibrillation group (p=0.031 and IV compared to the CPR-only group (p=0.001. There was a significant difference between the IO group compared to the CPR+ defibrillation group (p=0.031 and IO compared to the CPR-only group (p=0.001. There was no significant difference between the CPR + defibrillation group and the CPR group (p=0.127. There was no significant difference in Cmax between the IO and IV groups (p=0.079. The mean ± standard deviation of Cmax of the IO group was 58,709±25,463pg/mL compared to the IV group, which was 106,198±62,135pg/mL. There was no significant difference in mean Tmax between the groups (p=0.084. There were no significant differences in odds of ROSC between the tibial IO and IV groups. Conclusion: Prompt access to the vascular system using the IO route can circumvent

  12. Comparison of Cerebral Metabolism between Pig Ventricular Fibrillation and Asphyxial Cardiac Arrest Models

    Directory of Open Access Journals (Sweden)

    Yi Zhang

    2015-01-01

    Full Text Available Background: Morbidity and mortality after resuscitation largely depend on the recovery of brain function. Ventricular fibrillation cardiac arrest (VFCA and asphyxial cardiac arrest (ACA are the two most prevalent causes of sudden cardiac death. Up to now, most studies have focused on VFCA. However, results from the two models have been largely variable. So, it is necessary to characterize the features of postresuscitation cerebral metabolism of both models. Methods: Forty-four Wuzhishan miniature inbred pigs were randomly divided into three groups: 18 for VFCA group, ACA group, respectively, and other 8 for sham-operated group (SHAM. VFCA was induced by programmed electric stimulation, and ACA was induced by endotracheal tube clamping. After 8 min without treatment, standard cardiopulmonary resuscitation (CPR was initiated. Following neurological deficit scores (NDS were evaluated at 24 h after achievement of spontaneous circulation, cerebral metabolism showed as the maximum standardized uptake value (SUVmax was measured by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography. Levels of serum markers of brain injury, neuron specific enolase (NSE, and S100β were quantified with an enzyme-linked immunosorbent assay. Results: Compared with VFCA group, fewer ACA animals achieved restoration of spontaneous circulation (61.1% vs. 94.4%, P < 0.01 and survived 24-h after resuscitation (38.9% vs. 77.8%, P < 0.01 with worse neurological outcome (NDS: 244.3 ± 15.3 vs. 168.8 ± 9.71, P < 0.01. The CPR duration of ACA group was longer than that of VFCA group (8.1 ± 1.2 min vs. 4.5 ± 1.1 min, P < 0.01. Cerebral energy metabolism showed as SUVmax in ACA was lower than in VFCA (P < 0.05 or P < 0.01. Higher serum biomarkers of brain damage (NSE, S100β were found in ACA than VFCA after resuscitation (P < 0.01. Conclusions: Compared with VFCA, ACA causes more severe cerebral metabolism injuries with less successful resuscitation and worse

  13. Comparison of Cerebral Metabolism between Pig Ventricular Fibrillation and Asphyxial Cardiac Arrest Models

    Institute of Scientific and Technical Information of China (English)

    Yi Zhang; Chun-Sheng Li; Cai-Jun Wu; Jun Yang; Chen-Chen Hang

    2015-01-01

    Background:Morbidity and mortality after resuscitation largely depend on the recovery of brain function.Ventricular fibrillation cardiac arrest (VFCA) and asphyxial cardiac arrest (ACA) are the two most prevalent causes of sudden cardiac death.Up to now,most studies have focused on VFCA.However,results from the two models have been largely variable.So,it is necessary to characterize the features of postresuscitation cerebral metabolism of both models.Methods:Forty-four Wuzhishan miniature inbred pigs were randomly divided into three groups:18 for VFCA group,ACA group,respectively,and other 8 for sham-operated group (SHAM).VFCA was induced by programmed electric stimulation,andACA was induced by endotracheal tube clamping.After 8 min without treatment,standard cardiopulmonary resuscitation (CPR) was initiated.Following neurological deficit scores (NDS) were evaluated at 24 h after achievement of spontaneous circulation,cerebral metabolism showed as the maximum standardized uptake value (SUVmax) was measured by 18F-fluorodeoxyglucose positron emission tomography/computed tomography.Levels of serum markers of brain injury,neuron specific enolase (NSE),and S100β were quantified with an enzyme-linked immunosorbent assay.Results:Compared with VFCA group,fewer ACA animals achieved restoration of spontaneous circulation (61.1% vs.94.4%,P < 0.01) and survived 24-h after resuscitation (38.9% vs.77.8%,P < 0.01) with worse neurological outcome (NDS:244.3 ± 15.3 vs.168.8 ± 9.71,P < 0.01).The CPR duration of ACA group was longer than that of VFCA group (8.1 ± 1.2 min vs.4.5 ± 1.1 min,P < 0.01).Cerebral energy metabolism showed as SUVmax in ACA was lower than in VFCA (P < 0.05 or P < 0.01).Higher serum biomarkers of brain damage (NSE,S100β) were found inACA than VFCA after resuscitation (P < 0.01).Conclusions:Compared with VFCA,ACA causes more severe cerebral metabolism injuries with less successful resuscitation and worse neurological outcome.

  14. Electrocardiographic changes during induced therapeutic hypothermia in comatose survivors after cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    Pablo; Salinas; Esteban; Lopez-de-Sa; Laura; Pena-Conde; Ana; Viana-Tejedor; Juan; Ramon; Rey-Blas; Eduardo; Armada; Jose; Luis; Lopez-Sendon

    2015-01-01

    AIM: To assess the safety of therapeutic hypothermia(TH) concerning arrhythmias we analyzed serial electrocardiograms(ECG) during TH.METHODS: All patients recovered from a cardiac arrest with Glasgow < 9 at admission were treated with induced mild TH to 32-34℃. TH was obtained with cool fluid infusion or a specific intravascular device. Twelvelead ECG before,during,and after TH,as well as ECG telemetry data was recorded in all patients. From a total of 54 patients admitted with cardiac arrest during the study period,47 patients had the 3 ECG and telemetry data available. ECG analysis was blinded and performed with manual caliper by two independent cardiologists from blinded copies of original ECG,recorded at 25 mm/s and 10 mm/m V. Coronary care unit staff analyzed ECG telemetry for rhythm disturbances. Variables measured in ECG were rhythm,RR,PR,QT and corrected QT(QTc by Bazett formula,measured in lead v2) intervals,QRS duration,presence of Osborn’s J wave and U wave,as well as ST segment displacement and T wave amplitude in leads Ⅱ,v2 and v5.RESULTS: Heart rate went down an average of 19 bpm during hypothermia and increased again 16 bpm with rewarming(P < 0.0005,both). There was a nonsignificant prolongation of the PR interval during TH and a significant decrease with rewarming(P = 0.041). QRS duration significantly prolonged(P = 0.041) with TH and shortened back(P < 0.005) with rewarming. QTc interval presented a mean prolongation of 58 ms(P < 0.005) during TH and a significant shortening with rewarming of 22.2 ms(P = 0.017). Osborn or J wave was found in 21.3% of the patients. New arrhythmias occurred in 38.3% of the patients. Most frequent arrhythmia was non-sustained ventricular tachycardia(19.1%),followed by severe bradycardia or paced rhythm(10.6%),accelerated nodal rhythm(8.5%) and atrial fibrillation(6.4%). No life threatening arrhythmias(sustained ventricular tachycardia,polymorphic ventricular tachycardia or ventricular fibrillation) occurred

  15. Determinants of unfavorable prognosis for out-of-hospital sudden cardiac arrest in Bielsko-Biala district

    Science.gov (United States)

    Nowak, Jolanta U.; Krzych, Łukasz J.

    2016-01-01

    Introduction The prognosis in out-of-hospital sudden cardiac arrest (OHCA) remains unfavorable and depends on a number of demographic and clinical variables, the reversibility of its causes and its mechanisms. Aim To investigate the risk factors of prehospital death in patients with OHCA in Bielsko County. Material and methods The study analyzed all dispatch cards of the National Emergency Medical Services (EMS) teams in Bielsko-Biala for the year 2013 (n = 23 400). Only the cards related to sudden cardiac arrest in adults were ultimately included in the study (n = 272; 190 men, 82 women; median age: 71 years). Results Sixty-seven victims (45 men, 22 women) were pronounced dead upon the arrival of the EMS team, and cardiopulmonary resuscitation (CPR) was not undertaken. In the remaining group of 205 subjects, CPR was commenced but was ineffective in 141 patients (97 male, 44 female). Although univariate analysis indicated 6 predictors of prehospital death, including OHCA without the presence of witnesses (odds ratio (OR) = 4.2), OHCA occurring in a public place (OR = 3.1), no bystander CPR (OR = 9.7), no bystander cardiac massage (OR = 13.1), initial diagnosis of non-shockable cardiac rhythm (OR = 7.0), and the amount of drugs used for CPR (OR = 0.4), logistic regression confirmed that only the lack of bystander cardiac massage (OR = 6.5) and non-shockable rhythm (OR = 4.6) were independent determinants of prehospital death (area under ROC curve = 0.801). Conclusions Non-shockable rhythm of cardiac arrest and lack of bystander cardiac massage are independent determinants of prehospital death in Bielsko-Biala inhabitants suffering from OHCA.

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

    Directory of Open Access Journals (Sweden)

    Ogawa Toshio

    2011-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Ricardo Navarro Vargas

    2005-07-01

    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.

  18. ARRESTING OF COMPLICATED HYPERTENSIVE CRISES IN THE PHYSICIAN’S PRACTICE: URAPIDIL VALUE AND STUDY RESULTS

    Directory of Open Access Journals (Sweden)

    G. P. Arutyunov

    2011-01-01

    Full Text Available Aim. To compare the efficacy and safety of urapidil (i/v solution 5 mg/ml in 5 and 10 ml ampoules and enalaprilat (i/v solution 1.25 mg/ml in 1 ml ampoules in the treatment of complicated hypertensive crises in patients with arterial hypertension, 1-3 degrees. Material and methods. Patients with complicated hypertensive crisis (n=70 were included into the comparative randomized study. Patients were randomized for treatment with urapidil (the initial dose 12.5 mg; if there was no effect after 15 minutes it was possible to re-infused urapidil 12.5 mg or enalaprilat (the initial dose 1.25 mg. The frequency of target blood pressure (BP achievement, BP and heart rate dynamics, as well as safety of treatment were evaluated in groups during 6 hours. Results. The frequency of target BP achievement in the urapidil treatment group was higher than this in enalaprilat group (96.7 vs 73.3%; p<0.001, for the first hour systolic BP (SBP in the urapidil group reduced from 210.5±13.6 to 157.8±8.3 mmHg (p<0.05, and diastolic BP (DBP - from 115.7±8.5 to 86.9±9.1 mmHg (p<0.05. In the enalaprilat group in the first hour SBP reduced from 208.1 to 182.5 mmHg (p<0.05, DBP — from 114.8 to 95.0 mmHg (p<0.05. During next 6 hours the urapidil group demonstrated longer lasting antihypertensive effect in comparison with enalaprilat. Both drugs did not have a significant effect on heart rate and showed no significant adverse events. In next 72 hours no one acute vascular event was registered in the patients of both groups. Conclusion. Urapidil is an effective and safe drug for arresting of complicated hypertensive crises. Its efficacy is not inferior to this of enalaprilat.

  19. Usefulness of the Myocardial Infarction and Cardiac Arrest Calculator as a Discriminator of Adverse Cardiac Events After Elective Hip and Knee Surgery.

    Science.gov (United States)

    Peterson, Brandon; Ghahramani, Mehrdad; Harris, Stephanie; Suchniak-Mussari, Kristen; Bedi, Gurneet; Bulathsinghala, Charles; Foy, Andrew

    2016-06-15

    The 2014 American College of Cardiology and American Heart Association guidelines on perioperative evaluation recommend differentiating patients at low risk (discriminate adverse cardiac events in a cohort of adult patients undergoing elective orthopedic surgery. We retrospectively reviewed 1,098 consecutive, elective orthopedic surgeries performed at Hershey Medical Center from January 1, 2013, to December 31, 2014. Adverse cardiac events were defined as myocardial infarction or cardiac arrest within 30 days of surgery. The mean estimated risk for adverse cardiac events using the NSQIP MICA risk calculator was 0.54%, which was not significantly different (p = 1) compared with the observed incidence of 0.64% (7 of 1,098 procedures). The c-statistic for discriminating adverse cardiac events was 0.85 (95% CI 0.67 to 1) for the NSQIP MICA risk calculator and 0.9 (95% CI 0.75 to 1) for the Revised Cardiac Risk Index. In conclusion, the NSQIP MICA risk calculator is a good discriminator of adverse cardiac events in patients undergoing elective hip and knee surgery, performing comparably to the Revised Cardiac Risk Index. PMID:27131613

  20. Dextrose containing intravenous fluid impairs outcome and increases death after eight minutes of cardiac arrest and resuscitation in dogs.

    Science.gov (United States)

    D'Alecy, L G; Lundy, E F; Barton, K J; Zelenock, G B

    1986-09-01

    Use of dextrose in intravenous resuscitation fluids is common practice; however, this study indicates that 5% dextrose solutions, even if administered in physiologic quantities, greatly worsens the outcome of survivable cardiac arrest. Twelve adult male mongrel dogs were premedicated with morphine, anesthetized with halothane, instrumented, intubated, and ventilated. Each dog was first given 500 ml of either lactated Ringer's (LR) (n = 6) or 5% dextrose in LR (D5LR) (n = 6). Halothane was stopped and fibrillation was induced (60 Hz). Blood glucose just before cardiac arrest was 129 mg/dl in the LR dogs and was increased to 335 mg/dl in the D5LR dogs. After eight minutes of arrest, resuscitation, including internal cardiac massage and standard advanced cardiac life support drug protocols (modified for dogs), was begun. When stable cardiac rhythm was obtained, the chest was closed, and LR or D5LR continued until a total of 1L was given. A neurologic score (0 = normal to 100 = dead) was assigned at 1, 2, 6, and 24 hours. The LR group did not differ statistically from the D5LR group in operative time, number of defibrillatory shocks, time to spontaneous ventilation, time to extubation, or drugs required. Resuscitation was successful in all six LR and five of six D5LR group; however, by 2 hours after resuscitation and thereafter, D5LR group had a significantly greater neurologic deficit (p less than 0.05) than did the LR group. By 9 hours, four of six D5LR dogs displayed convulsive activity and died. At 24 hours the D5LR group had a greater (p less than 0.008) neurologic deficit (82 +/- 11) than did the LR group (21 +/- 7), which walked and ate. We conclude that the addition of 5% dextrose to standard intravenous fluids greatly increases the morbidity and mortality associated with cardiac resuscitation. PMID:3738770

  1. Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest.

    Science.gov (United States)

    Hammer, Laure; Vitrat, François; Savary, Dominique; Debaty, Guillaume; Santre, Charles; Durand, Michel; Dessertaine, Geraldine; Timsit, Jean-François

    2009-06-01

    Therapeutic hypothermia (TH) improves the outcomes of cardiac arrest (CA) survivors. The aim of this study was to evaluate retrospectively the efficacy and safety of an immediate prehospital cooling procedure implemented just after the return of spontaneous circulation with a prehospital setting. During 30 months, the case records of comatose survivors of out-of-hospital CA presumably due to a cardiac disease were studied. A routine protocol of immediate postresuscitation cooling had been tested by an emergency team, which consisted of an infusion of large-volume, ice-cold intravenous saline. We decided to assess the efficacy and tolerance of this procedure. A total of 99 patients were studied; 22 were treated with prehospital TH, and 77 consecutive patients treated with prehospital standard resuscitation served as controls. For all patients, TH was maintained for 12 to 24 hours. The demographic, clinical, and biological characteristics of the patients were similar in the 2 groups. The rate of patients with a body temperature of less than 35 degrees C upon admission was 41% in the cooling group and 18% in the control group. Rapid infusion of fluid was not associated with pulmonary edema. After 1 year of follow-up, 6 (27%) of 22 patients in the cooling group and 30 (39%) of 77 patients in the control group had a good outcome. Our preliminary observation suggests that in comatose survivors of CA, prehospital TH with infusion of large-volume, ice-cold intravenous saline is feasible and can be used safely by mobile emergency and intensive care units. PMID:19497463

  2. Etiology of out-of-hospital cardiac arrest diagnosed via detailed examinations including perimortem computed tomography

    Directory of Open Access Journals (Sweden)

    Yoshihiro Moriwaki

    2013-01-01

    Full Text Available Context: The spectrum of the etiology of out-of-hospital cardiopulmonary arrest (OHCPA has not been established. We have performed perimortem computed tomography (CT during cardiopulmonary resuscitation. Aims: To clarify the incidence of non-cardiac etiology (NCE, actual distribution of the causes of OHCPA via perimortem CT and its usefulness. Settings and Design: Population-based observational case series study. Materials and Methods: We reviewed the medical records of 1846 consecutive OHCPA cases and divided them into two groups: 370 showing an obvious cause of OHCPA with NCE (trauma, neck hanging, terminal stage of malignancy, and gastrointestinal bleeding and others. Results: Of a total OHCPA, perimortem CT was performed in 57.5% and 62.5% were finally diagnosed as NCE: Acute aortic dissection (AAD 8.07%, pulmonary thrombo-embolization (PTE 1.46%, hypoxia due to pneumonia 5.25%, asthma and acute worsening of chronic obstructive pulmonary disease 2.06%, cerebrovascular disorder (CVD 4.48%, airway obstruction 7.64%, and submersion 5.63%. The rates of patients who survived to hospital discharge were 6-14% in patients with NCE. Out of the 1476 cases excluding obvious NCE of OHCPA, 66.3% underwent perimortem CT, 14.6% of cases without obvious NCE and 22.1% of cases with perimortem CT were confirmed as having some NCE. Conclusions: Of the total OHCPA the incidences of NCE was 62.5%; the leading etiologies were AAD, airway obstruction, submersion, hypoxia and CVD. The rates of cases converted from cardiac etiology to NCE using perimortem CT were 14.6% of cases without an obvious NCE.

  3. Sudden Cardiac Arrest in a Patient With Apical Hypertrophic Cardiomyopathy: Case Report and a Brief Review of Literature.

    Science.gov (United States)

    Gupta, Tanush; Paul, Neha; Palaniswamy, Chandrasekar; Balasubramaniyam, Nivas; Aronow, Wilbert S; Kolte, Dhaval; Khera, Sahil; Shah, Amar B; Gass, Alan

    2016-01-01

    Apical hypertrophic cardiomyopathy (HCM) is a phenotypic variant of nonobstructive HCM, in which hypertrophy of the myocardium predominantly involves the left ventricular apex. It is common in Japanese and other Asian populations but is rare in the United States. Apical HCM has a relatively benign prognosis in terms of cardiovascular mortality; however, morbid events such as ventricular aneurysms, apical thrombi, diastolic dysfunction, atrial fibrillation, and myocardial infarction are not uncommon. We report a case of an 18-year-old white man who presented to our hospital after an out-of-hospital cardiac arrest. The patient had a witnessed collapse while playing basketball in the field. He was found to be pulseless and unresponsive by his coach, and cardiopulmonary resuscitation was immediately started. Upon arrival of emergency medical services, an automated external defibrillator advised shock and he was defibrillated thrice. Return of spontaneous circulation was achieved in 15 minutes. He was intubated for airway protection and was brought to the hospital. Therapeutic hypothermia was initiated. He demonstrated good neurological status after active rewarming. Subsequent cardiac magnetic resonance imaging was suggestive of apical HCM with right ventricular involvement. The patient underwent an implantable cardioverter defibrillator placement for secondary prevention and was subsequently discharged. In conclusion, apical HCM can rarely be associated with adverse cardiovascular events. The diagnosis may be missed on transthoracic 2-dimensional cardiac echocardiogram, and cardiac magnetic resonance imaging should be considered to exclude apical HCM in young patients who present after sudden cardiac arrest. PMID:25923227

  4. Pheochromocytoma-induced atrial tachycardia leading to cardiogenic shock and cardiac arrest: resolution with atrioventricular node ablation and pacemaker placement.

    Science.gov (United States)

    Shawa, Hassan; Bajaj, Mandeep; Cunningham, Glenn R

    2014-12-01

    Pheochromocytoma should be considered in young patients who have acute cardiac decompensation, even if they have no history of hypertension. Atrioventricular node ablation and pacemaker placement should be considered for stabilizing pheochromocytoma patients with cardiogenic shock due to atrial tachyarrhythmias. A 38-year-old black woman presented with cardiogenic shock (left ventricular ejection fraction, cardiogenic shock and cardiac arrest unresolved by the placement of 2 different ventricular assist devices, but that was completely reversed by radiofrequency ablation of the atrioventricular node and the placement of a temporary pacemaker. We present the patient's clinical, laboratory, and imaging findings, and we review the relevant literature.

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

    Directory of Open Access Journals (Sweden)

    Trygve Eftestøl

    2005-10-01

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

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

    DEFF Research Database (Denmark)

    Linderoth, Gitte; Hallas, Peter; Lippert, Freddy;

    2015-01-01

    UNLABELLED: The aim of this study was to explore challenges in recognition and initial treatment of out-of-hospital cardiac arrest (OHCA) by using closed-circuit television (CCTV) recordings combined with audio recordings from emergency medical calls. METHOD: All OHCA captured by CCTV in the Capi......UNLABELLED: The aim of this study was to explore challenges in recognition and initial treatment of out-of-hospital cardiac arrest (OHCA) by using closed-circuit television (CCTV) recordings combined with audio recordings from emergency medical calls. METHOD: All OHCA captured by CCTV...... in the Capital Region of Denmark, 15 June 2013-14 June 2014, were included. Using a qualitative approach based on thematic analysis, we focused on the interval from the victim's collapse to the arrival of the ambulance. RESULTS: Based on the 21 CCTV recordings collected, the main challenges in OHCA seemed...

  7. The use of pre-hospital mild hypothermia after resuscitation from out-of-hospital cardiac arrest.

    Science.gov (United States)

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

    2009-03-01

    Hypothermia has emerged as a potent neuroprotective modality following resuscitation from cardiac arrest. Although delayed hospital cooling has been demonstrated to improve outcome after cardiac arrest, in-field cooling begun immediately following the return of spontaneous circulation may be more beneficial. Cooling in the field following resuscitation, however, presents new challenges, in that the cooling method has to be portable, safe, and effective. Rapid infusion of intravenous fluid at 4 degrees C, the use of a cooling helmet, and cooling plates have all been proposed as methods for field cooling, and are all in various stages of clinical and animal testing. Whether field cooling will improve survival and neurologic outcome remains an important unanswered clinical question. PMID:19072587

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

    DEFF Research Database (Denmark)

    Hansen, Marco Bo; Lippert, Freddy Knudsen; Rasmussen, Lars Simon;

    2014-01-01

    BACKGROUND: Valuable information can be retrieved from automated external defibrillators (AEDs) used in victims of out-of-hospital cardiac arrest (OHCA). We describe our experience with systematic downloading of data from deployed AEDs. The primary aim was to compare the proportion of shockable...... rhythm from AEDs used by laypersons with the corresponding proportion recorded by the Emergency Medical Services (EMS) on arrival. METHODS: In a 20-month study, we collected data on OHCAs in the Capital Region of Denmark where an AED was deployed prior to arrival of EMS. The AEDs were brought to the...... emergency medical dispatch centre for data downloading and rhythm analysis. Patient data were retrieved from the medical records from the admitting hospital, whereas data on EMS rhythm analyses were obtained from the Danish Cardiac Arrest Register between 2001 and 2010. RESULTS: A total of 121 AEDs were...

  9. A predictive model to identify patients with suspected acute coronary syndromes at high risk of cardiac arrest or in-hospital mortality: An IMMEDIATE Trial sub-study

    Directory of Open Access Journals (Sweden)

    Madhab Ray

    2015-12-01

    Conclusions: The multivariable predictive model developed identified patients with very early ACS at high risk of cardiac arrest or death. Using this model could assist treating those with greatest potential benefit from GIK.

  10. Management of Maternal Cardiac Arrest in the Third Trimester of Pregnancy: A Simulation-Based Pilot Study.

    Science.gov (United States)

    Adams, Jacquelyn; Cepeda Brito, Jose R; Baker, Lauren; Hughes, Patrick G; Gothard, M David; McCarroll, Michele L; Davis, Jocelyn; Silber, Angela; Ahmed, Rami A

    2016-01-01

    Objective. To evaluate confidence, knowledge, and competence after a simulation-based curriculum on maternal cardiac arrest in an Obstetrics & Gynecologic (OBGYN) residency program. Methods. Four simulations with structured debriefing focusing on high yield causes and management of maternal cardiac arrest were executed. Pre- and post-individual knowledge tests (KT) and confidence surveys (CS) were collected along with group scores of critical performance steps evaluated by content experts for the first and final simulations. Results. Significant differences were noted in individual KT scores (pre: 58.9 ± 8.9 versus post: 72.8 ± 6.1, p = 0.01) and CS total scores (pre: 22.2 ± 6.4 versus post: 29.9 ± 3.4, p = 0.007). Significant differences were noted in airway management, p = 0.008; appropriate cycles of drug/shock-CPR, p = 0.008; left uterine displacement, p = 0.008; and identifying causes of cardiac arrest, p = 0.008. Nonsignificant differences were noted for administration of appropriate drugs/doses, p = 0.074; chest compressions, p = 0.074; bag-mask ventilation before intubation, p = 0.074; and return of spontaneous circulation identification, p = 0.074. Groups remained noncompetent in team leader tasks and considering therapeutic hypothermia. Conclusion. This study demonstrated improved OBGYN resident knowledge, confidence, and competence in the management of third trimester maternal cardiac arrest. Several skills, however, will likely require more longitudinal curricular exposure and training to develop and maintain proficiency. PMID:27555967

  11. Effects of large volume, ice-cold intravenous fluid infusion on respiratory function in cardiac arrest survivors.

    Science.gov (United States)

    Jacobshagen, Claudius; Pax, Anja; Unsöld, Bernhard W; Seidler, Tim; Schmidt-Schweda, Stephan; Hasenfuss, Gerd; Maier, Lars S

    2009-11-01

    International guidelines for cardiopulmonary resuscitation recommend mild hypothermia (32-34 degrees C) for 12-24h in comatose survivors of cardiac arrest. To induce therapeutic hypothermia a variety of external and intravascular cooling devices are available. A cheap and effective method for inducing hypothermia is the infusion of large volume, ice-cold intravenous fluid. There are concerns regarding the effects of rapid infusion of large volumes of fluid on respiratory function in cardiac arrest survivors. We have retrospectively studied the effects of high volume cold fluid infusion on respiratory function in 52 resuscitated cardiac arrest patients. The target temperature of 32-34 degrees C was achieved after 4.1+/-0.5h (cooling rate 0.48 degrees C/h). During this period 3427+/-210 mL ice-cold fluid was infused. Despite significantly reduced LV-function (EF 35.8+/-2.2%) the respiratory status of these patients did not deteriorate significantly. On intensive care unit admission the mean PaO(2) was 231.4+/-20.6 mmHg at a F(i)O(2) of 0.82+/-0.03 (PaO(2)/F(i)O(2)=290.0+/-24.1) and a PEEP level of 7.14+/-0.31 mbar. Until reaching the target temperature of fluid is an effective and inexpensive method for inducing therapeutic hypothermia. Resuscitation from cardiac arrest is associated with a deterioration in respiratory function. The infusion of large volumes of cold fluid does not cause a statistically significant further deterioration in respiratory function. A larger, randomized and prospective study is required to assess the efficacy and safety of ice-cold fluid infusion for the induction of therapeutic hypothermia. PMID:19674825

  12. Management of Maternal Cardiac Arrest in the Third Trimester of Pregnancy: A Simulation-Based Pilot Study

    Science.gov (United States)

    Adams, Jacquelyn; Cepeda Brito, Jose R.; Baker, Lauren; Hughes, Patrick G.; Gothard, M. David; Davis, Jocelyn; Silber, Angela

    2016-01-01

    Objective. To evaluate confidence, knowledge, and competence after a simulation-based curriculum on maternal cardiac arrest in an Obstetrics & Gynecologic (OBGYN) residency program. Methods. Four simulations with structured debriefing focusing on high yield causes and management of maternal cardiac arrest were executed. Pre- and post-individual knowledge tests (KT) and confidence surveys (CS) were collected along with group scores of critical performance steps evaluated by content experts for the first and final simulations. Results. Significant differences were noted in individual KT scores (pre: 58.9 ± 8.9 versus post: 72.8 ± 6.1, p = 0.01) and CS total scores (pre: 22.2 ± 6.4 versus post: 29.9 ± 3.4, p = 0.007). Significant differences were noted in airway management, p = 0.008; appropriate cycles of drug/shock-CPR, p = 0.008; left uterine displacement, p = 0.008; and identifying causes of cardiac arrest, p = 0.008. Nonsignificant differences were noted for administration of appropriate drugs/doses, p = 0.074; chest compressions, p = 0.074; bag-mask ventilation before intubation, p = 0.074; and return of spontaneous circulation identification, p = 0.074. Groups remained noncompetent in team leader tasks and considering therapeutic hypothermia. Conclusion. This study demonstrated improved OBGYN resident knowledge, confidence, and competence in the management of third trimester maternal cardiac arrest. Several skills, however, will likely require more longitudinal curricular exposure and training to develop and maintain proficiency. PMID:27555967

  13. Combination of Epinephrine with Esmolol Attenuates Post-Resuscitation Myocardial Dysfunction in a Porcine Model of Cardiac Arrest

    OpenAIRE

    Qian Zhang; Chunsheng Li

    2013-01-01

    BACKGROUND: Recent experimental and clinical studies have indicated that the β-adrenergic effect of epinephrine significantly increases the severity of post resuscitation myocardial dysfunction. The aim of the study was to investigate whether the short-acting β₁-selective adrenergic blocking agent, esmolol, would attenuate post resuscitation myocardial dysfunction in a porcine model of cardiac arrest. METHODS AND RESULTS: After 8 min of untreated ventricular fibrillation and 2 min of basic li...

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

    DEFF Research Database (Denmark)

    Dragancea, Irina; Horn, Janneke; Kuiper, Michael;

    2015-01-01

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

  15. Recognition of out-of-hospital cardiac arrest by medical dispatchers in emergency medical dispatch centres in two countries

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Andréll, Cecilia; Viereck, Søren;

    2016-01-01

    INTRODUCTION: Survival after out-of-hospital cardiac arrest (OHCA) remains low. Early recognition by emergency medical dispatchers is essential for an effective chain of actions, leading to early cardiopulmonary resuscitation, use of an automated external defibrillator and rapid dispatching....... This raises a discussion of definitions and transparency in general in scientific reporting of OHCA recognition, which is essential if used as quality indicator in emergency medical services....

  16. Management of Maternal Cardiac Arrest in the Third Trimester of Pregnancy: A Simulation-Based Pilot Study

    Directory of Open Access Journals (Sweden)

    Jacquelyn Adams

    2016-01-01

    Full Text Available Objective. To evaluate confidence, knowledge, and competence after a simulation-based curriculum on maternal cardiac arrest in an Obstetrics & Gynecologic (OBGYN residency program. Methods. Four simulations with structured debriefing focusing on high yield causes and management of maternal cardiac arrest were executed. Pre- and post-individual knowledge tests (KT and confidence surveys (CS were collected along with group scores of critical performance steps evaluated by content experts for the first and final simulations. Results. Significant differences were noted in individual KT scores (pre: 58.9±8.9 versus post: 72.8±6.1, p=0.01 and CS total scores (pre: 22.2±6.4 versus post: 29.9±3.4, p=0.007. Significant differences were noted in airway management, p=0.008; appropriate cycles of drug/shock-CPR, p=0.008; left uterine displacement, p=0.008; and identifying causes of cardiac arrest, p=0.008. Nonsignificant differences were noted for administration of appropriate drugs/doses, p=0.074; chest compressions, p=0.074; bag-mask ventilation before intubation, p=0.074; and return of spontaneous circulation identification, p=0.074. Groups remained noncompetent in team leader tasks and considering therapeutic hypothermia. Conclusion. This study demonstrated improved OBGYN resident knowledge, confidence, and competence in the management of third trimester maternal cardiac arrest. Several skills, however, will likely require more longitudinal curricular exposure and training to develop and maintain proficiency.

  17. Automated analysis of background EEG and reactivity during therapeutic hypothermia in comatose patients after cardiac arrest.

    Science.gov (United States)

    Noirhomme, Quentin; Lehembre, Rémy; Lugo, Zulay Del Rosario; Lesenfants, Damien; Luxen, André; Laureys, Steven; Oddo, Mauro; Rossetti, Andrea O

    2014-01-01

    Visual analysis of electroencephalography (EEG) background and reactivity during therapeutic hypothermia provides important outcome information, but is time-consuming and not always consistent between reviewers. Automated EEG analysis may help quantify the brain damage. Forty-six comatose patients in therapeutic hypothermia, after cardiac arrest, were included in the study. EEG background was quantified with burst-suppression ratio (BSR) and approximate entropy, both used to monitor anesthesia. Reactivity was detected through change in the power spectrum of signal before and after stimulation. Automatic results obtained almost perfect agreement (discontinuity) to substantial agreement (background reactivity) with a visual score from EEG-certified neurologists. Burst-suppression ratio was more suited to distinguish continuous EEG background from burst-suppression than approximate entropy in this specific population. Automatic EEG background and reactivity measures were significantly related to good and poor outcome. We conclude that quantitative EEG measurements can provide promising information regarding current state of the patient and clinical outcome, but further work is needed before routine application in a clinical setting.

  18. Towards the Automated Analysis and Database Development of Defibrillator Data from Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Trygve Eftestøl

    2014-01-01

    Full Text Available Background. During resuscitation of cardiac arrest victims a variety of information in electronic format is recorded as part of the documentation of the patient care contact and in order to be provided for case review for quality improvement. Such review requires considerable effort and resources. There is also the problem of interobserver effects. Objective. We show that it is possible to efficiently analyze resuscitation episodes automatically using a minimal set of the available information. Methods and Results. A minimal set of variables is defined which describe therapeutic events (compression sequences and defibrillations and corresponding patient response events (annotated rhythm transitions. From this a state sequence representation of the resuscitation episode is constructed and an algorithm is developed for reasoning with this representation and extract review variables automatically. As a case study, the method is applied to the data abstraction process used in the King County EMS. The automatically generated variables are compared to the original ones with accuracies ≥90% for 18 variables and ≥85% for the remaining four variables. Conclusions. It is possible to use the information present in the CPR process data recorded by the AED along with rhythm and chest compression annotations to automate the episode review.

  19. Sudden cardiac arrest risk stratification based on 24-hour Holter ECG statistics.

    Science.gov (United States)

    Kasahara, Keisuke; Shiobara, Masahito; Nakamura, Saya; Yamashiro, Koichiro; Yana, Kazuo; Ono, Takuya

    2015-08-01

    This study examined the feasibility of using indices obtained from a long term Holter ECG record for sudden cardiac arrest (SCA) risk stratification. The ndices tested were the QT-RR interval co-variability and the alternans ratio percentile (ARP(θ)) which is defined as the θ(th) percentile of alternans ratios over a 24 hour period. The QT-RR interval co-variabilities are evaluated by the serial correlation coefficient between QT and RR trend sequences (QTRC). Previously reported Kalman filter technique and a simple smoothing spline method for the trend estimation are compared. Parameter θ in the alternans ratio percentile index was optimized to achieve the best classification accuracy. These indices were estimated from 26 cardiovascular outpatients for Holter ECG record. Patients were classified into high and low risk groups according to their clinical diagnosis, and the obtained indices were compared with those of 25 control subjects. A risk stratification using the two indices QTRC and ARP(θ) yielded an average sensitivity of 0.812 and a specificity of 0.925. The sensitivities and specificities of all three categories exceeded 0.8 except for the sensitivity to detect the high-risk patient group. Other short-term ECG parameters may need to be incorporated in order to improve the sensitivity.

  20. Study of Cardiac Arrest Caused by Acute Pulmonary Thromboembolism and Thrombolytic Resuscitation in a Porcine Model

    Institute of Scientific and Technical Information of China (English)

    Lian-Xing Zhao; Chun-Sheng Li; Jun Yang; Nan Tong; Hong-Li Xiao; Le An

    2016-01-01

    Background:The success rate of resuscitation in cardiac arrest (CA) caused by pulmonary thromboembolism (PTE) is low.Furthermore,there are no large animal models that simulate clinical CA.The aim of this study was to establish a porcine CA model caused by PTE and to investigate the pathophysiology of CA and postresuscitation.Methods:This model was induced in castrated male pigs (30 ± 2 kg;n =21) by injecting thrombi (10-15 ml) via the left external jugular vein.Computed tomographic pulmonary angiography (CTPA) was performed at baseline,CA,and return of spontaneous circulation (ROSC).After CTPA during CA,cardiopulmonary resuscitation (CPR) with thrombolysis (recombinant tissue plasminogen activator 50 mg) was initiated.Hemodynamic,respiratory,and blood gas data were monitored.Cardiac troponins T,cardiac troponin I,creatine kinase-MB,myoglobin,and brain natriuretic peptide (BNP) were measured by enzyme-linked immunosorbent assay.Data were compared between baseline and CA with paired-sample t-test and compared among different time points for survival animals with repeated measures analysis of variance.Results:Seventeen animals achieved CA after emboli injection,while four achieved CA after 5-8 ml more thrombi.Nine animals survived 6 h after CPR.CTPA showed obstruction of the pulmonary arteries.Mean aortic pressure data showed occurrence of CA caused by PTE (Z =-2.803,P =0.002).The maximal rate of mean increase of left ventricular pressure (dp/dtmax) was statistically decreased (t =6.315,P =0.000,variation coefficient =0.25),and end-tidal carbon dioxide partial pressure (PetCO2) decreased to the lowest value (t =27.240,P =0.000).After ROSC (n =9),heart rate (HR) and mean right ventricular pressure (MRVP) remained different versus baseline until 2 h after ROSC (HR,P =0.036;MRVP,P =0.027).Myoglobin was statistically increased from CA to 1 h after ROSC (P =0.036,0.026,0.009,respectively),and BNP was increased from 2 h to 6 h after ROSC (P =0.012,0.014,0.039,respectively

  1. Study of Cardiac Arrest Caused by Acute Pulmonary Thromboembolism and Thrombolytic Resuscitation in a Porcine Model

    Science.gov (United States)

    Zhao, Lian-Xing; Li, Chun-Sheng; Yang, Jun; Tong, Nan; Xiao, Hong-Li; An, Le

    2016-01-01

    Background: The success rate of resuscitation in cardiac arrest (CA) caused by pulmonary thromboembolism (PTE) is low. Furthermore, there are no large animal models that simulate clinical CA. The aim of this study was to establish a porcine CA model caused by PTE and to investigate the pathophysiology of CA and postresuscitation. Methods: This model was induced in castrated male pigs (30 ± 2 kg; n = 21) by injecting thrombi (10–15 ml) via the left external jugular vein. Computed tomographic pulmonary angiography (CTPA) was performed at baseline, CA, and return of spontaneous circulation (ROSC). After CTPA during CA, cardiopulmonary resuscitation (CPR) with thrombolysis (recombinant tissue plasminogen activator 50 mg) was initiated. Hemodynamic, respiratory, and blood gas data were monitored. Cardiac troponins T, cardiac troponin I, creatine kinase-MB, myoglobin, and brain natriuretic peptide (BNP) were measured by enzyme-linked immunosorbent assay. Data were compared between baseline and CA with paired-sample t-test and compared among different time points for survival animals with repeated measures analysis of variance. Results: Seventeen animals achieved CA after emboli injection, while four achieved CA after 5–8 ml more thrombi. Nine animals survived 6 h after CPR. CTPA showed obstruction of the pulmonary arteries. Mean aortic pressure data showed occurrence of CA caused by PTE (Z = −2.803, P = 0.002). The maximal rate of mean increase of left ventricular pressure (dp/dtmax) was statistically decreased (t = 6.315, P = 0.000, variation coefficient = 0.25), and end-tidal carbon dioxide partial pressure (PetCO2) decreased to the lowest value (t = 27.240, P = 0.000). After ROSC (n = 9), heart rate (HR) and mean right ventricular pressure (MRVP) remained different versus baseline until 2 h after ROSC (HR, P = 0.036; MRVP, P = 0.027). Myoglobin was statistically increased from CA to 1 h after ROSC (P = 0.036, 0.026, 0.009, respectively), and BNP was increased

  2. Minocycline attenuates brain tissue levels of TNF-α produced by neurons after prolonged hypothermic cardiac arrest in rats

    Science.gov (United States)

    Drabek, Tomas; Janata, Andreas; Wilson, Caleb D.; Stezoski, Jason; Janesko-Feldman, Keri; Tisherman, Samuel A.; Foley, Lesley M.; Verrier, Jonathan; Kochanek, Patrick M.

    2014-01-01

    Neuro-cognitive disabilities are a well-recognized complication of hypothermic circulatory arrest. We and others have reported that prolonged cardiac arrest (CA) produces neuronal death and microglial proliferation and activation that are only partially mitigated by hypothermia. Microglia, and possibly other cells, are suggested to elaborate tumor necrosis factor alpha (TNF-α) which can trigger neuronal death cascades and exacerbate edema after CNS insults. Minocycline is neuroprotective in some brain ischemia models in part by blunting the microglial response. We tested the hypothesis that minocycline would attenuate neuroinflammation as reflected by brain tissue levels of TNF-α after hypothermic CA in rats. Rats were subjected to rapid exsanguination, followed by a 6 min normothermic CA. Hypothermia (30 °C) was then induced by an aortic saline flush. After a total of 20 min CA, resuscitation was achieved via cardiopulmonary bypass (CPB). After 5 min reperfusion, minocycline (90 mg/kg; n=6) or vehicle (PBS; n=6) were given. Hypothermia (34 °C) was maintained for 6 h. Rats were sacrificed at 6 or 24 h. TNF-α was quantified (ELISA) in four brain regions (cerebellum, CEREB; cortex, CTX; hippocampus, HIP; striatum, STRI). Naïve rats (n=6) and rats subjected to the same anesthesia and CPB but no CA served as controls (n=6). Immunocytochemistry was used to localize TNF-α. Naïve rats and CPB controls had no detectable TNF-α in any brain region. CA markedly increased brain TNF-α. Regional differences were seen, with the highest TNF-α levels in striatum in CA groups (10-fold higher, P<0.05 vs. all other brain regions). TNF-α was undetectable at 24 h. Minocycline attenuated TNF-α levels in CTX, HIP and STRI (P<0.05). TNF-α showed unique co-localization with neurons. In conclusion, we report region-dependent early increases in brain TNF-α levels after prolonged hypothermic CA, with maximal increases in striatum. Surprisingly, TNF-α co-localized in neurons and

  3. Even Four Minutes of Poor Quality of CPR Compromises Outcome in a Porcine Model of Prolonged Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Heng Li

    2013-01-01

    Full Text Available Objective. Untrained bystanders usually delivered suboptimal chest compression to victims who suffered from cardiac arrest in out-of-hospital settings. We therefore investigated the hemodynamics and resuscitation outcome of initial suboptimal quality of chest compressions compared to the optimal ones in a porcine model of cardiac arrest. Methods. Fourteen Yorkshire pigs weighted 30 ± 2 kg were randomized into good and poor cardiopulmonary resuscitation (CPR groups. Ventricular fibrillation was electrically induced and untreated for 6 mins. In good CPR group, animals received high quality manual chest compressions according to the Guidelines (25% of animal’s anterior-posterior thoracic diameter during first two minutes of CPR compared with poor (70% of the optimal depth compressions. After that, a 120-J biphasic shock was delivered. If the animal did not acquire return of spontaneous circulation, another 2 mins of CPR and shock followed. Four minutes later, both groups received optimal CPR until total 10 mins of CPR has been finished. Results. All seven animals in good CPR group were resuscitated compared with only two in poor CPR group (P<0.05. The delayed optimal compressions which followed 4 mins of suboptimal compressions failed to increase the lower coronary perfusion pressure of five non-survival animals in poor CPR group. Conclusions. In a porcine model of prolonged cardiac arrest, even four minutes of initial poor quality of CPR compromises the hemodynamics and survival outcome.

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

    OpenAIRE

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

    2011-01-01

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

  5. Cognitive function after cardiac arrest and temperature management; rationale and description of a sub-study in the Target Temperature Management trial

    DEFF Research Database (Denmark)

    Lilja, Gisela; Nielsen, Niklas; Friberg, Hans;

    2013-01-01

    Mild to moderate cognitive impairment is common amongst long-term survivors of cardiac arrest. In the Target Temperature Management trial (TTM-trial) comatose survivors were randomized to 33°C or 36°C temperature control for 24 hours after cardiac arrest and the effects on survival and neurological...... outcome assessed. This protocol describes a sub-study of the TTM-trial investigating cognitive dysfunction and its consequences for patients' and relatives' daily life....

  6. Incidence of and factors associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery

    Directory of Open Access Journals (Sweden)

    Siriphuwanun V

    2014-09-01

    Full Text Available Visith Siriphuwanun,1 Yodying Punjasawadwong,1 Worawut Lapisatepun,1 Somrat Charuluxananan,2 Ketchada Uerpairojkit2 1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Mueang District, Chiang Mai, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Purpose: To determine the incidence of and factors associated with perioperative cardiac arrest within 24 hours of receiving anesthesia for emergency surgery. Patients and methods: This retrospective cohort study was approved by the ethical committee of Maharaj Nakorn Chiang Mai Hospital, Thailand. We reviewed the data of 44,339 patients receiving anesthesia for emergency surgery during the period from January 1, 2003 to March 31, 2011. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA physical status classification, anesthesia information, location of anesthesia performed, and outcomes. Data of patients who had received topical anesthesia or monitoring anesthesia care were excluded. Factors associated with cardiac arrest were identified by univariate analyses. Multiple regressions for the risk ratio (RR and 95% confidence intervals (CI were used to determine the strength of factors associated with cardiac arrest. A forward stepwise algorithm was chosen at a P-value <0.05. Results: The incidence (within 24 hours of perioperative cardiac arrest in patients receiving anesthesia for emergency surgery was 163 per 10,000. Factors associated with 24-hour perioperative cardiac arrest in emergency surgery were age of 2 years or younger (RR =1.46, CI =1.03–2.08, P=0.036, ASA physical status classification of 3–4 (RR =5.84, CI =4.20–8.12, P<0.001 and 5–6 (RR =33.98, CI =23.09–49.98, P<0.001, the anatomic site of surgery (upper intra-abdominal, RR =2.67, CI =2.14–3.33, P<0.001; intracranial, RR =1.74, CI =1.35–2.25, P<0.001; intrathoracic, RR =2.35, CI =1.70–3

  7. The Responses of Tissues from the Brain, Heart, Kidney, and Liver to Resuscitation following Prolonged Cardiac Arrest by Examining Mitochondrial Respiration in Rats.

    Science.gov (United States)

    Kim, Junhwan; Villarroel, José Paul Perales; Zhang, Wei; Yin, Tai; Shinozaki, Koichiro; Hong, Angela; Lampe, Joshua W; Becker, Lance B

    2016-01-01

    Cardiac arrest induces whole-body ischemia, which causes damage to multiple organs. Understanding how each organ responds to ischemia/reperfusion is important to develop better resuscitation strategies. Because direct measurement of organ function is not practicable in most animal models, we attempt to use mitochondrial respiration to test efficacy of resuscitation on the brain, heart, kidney, and liver following prolonged cardiac arrest. Male Sprague-Dawley rats are subjected to asphyxia-induced cardiac arrest for 30 min or 45 min, or 30 min cardiac arrest followed by 60 min cardiopulmonary bypass resuscitation. Mitochondria are isolated from brain, heart, kidney, and liver tissues and examined for respiration activity. Following cardiac arrest, a time-dependent decrease in state-3 respiration is observed in mitochondria from all four tissues. Following 60 min resuscitation, the respiration activity of brain mitochondria varies greatly in different animals. The activity after resuscitation remains the same in heart mitochondria and significantly increases in kidney and liver mitochondria. The result shows that inhibition of state-3 respiration is a good marker to evaluate the efficacy of resuscitation for each organ. The resulting state-3 respiration of brain and heart mitochondria following resuscitation reenforces the need for developing better strategies to resuscitate these critical organs following prolonged cardiac arrest.

  8. The Responses of Tissues from the Brain, Heart, Kidney, and Liver to Resuscitation following Prolonged Cardiac Arrest by Examining Mitochondrial Respiration in Rats

    Directory of Open Access Journals (Sweden)

    Junhwan Kim

    2016-01-01

    Full Text Available Cardiac arrest induces whole-body ischemia, which causes damage to multiple organs. Understanding how each organ responds to ischemia/reperfusion is important to develop better resuscitation strategies. Because direct measurement of organ function is not practicable in most animal models, we attempt to use mitochondrial respiration to test efficacy of resuscitation on the brain, heart, kidney, and liver following prolonged cardiac arrest. Male Sprague-Dawley rats are subjected to asphyxia-induced cardiac arrest for 30 min or 45 min, or 30 min cardiac arrest followed by 60 min cardiopulmonary bypass resuscitation. Mitochondria are isolated from brain, heart, kidney, and liver tissues and examined for respiration activity. Following cardiac arrest, a time-dependent decrease in state-3 respiration is observed in mitochondria from all four tissues. Following 60 min resuscitation, the respiration activity of brain mitochondria varies greatly in different animals. The activity after resuscitation remains the same in heart mitochondria and significantly increases in kidney and liver mitochondria. The result shows that inhibition of state-3 respiration is a good marker to evaluate the efficacy of resuscitation for each organ. The resulting state-3 respiration of brain and heart mitochondria following resuscitation reenforces the need for developing better strategies to resuscitate these critical organs following prolonged cardiac arrest.

  9. Monitoring of immune activation using biochemical changes in a porcine model of cardiac arrest

    Directory of Open Access Journals (Sweden)

    Anton Amann

    2001-01-01

    Full Text Available In animal models, immune activation is often difficult to assess because of the limited availability of specific assays to detect cytokine activities. In human monocytes/macrophages, interferon-γ induces increased production of neopterin and an enhanced activity of indoleamine 2,3-dioxygenase, which degrades tryptophan via the kynurenine pathway. Therefore, monitoring of neopterin concentrations and of tryptophan degradation can serve to detect the extent of T helper cell 1-type immune activation during cellular immune response in humans. In a porcine model of cardiac arrest, we examined the potential use of neopterin measurements and determination of the tryptophan degradation rate as a means of estimating the extent of immune activation. Urinary neopterin concentrations were measured with high-performance liquid chromatography (HPLC and radioimmunoassay (RIA (BRAHMS Diagnostica, Berlin, Germany. Serum and plasma tryptophan and kynurenine concentrations were also determined using HPLC. Serum and urine neopterin concentrations were not detectable with HPLC in these specimens, whereas RIA gave weakly (presumably false positive results. The mean serum tryptophan concentration was 39.0 Ī 6.2 μmol/l, and the mean kynurenine concentration was 0.85 Ī 0.33 μmol/l. The average kynurenine-per-tryptophan quotient in serum was 21.7Ī 8.4 nmol/μmol, and that in plasma was 20.7Ī 9.5 nmol/μmol (n = 7, which corresponds well to normal values in humans. This study provides preliminary data to support the monitoring of tryptophan degradation but not neopterin concentrations as a potential means of detecting immune activation in a porcine model. The kynurenine-per-tryptophan quotient may serve as a short-term measurement of immune activation and hence permit an estimate of the extent of immune activation.

  10. Spatial Variation and Resuscitation Process Affecting Survival after Out-of-Hospital Cardiac Arrests (OHCA.

    Directory of Open Access Journals (Sweden)

    Chien-Chou Chen

    Full Text Available Ambulance response times and resuscitation efforts are critical predictors of the survival rate after out-of-hospital cardiac arrests (OHCA. On the other hand, rural-urban differences in the OHCA survival rates are an important public health issue.We retrospectively reviewed the January 2011-December 2013 OHCA registry data of Kaohsiung City, Taiwan. With particular focus on geospatial variables, we aimed to unveil risk factors predicting the overall OHCA survival until hospital admission. Spatial analysis, network analysis, and the Kriging method by using geographic information systems were applied to analyze spatial variations and calculate the transport distance. Logistic regression was used to identify the risk factors for OHCA survival.Among the 4,957 patients, the overall OHCA survival to hospital admission was 16.5%. In the multivariate analysis, female sex (adjusted odds ratio:, AOR, 1.24 [1.06-1.45], events in public areas (AOR: 1.30 [1.05-1.61], exposure to automated external defibrillator (AED shock (AOR: 1.70 [1.30-2.23], use of laryngeal mask airway (LMA (AOR: 1.35 [1.16-1.58], non-trauma patients (AOR: 1.41 [1.04-1.90], ambulance bypassed the closest hospital (AOR: 1.28 [1.07-1.53], and OHCA within the high population density areas (AOR: 1.89 [1.55-2.32] were positively associated with improved OHCA survival. By contrast, a prolonged total emergency medical services (EMS time interval was negatively associated with OHCA survival (AOR: 0.98 [0.96-0.99].Resuscitative efforts, such as AED or LMA use, and a short total EMS time interval improved OHCA outcomes in emergency departments. The spatial heterogeneity of emergency medical resources between rural and urban areas might affect survival rate.

  11. Ubiquitous protective effects of cyclosporine A in preventing cardiac arrest-induced multiple organ failure.

    Science.gov (United States)

    Cour, Martin; Abrial, Maryline; Jahandiez, Vincent; Loufouat, Joseph; Belaïdi, Elise; Gharib, Abdallah; Varennes, Annie; Monneret, Guillaume; Thibault, Hélène; Ovize, Michel; Argaud, Laurent

    2014-10-15

    Opening of the mitochondrial permeability transition pore (mPTP) appears to be a pivotal event in myocardial ischemia-reperfusion (I/R) injury. Resuscitated cardiac arrest (CA) leads to the post-CA syndrome that encompasses, not only myocardial dysfunction, but also brain injury, failure of other organs (kidney, liver, or lung), and systemic response to I/R. We aimed to determine whether cyclosporine A (CsA) might prevent multiple organ failure following CA through a ubiquitous mPTP inhibition in each distant vital organ. Anesthetized New Zealand White rabbits were subjected to 15 min of CA and 120 min of reperfusion. At the onset of resuscitation, the rabbits received CsA, its non-immunosuppressive derivative NIM811, or vehicle (controls). Survival, hemodynamics, brain damage, organ injuries, and systemic I/R response were analyzed. Fresh mitochondria were isolated from the brain, heart, kidney, liver, and lung to assess both oxidative phosphorylation and permeability transition. CsA analogs significantly improved short-term survival and prevented multiple organ failure, including brain damage and myocardial dysfunction (P < 0.05 vs. controls). Susceptibility of mPTP opening was significantly increased in heart, brain, kidney, and liver mitochondria isolated from controls, while mitochondrial respiration was impaired (P < 0.05 vs. sham). CsA analogs prevented these mitochondrial dysfunctions (P < 0.05 vs. controls). These results suggest that CsA and NIM811 can prevent the post-CA syndrome through a ubiquitous mitochondrial protective effect at the level of each major distant organ. PMID:25213634

  12. Cognitive function in survivors of out-of-hospital cardiac arrest after target temperature management at 33°C versus 36°C

    DEFF Research Database (Denmark)

    Lilja, Gisela; Nielsen, Niklas; Friberg, Hans;

    2015-01-01

    assessed with tests for memory (Rivermead Behavioural Memory Test), executive functions (Frontal Assessment Battery), and attention/mental speed (Symbol Digit Modalities Test). A control group of 119 matched patients hospitalized for acute ST-segment-elevation myocardial infarction without cardiac arrest......BACKGROUND: Target temperature management is recommended as a neuroprotective strategy after out-of-hospital cardiac arrest. Potential effects of different target temperatures on cognitive impairment commonly described in survivors have not been investigated sufficiently. The primary aim...... and stratified for site to temperature control at 33°C or 36°C within the Target Temperature Management trial. Survival until 180 days after the arrest was 52% (33°C, n=178/328; 36°C, n=164/324). Survivors were invited to a face-to-face follow-up, and 287 cardiac arrest survivors (33°C, n=148/36°C, n=139) were...

  13. Vascular complications following therapeutic and diagnostic cardiac catheterisation by the femoral artery

    DEFF Research Database (Denmark)

    Bitsch, M; Liisberg-Larsen, Ole Christian; Schroeder, T V

    1994-01-01

    Twenty-one of 6327 (0.33%) patients undergoing cardiac catheterisation via the femoral artery had an acute vascular complication requiring surgical intervention. The complication rate was 0.1% after coronary angiography, 2% after PTCA and 6% after aortic ballon dilatation. The size of the cathete...... and evaluation of vascular injuries following diagnostic and therapeutic invasive interventions could have a self limitating effect on the complication rate....

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

    DEFF Research Database (Denmark)

    Søholm, Helle; Kjaergaard, Jesper; Thomsen, Jakob Hartvig;

    2014-01-01

    performed (88% vs. 54%, pCardiac etiology was the predominant cause of OHCA in both exercise and non-exercise patients......BACKGROUND: Performing exercise is shown to prevent cardiovascular disease, but the risk of an out-of-hospital cardiac arrest (OHCA) is temporarily increased during strenuous activity. We examined the etiology and outcome after successfully resuscitated OHCA during exercise in a general non......: OHCA occurring during exercise was associated with a significantly lower mortality in successfully resuscitated patients even after adjusting for confounding factors. Acute coronary syndrome was more common among exercise-related cardiac arrest patients....

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

    Directory of Open Access Journals (Sweden)

    Hayashi,Hoei

    2005-04-01

    Full Text Available

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

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

    Directory of Open Access Journals (Sweden)

    Padeletti L

    2011-09-01

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

  17. Survival with good neurological outcome in a patient with prolonged ischemic cardiac arrest--utility of automated chest compression systems in the cardiac catheterization laboratory.

    Science.gov (United States)

    Psaltis, Peter J; Meredith, Ian T; Ahmar, Walid

    2014-11-15

    The management of refractory cardiac arrest during invasive coronary procedures has substantial logistical challenges and is typically associated with disappointing outcomes. We describe the case of a young woman with recalcitrant ventricular fibrillation due to acute anterior ST-elevation myocardial infarction caused by occlusion of her proximal left anterior descending artery. Survival without neurological deficit or organ failure was achieved following primary percutaneous reperfusion and a total of 52 min of intra-procedural chest compression support, made possible by the use of an automated chest compression device. PMID:24403102

  18. Activity and Life After Survival of a Cardiac Arrest (ALASCA and the effectiveness of an early intervention service: design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Bakx Wilbert GM

    2007-08-01

    Full Text Available Abstract Background Cardiac arrest survivors may experience hypoxic brain injury that results in cognitive impairments which frequently remain unrecognised. This may lead to limitations in daily activities and participation in society, a decreased quality of life for the patient, and a high strain for the caregiver. Publications about interventions directed at improving quality of life after survival of a cardiac arrest are scarce. Therefore, evidence about effective rehabilitation programmes for cardiac arrest survivors is urgently needed. This paper presents the design of the ALASCA (Activity and Life After Survival of a Cardiac Arrest trial, a randomised, controlled clinical trial to evaluate the effects of a new early intervention service for survivors of a cardiac arrest and their caregivers. Methods/design The study population comprises all people who survive two weeks after a cardiac arrest and are admitted to one of the participating hospitals in the Southern part of the Netherlands. In a two-group randomised, controlled clinical trial, half of the participants will receive an early intervention service. The early intervention service consists of several consultations with a specialised nurse for the patient and their caregiver during the first three months after the cardiac arrest. The intervention is directed at screening for cognitive problems, provision of informational, emotional and practical support, and stimulating self-management. If necessary, referral to specialised care can take place. Persons in the control group will receive the care as usual. The primary outcome measures are the extent of participation in society and quality of life of the patient one year after a cardiac arrest. Secondary outcome measures are the level of cognitive, emotional and cardiovascular impairment and daily functioning of the patient, as well as the strain for and quality of life of the caregiver. Participants and their caregivers will be followed

  19. Load-distributing band improves ventilation and hemodynamics during resuscitation in a porcine model of prolonged cardiac arrest

    OpenAIRE

    Wang Shuo; Wu Jun-Yuan; Li Chun-Sheng

    2012-01-01

    Abstract Background The use of mechanical cardiopulmonary resuscitation (CPR) has great potential for the clinical setting. The purpose of present study is to compare the hemodynamics and ventilation during and after the load-distributing band CPR, versus the manual CPR in a porcine model of prolonged cardiac arrest, and to investigate the influence of rescue breathing in different CPR protocols. Methods Sixty-four male pigs (n = 16/group), weighing 30 ± 2 kg, were induced ventricular fibrill...

  20. Post resuscitation care of out-of-hospital cardiac arrest patients in the Nordic countries: a questionnaire study

    OpenAIRE

    Saarinen, Sini; Castrén, Maaret; Virkkunen, Ilkka; Kämäräinen, Antti

    2015-01-01

    Background Aim of this study was to compare post resuscitation care of out-of-hospital cardiac arrest (OHCA) patients in Nordic (Denmark, Finland, Iceland, Norway, Sweden) intensive care units (ICUs). Methods An online questionnaire was sent to Nordic ICUs in 2012 and was complemented by an additional one in 2014. Results The first questionnaire was sent to 188 and the second one to 184 ICUs. Response rates were 51 % and 46 %. In 2012, 37 % of the ICUs treated all patients resuscitated from O...

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

    DEFF Research Database (Denmark)

    Ostenfeld, Sarah; Lindholm, Matias Greve; Kjaergaard, Jesper;

    2015-01-01

    OBJECTIVES: To compare outcome in patients with acute myocardial infarction (MI) and cardiogenic shock (CS) presenting with and without out-of-hospital cardiac arrest (OHCA). BACKGROUND: Despite general improvement in outcome after acute MI, CS remains a leading cause of death in acute MI patients...... with a high 30-day mortality rate. OHCA on top of cardiogenic shock may further increase mortality in these patients resulting in premature withdrawal of supportive therapy, but this is not known. METHODS AND RESULTS: In a retrospective study from 2008 to 2013, 248 consecutive patients admitted alive...... by cardiogenic shock. This should encourage active intensive treatment of CS patients regardless of OHCA....

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

    DEFF Research Database (Denmark)

    Søholm, Helle; Kjaergaard, Jesper; Bro-Jeppesen, John;

    2015-01-01

    BACKGROUND: Studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centers. The aim was to examine the level-of-care at tertiary centers compared with nontertiary hospitals and the association with outcome after out-of-hospital cardiac arrest....... METHODS AND RESULTS: Consecutive out-of-hospital cardiac arrest patients (n=1078) without ST-segment-elevation myocardial infarction admitted to tertiary centers (54%) and nontertiary hospitals (46%) were included (2002-2011). Patient charts were reviewed focusing on level-of-care and comorbidity....... Survival to discharge differed significantly with 45% versus 24% of patients discharged alive (Pday mortality (hazard ratio, 0.78 [0.64-0.96; P=0.02]), independent of comorbidity...

  3. Successful resuscitation from two cardiac arrests in a female patient with critical aortic stenosis, severe mitral regurgitation and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Mijušković Dragan

    2012-01-01

    Full Text Available Introduction. The incidence of sudden cardiac death in patients with severe symptomatic aortic stenosis is up to 34% and resuscitation is described as highly unsuccessful. Case report. A 72-year-old female patient with severe aortic stenosis combined with severe mitral regurgitation and three-vessel coronary artery disease was successfully resuscitated following two in-hospital cardiac arrests. The first cardiac arrest occurred immediately after intraarterial injection of low osmolar iodinated agent during coronary angiography. Angiography revealed 90% occlusion of the proximal left main coronary artery and circumflex branch. The second arrest followed induction of anesthesia. Following successful open-chest resuscitation, aortic valve replacement, mitral valvuloplasty and three-vessel aortocoronary bypass were performed. Postoperative pericardial tamponade required surgical revision. The patient recovered completely. Conclusion. Decision to start resuscitation may be justified in selected patients with critical aortic stenosis, even though cardiopulmonary resuscitation in such cases is generally considered futile.

  4. Therapeutic hypothermia protects against ischemia-induced impairment of synaptic plasticity following juvenile cardiac arrest in sex-dependent manner.

    Science.gov (United States)

    Dietz, R M; Deng, G; Orfila, J E; Hui, X; Traystman, R J; Herson, P S

    2016-06-14

    Pediatric cardiac arrest (CA) often leads to poor neurologic outcomes, including deficits in learning and memory. The only approved treatment for CA is therapeutic hypothermia, although its utility in the pediatric population remains unclear. This study analyzed the effect of mild therapeutic hypothermia after CA in juvenile mice on hippocampal neuronal injury and the cellular model of learning and memory, termed long-term potentiation (LTP). Juvenile mice were subjected to cardiac arrest and cardiopulmonary resuscitation (CA/CPR) followed by normothermia (37°C) and hypothermia (30°C, 32°C). Histological injury of hippocampal CA1 neurons was performed 3days after resuscitation using hematoxylin and eosin (H&E) staining. Field excitatory post-synaptic potentials (fEPSPs) were recorded from acute hippocampal slices 7days after CA/CPR to determine LTP. Synaptic function was impaired 7days after CA/CPR. Mice exposed to hypothermia showed equivalent neuroprotection, but exhibited sexually dimorphic protection against ischemia-induced impairment of LTP. Hypothermia (32°C) protects synaptic plasticity more effectively in females, with males requiring a deeper level of hypothermia (30°C) for equivalent protection. In conclusion, male and female juvenile mice exhibit equivalent neuronal injury following CA/CPR and hypothermia protects both males and females. We made the surprising finding that juvenile mice have a sexually dimorphic response to mild therapeutic hypothermia protection of synaptic function, where males may need a deeper level of hypothermia for equivalent synaptic protection. PMID:27033251

  5. Submersion, accidental hypothermia and cardiac arrest, mechanical chest compressions as a bridge to final treatment: a case report

    Directory of Open Access Journals (Sweden)

    Rundgren Malin

    2009-02-01

    Full Text Available Abstract Three young men were trapped in a car at the bottom of a canal at two meters depth, after losing control of their vehicle. They were brought up by rescue divers and found in cardiac arrest. One of three patients had return of spontaneous circulation (ROSC, at 47 min after the accident. This sole survivor had the longest submersion time of the three and he received continued mechanical chest compressions during transportation to the hospital. His temperature at admission was 26.9°C, he was rewarmed to 33°C and kept there for 24 h, followed by continued rewarming to normothermia. On day three, he woke up from coma and was discharged from the intensive care unit after one week. At follow-up six months later, he had a complete cerebral recovery but still had myoclonic twitches in the lower extremities. A mechanical device facilitates chest compressions during transportation and may be beneficial as a bridge to final treatment in the hospital. We recommend that comatose patients after submersion, accidental hypothermia and cardiac arrest are treated with mild hypothermia for 12–24 h.

  6. Renal Doppler and Novel Biomarkers to Assess Acute Kidney Injury in a Swine Model of Ventricular Fibrillation Cardiac Arrest

    Institute of Scientific and Technical Information of China (English)

    Xue Mei; Chen-Chen Hang; Shuo Wang; Chun-Sheng Li; Ze-Xing Yu

    2015-01-01

    Background: Majority of the research on cardiac arrest (CA) have focused on post-CA brain injury and myocardial dysfunction, the renal dysfunction and acute kidney injury (AKI) in other critical illnesses after CA have not been well described.This study was designed to assess AKI with renal Doppler and novel AKI biomarkers in a swine model ofventricular fibrillation cardiac arrest (VFCA).Methods: Thirty healthy piglets were divided into VFCA group (n =22) and Sham group (n =8) in a blinded manner.Mean arterial pressure, heart rate, and cardiac output were recorded continuously.Cardiac arrest (CA) was induced by programmed electric stimulation in the VFCA group, and then cardiopulmonary resuscitation was performed.Twenty piglets retumed of spontaneous circulation (ROSC) and received intensive care.Blood and urine samples were collected for AKI biomarkers testing, and Color Doppler flow imaging was performed at baseline, 6 h, 12 h, and 24 h,respectively after ROSC.At ROSC 24 h, the animals were sacrificed and a semi-quantitative evaluation of pathologic kidney injury was performed.Results: In the VFCA group, corrected resistive index (cRI) increased from 0.47 ± 0.03 to 0.64 ± 0.06, and pulsatility index (PI) decreased from 0.82 ± 0.03 to 0.68 ± 0.04 after ROSC.Cystatin C (CysC) in both serum and urine samples increased at ROSC 6 h, but neutrophil gelatinase-associated lipocalin (NGAL) in serum increased to 5.34 ± 1.68 ng/ml at ROSC 6 h, and then decreased to 3.16 ± 0.69 ng/ml at ROSC 24 h while CysC increasing constantly.According to the renal histopathology, 18 of 20 animals suffered from kidney injury.The grade of renal injury was highly correlated with RI, cRI, NGAL, and CysC.Linear regression equation was established: Grade of renal injury =0.002 × serum CysC + 6.489 × PI + 4.544 × cRI-8.358 (r2 =0.698, F =18.506, P < 0.001).Conclusions: AKI is common in post-CA syndrome.Renal Doppler and novel AKI biomarkers in serum and urine are of significant

  7. Progress of Animal Model of Cardiac Arrest and Resuscitation in Rabbits%家兔心跳骤停复苏模型的研究进展

    Institute of Scientific and Technical Information of China (English)

    田苗苗; 张兵; 李文志

    2012-01-01

    心跳骤停是临床医学中最为危急的事件之一,其发生发展过程涉及了一系列的病理生理学改变.近几年来,有关于心跳骤停复苏的研究有很多,也取得了一定的进展,但关于其各种不同类型心跳骤停的病理生理学改变的理解仍不是十分的全面,其有效地治疗药物和治疗手段也仍需要进一步的研究.因此,成功地制备与人类心跳骤停相似的动物模型就显得非常必要来,这不仅是深入研究心跳骤停复苏病理生理学改变的重要基础和研究途径,也是研制其治疗药物及方法的有效手段.本文重点讨论家兔各种类型心跳骤停复苏模型不同的研究方法.%Cardiac arrest is one of the most critical events in the clinical medicine, involving a series ofpathophysiological changes. In recent years, there are many researches about cardiac arrest and cardiopulmonary resuscitation and have achieved some progress, however, it they are not enough, the explanation of the pathophysiological changes in different types of cardiac arrest is not very comprehensive, and the effective drugs and treatments which will benefit cardiac arrest also still need further study. The successed establishment of different types of animal model of cardiac arrest and resuscitation that similar to human is not only the important foundation and research approach for further study of the pathophysiology in various tapes of cardiac arrest, but also the necessary means for the research of much more effective drugs and treatment which will benefit the patients who suffered cardiac arrest. This paper mainly focused on the different research methods in various types of cardiac arrest animal model in rabbits.

  8. Nonaccidental Out-of-Hospital Cardiac Arrest in an Urban Area as a Potential Source of Uncontrolled Organ Donors.

    Science.gov (United States)

    Pabisiak, Krzysztof; Krejczy, Arkadiusz; Dutkiewicz, Grażyna; Safranow, Krzysztof; Sienko, Jerzy; Bohatyrewicz, Romuald; Ciechanowski, Kazimierz

    2016-09-15

    BACKGROUND Donation after cardiac death offers the possibility of increasing the pool of organs for transplantation by up to 30%. Maastricht category type 3 (M3) dominates in most countries with active DCD programs. During preparations to introduce a permanent program for uncontrolled donation after circulatory death in Szczecin, Poland, the donor pool has been estimated. In Poland, Maastricht category type 2 (M2) is considered a basic source for organ recovery. MATERIAL AND METHODS This was a retrospective cohort study of out-of-hospital cardiac arrests (OHCA) reported to local Emergency Medical Services (EMS) between 1 December 2014 and 30 November 2015. The following inclusion criteria were used in the analysis: demographic (age 18-60 years, known identity), clinical (no chest or abdominal injury, no cachexia as an equivalent of wasting diseases), and organizational (weekdays from 8:00 am to 3:00 pm). RESULTS During 12-month period, 118 EMS interventions were recorded in response to sudden cardiac arrest. The stratification process mentioned above used criteria to establish potential, eligible, qualified, and actual donor pools (27 (30.3%), 24 (26.4%), 7 (7.3%), and 6 (6.7%), respectively). To establish a "virtual" actual number of uDCD, the nationwide average level of lack of authorization for donation was 12%. CONCLUSIONS Activation of a permanent program of organ recovery from uDCD would increase the donor pool by 6 cases. Compared to the number of brain-dead donors referred from regional hospitals, this increase would be equivalent to the formation of a new reporting center. The number of transplantable organs could increase by 22% per year.

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

    Directory of Open Access Journals (Sweden)

    Matti-Aleski eMosorin

    2015-01-01

    Full Text Available Objective: The aim of this study is 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 were 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. Such good early and intermediate results observed after CABG suggest a confident approach toward surgical revascularization also in this critically ill patient population.

  10. Application of Positron Emission TomographyintheDetection of Myocardial Metabolism inPigVentricularFibrillation and Asphyxiation Cardiac Arrest ModelsafterResuscitation

    Institute of Scientific and Technical Information of China (English)

    WUCaiJun; LIChunSheng; ZHANGYi; YANGJun

    2014-01-01

    ObjectiveTo study the application of positron emission tomography (PET) in detection of myocardial metabolism in pig ventricular fibrillation and asphyxiation cardiac arrest models after resuscitation. MethodsThirty-two healthyminiature pigs were randomized into aventricular fibrillation cardiac arrest (VFCA) group (n=16) and an asphyxiation cardiac arrest (ACA)group (n=16). Cardiac arrest (CA) was induced byprogrammed electric stimulationorendotracheal tube clamping followed by cardiopulmonary resuscitation (CPR) anddefibrillation. At four hours and 24 h afterspontaneous circulation was achieved, myocardial metabolism was assessed by PET.18F-FDG myocardial uptake in PET was analyzed and the maximum standardized uptake value (SUVmax) was measured. ResultsSpontaneous circulation was 100% and 62.5% in VFCA group and ACA group, respectively.PET demonstrated that the myocardial metabolism injuries was more severe and widespread after ACA than after VFCA. The SUVmax was higher in VFCA group than in ACA group (P<0.01).In VFCA group,SUVmaxat 24h after spontaneous circulation increased to the level of baseline. ConclusionACA causes more severe cardiac metabolism injuries than VFCA. Myocardial dysfunction is associated with less successful resuscitation. Myocardial stunning does occur with VFCA but not with ACA.

  11. Genetic, clinical and pharmacological determinants of out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Blom, M T; van Hoeijen, D A; Bardai, A;

    2014-01-01

    victims since June 2005, we prospectively collect medical history (through hospital and general practitioner), and current and previous medication use (through community pharmacy). In addition, we include DNA samples from OHCA victims with documented ventricular tachycardia/fibrillation during...... the resuscitation attempt since July 2007. Various study designs are employed to analyse the data of the ARREST registry, including case-control, cohort, case only and case-cross over designs. ETHICS AND DISSEMINATION: We describe the rationale, outline and potential results of the ARREST registry. The design...

  12. Alternative therapies for diabetes and its cardiac complications: role of vanadium.

    Science.gov (United States)

    Clark, Tod A; Deniset, Justin F; Heyliger, Clayton E; Pierce, Grant N

    2014-01-01

    It is now well known that a cardiomyopathic state accompanies diabetes mellitus. Although insulin injections and conventional hypoglycemic drug therapy have been of invaluable help in reducing cardiac damage and dysfunction in diabetes, cardiac failure continues to be a common cause of death in the diabetic population. The use of alternative medicine to maintain health and treat a variety of diseases has achieved increasing popularity in recent years. The goal of alternative therapies in diabetic patients has been to lower circulating blood glucose levels and thereby treat diabetic complications. This paper will focus its discussion on the role of vanadium on diabetes and the associated cardiac dysfunction. Careful administration of a variety of forms of vanadium has produced impressive long-lasting control of blood glucose levels in both Type 1 and Type 2 diabetes in animals. This has been accompanied by, in many cases, a complete correction of the diabetic cardiomyopathy. The oral delivery of vanadium as a vanadate salt in the presence of tea has produced particularly impressive hypoglycemic effects and a restoration of cardiac function. This intriguing approach to the treatment of diabetes and its complications, however, deserves further intense investigation prior to its use as a conventional therapy for diabetic complications due to the unknown long-term effects of vanadium accumulation in the heart and other organs of the body. PMID:23430125

  13. Enalapril protects against myocardial ischemia/reperfusion injury in a swine model of cardiac arrest and resuscitation

    Science.gov (United States)

    Wang, Guoxing; Zhang, Qian; Yuan, Wei; Wu, Junyuan; Li, Chunsheng

    2016-01-01

    There is strong evidence to suggest that angiotensin-converting enzyme inhibitors (ACEIs) protect against local myocardial ischemia/reperfusion (I/R) injury. This study was designed to explore whether ACEIs exert cardioprotective effects in a swine model of cardiac arrest (CA) and resuscitation. Male pigs were randomly assigned to three groups: sham-operated group, saline treatment group and enalapril treatment group. Thirty minutes after drug infusion, the animals in the saline and enalapril groups were subjected to ventricular fibrillation (8 min) followed by cardiopulmonary resuscitation (up to 30 min). Cardiac function was monitored, and myocardial tissue and blood were collected for analysis. Enalapril pre-treatment did not improve cardiac function or the 6-h survival rate after CA and resuscitation; however, this intervention ameliorated myocardial ultrastructural damage, reduced the level of plasma cardiac troponin I and decreased myocardial apoptosis. Plasma angiotensin (Ang) II and Ang-(1–7) levels were enhanced in the model of CA and resuscitation. Enalapril reduced the plasma Ang II level at 4 and 6 h after the return of spontaneous circulation whereas enalapril did not affect the plasma Ang-(1–7) level. Enalapril pre-treatment decreased the myocardial mRNA and protein expression of angiotensin-converting enzyme (ACE). Enalapril treatment also reduced the myocardial ACE/ACE2 ratio, both at the mRNA and the protein level. Enalapril pre-treatment did not affect the upregulation of ACE2, Ang II type 1 receptor (AT1R) and MAS after CA and resuscitation. Taken together, these findings suggest that enalapril protects against ischemic injury through the attenuation of the ACE/Ang II/AT1R axis after CA and resuscitation in pigs. These results suggest the potential therapeutic value of ACEIs in patients with CA. PMID:27633002

  14. Inter-Association Task Force Recommendations on Emergency Preparedness and Management of Sudden Cardiac Arrest in High School and College Athletic Programs: A Consensus Statement

    OpenAIRE

    Drezner, Jonathan A; Courson, Ron W; Roberts, William O; Mosesso, Vincent N.; Link, Mark S.; Maron, Barry J.

    2007-01-01

    Objective: To assist high school and college athletic programs prepare for and respond to a sudden cardiac arrest (SCA). This consensus statement summarizes our current understanding of SCA in young athletes, defines the necessary elements for emergency preparedness, and establishes uniform treatment protocols for the management of SCA.

  15. Temporal Trends in Coverage of Historical Cardiac Arrests Using a Volunteer-Based Network of Automated External Defibrillators Accessible to Laypersons and Emergency Dispatch Centers

    DEFF Research Database (Denmark)

    Malta Hansen, Carolina; Knudsen Lippert, Freddy; Wissenberg, Mads;

    2014-01-01

    BACKGROUND: -Although increased dissemination of Automated External Defibrillators (AEDs) has been associated with more frequent AED use, the trade-off between the number of deployed AEDs and coverage of cardiac arrests remains unclear. We investigated how volunteer-based AED dissemination affect...

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

    DEFF Research Database (Denmark)

    Nielsen, Niklas; Wetterslev, Jørn; al-Subaie, Nawaf;

    2012-01-01

    Experimental animal studies and previous randomized trials suggest an improvement in mortality and neurologic function with induced hypothermia after cardiac arrest. International guidelines advocate the use of a target temperature management of 32°C to 34°C for 12 to 24 hours after resuscitation...

  17. Survival after out-of-hospital cardiac arrest in relation to age and early identification of patients with minimal chance of long-term survival

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Folke, Fredrik; Hansen, Carolina Malta;

    2015-01-01

    BACKGROUND: Survival after out-of-hospital cardiac arrest has increased during the last decade in Denmark. We aimed to study the impact of age on changes in survival and whether it was possible to identify patients with minimal chance of 30-day survival. METHODS AND RESULTS: Using data from the n...

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

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske;

    2011-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...

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

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske;

    2010-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...

  20. Impact of Dispatcher‐Assisted Bystander Cardiopulmonary Resuscitation on Neurological Outcomes in Children With Out‐of‐Hospital Cardiac Arrests: A Prospective, Nationwide, Population‐Based Cohort Study

    OpenAIRE

    Goto, Yoshikazu; Maeda, Tetsuo; GOTO, YUMIKO

    2014-01-01

    Background The impact of dispatcher‐assisted bystander cardiopulmonary resuscitation (CPR) on neurological outcomes in children is unclear. We investigated whether dispatcher‐assisted bystander CPR shows favorable neurological outcomes (Cerebral Performance Category scale 1 or 2) in children with out‐of‐hospital cardiac arrest (OHCA). Methods and Results Children (n=5009, age

  1. Incidence, Causes, and Outcomes of Out-of-Hospital Cardiac Arrest in Children A Comprehensive, Prospective, Population-Based Study in the Netherlands

    NARCIS (Netherlands)

    A. Bardai; J. Berdowski; C. van der Werf; M.T. Blom; M. Ceelen; I.M. van Langen; J.G.P. Tijssen; A.A.M. Wilde; R.W. Koster; H.L. Tan

    2011-01-01

    Objectives This study sought to determine comprehensively the incidence of pediatric out-of-hospital cardiac arrest (OHCA) and its contribution to total pediatric mortality, the causes of pediatric OHCA, and the outcome of resuscitation of pediatric OHCA patients. Background There is a paucity of co

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

    DEFF Research Database (Denmark)

    Søholm, Helle; Wachtell, Kristian; Nielsen, Søren Loumann;

    2013-01-01

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

  3. Resuscitation and post resuscitation care of the very old after out-of-hospital cardiac arrest is worthwhile

    DEFF Research Database (Denmark)

    Winther-Jensen, Matilde; Kjaergaard, Jesper; Hassager, Christian;

    2015-01-01

    BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. OBJECTIVES: We aimed to investigate mortality, neurological outcome and post resuscitation care...... in octogenarians (≥80) to assess whether resuscitation and post resuscitation care should be avoided. METHODS: During 2007-2011 consecutive OHCA-patients were attended by the physician-based Emergency Medical Services-system in Copenhagen. Pre-hospital data based on Utstein-criteria, and data on post resuscitation...... care were collected. Primary outcome was successful resuscitation; secondary endpoints were 30-day mortality and neurological outcome (Cerebral Performance Category (CPC)). RESULTS: 2509 OHCA-patients with attempted resuscitation were recorded, 22% (n=558) were octogenarians/nonagenarians. 166 (30...

  4. High resolution ECG-aided early prognostic model for comatose survivors of out of hospital cardiac arrest.

    Science.gov (United States)

    Rauber, Martin; Štajer, Dušan; Noč, Marko; Schlegel, Todd T; Starc, Vito

    2015-01-01

    Out of hospital cardiac arrest (OHCA) has a high mortality despite modern treatment. Reliable early prognosis in OHCA could significantly improve clinical decision making. We explored prognostic utility of advanced ECG parameters, obtained from high-resolution ECG, in combination with clinical and OHCA-related parameters during treatment with mild induced hypothermia (MIH) and after rewarming in unconscious survivors of OHCA. Ninety-two patients during MIH and 66 after rewarming were included. During MIH, a score based on initial rhythm, QRS-upslope and systolic pressure resulted in an area under curve (AUC) of 0.82 and accuracy of 80% for survival. After rewarming, a score based on admission rhythm, sum of 12 lead QRS voltages, and mean lateral ST segment level in leads I and V6 resulted in an AUC of 0.88 and accuracy of 85% for survival. ECG can assist with early prognostication in unconscious survivors of OHCA during MIH and after rewarming. PMID:25911585

  5. Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer's solution: a pilot study.

    Science.gov (United States)

    Virkkunen, Ilkka; Yli-Hankala, Arvi; Silfvast, Tom

    2004-09-01

    The cooling and haemodynamic effects of prehospital infusion of ice-cold Ringer's solution were studied in 13 adult patients after successful resuscitation from non-traumatic cardiac arrest. After haemodynamics stabilisation, 30 ml/kg of Ringer's solution was infused at a rate of 100ml/min into the antecubital vein. Arterial blood pressure and blood gases, pulse rate, end-tidal CO(2) and oesophageal temperature were monitored closely. The mean core temperature decreased from 35.8 +/- 0.9 degrees C at the start of infusion to 34.0 +/- 1.2 degrees C on arrival at hospital (P < 0.0001). No serious adverse haemodynamic effects occurred. It is concluded that the induction of therapeutic hypothermia using this technique in the prehospital setting is feasible. PMID:15325449

  6. Prophylactic antibiotics are associated with a lower incidence of pneumonia in cardiac arrest survivors treated with targeted temperature management

    DEFF Research Database (Denmark)

    Gagnon, David J; Nielsen, Niklas; Fraser, Gilles L;

    2015-01-01

    -34 °C were enrolled in the registry. Differences were analyzed in univariate analyses and with logistic regression models to evaluate independent associations of clinical factors with incidence of pneumonia and good functional outcome. RESULTS: 416 of 1240 patients (33.5%) received PRO. Groups were......INTRODUCTION: Prophylactic antibiotics (PRO) reduce the incidence of early-onset pneumonia in comatose patients with structural brain injury, but have not been examined in cardiac arrest survivors undergoing targeted temperature management (TTM). We investigated the effect of PRO on the development...... of a good functional outcome (41.1 vs. 36.6%, p = 0.19) were similar between groups. Backwards stepwise logistic regression demonstrated PRO were independently associated with a lower incidence of pneumonia (OR 0.09, 95% 0.06-0.14, p

  7. Difficulties with neurological prognostication in a young woman with delayed-onset generalised status myoclonus after cardiac arrest due to acute severe asthma

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    Arvind Rajamani

    2011-01-01

    Full Text Available Neurological prognostication in cardiac arrest survivors is difficult, especially when the primary etiology is respiratory arrest. Prognostic factors designed to have zero false-positive rates to robustly confirm poor outcome are usually inadequate to rule out poor outcomes (i.e., high specificity and low sensitivity. One of the least understood prognosticators is generalised status myoclonus (GSM, with case reports confusing GSM, isolated myoclonic jerks and post-hypoxic intention myoclonus (Lance Adams syndrome [LAS]. With several prognostic indicators (including status myoclonus having been validated in the pre-hypothermia era, their current relevance is debatable. New modalities such as brain magnetic resonance imaging (MRI and continuous electroencephalography are being evaluated. We describe here a pregnant woman resuscitated from a cardiac arrest due to acute severe asthma, and an inability to reach a consensus based on published guidelines, with a brief overview of myoclonus, LAS and the role of MRI brain in assisting prognostication.

  8. Cardiac arrest provoked by itraconazole and amiodarone interaction: a case report

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    Betrosian Alex

    2011-07-01

    Full Text Available Abstract Introduction Azoles, and specifically itraconazole, are often prescribed for the treatment of fungal diseases or empirically for persistent sepsis in patients who are neutropenic or in intensive care. Occasional cardiovascular adverse events have been associated with itraconazole use, and are usually attributed to the interaction of itraconazole with cisapride, terfenadine or digoxin. Its interaction with amiodarone has not been previously described. Case presentation A 65-year-old Caucasian man was admitted to the Intensive Care Unit at our facility for an extensive ischemic stroke associated with atrial fibrillation. Due to rapid ventricular response he was started on intravenous amiodarone and few days later itraconazole was also prescribed for presumed candidemia. After receiving the first dose our patient became profoundly hypotensive but responded rapidly to fluids and adrenaline. Then, two months later, itraconazole was again prescribed for confirmed fungemia. After receiving the first dose via a central venous catheter our patient became hypotensive and subsequently arrested. He was resuscitated successfully, and as no other cause was identified the arrest was attributed to septic shock and his antifungal treatment was changed to caspofungin. When sensitivity test results became available, antifungal treatment was down-staged to itraconazole and immediately after drug administration our patient suffered another arrest and was once again resuscitated successfully. This time the arrest was related to itraconazole, which was discontinued, and from then on our patient remained stable until his discharge to our neurology ward. Conclusions Itraconazole and amiodarone coadministration can lead to serious cardiovascular adverse events in patients who are critically ill. Intensivists, pharmacists and medical physicians should be aware of the interaction of these two commonly used drugs.

  9. Hyperoxia Early After Hospital Admission in Comatose Patients with Non-Traumatic Out-of-Hospital Cardiac Arrest

    Science.gov (United States)

    Christ, Martin; von Auenmueller, Katharina Isabel; Brand, Michael; Amirie, Scharbanu; Sasko, Benjamin Michel; Trappe, Hans-Joachim

    2016-01-01

    Background The clinical effect of hyperoxia in patients with non-traumatic out-of-hospital cardiac arrest (OHCA) remains uncertain. We therefore initiated this study to find out whether there is an association between survival and hyperoxia early after return of spontaneous circulation (ROSC) in OHCA patients admitted to our hospital. Material/Methods All OHCA patients admitted to our hospital between 1 January 2008 and 30 June 2015 were identified by analysis of our central admission register. Data from individual patients were collected from patient health records and anonymously stored on a central database. Results Altogether, there were 280 OHCA patients admitted to our hospital between 1 January 2008 and 30 June 2015, including 35 patients (12.5%) with hyperoxia and 99 patients (35.4%) with normoxia. Comparison of these 2 groups showed lower pH values in OHCA patients admitted with normoxia compared to those with hyperoxia (7.10±0.18 vs. 7.21±0.17; p=0.001) but similar rates of initial lactate (7.92±3.87 mmol/l vs. 11.14±16.40 mmol/l; p=0.072). Survival rates differed between both groups (34.4% vs. 54.3%; p=0.038) with better survival rates in OHCA patients with hyperoxia at hospital admission. Conclusions Currently, different criteria are used to define hyperoxia following OHCA, but if the negative effects of hyperoxia in OHCA patients are a cumulative effect over time, hyperoxia < 60 min after hospital admission as investigated in this study would be equivalent to a short period of hyperoxia. It may be that the positive effect of buffering metabolic acidosis early after cardiac arrest maintains the negative effects of hyperoxia in general. PMID:27638399

  10. The Effect of Compressor-Administered Defibrillation on Peri-shock Pauses in a Simulated Cardiac Arrest Scenario

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    Joshua Glick

    2014-03-01

    Full Text Available Introduction: Coordination of the tasks of performing chest compressions and defibrillation can lead to communication challenges that may prolong time spent off the chest. The purpose of this study was to determine whether defibrillation provided by the provider performing chest compressions led to a decrease in peri-shock pauses as compared to defibrillation administered by a second provider, in a simulated cardiac arrest scenario. Methods: This was a randomized, controlled study measuring pauses in chest compressions for defibrillation in a simulated cardiac arrest model. We approached hospital providers with current CPR certification for participation between July, 2011 and October, 2011. Volunteers were randomized to control (facilitator-administered defibrillation or experimental (compressor-administered defibrillation groups. All participants completed one minute of chest compressions on a mannequin in a shockable rhythm prior to administration of defibrillation. We measured and compared pauses for defibrillation in both groups. Results: Out of 200 total participants, we analyzed data from 197 defibrillations. Compressor-initiated defibrillation resulted in a significantly lower pre-shock hands-off time (0.57 s; 95% CI: 0.47-0.67 compared to facilitator-initiated defibrillation (1.49 s; 95% CI: 1.35-1.64. Furthermore, compressor-initiated defibrillation resulted in a significantly lower peri-shock hands-off time (2.77 s; 95% CI: 2.58-2.95 compared to facilitator-initiated defibrillation (4.25 s; 95% CI: 4.08-4.43. Conclusion: Assigning the responsibility for shock delivery to the provider performing compressions encourages continuous compressions throughout the charging period and decreases total time spent off the chest. However, as this was a simulation-based study, clinical implementation is necessary to further evaluate these potential benefits. [West J Emerg Med. 2014;15(2:246–250.

  11. Microdialysis Assessment of Cerebral Perfusion during Cardiac Arrest, Extracorporeal Life Support and Cardiopulmonary Resuscitation in Rats – A Pilot Trial

    Science.gov (United States)

    Schober, Andreas; Warenits, Alexandra M.; Testori, Christoph; Weihs, Wolfgang; Hosmann, Arthur; Högler, Sandra; Sterz, Fritz; Janata, Andreas; Scherer, Thomas; Magnet, Ingrid A. M.; Ettl, Florian; Laggner, Anton N.; Herkner, Harald; Zeitlinger, Markus

    2016-01-01

    Cerebral metabolic alterations during cardiac arrest, cardiopulmonary resuscitation (CPR) and extracorporeal cardiopulmonary life support (ECLS) are poorly explored. Markers are needed for a more personalized resuscitation and post—resuscitation care. Aim of this study was to investigate early metabolic changes in the hippocampal CA1 region during ventricular fibrillation cardiac arrest (VF-CA) and ECLS versus conventional CPR. Male Sprague-Dawley rats (350g) underwent 8min untreated VF-CA followed by ECLS (n = 8; bloodflow 100ml/kg), mechanical CPR (n = 18; 200/min) until return of spontaneous circulation (ROSC). Shams (n = 2) were included. Glucose, glutamate and lactate/pyruvate ratio were compared between treatment groups and animals with and without ROSC. Ten animals (39%) achieved ROSC (ECLS 5/8 vs. CPR 5/18; OR 4,3;CI:0.7–25;p = 0.189). During VF-CA central nervous glucose decreased (0.32±0.1mmol/l to 0.04±0.01mmol/l; p<0.001) and showed a significant rise (0.53±0.1;p<0.001) after resuscitation. Lactate/pyruvate (L/P) ratio showed a 5fold increase (31 to 164; p<0.001; maximum 8min post ROSC). Glutamate showed a 3.5-fold increase to (2.06±1.5 to 7.12±5.1μmol/L; p<0.001) after CA. All parameters normalized after ROSC with no significant differences between ECLS and CPR. Metabolic changes during ischemia and resuscitation can be displayed by cerebral microdialysis in our VF-CA CPR and ECLS rat model. We found similar microdialysate concentrations and patterns of normalization in both resuscitation methods used. Institutional Protocol Number: GZ0064.11/3b/2011 PMID:27175905

  12. Regions of High Out-Of-Hospital Cardiac Arrest Incidence and Low Bystander CPR Rates in Victoria, Australia

    Science.gov (United States)

    Straney, Lahn D.; Bray, Janet E.; Beck, Ben; Finn, Judith; Bernard, Stephen; Dyson, Kylie; Lijovic, Marijana; Smith, Karen

    2015-01-01

    Background Out-of-hospital cardiac arrest (OHCA) remains a major public health issue and research has shown that large regional variation in outcomes exists. Of the interventions associated with survival, the provision of bystander CPR is one of the most important modifiable factors. The aim of this study is to identify census areas with high incidence of OHCA and low rates of bystander CPR in Victoria, Australia Methods We conducted an observational study using prospectively collected population-based OHCA data from the state of Victoria in Australia. Using ArcGIS (ArcMap 10.0), we linked the location of the arrest using the dispatch coordinates (longitude and latitude) to Victorian Local Government Areas (LGAs). We used Bayesian hierarchical models with random effects on each LGA to provide shrunken estimates of the rates of bystander CPR and the incidence rates. Results Over the study period there were 31,019 adult OHCA attended, of which 21,436 (69.1%) cases were of presumed cardiac etiology. Significant variation in the incidence of OHCA among LGAs was observed. There was a 3 fold difference in the incidence rate between the lowest and highest LGAs, ranging from 38.5 to 115.1 cases per 100,000 person-years. The overall rate of bystander CPR for bystander witnessed OHCAs was 62.4%, with the rate increasing from 56.4% in 2008–2010 to 68.6% in 2010–2013. There was a 25.1% absolute difference in bystander CPR rates between the highest and lowest LGAs. Conclusion Significant regional variation in OHCA incidence and bystander CPR rates exists throughout Victoria. Regions with high incidence and low bystander CPR participation can be identified and would make suitable targets for interventions to improve CPR participation rates. PMID:26447844

  13. Regions of High Out-Of-Hospital Cardiac Arrest Incidence and Low Bystander CPR Rates in Victoria, Australia.

    Directory of Open Access Journals (Sweden)

    Lahn D Straney

    Full Text Available Out-of-hospital cardiac arrest (OHCA remains a major public health issue and research has shown that large regional variation in outcomes exists. Of the interventions associated with survival, the provision of bystander CPR is one of the most important modifiable factors. The aim of this study is to identify census areas with high incidence of OHCA and low rates of bystander CPR in Victoria, Australia.We conducted an observational study using prospectively collected population-based OHCA data from the state of Victoria in Australia. Using ArcGIS (ArcMap 10.0, we linked the location of the arrest using the dispatch coordinates (longitude and latitude to Victorian Local Government Areas (LGAs. We used Bayesian hierarchical models with random effects on each LGA to provide shrunken estimates of the rates of bystander CPR and the incidence rates.Over the study period there were 31,019 adult OHCA attended, of which 21,436 (69.1% cases were of presumed cardiac etiology. Significant variation in the incidence of OHCA among LGAs was observed. There was a 3 fold difference in the incidence rate between the lowest and highest LGAs, ranging from 38.5 to 115.1 cases per 100,000 person-years. The overall rate of bystander CPR for bystander witnessed OHCAs was 62.4%, with the rate increasing from 56.4% in 2008-2010 to 68.6% in 2010-2013. There was a 25.1% absolute difference in bystander CPR rates between the highest and lowest LGAs.Significant regional variation in OHCA incidence and bystander CPR rates exists throughout Victoria. Regions with high incidence and low bystander CPR participation can be identified and would make suitable targets for interventions to improve CPR participation rates.

  14. Decreased Monocyte HLA-DR Expression in Patients After Non-Shockable out-of-Hospital Cardiac Arrest.

    Science.gov (United States)

    Venet, Fabienne; Cour, Martin; Demaret, Julie; Monneret, Guillaume; Argaud, Laurent

    2016-07-01

    Out-of-hospital cardiac arrest (OHCA) constitutes a major health care problem with the development in immediate survivors of a post-cardiac arrest syndrome including systemic inflammatory response as observed in sepsis. As a decreased monocyte HLA-DR expression (mHLA-DR) has been repeatedly described in septic patients in association with an increased risk of death and nosocomial infections, we tested whether this immune alteration could also be observed after OHCA. Fifty-five non-shockable OHCA patients sampled at Day 0 (D0: within 4 h after OHCA), D1 (the next day), and D3: (after 2 additional days) were included. CD4+ lymphocyte count and mHLA-DR were evaluated by flow cytometry. We observed a marked decrease in mHLA-DR as early as D0 in patients compared with normal values. This decrease persisted till D3 and was associated with a moderate decrease in the number of circulating CD4+ lymphocytes. No correlations were identified between mHLA-DR and usual prognostic markers after OHCA. However, overtime evolution in mHLA-DR values appeared different between survivors and non-survivors with a quasisystematic decrease between D1 and D3 in non-survivors versus an increased expression in survivors. In conclusion, this preliminary pilot study describes the occurrence of OHCA-induced immune alterations as illustrated by a decreased mHLA-DR and CD4+ lymphopenia. Furthermore, we show for the first time the differential overtime evolution in mHLA-DR between survivors and non-survivors without association with usual prognostic markers and multiple organ failure. These initial results should now be confirmed in a larger cohort of OHCA patients. PMID:26796574

  15. A survey of attitudes and factors associated with successful cardiopulmonary resuscitation (CPR knowledge transfer in an older population most likely to witness cardiac arrest: design and methodology

    Directory of Open Access Journals (Sweden)

    Brehaut Jamie C

    2008-11-01

    Full Text Available Abstract Background Overall survival rates for out-of-hospital cardiac arrest rarely exceed 5%. While bystander cardiopulmonary resuscitation (CPR can increase survival for cardiac arrest victims by up to four times, bystander CPR rates remain low in Canada (15%. Most cardiac arrest victims are men in their sixties, they usually collapse in their own home (85% and the event is witnessed 50% of the time. These statistics would appear to support a strategy of targeted CPR training for an older population that is most likely to witness a cardiac arrest event. However, interest in CPR training appears to decrease with advancing age. Behaviour surrounding CPR training and performance has never been studied using well validated behavioural theories. Methods/Design The overall goal of this study is to conduct a survey to better understand the behavioural factors influencing CPR training and performance in men and women 55 years of age and older. The study will proceed in three phases. In phase one, semi-structured qualitative interviews will be conducted and recorded to identify common categories and themes regarding seeking CPR training and providing CPR to a cardiac arrest victim. The themes identified in the first phase will be used in phase two to develop, pilot-test, and refine a survey instrument based upon the Theory of Planned Behaviour. In the third phase of the project, the final survey will be administered to a sample of the study population over the telephone. Analyses will include measures of sampling bias, reliability of the measures, construct validity, as well as multiple regression analyses to identify constructs and beliefs most salient to seniors' decisions about whether to attend CPR classes or perform CPR on a cardiac arrest victim. Discussion The results of this survey will provide valuable insight into factors influencing the interest in CPR training and performance among a targeted group of individuals most susceptible to

  16. Effects of nimodipine on cerebral blood flow and cerebrospinal fluid pressure after cardiac arrest: correlation with neurologic outcome.

    Science.gov (United States)

    Forsman, M; Aarseth, H P; Nordby, H K; Skulberg, A; Steen, P A

    1989-04-01

    Fifty-one patients were included in a blind randomized study to evaluate whether the Ca-blocker nimodipine could influence cerebral blood flow (CBF) or cerebrospinal fluid pressure (CSFP) during the cerebral hypoperfusion period that follows resuscitation from cardiac arrest and to determine whether changes in CBF correlate with neurologic outcome. CBF measured 1 to 4 hours after arrest with the use of 133Xe intravenous was significantly greater with nimodipine than with placebo (27 +/- 3 versus 13 +/- 1 ml.100 g-1.min-1 at 3 hours), but with no significant difference at 24 hours. There was no clinical evidence of seriously increased CSFP in any patient in either group the first 48 hours. Mean arterial pressure was significantly lower (86 +/- 4 versus 101 +/- 4 mm Hg at 3 hours), and antiarrhythmic drugs were used significantly less frequently in the nimodipine group than in the placebo group. Twelve patients in each group eventually regained consciousness. There was no significant difference in neurologic status between the two groups at any point, and no positive correlation between CBF in the hypoperfusion period and neurologic outcome. PMID:2929976

  17. Myocardial Infarction and Aortic Root Mycotic Aneurysm Complicating Aortic Valve Endocarditis: Utility of Cardiac CT.

    Science.gov (United States)

    Moores, Aimee E; Cahill, Michael S; Villines, Todd C

    2016-01-01

    Aortic mycotic aneurysms are a rare but life-threatening potential complication of infective endocarditis. Rapid deterioration of the vascular wall in highly focal areas makes these pseudoaneurysms particularly prone to rupture, resulting in uncontrolled aortic hemorrhage. While computed tomography angiography (CTA) is the imaging modality of choice for the evaluation of mycotic aneurysms, it is not routinely performed in patients with known or suspected infective endocarditis (IE). However, current valvular heart disease guidelines support the use of cardiac CTA in cases of IE and suspected perivalvular extension when there is inadequate or ambiguous visualization on echocardiography. Here, we describe a case of IE in which cardiac CTA was used for two purposes: to assess perivalvular complications and to define coronary anatomy in a patient with a suspected embolic myocardial infarction. Subsequent detection of an aortic root mycotic aneurysm not previously demonstrated on transthoracic or transesophageal echocardiography allowed for timely and uncomplicated surgical intervention, while avoiding invasive coronary angiography. PMID:27642299

  18. [Hydatic pulmonary embolism complicating a cardiac hydatic cyst. A case report].

    Science.gov (United States)

    Kammoun, Ikram; Ben Halima, Afef; Ammar, Jamel; Chine, Samira; Chaabane, Olfa; Zouaoui, Walid; Rebeh, Balsam; Keskes, Hend; Gargouri, Sami; Lefi, Abdellatif; Hamzaoui, Agnès; Kachboura, Salem

    2004-08-01

    Hydatic pulmonary embolism: complication of a cardiac hydatic cyst:a case report hydatic cardiac cyst is a rare condition and represents only 0.5 to 2% of all visceral localisations of the hydatid disease. We reported a 28 year old patient with a multiple hydatic pulmonary embolism caused by the rupture of a hydatic cyst of the interventricular septum. The diagnosis was established by transthoracic echocardiography and CT Scan. Surgery was performed without delay and the outcome was good after a five month follow-up. This case illustrates the diagnostic value of the non invasive imaging means in hydatic cyst of the heart and underlines the importance of surgery realized before complications occur.

  19. Spiral CT of Non-Graft Post Cardiac Surgery Complications: A Pictorial Essay

    Directory of Open Access Journals (Sweden)

    S. Shirani

    2010-06-01

    Full Text Available Spiral CT is a rapidly growing method for noninvasive visualization of post-operative complications, including post-operative complications in CABG (coronary artery bypass graft. In the recent years, several different, yet more efficient types have been introduced with progressive improvement in the diagnostic accuracy in the detection of post-operative complications. The introduction of 64-slice technology, which allows high resolution as well as reconstructed images, has resulted in further progress in the diagnostic process. This kind of diagnostic equipment will spread rapidly in the world. Although studies with large numbers of patients regarding spiral CT as a routine diagnostic method have not been reported, there is great need for it all over the world. In this article, we intend to review the spiral CT findings of non-graft complications in patients after cardiac surgery.

  20. Influence of pre-, post-, and simultaneous perfusion of elevated calcium on the effect of ascending concentrations of lead on digoxin-induced cardiac arrest in isolated frog heart

    Energy Technology Data Exchange (ETDEWEB)

    Krishnamoorthy, M.S.; Muthu, P.; Parthiban, N. [Univ. of Madras (Indonesia)

    1995-10-01

    Cardiotoxicity of lead, a ubiquitous environmental pollutant, has already been documented as a potentially lethal, although rarely recognized, complication of lead intoxication. Further, it has already been reported from this laboratory that lead acetate (LA) preperfusion potentiated cardiotoxicity of digoxin (DGN) in isolated frog heart preparation and that exposure to elevated calcium (elev. Ca{sup 2+}) prior to, and simultaneously with LA at 10{sup {minus}7} M concentration, attenuated this potentiation. As an extension of this work, it was considered of interest to study the effect of perfusion of elev. Ca{sup 2+} (6.5 mM) prior to, after and simultaneously with ascending concentrations of lead (10{sup {minus}9}, 10{sup {minus}7} and 10{sup {minus}5}M) on DGN induced cardiac arrest (CA) in isolated frog heart, since Pb{sup 2+} and Ca{sup 2+} ions are known to compete with each other for the same target sites at the cellular level, an instance of competitive mass action effect. 15 refs., 1 fig., 1 tab.

  1. Early-Onset Pneumonia in Non-Traumatic Out-of-Hospital Cardiac Arrest Patients with Special Focus on Prehospital Airway Management.

    Science.gov (United States)

    Christ, Martin; von Auenmueller, Katharina Isabel; Amirie, Scharbanu; Sasko, Benjamin Michel; Brand, Michael; Trappe, Hans-Joachim

    2016-01-01

    BACKGROUND More than half of all non-traumatic out-of-hospital cardiac arrest (OHCA) patients die in the hospital. Early-onset pneumonia (EOP) has been described as one of the most common complications after successful cardiopulmonary resuscitation. However, the expanded use of alternative airway devices (AAD) might influence the incidence of EOP following OHCA. MATERIAL AND METHODS We analyzed data from all OHCA patients admitted to our hospital between 1 January 2008 and 31 December 2014. EOP was defined as proof of the presence of a pathogenic microorganism in samples of respiratory secretions within the first 5 days after hospital admission. RESULTS There were 252 patients admitted: 155 men (61.5%) and 97 women (38.5%), with a mean age of 69.1±13.8 years. Of these, 164 patients (77.6%) were admitted with an endotracheal tube (ET) and 62 (27.4%) with an AAD. We found that 36 out of a total of 80 respiratory secretion samples (45.0%) contained pathogenic microorganisms, with Staphylococcus aureus as the most common bacteria. Neither bacterial detection (p=0.765) nor survival rates (p=0.538) differed between patients admitted with ET and those with AAD. CONCLUSIONS Irrespective of increasing use of AAD, the incidence of EOP remains high. PMID:27295123

  2. 急性脑卒中致心脏骤停原因分析%Analysis of the causes of cardiac arrest induced by acute stroke

    Institute of Scientific and Technical Information of China (English)

    王智超; 刘霖

    2013-01-01

    Objective:To discuss the reasons of cardiac arrest caused by acute stroke,so as to strengthen the comprehensive treatment after cardiac arrest.Method:Retrospectively analyzed the medical records of 36 patients with cardiac arrest caused by acute stroke treated in our department in the recent 3 years.Result:The cardiac arrest in 29 of the 36 cases were considered as secondary heart injury or arrhythmia caused;5 cases were brain stem damage caused; 2 cases were vomiting obstruction of respiratory tract and suffocation caused.Conclusion:The frequent causes of cardiac arrest caused by acute stroke include secondary heart injury or arrhythmia,brain stem damage,asphyxia.And secondary heart injury or arrhythmia might be the most common reason.%目的:探讨急性脑卒中致心脏骤停原因,以加强心脏骤停后治疗.方法:回顾性分析我科近三年来收治的36例急性脑卒中导致心脏骤停患者的病历资料,探讨急性脑卒中导致心脏骤停病因.结果:36例患者中29例考虑出现继发心肌损伤或心律失常而引起心脏骤停;5例因脑干生命中枢受损引起心脏骤停;2例呕吐物阻塞呼吸道,出现窒息而引起心脏骤停.结论:急性脑卒中致心脏骤停原因考虑:继发心肌损伤或心律失常、脑干生命中枢受损、窒息,以继发心肌损伤或心律失常最常见.

  3. Cardiac surgery in a patient with immunological thrombocytopenic purpura: Complications and precautions

    Directory of Open Access Journals (Sweden)

    Vivek Chowdhry

    2013-01-01

    Full Text Available Immune thrombocytopenic purpura (ITP patients are at high-risk for bleeding complications during and after cardiac surgeries involving cardiopulmonary bypass. We report a patient with ITP with severe coronary artery disease and mitral valve regurgitation who underwent uncomplicated coronary artery bypass grafting and mitral valve replacement. Three weeks later, the patient was readmitted in a very low general condition with signs of pericardial tamponade. We describe our experience of managing the case.

  4. Collaborative effects of bystander-initiated cardiopulmonary resuscitation and prehospital advanced cardiac life support by physicians on survival of out-of-hospital cardiac arrest: a nationwide population-based observational study

    OpenAIRE

    Yasunaga, Hideo; Horiguchi, Hiromasa; Tanabe, Seizan; Akahane, Manabu; OGAWA, Toshio; Koike, Soichi; Imamura, Tomoaki

    2010-01-01

    Introduction There are inconsistent data about the effectiveness of prehospital physician-staffed advanced cardiac life support (ACLS) on the outcomes of out-of-hospital cardiac arrest (OHCA). Furthermore, the relative importance of bystander-initiated cardiopulmonary resuscitation (BCPR) and ACLS and the effectiveness of their combination have not been clearly demonstrated. Methods Using a prospective, nationwide, population-based registry of all OHCA patients in Japan, we enrolled 95,072 pa...

  5. Mechanical Chest Compressions in Prolonged Cardiac Arrest due to ST Elevation Myocardial Infarction Can Cause Myocardial Contusion.

    Science.gov (United States)

    Stechovsky, Cyril; Hajek, Petr; Cipro, Simon; Veselka, Josef

    2016-09-01

    Acute coronary syndrome is a common cause of sudden cardiac death. We present a case report of a 60-year-old man without a history of coronary artery disease who presented with ST-elevation myocardial infarction. During transportation to the hospital, he developed ventricular fibrillation (VF) and later pulseless electrical activity. Chest compressions with LUCAS 2 (Medtronic, Minneapolis, MN) automated mechanical compression-decompression device were initiated. Coronary angiography showed total occlusion of the left main coronary artery and primary percutaneous coronary intervention (PCI) was performed. After the PCI, his heart started to generate effective contractions and LUCAS could be discontinued. Return of spontaneous circulation was achieved after 90 minutes of cardiac arrest. The patient died of cardiogenic shock 11 hours later. An autopsy revealed a transmural anterolateral myocardial infarction but also massive subepicardial hemorrhage and interstitial edema and hemorrhages on histologic samples from regions of the myocardium outside the infarction itself and also from the right ventricle. These lesions were concluded to be a myocardial contusion. The true incidence of myocardial contusion as a consequence of mechanical chest compressions is not known. We speculate that severe myocardial contusion might have influenced outcome of our patient. PMID:27574387

  6. Comparison of epinephrine and Shen-Fu injection on resuscitation outcomes in a porcine model of prolonged cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    Yin Wenpeng; Guo Zhijun; Li Chunsheng

    2014-01-01

    Background Epinephrine has been used as a first-choice vasopressor drug for cardiac arrest (CA) since 1974.However,the administration of epinephrine is controversial.This study aims to compare the effects of Shen-Fu injection (SFI) and epinephrine on resuscitation outcomes in a porcine model of prolonged CA.Methods Ventricular fibrillation (VF) was electrically induced.After 8 minutes of untreated VF and 2 minutes of chest compressions,24 pigs were randomly divided into 3 groups (n=8 per group):central venous injection of SFI (SFI group),epinephrine (EPI group),or saline solution (SA group).The haemodynamic status and oxygen metabolism parameters,including cardiac output,mean arterial pressure,left ventricular dp/dtmax and negative dp/dtmax,oxygen delivery (DO2),and oxygen consumption (VO2),were calculated.Results SFI shortened the time to restoration of spontaneous circulation (ROSC) and decreased the number of shocks,similar to epinephrine.However,the mean arterial pressure,cardiac output,left ventricular dp/dtmax and negative dp/dtmax were significantly higher in the SFI group than in the EPI group at 4 and 6 hours after ROSC.VO2 and ERO2 decreased after ROSC and then increased.VO2 and ERO2 were significantly higher in the SFI group than in the EPI and SA groups after ROSC,while those were lowest in the EPI group among all groups.Conclusions SFI shortened the time to ROSC and decreased the number of shocks,similar to epinephrine.However,SFI improved oxygen metabolism,and produced a better hemodynamic status compared with epinephrine.SFI might be a potentially vasopressor drug for the treatment of CA.

  7. Invasive strategy in patients with resuscitated cardiac arrest and ST elevation myocardial infarction

    OpenAIRE

    Gorjup, Vojka; Noc, Marko; Radsel, Peter

    2014-01-01

    Coronary artery disease is the most frequent cause of sudden cardiac death. There is general consensus that immediate coronary angiography with percutaneous coronary intervention (PCI) should be performed in all conscious and unconscious patients with ST-elevation myocardial infarction in post-resuscitation electrocardiogram. In these patients acute coronary thrombotic lesion (“ACS” lesion) suitable for PCI is typically present in more than 90%. PCI in these patients is not only feasible and ...

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

    Science.gov (United States)

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

    2015-03-15

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

  9. Combination of epinephrine with esmolol attenuates post-resuscitation myocardial dysfunction in a porcine model of cardiac arrest.

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    Qian Zhang

    Full Text Available BACKGROUND: Recent experimental and clinical studies have indicated that the β-adrenergic effect of epinephrine significantly increases the severity of post resuscitation myocardial dysfunction. The aim of the study was to investigate whether the short-acting β₁-selective adrenergic blocking agent, esmolol, would attenuate post resuscitation myocardial dysfunction in a porcine model of cardiac arrest. METHODS AND RESULTS: After 8 min of untreated ventricular fibrillation and 2 min of basic life support, 24 pigs were randomized to three groups (n = 8 per group, which received central venous injection of either epinephrine combined with esmolol (EE group, epinephrine (EP group, or saline (SA group. Hemodynamic status and blood samples were obtained at 0, 30, 60, 120, 240 and 360 min after return of spontaneous circulation (ROSC. Surviving pigs were euthanatized at 24 h after ROSC, and the hearts were removed for analysis by electron microscopy, Western blotting, quantitative real-time polymerase chain reaction, and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL assay. Compared with the EP and SA groups, EE group had a better outcome in hemodynamic function, (improved dp/dt maxima and minima and cardiac output (P<0.05, and improved oxygen metabolism (oxygen delivery and oxygen consumption (P<0.05, which suggesting that EE can protect myocardial tissue from injury and improve post-resuscitation myocardial dysfunction. The protective effect of EE also correlated with reducing cardiomyocyte apoptosis, evidenced by reducing TUNEL-positive cells, increasing anti-apoptotic Bcl-2/Bax ratio and suppression of caspase-3 activity in myocardium. CONCLUSIONS: Esmolol, a short-acting β₁-selective adrenergic blocking agent, given during CPR has significant effects on attenuating post resuscitation myocardial dysfunction. The current study provides a potential pharmacologic target for post resuscitation myocardial dysfunction.

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

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper; Wanscher, Michael;

    2015-01-01

    -1β, interleukin-2, interleukin-4, interleukin-5, interleukin-6, interleukin-9, interleukin-10, interleukin-12, interleukin-13, tumor necrosis factor-α, interferon-γ, C-reactive protein, and procalcitonin were measured. Mortality at 30 days was evaluated by Cox analysis, and the predictive capability...... of inflammatory markers was evaluated by area under the curve. Level of all inflammatory markers changed significantly within 72 hours after out-of-hospital cardiac arrest (all p values<0.001), but only procalcitonin levels showed overall differences between nonsurvivors and survivors (p=0.0002). At...... baseline, interleukin-6 was independently associated with mortality, whereas both interleukin-6 levels (hazard ratio=1.23 [1.01-1.49]; p=0.04) and procalcitonin levels (hazard ratio=1.20 [1.03-1.39]; p=0.02) 24 hours after out-of-hospital cardiac arrest were associated with 30-day mortality with no...

  11. Invasive strategy in patients with resuscitated cardiac arrest and ST elevation myocardial infarction.

    Science.gov (United States)

    Gorjup, Vojka; Noc, Marko; Radsel, Peter

    2014-06-26

    Coronary artery disease is the most frequent cause of sudden cardiac death. There is general consensus that immediate coronary angiography with percutaneous coronary intervention (PCI) should be performed in all conscious and unconscious patients with ST-elevation myocardial infarction in post-resuscitation electrocardiogram. In these patients acute coronary thrombotic lesion ("ACS" lesion) suitable for PCI is typically present in more than 90%. PCI in these patients is not only feasible and safe but highly effective and there is evidence of improved survival with good neurological outcome. PCI of the culprit lesion is the primary goal while PCI of stable obstructive lesions may be postponed unless post-resuscitation cardiogenic shock is present.

  12. Choice of hospital after out-of-hospital cardiac arrest - a decision with far-reaching consequences: a study in a large German city

    OpenAIRE

    Wnent, Jan; Seewald, Stephan; Heringlake, Matthias; Lemke, Hans; Brauer, Kirk; Lefering, Rolf; Fischer, Matthias; Jantzen, Tanja; Bein, Berthold; Messelken, Martin; Gräsner, Jan-Thorsten

    2012-01-01

    Introduction Between 1 and 31% of patients suffering out-of-hospital cardiac arrest (OHCA) survive to discharge from hospital. International studies have shown that the level of care provided by the admitting hospital determines survival for patients suffering from OHCA. These data may only be partially transferable to the German medical system where responders are in-field emergency medical physicians. The present study determines the influence of the emergency physician's choice of admittin...

  13. Cardiac arrest due to intracranial hypotension following pseudohypoxic brain swelling induced by negative suction drainage in a cranioplasty patient: a case report

    OpenAIRE

    Moon, Hyun-Soo; Lee, Soo Kyung; Kim, Su Ryun; Kim, Seon Ju

    2016-01-01

    Pseudohypoxic brain swelling (PHBS) is known to be an uncommon event that may occur during and following an uneventful brain surgery, when negative suction drainage is used. The cerebrospinal fluid loss related to suction drainage can evoke intracranial hypotension that progress to PHBS. The main presentations of PHBS are sudden unexpected circulatory collapses, such as severe bradycardia, hypotension, cardiac arrest, consciousness deterioration and diffuse brain swelling as seen with brain c...

  14. Better management of out-of-hospital cardiac arrest increases survival rate and improves neurological outcome in the Swiss Canton Ticino

    OpenAIRE

    Mauri, Romano; Burkart, Roman; Benvenuti, Claudio; Caputo, Maria Luce; Moccetti, Tiziano; Del Bufalo, Alessandro; Gallino, Augusto; Casso, Carlo; Anselmi, Luciano; Cassina, Tiziano; Klersy, Catherine; Auricchio, Angelo

    2015-01-01

    Aim To determine the incidence of out-of-hospital cardiac arrest (OHCA) fulfilling Utstein criteria in the Canton Ticino, Switzerland, the survival rate of OHCA patients and their neurological outcome. Methods and results All OHCAs treated in Canton Ticino between 1 January 2005 and 31 December 2014 were followed until either death or hospital discharge. The survival and neurological outcome of those OHCA fulfilling Utstein criteria are reported. A total of 3367 OHCAs occurred in the Canton T...

  15. Reduced in-hospital survival rates of out-of-hospital cardiac arrest victims with obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Blom, M T; Warnier, M J; Bardai, A;

    2013-01-01

    AIM: Out-of-hospital cardiac arrest (OHCA) due to sustained ventricular tachycardia/fibrillation (VT/VF) is common and often lethal. Patient's co-morbidities may determine survival after OHCA, and be instrumental in post-resuscitation care, but are poorly studied. We aimed to study whether patients......, to hospital discharge, and at 30 days after OHCA, of OPD-patients and non-OPD patients, using logistic regression analysis. We also compared 30-day survival of patients who were admitted to hospital, using multivariate logistic regression analysis. RESULTS: OPD patients (n=178) and non-OPD patients (n=994...... admitted to hospital (OPD: n=100, no OPD: n=561) revealed that OPD was an independent determinant of reduced 30-day survival rate (39% vs. 59%, adjusted OR 0.6 [0.4-1.0, p=0.035]). CONCLUSION: OPD-patients had lower survival rates after OHCA than non-OPD patients. Survival to ER and to hospital admission...

  16. Load-distributing band improves ventilation and hemodynamics during resuscitation in a porcine model of prolonged cardiac arrest

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    Wang Shuo

    2012-09-01

    Full Text Available Abstract Background The use of mechanical cardiopulmonary resuscitation (CPR has great potential for the clinical setting. The purpose of present study is to compare the hemodynamics and ventilation during and after the load-distributing band CPR, versus the manual CPR in a porcine model of prolonged cardiac arrest, and to investigate the influence of rescue breathing in different CPR protocols. Methods Sixty-four male pigs (n = 16/group, weighing 30 ± 2 kg, were induced ventricular fibrillation and randomized into four resuscitation groups: continuous load-distributing band CPR without rescue ventilation (C-CPR, load-distributing band 30:2 CPR (A-CPR, load-distributing band CPR with continuous rescue breathing (10/min (V-CPR or manual 30:2 CPR (M-CPR. Respiratory variables and hemodynamics were recorded continuously; blood gas was analyzed. Results Tidal volume produced by compressions in the A-, C- and V-CPR groups were significantly higher compared with the M-CPR group (all p 2 of the A-, C- and V-CPR groups were significantly higher and PaCO2 were significantly lower compared with the M-CPR (both p  Conclusions The load-distributing band CPR significantly improved respiratory parameters during resuscitation by augmenting passive ventilation, and significantly improved coronary perfusion pressure. The volume of ventilation produced by the load-distributing band CPR was adequate to maintain sufficient gas exchange independent of rescue breathing.

  17. Predictive value of interleukin-6 in post-cardiac arrest patients treated with targeted temperature management at 33 °C or 36 °C

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper; Stammet, Pascal;

    2016-01-01

    AIM: Post-cardiac arrest syndrome (PCAS) is characterized by systemic inflammation, however data on the prognostic value of inflammatory markers is sparse. We sought to investigate the importance of systemic inflammation, assessed by interleukin-6 (IL-6) in comatose survivors of out-of-hospital c......AIM: Post-cardiac arrest syndrome (PCAS) is characterized by systemic inflammation, however data on the prognostic value of inflammatory markers is sparse. We sought to investigate the importance of systemic inflammation, assessed by interleukin-6 (IL-6) in comatose survivors of out......-of-hospital cardiac arrest. METHODS: A total of 682 patients enrolled in the Target Temperature Management (TTM) trial, surviving >24h with available IL-6 data were included. IL-6 was measured on days 1, 2 and 3 after return of spontaneous circulation. Severity of PCAS was assessed daily by the Sequential Organ...... Failure Assessment score. Survival status was recorded at 30 days. RESULTS: High levels of IL-6 at day 1-3 (all p

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

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Hassager, Christian; Wanscher, Michael;

    2014-01-01

    BACKGROUND: Cardiovascular dysfunction is common after out-of-hospital cardiac arrest as part of the postcardiac arrest syndrome, and hypothermia may pose additional impact on hemodynamics. The aim was to investigate systemic vascular resistance index (SVRI), cardiac index, and myocardial perform...... because of lower heart rate with unaffected left ventricular systolic function compared with 36°C. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01020916....

  19. Importance of leadership in cardiac arrest situations: from simulation to real life and back.

    Science.gov (United States)

    Hunziker, Sabnina; Tschan, Franziska; Semmer, Norbert K; Marsch, Stephan

    2013-04-18

    The 2010 American Heart Association guidelines now recommend leadership training in Advanced Cardiac Life Support courses. In this review we provide a comprehensive summary of data derived from clinical studies that investigated the importance of leadership in cardiopulmonary resuscitation (CPR). Only a few, mostly observational, studies have been conducted under real-life conditions because of the high heterogeneity of the situations, difficulties in capturing the initial phase of CPR, and ethical issues. Well-controlled studies in the human simulator can fill existing gaps and provide important insights. High-fidelity video-assisted simulator studies from different research groups have shown that a prolonged process of teambuilding is associated with significant shortcomings in CPR, whereas effective leadership improves team performance. In addition, randomised controlled studies have provided evidence that medical students receiving leadership training subsequently showed improved CPR performance, which was sustained after a follow up of 4 months. In addition, leadership is influenced by gender and other factors such as emotional stress. Future studies are needed to investigate cultural differences and how findings from the simulator can be transferred to real-life situations.

  20. Probabilities of Pulmonary and Cardiac Complications and Radiographic Parameters in Breast Cancer Radiotherapy

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    Noh, O Kyu; Paek, Sung Ho; Ahn, Seung Do; Choi, Eun Kyung; Lee, Sang Wook; Song, Si Yeol; Yoon, Sang Min; Kim, Jong Hoon [Dept. of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2010-11-15

    To evaluate the relationship between the normal tissue complication probability (NTCP) of 3- dimensional (3-D) radiotherapy and the radiographic parameters of 2-dimensional (2-D) radiotherapy such as central lung distance (CLD) and maximal heart distance (MHD). We analyzed 110 patients who were treated with postoperative radiotherapy for breast cancer. A two-field tangential technique, a three-field technique, and the reverse hockey stick method were used. The radiation dose administered to whole breast or the chest wall was 50.4 Gy, whereas a 45 Gy was administered to the supraclavicular field. The NTCPs of the heart and lung were calculated by the modified Lyman model and the relative seriality model. For all patients, the NTCPs of radiation-induced pneumonitis and cardiac mortality were 0.5% and 0.7%, respectively. The NTCP of radiation-induced pneumonitis was higher in patients treated with the reverse hockey stick method than in those treated by other two techniques (0.0%, 0.0%, 3.1%, p<0.001). The NTCP of radiation-induced pneumonitis increased with CLD. The NTCP of cardiac mortality increased with MHD (R2=0.808). We found a close correlation between the NTCP of 3-D radiotherapy and 2-D radiographic parameters. Our results are useful to reanalyze the previous 2-D based clinical reports about breast radiation therapy complications as a viewpoint of NTCP.

  1. Complications of cardiac resynchronization therapy in patients with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background Previous clinical studies have suggested that patients with congestive heart failure and intraventricular conduction delay could benefit from cardiac resynchronization therapy (CRT). Implantation of left ventricular lead is a complex procedure with some potential for complications. This study was conducted to analyse the complications of CRT in patients with congestive heart failure.Methods Totally 117 patients, 86 males and 31 females, mean age of 53 years, with congestive heart failure and intraventricular conduction delaywere enrolled in this study. Venography was performed on all patients. Different types of coronary sinus leads were used to pace the left ventricle. Results Left ventricular lead was attempted to implant through coronary sinus for all the 117 patients and was successfully implanted in 111 patients. The success rate was 94.9%. Main complications rate was 6.8%, including coronary sinus dissection in 4 patients, phrenic nerve stimulation required lead repositioning in 2 patients and lead dislodgement in 2 patients. Conclusions It is feasible and safe to pace left ventricle through coronary sinus. However, there are some procedural complications.

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

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    Wax Randy

    2011-01-01

    Full Text Available Abstract Background Advances in resuscitation science have dramatically improved survival rates following cardiac arrest. However, about 60% of adults that regain spontaneous circulation die before leaving the hospital. Recently it has been shown that inducing hypothermia in cardiac arrest survivors immediately following their arrival in hospital can dramatically improve both overall survival and neurological outcomes. Despite the strong evidence for its efficacy and the apparent simplicity of this intervention, recent surveys show that therapeutic hypothermia is delivered inconsistently, incompletely, and often with delay. Methods and design This study will evaluate a multi-faceted knowledge translation strategy designed to increase the utilization rate of induced hypothermia in survivors of cardiac arrest across a network of 37 hospitals in Southwestern Ontario, Canada. The study is designed as a stepped wedge randomized trial lasting two years. Individual hospitals will be randomly assigned to four different wedges that will receive the active knowledge translation strategy according to a sequential rollout over a number of time periods. By the end of the study, all hospitals will have received the intervention. The primary aim is to measure the effectiveness of a multifaceted knowledge translation plan involving education, reminders, and audit-feedback for improving the use of induced hypothermia in survivors of cardiac arrest presenting to the emergency department. The primary outcome is the proportion of eligible OHCA patients that are cooled to a body temperature of 32 to 34°C within six hours of arrival in the hospital. Secondary outcomes will include process of care measures and clinical outcomes. Discussion Inducing hypothermia in cardiac arrest survivors immediately following their arrival to hospital has been shown to dramatically improve both overall survival and neurological outcomes. However, this lifesaving treatment is

  3. Physician presence in an ambulance car is associated with increased survival in out-of-hospital cardiac arrest: a prospective cohort analysis.

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    Akihito Hagihara

    Full Text Available The presence of a physician seems to be beneficial for pre-hospital cardiopulmonary resuscitation (CPR of patients with out-of-hospital cardiac arrest. However, the effectiveness of a physician's presence during CPR before hospital arrival has not been established. We conducted a prospective, non-randomized, observational study using national data from out-of-hospital cardiac arrests between 2005 and 2010 in Japan. We performed a propensity analysis and examined the association between a physician's presence during an ambulance car ride and short- and long-term survival from out-of-hospital cardiac arrest. Specifically, a full non-parsimonious logistic regression model was fitted with the physician presence in the ambulance as the dependent variable; the independent variables included all study variables except for endpoint variables plus dummy variables for the 47 prefectures in Japan (i.e., 46 variables. In total, 619,928 out-of-hospital cardiac arrest cases that met the inclusion criteria were analyzed. Among propensity-matched patients, a positive association was observed between a physician's presence during an ambulance car ride and return of spontaneous circulation (ROSC before hospital arrival, 1-month survival, and 1-month survival with minimal neurological or physical impairment (ROSC: OR = 1.84, 95% CI 1.63-2.07, p = 0.00 in adjusted for propensity and all covariates; 1-month survival: OR = 1.29, 95% CI 1.04-1.61, p = 0.02 in adjusted for propensity and all covariates; cerebral performance category (1 or 2: OR = 1.54, 95% CI 1.03-2.29, p = 0.04 in adjusted for propensity and all covariates; and overall performance category (1 or 2: OR = 1.50, 95% CI 1.01-2.24, p = 0.05 in adjusted for propensity and all covariates. A prospective observational study using national data from out-of-hospital cardiac arrests shows that a physician's presence during an ambulance car ride was independently associated with

  4. The course of circulatory and cerebral recovery after circulatory arrest: influence of pre-arrest, arrest and post-arrest factors.

    Science.gov (United States)

    Jørgensen, E O; Holm, S

    1999-11-01

    We evaluated the influence of pre-arrest, arrest and post-arrest factors on circulatory and neurological recovery for up to 1 year following circulatory arrest of cardio-pulmonary aetiology in 231 patients. Initially, all patients were unconscious and 106 had some cortical activity recorded in the immediate post-resuscitation EEG (Group I), while 125 had no such activity initially (Group II). The following variables were explored: age, sex, medical history, cause and location of arrest, initial cardiac dysrhythmia, duration of life support, metabolic acidosis, pulse-pressure product and heart pump function capacity early after resuscitation. Outcome measures were duration and quality of circulatory survival, cause of death, neurological recovery and ultimate outcome. First year survival was 33% in Group I and 16% in Group II. Severe heart failure and brain death occurred mainly in Group II. Circulatory recovery was negatively influenced by out-of-hospital arrest, metabolic acidosis and pulse-pressure products below 150. Neurological recovery was negatively influenced by initial dysrhythmias other than ventricular fibrillation, pulse-pressure products below 150, post-arrest heart failure and/or pulmonary complications. It seems that circulatory and cerebral outcomes are mainly determined by the global ischaemic insults sustained during the circulatory arrest period. PMID:10625157

  5. Embryonic Lethality Due to Arrested Cardiac Development in Psip1/Hdgfrp2 Double-Deficient Mice.

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    Hao Wang

    Full Text Available Hepatoma-derived growth factor (HDGF related protein 2 (HRP2 and lens epithelium-derived growth factor (LEDGF/p75 are closely related members of the HRP2 protein family. LEDGF/p75 has been implicated in numerous human pathologies including cancer, autoimmunity, and infectious disease. Knockout of the Psip1 gene, which encodes for LEDGF/p75 and the shorter LEDGF/p52 isoform, was previously shown to cause perinatal lethality in mice. The function of HRP2 was by contrast largely unknown. To learn about the role of HRP2 in development, we knocked out the Hdgfrp2 gene, which encodes for HRP2, in both normal and Psip1 knockout mice. Hdgfrp2 knockout mice developed normally and were fertile. By contrast, the double deficient mice died at approximate embryonic day (E 13.5. Histological examination revealed ventricular septal defect (VSD associated with E14.5 double knockout embryos. To investigate the underlying molecular mechanism(s, RNA recovered from ventricular tissue was subjected to RNA-sequencing on the Illumina platform. Bioinformatic analysis revealed several genes and biological pathways that were significantly deregulated by the Psip1 knockout and/or Psip1/Hdgfrp2 double knockout. Among the dozen genes known to encode for LEDGF/p75 binding factors, only the expression of Nova1, which encodes an RNA splicing factor, was significantly deregulated by the knockouts. However the expression of other RNA splicing factors, including the LEDGF/p52-interacting protein ASF/SF2, was not significantly altered, indicating that deregulation of global RNA splicing was not a driving factor in the pathology of the VSD. Tumor growth factor (Tgf β-signaling, which plays a key role in cardiac morphogenesis during development, was the only pathway significantly deregulated by the double knockout as compared to control and Psip1 knockout samples. We accordingly speculate that deregulated Tgf-β signaling was a contributing factor to the VSD and prenatal lethality

  6. Fibromuscular Dysplasia Leading to Spontaneous Coronary Artery Dissection with Sudden Cardiac Arrest

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    Ata Bajwa

    2015-01-01

    Full Text Available A 30-year-old previously healthy female, who was six-week postpartum, experienced sudden collapse and tonic-clonic seizure. Emergency medicine services arrived at the scene and the patient was found to be in ventricular fibrillation. Advanced cardiovascular life support (ACLS was initiated with return of spontaneous circulation. Afterwards, her initial EKG showed atrial fibrillation with rapid ventricular rate, ST elevation in leads II, III, and aVF, and ST depression in V2–V4. She was transferred to a tertiary care hospital where emergent angiogram was performed revealing obstruction of blood flow in the proximal and mid right coronary artery (RCA. A hazy and irregularly contoured appearance of the RCA was consistent with diagnosis of fibromuscular dysplasia. Subsequently, intravascular ultrasonogram (IVUS was performed which confirmed the diagnosis of RCA dissection. Successful revascularization of the RCA was performed using two bare mental stents. After a complicated course in hospital, she was discharged in stable condition and did very well overall.

  7. 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)

    Patel AA

    2014-07-01

    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

  8. Effect of hypertensive reperfusion on the changes between cerebral oxygen delivery and uptake after cardiac arrest and resuscitation in dogs

    Institute of Scientific and Technical Information of China (English)

    杜权; 马永达; 葛衡江; 刘怀琼; 李阳

    2004-01-01

    Objective: To study the changes between cerebral oxygen (O2) delivery and uptake in dogs resuscitated under normotension or hypertension for 4 h. Methods: The model of ventricular fibrillation of 8 min in 12 dogs was made,followed by open cardiopulmonary resuscitation, reperfnsion with normal or high mean arterial pressure (MAP), and controlled ventilation to 4 h. Animals were randomly assigned into Group NT (normotensive reperfusion, n = 6) and Group HT(hypertensive reperfusion, n = 6). Cerebral arteriovenous (sagittal sinus) O2 content difference (Ca-ssO2) and venous(sagittal sinus) PO2(PssO2) were determined before cardiac arrest (CA) and 30, 60, 120, and 240 min after CA. Results: In Group NT, Ca-ssO2 was lower at 30 min ( P < 0.05) but higher at 240 min ( P < 0.01 ) after CA than that before CA. In Group HT, Ca-ssO2 was not significantly different from that in Group NT before CA but was lower than that in Group NT at 30 min after CA ( P < 0.01 ). Ca-ssO2 was not significantly different in Group NT and HT thereafter. In both groups,PssO2 was both higher at 30 min after reperfnsion ( P < 0.01 ) and at 240 min after reperfnsion lower ( P < 0.05) than those before CA .At 30 min after reperfusion, PssO2 was higher (P<0.01) in Group HT than that in Group NT, with insignificant difference between two groups. Conclusion: Cerebral O2 delivery and uptake are mismatched after CA and resuscitation. Hypertensive reperfusion improves oxygen delivery to the brain early after CA.

  9. Epidemiological and Survival Trends of Pediatric Cardiac Arrests in Emergency Departments in Korea: A Cross-sectional, Nationwide Report.

    Science.gov (United States)

    Ahn, Jae Yun; Lee, Mi Jin; Kim, Hyun; Yoon, Han Deok; Jang, Hye Young

    2015-09-01

    Cardiac arrest (CA) in children is associated with high mortality rates. In Korea, cohort studies regarding the outcomes of pediatric CAs are lacking, especially in emergency departments (EDs) or in-hospital settings. This study was conducted to examine the trends in epidemiology and survival outcomes in children with resuscitation-attempted CAs using data from a cross-sectional, national, ED-based clinical registry. We extracted cases in which cardiopulmonary resuscitation and/or manual defibrillation were performed according to treatment codes using the National Emergency Department Information System (NEDIS) from 2008 to 2012. The total number of ED visits registered in the NEDIS during the 5-yr evaluation period was 20,424,530; among these, there were 2,970 resuscitation-attempted CAs in children. The annual rates of pediatric CAs per 1,000 ED visits showed an upward trend from 2.81 in 2009 to 3.62 in 2012 (P for trend = 0.045). The median number of estimated pediatric CAs at each ED was 7.8 (25th to 75th percentile, 4 to 13) per year. The overall rates for admission survival and discharge survival were 35.2% and 12.8%, respectively. The survival outcome of adults increased substantially over the past 5 yr (11.8% in 2008, 11.7% in 2010, and 13.6% in 2012; P for trend = 0.001); however, the results for children did not improve (13.6% in 2008, 11.4% in 2010, and 13.7% in 2012; P for trend = 0.870). Conclusively, we found that the overall incidence of pediatric CAs in EDs increased substantially over the past 5 yr, but without significantly higher survival outcomes. PMID:26339179

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

    Directory of Open Access Journals (Sweden)

    Jean-Philippe Didon

    2008-10-01

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

  11. Complications after Surgical Procedures in Patients with Cardiac Implantable Electronic Devices: Results of a Prospective Registry

    Science.gov (United States)

    da Silva, Katia Regina; Albertini, Caio Marcos de Moraes; Crevelari, Elizabeth Sartori; de Carvalho, Eduardo Infante Januzzi; Fiorelli, Alfredo Inácio; Martinelli Filho, Martino; Costa, Roberto

    2016-01-01

    Background: Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities. Objective: To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events. Methods: Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis. Results: A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III­-IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3). Conclusions: Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient's underlying heart disease. PMID:27579544

  12. Fontan procedure: imaging of normal post-surgical anatomy and the spectrum of cardiac and extracardiac complications

    International Nuclear Information System (INIS)

    Univentricular congenital heart diseases include a range of entities that result in a functionally single ventricular chamber. Although the only curative therapy is cardiac transplantation, there are several palliative surgical techniques that prevent ventricular volume overload, diverting part or all the systemic venous circulation into the pulmonary arteries. The modern Fontan procedure, which consists of anastomosing both the superior (SVC) and inferior vena cava (IVC) to the right pulmonary artery (RPA), is nowadays the last step before transplantation. The importance of imaging in these entities lies not only in the understanding of the new circuit established after surgical correction, but also in the early detection of the wide spectrum of cardiac and extracardiac complications that can occur due to the new physiological condition. Due to the increased survival of these patients, long-term complications are becoming more common. The main cardiac complications are atrial enlargement, ventricular dysfunction, and stenosis or thrombosis of the conduit. Pulmonary artery stenosis, pulmonary arteriovenous fistulae (PAVF), systemic-pulmonary veno venous shunts (VVS), hepatic congestion, cardiac cirrhosis, and protein-losing enteropathy are potential extracardiac complications. - Highlights: • Fontan procedure is the main palliative surgical procedure for univentricular heart correction. • Fontan procedure entails the anastomosis of SVC and IVC to the RPA. • Complications are becoming more common due to the increased survival of patients with Fontan

  13. Preoperative protein and energy intake and postoperative complications in well-nourished, non-hospitalized elderly cardiac surgery patients

    NARCIS (Netherlands)

    L.M.W. van Venrooij; P.A.M. van Leeuwen; R. de Vos; M.M.M.J. Borgmeijer-Hoelen; B.A.J.M. de Mol

    2009-01-01

    Background & aims: Little is known about the impact of preoperative protein or energy intake in relation to the occurrence of postoperative complications in patients who are not undernourished but cannot keep up their daily protein or energy requirements prior to cardiac surgery. Therefore, a prospe

  14. Effect of different resuscitation strategies on post-resuscitation brain damage in a porcine model of prolonged cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    Gu Wei; Hou Xiaomin; Li Chunsheng

    2014-01-01

    Background The choice of a defibrillation or a cardiopulmonary resuscitation (CPR)-first strategy in the treatment of prolonged cardiac arrest (CA) is still controversial.The purpose of this study was to compare the effects of defibrillation or CPR administered first on neurological prognostic markers in a porcine model of prolonged CA.Methods After 8 minutes of untreated ventricular fibrillation (VF),24 inbred Chinese Wuzhishan minipigs were randomized to receive either defibrillation first (ID group,n=12) or chest compression first (IC group,n=12).In the ID group,a shock was delivered immediately.If defibrillation failed to attain restoration of spontaneous circulation (ROSC),manual chest compressions were rapidly initiated at a rate of 100 compressions/min and a compression-to-ventilation ratio of 30:2.If VF persisted after five cycles of CPR,a second defibrillation attempt was made.In the IC group,chest compressions were delivered first,followed by a shock.After successful ROSC,hemodynamic status and blood samples were obtained at 0.5,1,2,4,6,and 24 hours after ROSC.Porcine-specific neuron-specific enolase (NSE) and S100B were measured from sera using enzyme-linked immunosorbent assays.Porcine cerebral performance category scores were used to evaluate preliminary neurological function following 24 hours recovery.Surviving pigs were sacrificed at 24 hours after ROSC and brains were removed for electron microscopy analysis.Results The number of shocks,total defibrillation energy,and time to ROSC were significantly lower in the ID group compared with the IC group.Compared with the IC group,S100B expression was decreased at 2 and 4 hours after ROSC,and NSE expression decreased at 6 and 24 hours after ROSC in the ID group.Brain tissue analysis showed that injury was attenuated in the ID group compared with the IC group.There were no significant differences between 6 and 24 hours survival rates.Conclusion Defibrillation first may result in a shorter time to ROSC and

  15. Implantable cardioverter-defibrillator therapy in a 34-year-old patient with eating disorders and after the third sudden cardiac arrest.

    Science.gov (United States)

    Piotrowicz, Ewa; Orzechowski, Piotr; Bilinska, Maria; Przybylski, Andrzej; Szumowski, Lukasz; Piotrowicz, Ryszard

    2015-03-01

    Eating disorders (ED) such as anorexia nervosa and bulimia are psychiatric diseases associated with the highest mortality rate of any other psychiatric disorders. More recently, long-term outcome studies with follow-up of over 20 years report a mortality of between 15% and 18% (Casiero and Frishman, Cardiol Rev 14(5), 227, 2006). The sudden death secondary to arrhythmias is often the cause of death in these patients (Casiero and Frishman, Cardiol Rev 14(5), 227, 2006). A case of life-threatening ventricular arrhythmia (VA) in a patient with ED is presented. Clinical records (cardiologic, psychiatric), electrocardiograms, echocardiogram, coronary angiogram, cardiac magnetic resonance, and endocrine diagnostics were performed. Finally a cardioverter-defibrillator (ICD) was implanted in the patient after her third cardiac arrest. An optimal approach to antiarrhythmic therapy in such patients is a real challenge for a cardiologist.

  16. Application and Nursing of Pulse Index Continuous Cardiac Output Monitoring in Patients with Post-cardiac Arrest Syndrome%脉波指示剂连续心排血量监测在心搏骤停后综合征患者中的应用与护理

    Institute of Scientific and Technical Information of China (English)

    陈淑兰; 刘刚; 张秋真; 陈秋恋

    2011-01-01

    Objective To investigate the application effect and nursing of the pulse index continuous cardiac output (PICCO) monitoring technique in patients with post-cardiac arrest syndrome (PCAS). Methods The precautions and nursing points were developed for the flowsheet of operation, cooperation for the vein catheterization and measurements. Results Of the 15 patients using the PICCO monitoring technique in early stage,no complication occurred ,except one patient died of multiple organ failure and 3 abandoned the treatment,and the rest 11 patients survived. Conclusion PCAS patients undergoing PICCO monitoring device in the early stage can efficiently assist the fluid management,maintain the vital signs of the patients,and save their lives.%目的 探讨脉波指示剂连续心排血量监测( pulse index continuous cardiac output,PICCO)在心搏骤停后综合征(postcardiac arrest syndrome,PCAS)患者中的应用效果及护理.方法 制定操作流程、置管配合、测量的注意事项和护理要点.结果 15例患者通过早期采用了PICCO监测,并采取了相应的护理措施,均未出现并发症,除了1例患者因多器官功能衰竭死亡外,3例患者放弃治疗,其余11例患者均存活.结论 对PCAS患者早期进行PICCO监测,能对患者进行更准确的血流动力学监测,可以有效协助液体管理,维持患者生命体征的稳定,挽救患者生命.

  17. Sudden cardiac arrest in sports - need for uniform registration: A Position Paper from the Sport Cardiology Section of the European Association for Cardiovascular Prevention and Rehabilitation.

    Science.gov (United States)

    Solberg, E E; Borjesson, M; Sharma, S; Papadakis, M; Wilhelm, M; Drezner, J A; Harmon, K G; Alonso, J M; Heidbuchel, H; Dugmore, D; Panhuyzen-Goedkoop, N M; Mellwig, K-P; Carre, F; Rasmusen, H; Niebauer, J; Behr, E R; Thiene, G; Sheppard, M N; Basso, C; Corrado, D

    2016-04-01

    There are large variations in the incidence, registration methods and reported causes of sudden cardiac arrest/sudden cardiac death (SCA/SCD) in competitive and recreational athletes. A crucial question is to which degree these variations are genuine or partly due to methodological incongruities. This paper discusses the uncertainties about available data and provides comprehensive suggestions for standard definitions and a guide for uniform registration parameters of SCA/SCD. The parameters include a definition of what constitutes an 'athlete', incidence calculations, enrolment of cases, the importance of gender, ethnicity and age of the athlete, as well as the type and level of sporting activity. A precise instruction for autopsy practice in the case of a SCD of athletes is given, including the role of molecular samples and evaluation of possible doping. Rational decisions about cardiac preparticipation screening and cardiac safety at sport facilities requires increased data quality concerning incidence, aetiology and management of SCA/SCD in sports. Uniform standard registration of SCA/SCD in athletes and leisure sportsmen would be a first step towards this goal.

  18. Periprocedural anticoagulation of patients undergoing pericardiocentesis for cardiac tamponade complicating catheter ablation of atrial fibrillation.

    Science.gov (United States)

    Lin, Tao; Bai, Rong; Chen, Ying-wei; Yu, Rong-hui; Tang, Ri-bo; Sang, Cai-hua; Li, Song-nan; Ma, Chang-sheng; Dong, Jian-zeng

    2015-01-01

    Anticoagulation of patients with cardiac tamponade (CT) complicating catheter ablation of atrial fibrillation (AF) is an ongoing problem. The aim of this study was to survey the clinical practice of periprocedural anticoagulation in such patients. This study analyzed the periprocedural anticoagulation of 17 patients with CT complicating AF ablation. Emergent pericardiocentesis was performed once CT was confirmed. The mean drained volume was 410.0 ± 194.1 mL. Protamine sulfate was administered to neutralize heparin (1 mg neutralizes 100 units heparin) in 11 patients with persistent pericardial bleeding and vitamin K1 (10 mg) was given to reverse warfarin in 3 patients with supratherapeutic INR (INR > 2.1). Drainage catheters were removed 12 hours after echocardiography confirmed absence of intrapericardial bleeding and anticoagulation therapy was restored 12 hours after removing the catheter. Fifteen patients took oral warfarin and 10 of them were given subcutaneous injection of LMWH (1 mg/kg, twice daily) as a bridge to resumption of systemic anticoagulation with warfarin. Two patients with a small amount of persistent pericardial effusion were given LMWH on days 5 and 13, and warfarin on days 6 and 24. The dosage of warfarin was adjusted to keep the INR within 2-3 in all patients. After 12 months of follow-up, all patients had no neurological events and no occurrence of delayed CT. The results showed that it was effective and safe to resume anticoagulation therapy 12 hours after removal of the drainage catheter. This may help to prevent thromboembolic events following catheter ablation of AF. PMID:25503659

  19. Periprocedural anticoagulation of patients undergoing pericardiocentesis for cardiac tamponade complicating catheter ablation of atrial fibrillation.

    Science.gov (United States)

    Lin, Tao; Bai, Rong; Chen, Ying-wei; Yu, Rong-hui; Tang, Ri-bo; Sang, Cai-hua; Li, Song-nan; Ma, Chang-sheng; Dong, Jian-zeng

    2015-01-01

    Anticoagulation of patients with cardiac tamponade (CT) complicating catheter ablation of atrial fibrillation (AF) is an ongoing problem. The aim of this study was to survey the clinical practice of periprocedural anticoagulation in such patients. This study analyzed the periprocedural anticoagulation of 17 patients with CT complicating AF ablation. Emergent pericardiocentesis was performed once CT was confirmed. The mean drained volume was 410.0 ± 194.1 mL. Protamine sulfate was administered to neutralize heparin (1 mg neutralizes 100 units heparin) in 11 patients with persistent pericardial bleeding and vitamin K1 (10 mg) was given to reverse warfarin in 3 patients with supratherapeutic INR (INR > 2.1). Drainage catheters were removed 12 hours after echocardiography confirmed absence of intrapericardial bleeding and anticoagulation therapy was restored 12 hours after removing the catheter. Fifteen patients took oral warfarin and 10 of them were given subcutaneous injection of LMWH (1 mg/kg, twice daily) as a bridge to resumption of systemic anticoagulation with warfarin. Two patients with a small amount of persistent pericardial effusion were given LMWH on days 5 and 13, and warfarin on days 6 and 24. The dosage of warfarin was adjusted to keep the INR within 2-3 in all patients. After 12 months of follow-up, all patients had no neurological events and no occurrence of delayed CT. The results showed that it was effective and safe to resume anticoagulation therapy 12 hours after removal of the drainage catheter. This may help to prevent thromboembolic events following catheter ablation of AF.

  20. Simultaneous occurrence of metabolic, hematologic, neurologic and cardiac complications after Roux-en-Y gastric bypass for morbid obesity.

    Science.gov (United States)

    Kara, Merve; Gundogdu, Yasemin; Karsli, Merve; Ozben, Volkan; Onder, Fatih Oguz; Baca, Bilgi

    2016-10-01

    Roux-en-Y gastric bypass (RYGB) is a commonly performed procedure in the surgical treatment of morbid obesity. Since a major anatomical alteration is made, this procedure may lead to significant postoperative complications, including nutritional deficiencies related to malabsorption. As a consequence of micronutrient deficiencies, secondary metabolic, hematologic and neurologic complications might also develop. Each of these complications is well reported in the literature; however, there are limited data on the simultaneous occurrence of these complications in a single patient. In this report, we aimed to present the diagnosis and management of metabolic, hematologic, neurologic and cardiac complications, which occurred simultaneously in a 57-year-old female patient after undergoing laparoscopic RYGB procedure.

  1. Gastroscopy-related adverse cardiac events and bleeding complications among patients treated with coronary stents and dual antiplatelet therapy

    Science.gov (United States)

    Egholm, Gro; Thim, Troels; Madsen, Morten; Sørensen, Henrik Toft; Pedersen, Jan Bech; Eggert Jensen, Svend; Jensen, Lisette Okkels; Kristensen, Steen Dalby; Bøtker, Hans Erik; Maeng, Michael

    2016-01-01

    Background and study aims: Dual antiplatelet therapy (DAPT) is recommended following percutaneous coronary intervention (PCI) with drug-eluting stent (DES). DAPT is a risk factor for gastrointestinal bleeding. We aimed to quantify (1) the rate of gastroscopy within 12 months after PCI, (2) the rate of adverse cardiac events and gastroscopy-related bleeding complications within 30 days of gastroscopy, and (3) the association between antiplatelet therapy and these events. Patients and methods: Patients receiving gastroscopy within 12 months of PCI were identified and two nested case-control analyses were performed within the PCI cohort by linking Danish medical registries. Cases were patients with adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis) or hemostatic intervention. In both studies, controls were patients with gastroscopy including biopsy without adverse cardiac events and hemostatic intervention, respectively. Medical records were reviewed to obtain information on exposure to DAPT. Results: We identified 22 654 PCI patients of whom 1497 patients (6.6 %) underwent gastroscopy. Twenty-two patients (1.5 %) suffered an adverse cardiac event, 93 patients (6.2 %) received hemostatic intervention during or within 30 days of the index gastroscopy. Interrupting DAPT was associated with a 3.46 times higher risk of adverse cardiac events (95 %CI 0.49 – 24.7). Discontinuation of one antiplatelet agent did not increase the risk (OR 0.65, 95 %CI 0.17 – 2.47). No hemostatic interventions were caused by endoscopic complications. Conclusion: Gastroscopy can be safely performed in PCI patients treated with DES and single antiplatelet therapy while interruption of DAPT may be associated with an increased risk of adverse cardiac events. PMID:27227109

  2. Cardiac involvement and its complications about three cases of severe scorpion envenomation.

    Science.gov (United States)

    Aboumaâd, B; Tiger, A; Khattabi, A; Soulaymani, R; Lahssaini, M; Benhassain, S M; Iba, N

    2014-02-01

    For several decades, Morocco is confronted to medico-social problem of scorpion stings and envenomations. In 2009, epidemiological data established by the Poison Control Center recorded 29,816 stung patients, with an incidence of 1.1‰ and a fatality rate of 0.18%. The neurotoxins from scorpion venom are potent activators of the autonomic nervous system resulting a physiopathological disorder of vital systems. The most serious clinical manifestations are neurotoxic effects, pulmonary edema and cardiovascular distress. This present work reports the cases of three children (4 years and 6 months, 8 months and 15 days, 4 years), hospitalized in intensive care for an envenomation by Androctonus mauritanicus (the most fatal scorpion specie). The children presented cardiac dysfunction where pulmonary edema and state of shock were complications resultants. Two cases survived after supportive and symptomatic treatment based on dobutamine as primordial treatment in cardiovascular and pulmonary correction and other drugs. The third case died. The objective of this work was to detect the limit of the effectiveness of symptomatic treatment during a severe scorpion envenomation. PMID:24316266

  3. Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review

    Directory of Open Access Journals (Sweden)

    David Snowdon

    2014-06-01

    Full Text Available Question: Does preoperative intervention in people undergoing cardiac surgery reduce pulmonary complications, shorten length of stay in the intensive care unit (ICU or hospital, or improve physical function? Design: Systematic review with meta-analysis of (quasi randomised trials. Participants: People undergoing coronary artery bypass grafts and/or valvular surgery. Intervention: Any intervention, such as education, inspiratory muscle training, exercise training or relaxation, delivered prior to surgery to prevent/reduce postoperative pulmonary complications or to hasten recovery of function. Outcome measures: Time to extubation, length of stay in ICU and hospital (reported in days. Postoperative pulmonary complications and physical function were measured as reported in the included trials. Results: The 17 eligible trials reported data on 2689 participants. Preoperative intervention significantly reduced the time to extubation (MD -0.14 days, 95% CI -0.26 to -0.01 and the relative risk of developing postoperative pulmonary complications (RR 0.39, 95% CI 0.23 to 0.66. However, it did not significantly affect the length of stay in ICU (MD -0.15 days, 95% CI -0.37 to 0.08 or hospital (MD -0.55 days, 95% CI -1.32 to 0.23, except among older participants (MD -1.32 days, 95% CI -2.36 to -0.28. When the preoperative interventions were separately analysed, inspiratory muscle training significantly reduced postoperative pulmonary complications and the length of stay in hospital. Trial quality ranged from good to poor and considerable heterogeneity was present in the study features. Other outcomes did not significantly differ. Conclusion: For people undergoing cardiac surgery, preoperative intervention reduces the incidence of postoperative pulmonary complications and, in older patients, the length of stay in hospital. [Snowdon D, Haines TP, Skinner EH (2014 Preoperative intervention reduces postoperative pulmonary complications but not length of stay in

  4. Gastroscopy-related adverse cardiac events and bleeding complications among patients treated with coronary stents and dual antiplatelet therapy

    DEFF Research Database (Denmark)

    Egholm, Gro; Thim, Troels; Madsen, Morten;

    2016-01-01

    of adverse cardiac events and gastroscopy-related bleeding complications within 30 days of gastroscopy, and (3) the association between antiplatelet therapy and these events. PATIENTS AND METHODS: Patients receiving gastroscopy within 12 months of PCI were identified and two nested case......BACKGROUND AND STUDY AIMS: Dual antiplatelet therapy (DAPT) is recommended following percutaneous coronary intervention (PCI) with drug-eluting stent (DES). DAPT is a risk factor for gastrointestinal bleeding. We aimed to quantify (1) the rate of gastroscopy within 12 months after PCI, (2) the rate......-control analyses were performed within the PCI cohort by linking Danish medical registries. Cases were patients with adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis) or hemostatic intervention. In both studies, controls were patients with gastroscopy including biopsy without...

  5. The relationship between cerebral oxygen saturation changes and post operative neurologic complications in patients undergoing cardiac surgery

    International Nuclear Information System (INIS)

    To study the relationship between cerebral oxygen saturation changes and postoperative neurologic complications. Seventy two adult patients with ASA class II, III who were scheduled for elective cardiac surgery, were randomized into three groups: Group I: with CPB (on -pump) Group II: without CPB (off- pump) Group III: valve surgery. Neuropsychological outcome was assessed by the Mini-Mental State Examination (MMSE). Cerebral oxygen saturation was also measured. There was no statistical difference in desaturation of more than 20% among three groups (P=0.113) but it was significant between group I and II (P=0.042). Changes of rSo/sub 2/ in different hours of surgery was significant in group I and group II (P=0.0001 in both) but it was not significant in group III ( P=0.075) . Although cerebral oximetry is a noninvasive and useful method of monitoring during cardiac surgery, it has low accuracy to determine postoperative neurologic complications. (author)

  6. [Heart arrest].

    Science.gov (United States)

    Chiarella, F; Giovannini, E; Bozzano, A; Caristo, G; Delise, P; Fedele, F; Fera, M S; Lavalle, C; Roghi, A; Valagussa, F

    2001-03-01

    Cardiac arrest is one of the leading causes of mortality in industrialized countries and is mainly due to ischemic heart disease. According to ISTAT estimates, approximately 45,000 sudden deaths occur annually in Italy whereas according to the World Health Organization, its incidence is 1 per 1000 persons. The most common cause of cardiac arrest is ventricular fibrillation due to an acute ischemic episode. During acute ischemia the onset of a ventricular tachyarrhythmia is sudden, unpredictable and often irreversible and lethal. Each minute that passes, the probability that the patient survives decreases by 10%. For this reason, the first 10 min are considered to be priceless for an efficacious first aid. The possibility of survival depends on the presence of witnesses, on the heart rhythm and on the resolution of the arrhythmia. In the majority of cases, the latter is possible by means of electrical defibrillation followed by the reestablishment of systolic function. An increase in equipment alone does not suffice for efficacious handling of cardiac arrest occurring outside the hospital premises. Above all, an adequate intervention strategy is required. Ambulance personnel must be well trained and capable of intervening rapidly, possibly within the first 5 min. The key to success lies in the diffusion and proper use of defibrillators. The availability of new generation instruments, the external automatic defibrillators, encourages their widespread use. On the territory, these emergencies are the responsibility of the 118 organization based, according to the characteristics specific to each country, on the regulated coordination between the operative command, the crews and the first-aid means. Strategies for the handling of these emergencies within hospitals have been proposed by the Conference of Bethesda and tend to guarantee an efficacious resuscitation with a maximum latency of 2 min between cardiac arrest and the first electric shock. The diffusion of external

  7. Bed rest for preventing complications after transfemoral cardiac catheterisation: a protocol of systematic review and network meta-analysis

    OpenAIRE

    Dal Molin, Alberto; Faggiano, Fabrizio; Bertoncini, Fabio; Buratti, Giulia; Busca, Erica; Casarotto, Roberta; Gaboardi, Samanta; Allara, Elias

    2015-01-01

    Background Transfemoral cardiac catheterisation is an invasive medical procedure used for therapeutic or diagnostic purposes. Postoperative bed rest can prevent a number of complications such as bleeding and haematoma formation and can result in side effects such as back pain and urinary discomfort. Currently, there is no consensus regarding the optimal length of bed rest. Our objective is to assess the effects of post-catheterisation length of bed rest on bleeding and haematoma, other vascul...

  8. Gastroscopy-related adverse cardiac events and bleeding complications among patients treated with coronary stents and dual antiplatelet therapy

    OpenAIRE

    Egholm, Gro; Thim, Troels; Madsen, Morten; Sørensen, Henrik Toft; Pedersen, Jan Bech; Eggert Jensen, Svend; Jensen, Lisette Okkels; Kristensen, Steen Dalby; Bøtker, Hans Erik; Maeng, Michael

    2016-01-01

    Background and study aims: Dual antiplatelet therapy (DAPT) is recommended following percutaneous coronary intervention (PCI) with drug-eluting stent (DES). DAPT is a risk factor for gastrointestinal bleeding. We aimed to quantify (1) the rate of gastroscopy within 12 months after PCI, (2) the rate of adverse cardiac events and gastroscopy-related bleeding complications within 30 days of gastroscopy, and (3) the association between antiplatelet therapy and these events. Patients and methods: ...

  9. NORMOTHERMIC EXTRACORPORAL PERFUSION IN SITU AS A WAY OF RECOVERY KIDNEY TRANSPLANTS FROM DONORS WITH SUDDEN IRREVERSIBLE CARDIAC ARREST

    OpenAIRE

    S. F. Bagnenko; A. E. Skvortsov; V. N. Poptsov; I. V. Loginov; A. N. Ananyev; O. N. Reznik; Y. G. Moysyuk

    2010-01-01

    The potential of donors after cardiac death is actual issue. The crucial point in uncontrolled donors after cardiac death is the warm ischemical time. Definition of the limit of warm ischemic time is was the one task of our work and other one is development of preservation protocol saving quality of kidneys. There were 6 uncontrolled donors with warm ischemic time from 45 up to 91 minutes in which was adapted extracorporal perfusion device for preservation and restoration of kidneys after isc...

  10. 绿色通道在青年心脏骤停患者急救中应用的效果%Application effects of green channel emergency care on young patients with cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    陈丹; 黄海燕

    2016-01-01

    Objective To explore the value of applying green channel emergency care on young patients with cardiac arrest. Methods A total of 130 young patients with cardiac arrest, who were admitted in the Emergency Department from January 2012 to December 2014, were selected as observation group;other 130 youngpatients, admitted from January 2009 to December 2011 were selected as control group. The patients of control group were given traditional model of emergency care, while the patients of observation group were intervened by the new mode of emergency care green channel. Emergency effects, short-term and long-term prognosis in both groups were compared. Results Time of transit, of staying in the emergency room, of auxiliary examination and time before surgery inside the hospital in the observation group were significantly shorter than that of the control group (P<0. 05). Rate of missed diagnosis, incidence of complications and mortality in the early stage in the observation group were significantly lower than that of the control group ( P<0. 05). Results of a 6-month follow-up investigation on the survivors in Emergency Department showed that the incidence of major cardiovascular events in the observation group was significantly lower than that of the control group (χ2 =42. 332,P <0. 01). Conclusions Application of green channel emergency care on young patients with cardiac arrest can save time, reduce rate of missed diagnosis, incidence of complications and mortality in the early stage, and improve long-term prognosis, which makes it worth promoting.%目的 探讨绿色通道急诊护理在青年心脏骤停患者中的应用价值.方法 选择2012年1月—2014年12月急诊科收治的青年心脏骤停患者130例作为观察组,2009年1月—2011年12月急诊科收治的青年心脏骤停患者130例作对照组,对照组给予传统模式进行急诊护理,观察组在新型绿色通道急诊护理模式下进行干预,观察两组的急诊治疗效果、短期

  11. Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Nielsen, Niklas; Winther-Jensen, Matilde;

    2015-01-01

    AIM: Time to Return of Spontaneous Circulation (ROSC) has a plausible relation to severity of hypoxic injury before and during resuscitation in Out-of-Hospital Cardiac Arrest (OHCA), and has consistently been associated with adverse outcome. The effect of Targeted Temperature Management (TTM) may...

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

    DEFF Research Database (Denmark)

    Salam, Idrees; Hassager, Christian; Thomsen, Jakob Hartvig;

    2016-01-01

    -hospital ROSC-ECG in predicting ST-elevation myocardial infarction (STEMI). METHOD: ROSC-ECGs of 145 comatose survivors of out-of-hospital cardiac arrest, randomly assigned in the Target Temperature Management trial, were classified according to the current STEMI ECG criteria (third universal definition...... of myocardial infarction). RESULTS: STEs were present in the pre-hospital ROSC-ECG of 78 (54%) patients. A final diagnosis revealed that 69 (48%) patients had STEMI, 31 (21%) patients had non-STEMI and 45 (31%) patients had no myocardial infarction. STE in ROSC-ECGs had a sensitivity of 74% (95% confidence...... intervention was successful in 68% versus 36% (PECG is a suboptimal diagnostic tool to predict STEMI...

  13. A low body temperature on arrival at hospital following out-of-hospital-cardiac-arrest is associated with increased mortality in the TTM-study

    DEFF Research Database (Denmark)

    Hovdenes, Jan; Røysland, Kjetil; Nielsen, Niklas;

    2016-01-01

    categorized according to their recorded body temperature on arrival and also categorized to groups of patients being actively cooled or passively rewarmed. RESULTS: OHCA patients having a temperature ≤34.0°C on arrival at hospital had a significantly higher mortality compared to the OHCA patients......AIM: To investigate the association of temperature on arrival to hospital after out-of-hospital-cardiac arrest (OHCA) with the primary outcome of mortality, in the targeted temperature management (TTM) trial. METHODS: The TTM trial randomized 939 patients to TTM at 33 or 36°C for 24h. Patients were...... with a higher temperature on arrival. A low body temperature on arrival was associated with a longer time to return of spontaneous circulation (ROSC) and duration of transport time to hospital. Patients who were actively cooled or passively rewarmed during the first 4h had similar mortality. In a multivariate...

  14. The use of cytosolic enzyme increase in cerebrospinal fluid of patients resuscitated after cardiac arrest. Brain Resuscitation Clinical Trial I Study Group.

    Science.gov (United States)

    Vaagenes, P; Mullie, A; Fodstad, D T; Abramson, N; Safar, P

    1994-11-01

    Levels of brain creatine phosphokinase (CPK), glutamic oxalic transaminase, lactate dehydrogenase, and lactate in lumbar cerebrospinal fluid (CSF) were analyzed as an adjunctive study in a randomized clinical trial evaluating the effects of thiopental loading intravenously in comatose survivors of cardiac arrest. Three hospitals participated and a total of 62 cases of enzyme changes were studied. Enzyme levels but not lactate were higher at 48 hours than at 24 hours after restoration of spontaneous circulation. All enzymes were highly correlated with one another at 24 and 48 hours (P < .001). There was a significant negative correlation between cerebral recovery and increased CPK levels at 24 hours (P < .05), and a highly significant correlation with all three enzyme levels at 48 hours (P < .0001). The increase of cytosolic enzyme activity in lumbar CSF reflects permanent brain damage, and there is a relationship between activity levels and cerebral outcome. PMID:7945601

  15. Target temperature management of 33°C and 36°C in patients with out-of-hospital cardiac arrest with initial non-shockable rhythm

    DEFF Research Database (Denmark)

    Frydland, Martin; Kjaergaard, Jesper; Erlinge, David;

    2015-01-01

    PURPOSE: Despite a lack of randomized trials in comatose survivors of out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm (NSR), guidelines recommend induced hypothermia to be considered in these patients. We assessed the effect on outcome of two levels of induced hypothermia...... in comatose patient resuscitated from NSR. METHODS: Hundred and seventy-eight patients out of 950 in the TTM trial with an initial NSR were randomly assigned to targeted temperature management at either 33°C (TTM33, n=96) or 36°C (TTM36, n=82). We assessed mortality, neurologic function (Cerebral...... prognosis. We found no effect of targeted temperature management at 33°C compared to 36°C in these patients....

  16. Research advance on airway management of patients with cardiac arrest%心搏骤停患者气道管理的研究进展

    Institute of Scientific and Technical Information of China (English)

    李瑞萍; 薛富善; 刘高谱; 孙超; 杨桂珍

    2015-01-01

    Background Recent discoveries surrounding the physiology of cardiac arrest have turned the ABC mnemonic around.Objective This review will focus on issues regarding airway management in patients with cardiac arrest.Content The main contents include the paradigm shifts in emergency airway management, airway management methods, ventilatory management strategies, etc.It is specially emphasized that the initial goal of emergency airway management is the provision of effective ventilation, and can be achieved with a bag-valve-mask (BVM) or supraglottic airway device in the first few minutes of resuscitation.The deployment of an advanced airway should be deferred until the completion of 3 chest compression cycles.Furthermore, the goals of ventilator support of the resuscitated patients include the need to use the lowest possiblepositive end expiratory pressure (PEEP) while carefully titrating inspiratory oxygen concernation to avoid hyperoxia.Trend Paradigm shifts by the understanding of cardiac arrest physiology have resulted in changes to overall management strategies of the resuscitated patients.It is hopeful that these changes would improve the outcomes of patients resuscitated from cardiac arrest.%背景 对心搏骤停的生理研究已经使人们对气道(airway)、呼吸(breathing)和循环(circulation)即ABC复苏三步骤的顺序进行了调整. 目的 综述心搏骤停患者的气道管理问题. 内容 包括紧急气道管理模式的转变、气道管理的方法和通气管理策略等.特别强调紧急气道管理的最初目标是保证有效通气.在复苏的最初几分钟内,应用简易呼吸囊-面罩(bag-valve-mask,BVM)或声门上气道装置即足以达到此目标,高级气道管理应推迟至3个胸部按压循环后实施.再者,复苏患者通气支持的目标是应用尽可能低的呼气末正压通气(positive end expiratory pressure,PEEP),同时调定吸入氧浓度避免高氧. 趋向 心搏骤停生理研究产生的治疗模式

  17. Hemodynamics and vasopressor support during targeted temperature management at 33°C Versus 36°C after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Annborn, Martin; Hassager, Christian;

    2015-01-01

    OBJECTIVE: To investigate the hemodynamic profile associated with different target temperatures and to assess the prognostic implication of inotropic/vasopressor support and mean arterial pressure after out-of-hospital cardiac arrest. There is a lack of information how different target temperatures...... may affect hemodynamics. DESIGN: Post hoc analysis of a prospective randomized study. SETTING: Thirty-six ICUs in 10 countries. PATIENTS: Nine hundred twenty patients (97%) with available vasopressor data out of 950 patients from the Target Temperature Management trial randomly assigned patients...... to a targeted temperature management at 33 °C or 36 °C. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure, heart rate, and lactate were registered at prespecified time points. The population was stratified according to cardiovascular Sequential Organ Failure Assessment = 4 defining...

  18. Cerebral physiology and preservation during cardiac arrest Fisiología y preservación cerebral durante el paro cardíaco: vulnerabilidad del cerebro

    Directory of Open Access Journals (Sweden)

    Luis M. Gómez

    1991-03-01

    Full Text Available

    Cerebral physiology during cardiac arrest is discussed with particular Interest on selective neuronal damage. Previous concepts on brain tolerance to hypoxia are analyzed and new information about brain function prognosis after cardiac arrest is presented. Therapeutic alternatives for brain preservation are discussed with emphasis on the lack of effectiveness of barbiturates, the results of research with other drugs and the future role that blockers of excitatory neurotransmission may have as elements of cerebral preservation.

    Se hace una aproximación a la fisiología cerebral durante el paro cardíaco, destacando el concepto de darlo neuronal selectivo. Se presentan elementos que permiten modificar concepciones antiguas sobre la tolerancia del cerebro a la hipoxia severa. Además, se hace un nuevo planteamiento sobre el pronóstico cerebral luego de un paro cardíaco y se esbozan las alternativas terapéuticas utilizadas hasta la fecha para la preservación cerebral. Se hace énfasis en la inefectividad de los barbitúricos, en la investigación sobre la terapia con otras drogas y en el futuro abierto hacia los bloqueadores de los neurotransmisores excitadores, como elementos terapéuticos para la preservación cerebral.

  19. Sildenafil Protects against Myocardial Ischemia-Reperfusion Injury Following Cardiac Arrest in a Porcine Model: Possible Role of the Renin-Angiotensin System.

    Science.gov (United States)

    Wang, Guoxing; Zhang, Qian; Yuan, Wei; Wu, Junyuan; Li, Chunsheng

    2015-11-12

    Sildenafil, a phosphodiesterase-5 inhibitor sold as Viagra, is a cardioprotector against myocardial ischemia/reperfusion (I/R) injury. Our study explored whether sildenafil protects against I/R-induced damage in a porcine cardiac arrest and resuscitation (CAR) model via modulating the renin-angiotensin system. Male pigs were randomly divided to three groups: Sham group, Saline group, and sildenafil (0.5 mg/kg) group. Thirty min after drug infusion, ventricular fibrillation (8 min) and cardiopulmonary resuscitation (up to 30 min) was conducted in these animals. We found that sildenafil ameliorated the reduced cardiac function and improved the 24-h survival rate in this model. Sildenafil partly attenuated the increases of plasma angiotensin II (Ang II) and Ang (1-7) levels after CAR. Sildenafil also decreased apoptosis and Ang II expression in myocardium. The increases of expression of angiotensin-converting-enzyme (ACE), ACE2, Ang II type 1 receptor (AT1R), and the Ang (1-7) receptor Mas in myocardial tissue were enhanced after CAR. Sildenafil suppressed AT1R up-regulation, but had no effect on ACE, ACE2, and Mas expression. Sildenafil further boosted the upregulation of endothelial nitric oxide synthase (eNOS), cyclic guanosine monophosphate (cGMP) and inducible nitric oxide synthase(iNOS). Collectively, our results suggest that cardioprotection of sildenafil in CAR model is accompanied by an inhibition of Ang II-AT1R axis activation.

  20. Association of ozone and particulate air pollution with out-of-hospital cardiac arrest in Helsinki, Finland: evidence for two different etiologies.

    Science.gov (United States)

    Rosenthal, Frank S; Kuisma, Markku; Lanki, Timo; Hussein, Tareq; Boyd, James; Halonen, Jaana I; Pekkanen, Juha

    2013-01-01

    Out-of-hospital cardiac arrest (OHCA) has been previously associated with exposure to particulate air pollution. However, there is uncertainty about the agents and mechanisms that are involved. We aimed to determine the association of gases and particulates with OHCA, and differences in pollutant effects on OHCAs due to acute myocardial infarction (AMI) vs those due to other causes. Helsinki Emergency Medical Services provided data on OHCAs of cardiac origin (OHCA_Cardiac). Hospital and autopsy reports determined whether OHCAs were due to AMI (OHCA_MI) or other cardiac causes (OHCA_Other). Pollutant data was obtained from central ambient monitors. A case-crossover analysis determined odds ratios (ORs) for hourly lagged exposures (Lag 0-3) and daily lagged exposures (Lag 0d-3d), expressed per interquartile range of pollutant level. For OHCA_Cardiac, elevated ORs were found for PM(2.5) (Lag 0, 1.07; 95% confidence interval (CI): 1.01-1.13) and ozone (O(3)) (Lag 2d, 1.18; CI: 1.03-1.35). For OHCA_MI, elevated ORs were found for PM(2.5) (Lag 0, 1.14; CI: 1.03-1.27; Lag 0d, 1.17; CI: 1.03-1.33), accumulation mode particulate (Acc) (Lag 0d, 1.19; CI: 1.04-1.35), NO (Lag 0d, 1.07; CI: 1.01-1.13), and ultrafine particulate (Lag 0d, 1.27; CI: 1.05-1.54). For OHCA_Other, elevated ORs were found only for O(3) (Lag 1d, 1.26; CI: 1.07-1.48; Lag 2d, 1.30; CI: 1.11-1.53). Results from two-pollutant models, with one of the pollutants either PM(2.5) or O(3), suggested that associations were primarily due to effects of PM(2.5) and O(3), rather than other pollutants. The results suggest that air pollution triggers OHCA via two distinct modes: one associated with particulates leading to AMI and one associated with O(3) involving etiologies other than AMI, for example, arrhythmias or respiratory insufficiency.

  1. Asystole to cross-clamp period predicts development of biliary complications in liver transplantation using donation after cardiac death donors.

    Science.gov (United States)

    Taner, C Burcin; Bulatao, Ilynn G; Perry, Dana K; Sibulesky, Lena; Willingham, Darrin L; Kramer, David J; Nguyen, Justin H

    2012-08-01

    This study sought to determine the procurement factors that lead to development of intrahepatic bile duct strictures (ITBS) and overall biliary complications in recipients of donation after cardiac death (DCD) liver grafts. Detailed information for different time points during procurement (withdrawal of support; SBP mandatory wait period; asystole; incision; aortic cross clamp) and their association with the development of ITBS and overall biliary complications were examined using logistic regression. Two hundred and fifteen liver transplants using DCD donors were performed between 1998 and 2010 at Mayo Clinic Florida. Of all the time periods during procurement, only asystole-cross clamp period was significantly different between patients with ITBS versus no ITBS (P = 0.048) and between the patients who had overall biliary complications versus no biliary complications (P = 0.047). On multivariate analysis, only asystole-cross clamp period was significant predictor for development of ITBS (P = 0.015) and development of overall biliary complications (P = 0.029). Hemodynamic changes in the agonal period did not emerge as risk factors. The results of the study raise the possibility of utilizing asystole-cross-clamp period in place of or in conjunction with donor warm ischemia time in determining viability or quality of liver grafts. PMID:22703372

  2. Cocaine-associated increase of atrial natriuretic peptides: an early predictor of cardiac complications in cocaine users?

    Science.gov (United States)

    Casartelli, Alessandro; Dacome, Lisa; Tessari, Michela; Pascali, Jennifer; Bortolotti, Federica; Trevisan, Maria Teresa; Bosco, Oliviero; Cristofori, Patrizia; Tagliaro, Franco

    2014-01-01

    Objective Cocaine is known to produce life-threatening cardiovascular complications, and the investigation of the causes of death may be challenging in forensic medicine. The increasing knowledge of the cardiac function biomarkers and the increasing sensitivity of assays provide new tools in monitoring the cardiac life-threatening pathological conditions and in the sudden death investigation in chronic abusers. In this work, cardiac dysfunction was assessed in an animal model by measuring troponin I and natriuretic peptides as biomarkers, and considering other standard endpoints used in preclinical toxicology studies. Methods Lister Hooded rats were treated with cocaine in chronic self-administration studies. Troponin I (cTnI) and atrial natriuretic peptide (ANP) were evaluated at different time points and heart weight and histopathology were assessed at the end of the treatment period. Furthermore, cocaine and its main metabolites were measured in the rat fur to assess rats’ cocaine exposure. All the procedures and endpoints considered were designed to allow an easy and complete translation from the laboratory animals to human beings, and the same approach was also adopted with a group of 10 healthy cocaine abuse volunteers with no cardiac pathologies. Results Cardiac troponin I values were unaffected, and ANP showed an increasing trend with time in all cocaine-treated animals considered. Similarly, in the healthy volunteers, no changes were observed in troponin serum levels, whereas the N-terminal brain natriuretic pro-peptide (NT proBNP) showed variations comparable with the changes observed in rats. Conclusions In conclusion, natriuretic peptides could represent an early indicator of heart dysfunction liability in chronic cocaine abusers. PMID:27326180

  3. 正颌手术中上颌骨 Lefort I型截骨致心跳骤停1例%A case of cardiac arrest induced by Lefort I osteotomy of the maxilla during orthognathic surgery

    Institute of Scientific and Technical Information of China (English)

    邱宝军; 汪伟; 张惠

    2016-01-01

    心跳骤停是手术麻醉过程中最严重的突发紧急情况。颌面外科行上颌骨 Lefort I 型截骨时可刺激或牵拉上颌神经引发“三叉神经-心脏反射”,其可表现为心律失常、异位起搏、房室传导阻滞、心动过缓、晕厥、呕吐,严重时可致心跳骤停。现报道1例正颌手术中上颌骨 Lefort I 型截骨致心跳骤停的发生及处理经过。%Cardiac arrest is the most serious emergency during operation and anesthesia.In maxillofacial surgery,Lefort I osteotomy of the maxilla may stimulate or retract maxillary nerve and trigger “trigeminal-cardiac reflex”,which manifests as arrhythmia,atrioventricular block,bradycardia,apsychia,vomit and cardiac arrest.A case of cardiac arrest during Lefort I osteotomy of the maxilla is reported in this pa-per.

  4. Magnetic resonance imaging tracing of transplanted bone marrow mesenchymal stem cells in a rat model of cardiac arrest-induced global brain ischemia

    Institute of Scientific and Technical Information of China (English)

    Yue Fu; Xiangshao Fang; Tong Wang; Jiwen Wang; Jun Jiang; Zhigang Luo; Xiaohui Duan; Jun Shen; Zitong Huang

    2009-01-01

    BACKGROUND: Numerous studies have shown that magnetic resonance imaging (MRI) can detect survival and migration of super paramagnetic iron oxide-labeled stem cells in models of focal cerebral infarction. OBJECTIVE: To observe distribution of bone marrow mesenchymal stem cells (BMSCs) in a rat model of global brain ischemia following cardiac arrest and resuscitation, and to investigate the feasibility of tracing iron oxide-labeled BMSCs using non-invasive MRI. DESIGN, TIME AND SETTING: The randomized, controlled, molecular imaging study was performed at the Linbaixin Medical Research Center, Second Affiliated Hospital, Sun Yat-sen University, and the Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, China from October 2006 to February 2009.MATERIALS: A total of 40 clean, Sprague Dawley rats, aged 6 weeks and of either gender, were supplied by the Experimental Animal Center, Sun Yat-sen University, China, for isolation of BMSCs. Feridex (iron oxide), Gyroscan Inetra 1.5T MRI system, and cardiopulmonary resuscitation device were used in this study. METHODS: A total of 30 healthy, male Sprague Dawley rats, aged 6 months, were used to induce ventricular fibrillation using alternating current. After 8 minutes, the rats underwent 6-minute chest compression and mechanical ventilation, followed by electric defibrillation, to establish rat models of global brain ischemia due to cardiac arrest and resuscitation. A total of 24 successful models were randomly assigned to Feridex-labeled and non-labeled groups (n=12 for each group). At 2 hours after resuscitation, 5 x 10 6 Feddex-labeled BMSCs, with protamine sulfate as a carrier, and 5 × 10 6 non-labeled BMSCs were respectively transplanted into both groups of rats through the right carotid artery (cells were harvested in 1 mL phosphate buffered saline). MAIN OUTCOME MEASURES: Feridex-labeled BMSCs were observed by Prussian blue staining and electron microscopy. Signal intensity, celluar viability

  5. NORMOTHERMIC EXTRACORPORAL PERFUSION IN SITU AS A WAY OF RECOVERY KIDNEY TRANSPLANTS FROM DONORS WITH SUDDEN IRREVERSIBLE CARDIAC ARREST

    Directory of Open Access Journals (Sweden)

    S. F. Bagnenko

    2010-01-01

    Full Text Available The potential of donors after cardiac death is actual issue. The crucial point in uncontrolled donors after cardiac death is the warm ischemical time. Definition of the limit of warm ischemic time is was the one task of our work and other one is development of preservation protocol saving quality of kidneys. There were 6 uncontrolled donors with warm ischemic time from 45 up to 91 minutes in which was adapted extracorporal perfusion device for preservation and restoration of kidneys after ischemical damage. The main attention was paid to the elimination of leucocytes as the main damaging factor from modificated donor’s blood circulating in device. In 6 of such kidneys recipients from 12 were immediately graft function, and to the end of third month the average creatinine was 121,3 ± 28,9 mmol/l. Treatment of ischemically damaged kidneys by normothermic extracorporal perfusion with leucocytes depletion before procurement could consider as challenging protocol and demands further study. 

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

    DEFF Research Database (Denmark)

    Cronberg, Tobias; Lilja, Gisela; Horn, Janneke;

    2015-01-01

    : In this multicenter, international, parallel group, assessor-masked randomized clinical trial performed from November 11, 2010, through January 10, 2013, we enrolled 950 unconscious adults with cardiac arrest of presumed cardiac cause from 36 intensive care units in Europe and Australia. Eleven patients were excluded...... from analysis for a total sample size of 939. INTERVENTIONS: Targeted temperature management at 33°C vs 36°C. MAIN OUTCOMES AND MEASURES: Cognitive function was measured by the Mini-Mental State Examination (MMSE) and assessed by observers through the Informant Questionnaire on Cognitive Decline...

  7. First autologous cell therapy of cerebral palsy caused by hypoxic-ischemic brain damage in a child after cardiac arrest-individual treatment with cord blood.

    Science.gov (United States)

    Jensen, A; Hamelmann, E

    2013-01-01

    Each year, thousands of children incur brain damage that results in lifelong sequelae. Therefore, based on experimental evidence, we explored the therapeutic potential of human cord blood, known to contain stem cells, to examine the functional neuroregeneration in a child with cerebral palsy after cardiac arrest. The boy, whose cord blood was stored at birth, was 2.5 years old and normally developed when global ischemic brain damage occurred resulting in a persistent vegetative state. Nine weeks later, he received autologous cord blood (91.7 mL, cryopreserved, 5.75 × 10e8 mononuclear cells) intravenously. Active rehabilitation (physio- and ergotherapy) was provided daily, follow-up at 2, 5, 12, 24, 30, and 40 months. At 2-months follow-up the boy's motor control improved, spastic paresis was largely reduced, and eyesight was recovered, as did the electroencephalogram. He smiled when played with, was able to sit and to speak simple words. At 40 months, independent eating, walking in gait trainer, crawling, and moving from prone position to free sitting were possible, and there was significantly improved receptive and expressive speech competence (four-word sentences, 200 words). This remarkable functional neuroregeneration is difficult to explain by intense active rehabilitation alone and suggests that autologous cord blood transplantation may be an additional and causative treatment of pediatric cerebral palsy after brain damage. PMID:23762741

  8. Diazoxide Attenuates Postresuscitation Brain Injury in a Rat Model of Asphyxial Cardiac Arrest by Opening Mitochondrial ATP-Sensitive Potassium Channels.

    Science.gov (United States)

    Wu, Haidong; Wang, Peng; Li, Yi; Wu, Manhui; Lin, Jiali; Huang, Zitong

    2016-01-01

    Objective. We investigated whether and how diazoxide can attenuate brain injury after cardiopulmonary resuscitation (CPR) by selective opening of mitochondrial ATP-sensitive potassium (mitoKATP) channels. Methods. Adult male Sprague-Dawley rats with induced cerebral ischemia (n = 10 per group) received an intraperitoneal injection of 0.1% dimethyl sulfoxide (1 mL; vehicle group), diazoxide (10 mg/kg; DZ group), or diazoxide (10 mg/kg) plus 5-hydroxydecanoate (5 mg/kg; DZ + 5-HD group) 30 min after CPR. The control group (sham group, n = 5) underwent sham operation, without cardiac arrest. Mitochondrial respiratory control rate (RCR) was determined. Brain cell apoptosis was assessed using TUNEL staining. Expression of Bcl-2, Bax, and protein kinase C epsilon (PKCε) in the cerebral cortex was determined by Western blotting and immunohistochemistry. Results. The neurological deficit scores (NDS) in the vehicle group decreased significantly at 24 h and 48 h after CPR. Diazoxide significantly improved NDS and mitochondrial RCR after CPR at both time points; 5-HD cotreatment abolished these effects. Diazoxide decreased TUNEL-positive cells following CPR, upregulated Bcl-2 and PKCε, downregulated Bax, and increased the Bcl-2/Bax ratio; 5-HD cotreatment reversed these effects. Conclusions. Diazoxide attenuates postresuscitation brain injury, protects mitochondrial function, inhibits brain cell apoptosis, and activates the PKC pathway by opening mitoKATP channels. PMID:27648441

  9. 治疗性亚低温对儿童心脏停搏后脑功能保护的作用%Neurologic protection of therapeutic hypothermia in cardiac arrest survivors

    Institute of Scientific and Technical Information of China (English)

    许巍; 刘春峰

    2012-01-01

    Brain injury is the leading cause of death after cardiopulmonary resuscitation.Clinical care for brain injury remains necessary.Therapeutic hypothermia has been shown to be effective in improving neurological outcome of children with cardiac arrest.We routinely induced hypothermia in children with coma after cardiac arrest,targeting 32 ~ 34 ℃,using cooling blankets and intravenous ice cap as primary methods for induction,for 24 ~ 72 h or much more duration,and vigilant re-warming.The objective of this article was to share our hypothermia protocol for cooling children with acute brain injury after cardiac arrest.%脑损伤是心脏停搏心肺复苏术后患儿的主要致死原因,脑功能保护措施十分必要.治疗性亚低温对改善脑功能预后效果明显.对于心肺复苏术后仍然昏迷的患儿实行亚低温治疗,应用降温毯和冰帽,目标温度32~ 34℃,治疗时间24~72 h或者适当延长,然后逐渐复温.本文就心脏停搏心肺复苏后的患儿实施亚低温脑功能保护措施作一介绍.

  10. [Clinical case of the month. Cardiac complications of acromegaly: a rare cause of dilated cardiomyopathy].

    Science.gov (United States)

    Devoitille, A; Beckers, A; Piérard, L A

    2012-04-01

    Acromegaly is a disease characterized by chronic growth hormone hypersecretion. Cardiovascular complications represent the main cause of death. We present here a rare case of dilated cardiomyopathy whose diagnosis revealed an acromegaly. This will provide the opportunity to review an uncommon disease and its recently reassessed prevalence.

  11. Cardiac and pulmonary complication probabilities for breast cancer patients after routine end-inspiration gated radiotherapy

    DEFF Research Database (Denmark)

    Korreman, Stine S; Pedersen, Anders N; Juhler-Nøttrup, Trine;

    2006-01-01

    and an uncoached end-inspiration gating technique. RESULTS: The ipsilateral lung V(50) (relative volume receiving more than 50% of the prescription dose) had a median value of 23.7% (range 10.8-35.1%) over the patient population. The corresponding median lung pneumonitis probability was 1.1% (range 0......-14%). The median heart V(50) was 0.8% (range 0-19.1%) with a corresponding median cardiac mortality NTCP of 0.1% (range 0-5.7%). These results compare well with the predictions of our previous CT-studies. There is a significant reduction in dose to the left anterior descending coronary artery for the enhanced end...

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

    Directory of Open Access Journals (Sweden)

    Ling Tiah

    2014-11-01

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

  13. Combining Amplitude Spectrum Area with Previous Shock Information Using Neural Networks Improves Prediction Performance of Defibrillation Outcome for Subsequent Shocks in Out-Of-Hospital Cardiac Arrest Patients.

    Directory of Open Access Journals (Sweden)

    Mi He

    Full Text Available Quantitative ventricular fibrillation (VF waveform analysis is a potentially powerful tool to optimize defibrillation. However, whether combining VF features with additional attributes that related to the previous shock could enhance the prediction performance for subsequent shocks is still uncertain.A total of 528 defibrillation shocks from 199 patients experienced out-of-hospital cardiac arrest were analyzed in this study. VF waveform was quantified using amplitude spectrum area (AMSA from defibrillator's ECG recordings prior to each shock. Combinations of AMSA with previous shock index (PSI or/and change of AMSA (ΔAMSA between successive shocks were exercised through a training dataset including 255shocks from 99patientswith neural networks. Performance of the combination methods were compared with AMSA based single feature prediction by area under receiver operating characteristic curve(AUC, sensitivity, positive predictive value (PPV, negative predictive value (NPV and prediction accuracy (PA through a validation dataset that was consisted of 273 shocks from 100patients.A total of61 (61.0% patients required subsequent shocks (N = 173 in the validation dataset. Combining AMSA with PSI and ΔAMSA obtained highest AUC (0.904 vs. 0.819, p<0.001 among different combination approaches for subsequent shocks. Sensitivity (76.5% vs. 35.3%, p<0.001, NPV (90.2% vs. 76.9%, p = 0.007 and PA (86.1% vs. 74.0%, p = 0.005were greatly improved compared with AMSA based single feature prediction with a threshold of 90% specificity.In this retrospective study, combining AMSA with previous shock information using neural networks greatly improves prediction performance of defibrillation outcome for subsequent shocks.

  14. Mild hypothermia attenuates post-resuscitation brain injury through a V-ATPase mechanism in a rat model of cardiac arrest.

    Science.gov (United States)

    Zhang, J C; Lu, W; Xie, X M; Pan, H; Wu, Z Q; Yang, G T

    2016-01-01

    Although therapeutic hypothermia is an effective treatment for post-resuscitation brain injury after cardiac arrest (CA), the underlying mechanism remains unclear. Vacuolar H(+)-ATPase (V-ATPase) plays a key role in cellular adaption to a hypoxic environment. This study sought to evaluate the effect of mild hypothermia on V-ATPase and its involvement in neuroprotection after CA. Male Sprague-Dawley rats were subjected to a 6-min CA, resuscitated successfully, and then assigned to either the normothermia (NT) group or the hypothermia (HT) group. Rats were further divided into 2 subgroups based on the time of euthanasia, either 3 or 24 h after CA (NT-3 h, HT-3 h; NT-24 h, HT-24 h). Mild hypothermia was induced following CA and maintained at 33°C for 2 h. Neurologic deficit scores were used to determine the status of neurological function. Brain specimens were analyzed by TUNEL assay, western blotting, and immunohistochemistry. V-ATPase activity was estimated by subtracting total ATP hydrolysis from the bafilomycin-sensitive activity. Mild hypothermia improved the neurological outcome (HT-24 h: 34.3 ± 16.4 vs NT-24 h: 50.3 ± 17.4) and significantly decreased neurocyte apoptosis 24 h after resuscitation. Mild hypothermia significantly increased V0a1 compared to NT-3 h; V0a1 expression was associated with a decrease in the cleaved caspase 3 expression. These findings suggested that mild hypothermia inhibits CA-induced apoptosis in the hippocampus, which may be associated with reduced V-ATPase impairment. These data provide new insights into the protective effects of hypothermia in vivo. PMID:27323115

  15. 高校心搏骤停四例急诊救治分析%Emergency Treatment of Four Cases with Cardiac Arrest in A University

    Institute of Scientific and Technical Information of China (English)

    陈立峰; 彭莉

    2012-01-01

    The gains and loses of rescue of 4 cardiac arrest patients in Hospital of Chongqing University of Science and Technology in recent years were summarized by reviewing field first aid of cardiopulmonary resuscitation ( CPR ) and the practical simplified flowsheet of 5 ring - joints of " chains of survival" , to deepen understanding of new concept of modern emergency medicine and make " 5E" of first - aid interlock. Medical professionals should ensure the quality of CPR, CPR education popularized in non - professionals. Thus the whole society could build first - aid systems of unexpected incidents of public health, to provide severe patients with more time and chances of receiving further treatment.%通过学习心肺复苏现场急救与"生存链"五环节实用简化流程,总结分析近年来我院在实践工作中抢救4例心搏骤停患者的得失,进而加深对现代急救医学新概念的理解,并得出现场急救"五早"环环相扣.专业医务人员应确保心肺复苏术(CPR)的高质量,非专业人员亦应学习和接受CPR教育,全社会共同构建突发性卫生事件的救护体系,使更多的危重病患者有接受进一步治疗的时间和机会.

  16. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

    Science.gov (United States)

    Donnino, Michael W; Andersen, Lars W; Berg, Katherine M; Reynolds, Joshua C; Nolan, Jerry P; Morley, Peter T; Lang, Eddy; Cocchi, Michael N; Xanthos, Theodoros; Callaway, Clifton W; Soar, Jasmeet

    2016-01-01

    For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32 °C and 36 °C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document.

  17. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

    Science.gov (United States)

    Donnino, Michael W; Andersen, Lars W; Berg, Katherine M; Reynolds, Joshua C; Nolan, Jerry P; Morley, Peter T; Lang, Eddy; Cocchi, Michael N; Xanthos, Theodoros; Callaway, Clifton W; Soar, Jasmeet

    2016-01-01

    For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32 °C and 36 °C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document. PMID:26449873

  18. Proenkefalin A and protachykinin in ischemic neurological complications after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Milan Skitek

    2016-02-01

    Full Text Available Aim The evaluation of biomarkers of acute ischemic brain injury following surgical revascularization of the heart with the use of the heart-lung machine (cardiopulmonary bypass, CPB. Methods Twenty consecutive patients were divided into two groups: the first 10 patients received a potential neuroprotective human recombinant erythropoietin, while the remaining 10 comprised the control group. Neurological complications were monitored by measuring serum concentrations of neuropeptide proenkephalin A (PENK-A and protachykinin A (PTA before and in the first 5 days after surgery, comparing the neurological outcome with MRI examinations. Results Both the erythropoietin-treated group and control group were comparable with a non-significant difference shown for the postoperative concentrations of PENK-A and PTA. A comparison of serum concentrations of the biomarkers of 16 patients without brain ischemia and 4 patients with acute ischemia also displayed no significant differences, regardless of erythropoietin therapy. Conclusion In our pilot study the analysis of PENK-A and PTA serum concentrations might not be the strategy to enable the monitoring and evaluation of neuroprotective stroke treatment, but further studies are required to investigate its role in acute ischemic brain injury.

  19. Lead Burden as a Factor for Higher Complication Rate in Patients With Implantable Cardiac Devices

    Directory of Open Access Journals (Sweden)

    Christopher Kolibash

    2015-01-01

    Full Text Available Purpose: Lead revisions have increased over the last decade. Patients who do not undergo lead extraction face an increased lead burden. Consequences of increased lead burden have not been fully defined. We sought to characterize the complication rate and outcomes in patients with sterile redundant leads. Methods: We retrospectively reviewed 242 consecutive patients [mean age 74 ± 12 years; 66.9% male] who underwent lead revision that resulted in an abandoned lead from January 2005 to June 2010. Patients were placed in a cohort based on number of leads after last recorded procedure (Group A: ≤2 [n=58]; Group B: 3-4 [n=168]; Group C: ≥5 [n=16]. Prespecified inhospital and long-term follow-up events were compared. Mortality rates were obtained from Social Security Death Index. Median follow-up was 2 years. Results: Baseline age, gender and race demographics were similar among the three groups. Increasing lead burden was associated with more adverse periprocedural events (A: 3.4%, B: 10.1%, C: 25.0%; P=0.031 and long-term device-related events (A: 1.7%, B: 13.0%, C: 18.8%; P=0.031. Device-related readmissions increased in frequency as lead burden increased (A: 3.5%, B: 18.5%, C: 37.5%; P=0.002. Combined periprocedural and late events also increased with more redundant leads (A: 5.2%, B: 23.2%, C: 44.0%; P=0.001. Total major events were infrequent (3.3%. There was no procedure-related mortality. Long-term all-cause mortality was not significantly different (A: 17.2%, B: 23.8%, C: 25.0%; P=0.567. Conclusions: Greater lead burden was associated with increased number of periprocedural and long-term minor events. It did not significantly impact major events or mortality.

  20. An unanticipated cardiac arrest and unusual post-resuscitation psycho-behavioural phenomena/near death experience in a patient with pregnancy induced hypertension and twin pregnancy undergoing elective lower segment caesarean section

    Directory of Open Access Journals (Sweden)

    Mridul M Panditrao

    2010-01-01

    Full Text Available A case report of a primigravida, who was admitted with severe pregnancy induced hypertension (BP 160/122 mmHg and twin pregnancy, is presented here. Antihypertensive therapy was initiated. Elective LSCS under general anaesthesia was planned. After the birth of both the babies, intramyometrial injections of Carboprost and Pitocin were administered. Immediately, she suffered cardiac arrest. Cardio pulmonary resucitation (CPR was started and within 3 minutes, she was successfully resuscitated. The patient initially showed peculiar psychological changes and with passage of time, certain psycho-behavioural patterns emerged which could be attributed to near death experiences, as described in this case report.

  1. An unanticipated cardiac arrest and unusual post-resuscitation psycho-behavioural phenomena/near death experience in a patient with pregnancy induced hypertension and twin pregnancy undergoing elective lower segment caesarean section.

    Science.gov (United States)

    Panditrao, Mridul M; Singh, Chanchal; Panditrao, Minnu M

    2010-09-01

    A case report of a primigravida, who was admitted with severe pregnancy induced hypertension (BP 160/122 mmHg) and twin pregnancy, is presented here. Antihypertensive therapy was initiated. Elective LSCS under general anaesthesia was planned. After the birth of both the babies, intramyometrial injections of Carboprost and Pitocin were administered. Immediately, she suffered cardiac arrest. Cardio pulmonary resucitation (CPR) was started and within 3 minutes, she was successfully resuscitated. The patient initially showed peculiar psychological changes and with passage of time, certain psycho-behavioural patterns emerged which could be attributed to near death experiences, as described in this case report.

  2. The secular trends in the incidence rate and outcomes of out-of-hospital cardiac arrest in Taiwan--a nationwide population-based study.

    Directory of Open Access Journals (Sweden)

    Cheng-Yi Wang

    Full Text Available This study investigated the trends in incidence and mortality of out-of-hospital cardiac arrest (OHCA, as well as factors associated with OHCA outcomes in Taiwan.Our study included OHCA patients requiring cardiopulmonary resuscitation (CPR upon arrival at the hospital. We used national time-series data on annual OHCA incidence rates and mortality rates from 2000 to 2012, and individual demographic and clinical data for all OHCA patients requiring mechanical ventilation (MV care from March of 2010 to September of 2011. Analytic techniques included the time-series regression and the logistic regression.There were 117,787 OHCAs in total. The overall incidence rate during the 13 years was 51.1 per 100,000 persons, and the secular trend indicates a sharp increase in the early 2000s and a decrease afterwards. The trend in mortality was also curvilinear, revealing a substantial increase in the early 2000s, a subsequent steep decline and finally a modest increase. Both the 30-day and 180-day mortality rates had a long-term decreasing trend over the period (p<0.01. For both incidence and mortality rates, a significant second-order autoregressive effect emerged. Among OHCA patients with MV, 1-day, 30-day and 180-day mortality rates were 31.3%, 75.8%, and 86.0%, respectively. In this cohort, older age, the female gender, and a Charlson comorbidity index score ≥ 2 were associated with higher 180-day mortality; patients delivered to regional hospitals and those residing in non-metropolitan areas had higher death risk.Overall, both the 30-day and the 180-day mortality rates after OHCA had a long-term decreasing trend, while the 1-day mortality had no long-term decline. Among OHCA patients requiring MV, those delivered to regional hospitals and those residing in non-metropolitan areas tended to have higher mortality, suggesting a need for effort to further standardize and improve in-hospital care across hospitals and to advance pre-hospital care in non

  3. Cardiac Arrest-Induced Global Brain Hypoxia-Ischemia during Development Affects Spontaneous Activity Organization in Rat Sensory and Motor Thalamocortical Circuits during Adulthood.

    Science.gov (United States)

    Shoykhet, Michael; Middleton, Jason W

    2016-01-01

    Normal maturation of sensory information processing in the cortex requires patterned synaptic activity during developmentally regulated critical periods. During early development, spontaneous synaptic activity establishes required patterns of synaptic input, and during later development it influences patterns of sensory experience-dependent neuronal firing. Thalamocortical neurons occupy a critical position in regulating the flow of patterned sensory information from the periphery to the cortex. Abnormal thalamocortical inputs may permanently affect the organization and function of cortical neuronal circuits, especially if they occur during a critical developmental window. We examined the effect of cardiac arrest (CA)-associated global brain hypoxia-ischemia in developing rats on spontaneous and evoked firing of somatosensory thalamocortical neurons and on large-scale correlations in the motor thalamocortical circuit. The mean spontaneous and sensory-evoked firing rate activity and variability were higher in CA injured rats. Furthermore, spontaneous and sensory-evoked activity and variability were correlated in uninjured rats, but not correlated in neurons from CA rats. Abnormal activity patterns of ventroposterior medial nucleus (VPm) neurons persisted into adulthood. Additionally, we found that neurons in the entopeduncular nucleus (EPN) in the basal ganglia had lower firing rates yet had higher variability and higher levels of burst firing after injury. Correlated levels of power in local field potentials (LFPs) between the EPN and the motor cortex (MCx) were also disrupted by injury. Our findings indicate that hypoxic-ischemic injury during development leads to abnormal spontaneous and sensory stimulus-evoked input patterns from thalamus to cortex. Abnormal thalamic inputs likely permanently and detrimentally affect the organization of cortical circuitry and processing of sensory information. Hypoxic-ischemic injury also leads to abnormal single neuron and

  4. Advance in the study of prognostication of neurological outcome in comatose survivors from cardiac arrest%心搏骤停后昏迷患者神经功能预后评估的研究进展

    Institute of Scientific and Technical Information of China (English)

    王淦楠; 张劲松

    2016-01-01

    心肺复苏后昏迷患者早期神经功能预后评估作为心搏骤停(CA)后管理的重要组成部分,具有显著的临床意义.本文从神经系统检查、脑电图、诱发电位、神经影像学及血清生物标志物等方面,结合亚低温治疗对神经功能评估的影响,综述了CA后昏迷患者神经功能预后评估的研究进展.%Early prognostication of neurological outcome in comatose survives after cardiopulmonary resuscitation,an essential component of post-cardiac arrest care is significantly meaningful in both clinical and economic fields.From the perspectives of predictors based on neurological examination,electroencephalogram,evoked potentials,neuroimaging and blood biomarkers and taking advantage of therapeutic hypothermia into consideration,this article reviews the development in evaluation of neurological outcome in comatose survives after cardiac arrest.

  5. Cardiac complications associated with short-term mortality in schizophrenia patients hospitalized for pneumonia: a nationwide case-control study.

    Directory of Open Access Journals (Sweden)

    Ya-Tang Liao

    Full Text Available BACKGROUND: Pneumonia is one of most prevalent infectious diseases worldwide and is associated with considerable mortality. In comparison to general population, schizophrenia patients hospitalized for pneumonia have poorer outcomes. We explored the risk factors of short-term mortality in this population because the information is lacking in the literature. METHODS: In a nationwide schizophrenia cohort, derived from the National Health Insurance Research Database in Taiwan, that was hospitalized for pneumonia between 2000 and 2008 (n = 1,741, we identified 141 subjects who died during their hospitalizations or shortly after their discharges. Based on risk-set sampling in a 1∶4 ratio, 468 matched controls were selected from the study cohort (i.e., schizophrenia cohort with pneumonia. Physical illnesses were categorized as pre-existing and incident illnesses that developed after pneumonia respectively. Exposures to medications were categorized by type, duration, and defined daily dose. We used stepwise conditional logistic regression to explore the risk factors for short-term mortality. RESULTS: Pre-existing arrhythmia was associated with short-term mortality (adjusted risk ratio [RR] = 4.99, p<0.01. Several variables during hospitalization were associated with increased mortality risk, including incident arrhythmia (RR = 7.44, p<0.01, incident heart failure (RR = 5.49, p = 0.0183 and the use of hypoglycemic drugs (RR = 2.32, p<0.01. Furthermore, individual antipsychotic drugs (such as clozapine known to induce pneumonia were not significantly associated with the risk. CONCLUSIONS: Incident cardiac complications following pneumonia are associated with increased short-term mortality. These findings have broad implications for clinical intervention and future studies are needed to clarify the mechanisms of the risk factors.

  6. Daily Arrests

    Data.gov (United States)

    Montgomery County of Maryland — This dataset provides the public with arrest information from the Montgomery County Central Processing Unit (CPU) systems. The data presented is derived from every...

  7. Reducing bed rest time from five to three hours does not increase complications after cardiac catheterization: the THREE CATH Trial 1

    Science.gov (United States)

    Matte, Roselene; Hilário, Thamires de Souza; Reich, Rejane; Aliti, Graziella Badin; Rabelo-Silva, Eneida Rejane

    2016-01-01

    Abstract Objective: to compare the incidence of vascular complications in patients undergoing transfemoral cardiac catheterization with a 6F introducer sheath followed by 3-hour versus 5-hour rest. Methods: randomized clinical trial. Subjects in the intervention group (IG) ambulated 3 hours after sheath removal, versus 5 hours in the control group (CG). All patients remained in the catheterization laboratory for 5 hours and were assessed hourly, and were contacted 24, 48, and 72 h after hospital discharge. Results: the sample comprised 367 patients in the IG and 363 in the GC. During cath lab stay, hematoma was the most common complication in both groups, occurring in 12 (3%) IG and 13 (4%) CG subjects (P=0.87). Bleeding occurred in 4 (1%) IG and 6 (2%) CG subjects (P=0.51), and vasovagal reaction in 5 (1.4%) IG and 4 (1.1%) CG subjects (P=0.75). At 24-h, 48-h, and 72-h bruising was the most commonly reported complication in both groups. None of the comparisons revealed any significant between-group differences. Conclusion: the results of this trial show that reducing bed rest time to 3 hours after elective cardiac catheterization is safe and does not increase complications as compared with a 5-hour rest. ClinicalTrials.gov Identifier: NCT-01740856 PMID:27463113

  8. 兔室颤心搏骤停模型的建立%Ventricular fibrillation-induced cardiac arrest model in rabbits

    Institute of Scientific and Technical Information of China (English)

    胡春林; 魏红艳; 廖晓星; 李欣; 李玉杰; 詹红; 荆小莉; 熊艳; 伍贵富

    2009-01-01

    Objective To establish a simple,easily-producible and practical cardiopulmonary cerebral resuscitation model in rabbits.Method Cardiac ventricular fibrillation was induced in 27 New Zealand rabbits by alternating electric current.The rabbits were randomly divided into three groups according to the duration of untreated cardiac arrest(CA):CA-8 min group(n = 9),CA-5 min group(n = 9)and CA-3 min group(n = 9).All animals received cardiopulmonary resuscitation(CPR)until return of spontaneous circulation(ROSC).The sample of vein blood was collected for the measurement troponin I level at 4 hours after ROSC.The animals were sacrificed at 72 hours after ROSC,hippocampus were removed and fixed in 3%formalin,and coronal sections were analyzed by TUNEL staining and N1SSLE staining.The other two animals without ventricular fibrillation or CPR served as sham-operated group.One-way ANOVA or Mann-Whitney rank was used to determine the statistical significance among the three groups.R×C test was used for ROSC,LSD test for multiple comparisons,and t test for comparisons of means between two independent samples.A two-tailed value of P<0.05 was considered statistically significant.Results There were no differences in rate of ROSC among groups.No animals survived until 72 hours after ROSC in CA-8 min group and CA-5 min group,while three animals in CA-3 min group survived.In group CA-8 min,CA-5 min and CA-3 min,the survival time of animals after ROSC were(1.67 ± 2.55)h,(37.78 ± 30.27)h,(12.0 ± 14.97)h,respectively.There were significant differences in the survival time of animals after ROSC and troponin I level after ROSC 4 h between CA-3 min group and the other two groups(P<0.05).Compared with animals in CA-3 min group,sham-operated animals(n = 2)did not have neuronal degeneration or TUNEL positive cells in the hippocampus CA1 area.Conclusions CPR initiated as soon as 3 min after CA can give longer survival tome to the rabbits.The rabbits have neuronal degeneration and

  9. 心脏介入术中并发急性心脏压塞的抢救与护理%Rescue and nursing of complicated acute cardiac tamponade cardiac in patients with cardiac interventional operation

    Institute of Scientific and Technical Information of China (English)

    杨福梅

    2015-01-01

    Objective To explore the rescue and nursing of complicated acute cardiac tam-ponade (ACT)in patients with cardiac interventional operation (CIO).Methods A total of 64 CIO patients with complicated ACT were randomly divided into observation group and control group,32 cases in each group.Both groups were conducted with emergency treatment for ACT, and on this basis the control group was treated with routine nursing,while the observation group was treated with comprehensive nursing.Discovery rate of ACT,success rate of rescue as well as satisfactory degree toward nursing and HDL score were compared between two groups.Results In the observation group,the discovery rate of ACT and success rate of rescue were significantly higher than those in the control group (P <0.05).Satisfactory degree toward nursing in the ob-servation group was significantly better than that in the control group (P <0.05).After nursing, scores of anxiety and depression as well as total score of HDL in the observation group were signifi-cantly lower than those before treatment and the control group (P <0.05).Conclusion For CIO patients with complicated ACT,rescue measures and comprehensive nursing can significantly im-prove the success rate of rescue and satisfactory degree toward nursing,reduce the HDL score and reduce medical disputes.%目的:研究心脏介入术(CIO)中并发急性心脏压塞(ACT)的抢救与护理。方法将64例患者实施 CIO 时并发ACT,以数字法随机分成观察组及对照组各32例,2组均实施 ACT 抢救措施,对照组在此基础上另实施常规护理,而观察组则实施综合护理。对比 2组 ACT 发现率及抢救成功率,2组护理满意情况以及 HDL 评分情况。结果观察组 ACT 发现率及抢救成功率均显著高于对照组,差异均有统计学意义(P <0.05);观察组的护理满意情况显著优于对照组,差异有统计学意义(P <0.05);观察组护理后的焦虑、抑郁评分及总

  10. Prophylactic treatment with coenzyme Q10 in patients undergoing cardiac surgery: could an antioxidant reduce complications? A systematic review and meta-analysis.

    Science.gov (United States)

    de Frutos, Fernando; Gea, Alfredo; Hernandez-Estefania, Rafael; Rabago, Gregorio

    2015-02-01

    Coenzyme Q10 (CoQ10) is a lipid-soluble antioxidant that could have beneficial effects in patients undergoing cardiac surgery with cardiopulmonary bypass. There is no clear evidence about its clinical effects or a systematic review published yet. We aimed to conduct a systematic review and meta-analysis of the literature to elucidate the role of coenzyme Q10 in preventing complications in patients undergoing cardiac surgery with cardiopulmonary bypass. We searched the PubMed Database using the following keywords: Coenzyme Q10, ubiquinone, ubiquinol, CoQ10, Heart Surgery, Cardiac surgery. Articles were systematically retrieved, selected, assessed and summarized for this review. We performed separate meta-analyses for different outcomes (inotropic drug requirements after surgery, incidence of ventricular arrhythmias and atrial fibrillation, cardiac index 24 h after surgery and hospital stay), estimating pooled odds ratios (ORs) or mean differences of the association of CoQ10 administration with the risk of these outcomes. Eight clinical trials met our inclusion criteria. Patients with CoQ10 treatment were significantly less likely to require inotropic drugs after surgery {OR [95% confidence interval (CI) 0.47 (0.27-0.81)]}, and to develop ventricular arrhythmias after surgery [OR (95% CI) 0.05 (0.01-0.31)]. However, CoQ10 treatment was not associated with Cardiac index 24 h after surgery [mean difference (95% CI) 0.06 (-0.30 to 0.43)], hospital stay (days) [mean difference (95% CI) -0.61 (-4.61 to 3.39)] and incidence of atrial fibrillation [OR (95% CI) 1.06 (0.19-6.04)]. Since none of the clinical trials included in this review report any adverse effects associated to CoQ10 administration, and coenzyme Q10 has been demonstrated to be safe even at much higher doses in other studies, we conclude that CoQ10 should be considered as a prophylactic treatment for preventing complications in patients undergoing cardiac surgery with cardiopulmonary bypass. However, better

  11. Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery

    DEFF Research Database (Denmark)

    Bradley, Katharine A; Rubinsky, Anna D; Sun, Haili;

    2011-01-01

    Patients who misuse alcohol are at increased risk for surgical complications. Four weeks of preoperative abstinence decreases the risk of complications, but practical approaches for early preoperative identification of alcohol misuse are needed....

  12. Clinical significance of lactate in acute cardiac patients

    Institute of Scientific and Technical Information of China (English)

    Chiara; Lazzeri; Serafina; Valente; Marco; Chiostri; Gian; Franco; Gensini

    2015-01-01

    Lactate, as a metabolite of easy and quick assessment, has been studied over time in critically ill patients in order to evaluate its prognostic ability. The present review is focused on the prognostic role of lactate levels in acute cardiac patients(that is with acute coronary syndrome, cardiogenic shock, cardiac arrest, non including post cardiac surgery patients). In patients with STelevation myocardial infarction treated with mechanical revascularization, hyperlactatemia identified a subset of patients at higher risk for early death and in-hospital complications, being strictly related mainly to hemodynamic derangement. The prognostic impact of hyperlactatemia on mortality has been documented in patients with cardiogenic shock and in those with cardiac arrest even if there is no cut-off value of lactate to be associated with worse outcome or to guide resuscitation or hemodynamic management. Therapeutic hypothermia seems to affect per se lactate values which have been shown to progressively decrease during hypothermia. The mechanism(s) accounting for lactate levels during hypothemia seem to be multiple ranging from the metabolic effects of reduced temperatures to the hemodynamic effects of hypothermia(i.e., reduced need of vasopressor agents). Serial lactate measurements over time, or lactate clearance, have been reported to be clinically more reliable than lactate absolute value also in acute cardiac patients. Despite differences in study design, timing of lactate measurements and type of acute cardiac conditions(i.e., cardiogenic shock, cardiac arrest, refractory cardiac arrest), available evidence strongly suggests that higher lactate levels can be observed on admission in non-survivors and that higher lactate clearance is associated with better outcome.

  13. Valvoplastia mitral percutânea complicada com tamponamento cardíaco em paciente gestante Percutaneous mitral valvuloplasty complicated by cardiac tamponade in a pregnant patient

    Directory of Open Access Journals (Sweden)

    Luís Seca

    2008-11-01

    Full Text Available A ocorrência de Hemopericárdio com Tamponamento Cardíaco é uma complicação da Valvoplastia Mitral Percutânea por balão (VMB, que apesar de pouco freqüente, pode ter graves conseqüências materno-fetais. Este artigo descreve o caso de um tamponamento cardíaco após VMB em uma mulher de 28 anos, com estenose mitral reumática severa na 20ª semana de gravidez.The occurrence of hemopericardium with cardiac tamponade is a complication of percutaneous balloon mitral valvuloplasty (BMV which, although uncommon, may have severe maternal and fetal consequences. This article describes a case of cardiac tamponade following BMV in a 28-year-old woman with severe rheumatic mitral stenosis in the 20th week of gestation.

  14. Sympathoadrenal activation and endothelial damage are inter correlated and predict increased mortality in patients resuscitated after out-of-hospital cardiac arrest. a post Hoc sub-study of patients from the TTM-trial.

    Directory of Open Access Journals (Sweden)

    Pär I Johansson

    Full Text Available Sympathoadrenal activation and endothelial damage are hallmarks of acute critical illness. This study investigated their association and predictive value in patients resuscitated from out-of-hospital cardiac arrest (OHCA.Post-hoc analysis of patients included at a single site in The Targeted Temperature Management at 33 degrees versus 36 degrees after Cardiac Arrest (TTM trial. The main study reported similar outcomes with targeting 33 versus 36 degrees. TTM main study ClinicalTrials.gov: NCT01020916. One hundred sixty three patients resuscitated from OHCA were included at a single site ICU. Blood was sampled a median 135 min (Inter Quartile Range (IQR 103-169 after OHCA. Plasma catecholamines (adrenaline, noradrenaline and serum endothelial biomarkers (syndecan-1, thrombomodulin, sE-selectin, sVE-cadherin were measured at admission (immediately after randomization. We had access to data on demography, medical history, characteristics of the OHCA, patients and 180-day outcome.Adrenaline and noradrenaline correlated positively with syndecan-1 and thrombomodulin i.e., biomarkers reflecting endothelial damage (both p<0.05. Overall 180-day mortality was 35%. By Cox analyses, plasma adrenaline, serum sE-selectin, reflecting endothelial cell activation, and thrombomodulin levels predicted mortality. However, thrombomodulin was the only biomarker independently associated with mortality after adjusting for gender, age, rhythm (shockable vs. non-shockable, OHCA to return of spontaneous circulation (ROSC time, shock at admission and ST elevation myocardial infarction (30-day Hazards Ratio 1.71 (IQR 1.05-2.77, p=0.031 and 180-day Hazards Ratio 1.65 (IQR 1.03-2.65, p=0.037 for 2-fold higher thrombomodulin levels.Circulating catecholamines and endothelial damage were intercorrelated and predicted increased mortality. Interventions aiming at protecting and/or restoring the endothelium may be beneficial in OHCA patients.

  15. Four patients with Sillence type I osteogenesis imperfecta and mild bone fragility, complicated by left ventricular cardiac valvular disease and cardiac tissue fragility caused by type I collagen mutations.

    Science.gov (United States)

    Vandersteen, Anthony M; Lund, Allan M; Ferguson, David J P; Sawle, Philip; Pollitt, Rebecca C; Holder, Susan E; Wakeling, Emma; Moat, Neil; Pope, F Michael

    2014-02-01

    Osteogenesis imperfecta (OI) type I is a hereditary disorder of connective tissue (HDCT) characterized by blue or gray sclerae, variable short stature, dentinogenesis imperfecta, hearing loss, and recurrent fractures from infancy. We present four examples of OI type I complicated by valvular heart disease and associated with tissue fragility. The diagnosis of a type I collagen disorder was confirmed by abnormal COL1A1 or COL1A2 gene sequencing. One patient was investigated with electrophoresis of collagens from cultured skin fibroblasts, showing structurally abnormal collagen type I, skin biopsy showed unusual histology and abnormal collagen fibril ultra-structure at electron microscopy. The combined clinical, surgical, histological, ultra-structural, and molecular genetic data suggest the type I collagen defect as contributory to cardiac valvular disease. The degree of tissue fragility experienced at cardiac surgery in these individuals, also reported in a small number of similar case reports, suggests that patients with OI type I need careful pre-operative assessment and consideration of the risks and benefits of cardiac surgery. PMID:24311407

  16. Four patients with Sillence type I osteogenesis imperfecta and mild bone fragility, complicated by left ventricular cardiac valvular disease and cardiac tissue fragility caused by type I collagen mutations.

    Science.gov (United States)

    Vandersteen, Anthony M; Lund, Allan M; Ferguson, David J P; Sawle, Philip; Pollitt, Rebecca C; Holder, Susan E; Wakeling, Emma; Moat, Neil; Pope, F Michael

    2014-02-01

    Osteogenesis imperfecta (OI) type I is a hereditary disorder of connective tissue (HDCT) characterized by blue or gray sclerae, variable short stature, dentinogenesis imperfecta, hearing loss, and recurrent fractures from infancy. We present four examples of OI type I complicated by valvular heart disease and associated with tissue fragility. The diagnosis of a type I collagen disorder was confirmed by abnormal COL1A1 or COL1A2 gene sequencing. One patient was investigated with electrophoresis of collagens from cultured skin fibroblasts, showing structurally abnormal collagen type I, skin biopsy showed unusual histology and abnormal collagen fibril ultra-structure at electron microscopy. The combined clinical, surgical, histological, ultra-structural, and molecular genetic data suggest the type I collagen defect as contributory to cardiac valvular disease. The degree of tissue fragility experienced at cardiac surgery in these individuals, also reported in a small number of similar case reports, suggests that patients with OI type I need careful pre-operative assessment and consideration of the risks and benefits of cardiac surgery.

  17. [Guidelines for uniform reporting of data from out-of-hospital and in-hospital cardiac arrest and resuscitation in the pediatric population: the pediatria utstein-style].

    Science.gov (United States)

    Tormo Calandín, C; Manrique Martínez, I

    2002-06-01

    Children who require cardiopulmonary resuscitation present high mortality and morbidity. The few studies that have been published on this subject use different terminology and methodology in data collection, which makes comparisons, evaluation of efficacy, and the performance of meta-analyses, etc. difficult. Consequently, standardized data collection both in clinical studies on cardiorespiratory arrest and in cardiopulmonary resuscitation in the pediatric age group are required. The Spanish Group of Pediatric Cardiopulmonary Resuscitation emphasizes that recommendations must be simple and easy to understand. The first step in the elaboration of guidelines on data collection is to develop uniform definitions (glossary of terms). The second step comprises the so-called time intervals that include time periods between two events. To describe the intervals of cardiorespiratory arrest different clocks are used: the patient's watch, that of the ambulance, the interval between call and response, etc.Thirdly, a series of clinical results are gathered to determine whether the efforts of cardiopulmonary resuscitation have a positive effect on the patient, the patient's family and society. With the information gathered a registry of data that includes the patient's personal details, general data of the cardiopulmonary resuscitation, treatment, times of performance and definitive patient outcome is made.

  18. Primary cardiac lymphoma complicated by cardiogenic shock: successful treatment with chemotherapy delivered under extracorporeal membrane oxygenation support.

    Science.gov (United States)

    Allain, Géraldine; Hajj-Chahine, Jamil; Lacroix, Corentin; Jayle, Christophe

    2015-12-01

    Primary cardiac lymphomas (PCLs) are rare in immunocompetent patients. Their clinical presentation is highly variable and in case of cardiogenic shock, death is often inevitable with a diagnosis made post-mortem. We report the case of a 65-year old immunocompetent man with cardiogenic shock requiring emergent extracorporeal membrane oxygenation (ECMO). Soon after, a diagnosis of PCL was given and chemotherapy was delivered under ECMO support. The patient was progressively weaned from the mechanical support. Six months later, he had fully recovered.

  19. 急性心肌梗塞合并心脏骤停的急救治疗分析%Analysis of emergency treatment of acute myocardial infarction with sudden cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    张杰清

    2013-01-01

    Objective To investigate the emergency treatment of acute myocardial infarction with sudden cardiac arrest and analyze the treatment outcome. Method A retrospective study was conducted in 10 patients with acute myocardial infarction plus sudden cardiac arrest to review the process of emergency treatment they received. The electrocardiographic (ECG) findings, electric defibrillation in the early stage, drugs used during electric defibrillation, and route and protocol of administration were analyzed. The effective method for emergency treatment was discussed to increase the resuscitation success rate. Results The 10 patients were given emergency treatment; electric defibrillation was performed, and ECG changes were observed;drugs were administered properly. All patients were rescued in time and resuscitated successfully; their blood pressure was controlled, heartbeat frequency was stabilized, and they returned to sinus rhythm. After post-treatment, 9 patients were cured and discharged, and 1 patient died. ConclusionTimely observation of ECG changes, which is helpful for early detection and emergency treatment and thus successful resuscitation, as well as nursing intervention, can ensure the cure and discharge of each patient with acute myocardial infarction plus sudden cardiac arrest.%目的:探讨急性心肌梗塞合并心脏骤停的急救方法,分析疗效。方法选取以往10例急性心肌梗塞合并心脏骤停的患者,回顾当时的急救治疗过程,通过对心电的检测情况、早期电击除颤情况、电击除颤时所用药物以及用药的方法和途径进行分析,讨论急救治疗的有效方法,提高复苏成功概率。结果通过对10例患者进行急救,利用电击除颤的方法,观察心电变化情况,进行合理药物治疗,10例患者都得到了及时的抢救,复苏成功,血压得到控制,心跳频率恢复平稳状态,心律逐渐变为窦性。经过后期治疗有9

  20. Comparative study of myocardial protection in cardiac arrest and beating heart surgery%心脏停跳与不停跳手术心肌保护的临床对比研究

    Institute of Scientific and Technical Information of China (English)

    王建堂; 马增山; 董铭峰; 马胜军

    2013-01-01

    目的 评价心脏停跳与不停跳手术对先天性心脏病患者的心肌保护效果.方法 房间隔缺损(ASD)、室间隔缺损(VSD)、肺动脉瓣狭窄(PS)患者共116例,随机分为实验组(不停跳组)和对照组(停跳组).实验组在体外循环(CPB)心脏跳动状态下手术,对照组在CPB心脏停跳下手术,分别于术前及术后2、6、24、48 h采集血标本,检测血清肌酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(cTnⅠ)、天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)含量;记录CPB时间、术后48 h心律失常发生率、残余分流发生率、呼吸机支持时间、ICU滞留时间、术后住院天数.结果 两组术后各时点血清CK-MB、cTnⅠ、AST、LDH含量均显著高于术前(P<0.01),但两组间各时点比较差异无统计学意义(P>0.05);实验组CPB时间较对照组短(P<0.01),其他临床观察指标与对照组比较差异无统计学意义(P>0.05).结论 体外循环心脏不停跳心内直视手术能缩短CPB时间,但手术效果与停跳手术比较差异无统计学意义.%Objective To evaluate the protective effects of cardiac arrest and beating heart on patients with congenital heart disease (CHD).Methods One hundred and sixteen CHD patients were randomly divided into experimental group (beating heart group) and control group (cardioplegia group).The experimental group received surgery on beating heart with cardiopulmonary bypass (CPB),cardiac arrest operation under CPB in the control group,respectively.Blood samples were taken and the serum levels of creatine kinase MB (CK-MB),troponin Ⅰ(cTnⅠ),aspartate aminotransferase (AST),lactate dehydrogenase (LDH) were detected before operation and 2,6,24,48 hours after operation.The clinical parameters including CPB times,incidence of arrhythmia,residual shunt occurred rate,duration of mechanical ventilation,ICU stay time and postoperative hospital stay were detected respectively.Results Postoperatively,the CK

  1. Analysis of prehospital care in patients suffering sudden cardiac arrest caused by acute myocardial infarction%急性心肌梗死心脏骤停患者的院前急救探析

    Institute of Scientific and Technical Information of China (English)

    段玲

    2013-01-01

    Objective To investigate the characteristics and efficacy of prehospital care in patients suffering sudden cardiac arrest caused by acute myocardial infarction. Methods Eighty patients suffering sudden cardiac arrest caused by acute myocardial infarction who were admitted to the emergency department of our hospital from February 2012 to May 2013 were enrolled in our study. All patients received prehospital care. Their clinical data were analyzed retrospectively.Results Of all patients, 48 (60%) were rescued successfully and 32 (40%) died. Among the patients who were rescued successfully, 25% (4/16) were aged not less than 65 years, which was significantly lower than that of death group (70.8%, 17/24). Cardiopulmonary resuscitation and electrical defibrillation were performed significantly earlier in the successful rescue group than in the death group. The rate of endotracheal intubation was 18.8% (3/16) in successful rescue group, significantly lower than that in death group (45.8%, 11/24) (P<0.05). ConclusionTo strengthen emergency network configuration, spread first-aid knowledge, well establish pre-hospital emergency procedures, and strengthen standardized treatment can significantly increase the treatment success rate in patients suffering sudden cardiac arrest caused by acute myocardial infarction and ensure their life safety, which have a very positive significance and are worthy of attention at all levels.%目的探讨急性心肌梗死心脏骤停院前急救特点及效果。方法本次共选取80例急性心肌梗死心脏骤停的患者作研究对象,均为我院急诊科2012年2月至2013年5月收治,行完善的院前急救,回顾分析临床资料。结果本次选取病例中,抢救成功48例,占60%,死亡32例,占40%。抢救成功患者年龄逸65岁占25%(4/16),明显少于死亡组70.8%(17/24),CPR、电除颤时间明显早于死亡组,气管插管人数抢救成功组为18.8%(3/16),明显低于死亡组45

  2. INDICACIONES DE ESTIMULACIÓN ELÉCTRICA TRANSITORIA, COMPLICACIONES Y NECESIDAD DE ESTIMULACIÓN CARDÍACA PERMANENTE / Use of temporary cardiac pacing, its complications and need for permanent cardiac pacing

    Directory of Open Access Journals (Sweden)

    Humberto Ramos González

    2013-07-01

    to medication, and little tolerance to slow pace. Objective: To describe the main use of temporary cardiac pacing that may lead to permanent pacing, and the complications that arise when using it. Method: A descriptive study was conducted in 266 of the 281 patients who were admitted to the Arnaldo Milian Castro Hospital and received a temporary pacemaker. The use and complications of the procedure are described. Results: There was a higher use of temporary cardiac pacing as the age of the study population increased, 45.86% for those over 80 years of age. Females predominated (156 patients, with a female-male ratio of 1.56:1. The degenerative cause (42.1% was the major cause for permanent pacing. The puncture of unwanted vessels was the most common complication (7.1%. Conclusions: The use of temporary cardiac pacing is more common in people over 80 years of age, mainly because of degenerative causes, which eventually leads to permanent pacing. The complication rate is not high considering that this procedure was not performed under fluoroscopic view.

  3. 应用心肺复苏仪对心搏骤停患者心脑缺血性损伤的影响%The effect of resuscitator CPR on cardio-cerebral ischemic injury of cardiac arrest patients

    Institute of Scientific and Technical Information of China (English)

    曹春水; 黄亮; 吕农华; 占钻; 殷勤; 杨继斌; 熊华威

    2013-01-01

    目的 比较徒手和心肺复苏(CPR)仪行CPR对心搏骤停患者心脑缺血性损伤的影响,探讨CPR仪在CPR中的应用价值.方法 采用前瞻性、双盲、随机对照的临床研究方法,将87例心搏骤停患者按数字表法随机分成两组,分别进行徒手CPR(n=42)及心肺复苏仪(n=45)CPR,记录两组患者自主循环恢复(ROSC)率、复苏时间、存活时间及死亡率.对46例ROSC维持>24 h的患者血清心型脂肪酸结合蛋白、血清肌钙蛋白I含量及血清S100蛋白、神经元特异性烯醇化酶的含量进行监测;比较两组CPR方法对患者心脑缺血性损伤的影响.结果 两组患者血清心型脂肪酸结合蛋白、血清肌钙蛋白I、血清S100蛋白、神经元特异性烯醇化酶较健康志愿者明显升高,CPR仪CPR组明显低于徒手CPR组;徒手CPR组复苏持续时间小于CPR仪CPR组;CPR仪组患者ROSC持续>24 h例数明显多于徒手CPR组,差异有统计学意义;但患者的ROSC率和死亡率差异无统计学意义.结论 应用心肺复苏仪行CPR更能持久、有效地使心、脑血管再灌注,减轻心脑组织细胞缺血性损伤,但不能提高CPR成功率和降低死亡率.%Objective To compare the effect of barehanded CPR and resuscitator CPR on cardiac arrest cardio - cerebral ischemic injury, and investigate the value of application resuscitator on CPR. Methods The prospective, double blinded and randomized controlled clinical trail was designed. 87 cardiac arrest patients were randomly divided into two groups according to table of random number, barehanded CPR and resuscitator CPR were carried out respectively. The rate of ROSC and mortality of the patients in two groups were recorded and the duration of CPR and survival time were also recorded. The content of myocardial damage markers serum heart fatty acid - binding protein ( H - FABP) and cardial troponin I(cTnI) , the content of serum S100 protein and neuron specific enolase (NSE) in patients of ROSC

  4. 急性重度有机磷农药中毒合并呼吸、心跳停止8例临床救治%Clinical treatment of 8 cases of acute severe organophosphorus pesticide poisoning with respiratory,cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    韩海涛

    2014-01-01

    目的:探讨急性重度有机磷农药中毒并呼吸、心跳停止的临床救治。方法:收治8例急性重度有机磷农药中毒并呼吸、心跳停止的患者,对其临床资料进行回顾性分析。结果:患者均抢救成功。结论:给予急性重度有机磷农药中毒并呼吸、心跳停止的患者积极有效的治疗,可促进其康复。%Objective:To explore the clinical treatment of acute severe organophosphorus pesticide poisoning with respiratory, cardiac arrest.Methods:8 cases with acute severe organophosphorus pesticide poisoning with respiratory,cardiac arrest were selected.The clinical data were retrospectively analyzed.Results:All the patients were successfully treated.Conclusion:The positive and effective treatment for patients with acute severe organophosphorus pesticide poisoning with respiratory,cardiac arrest,can promote the rehabilitation.

  5. Cardiopulmonary arrest induced by anaphylactoid reaction with contrast media.

    Science.gov (United States)

    Nakamura, Iwao; Hori, Shingo; Funabiki, Tomohiro; Sekine, Kazuhiko; Kimura, Hiroyuki; Fujishima, Seitaro; Aoki, Katsunori; Kuribayashi, Sachio; Aikawa, Naoki

    2002-05-01

    Anaphylactoid reactions to iodinated contrast media can cause life-threatening events and even death. A 44-year-old woman presented with cardiopulmonary arrest (CPA) immediately following the administration of nonionic iodinated contrast media for an intravenous pyelography. Her cardiac rhythm during CPA was asystole. She was successfully resuscitated by the radiologists supported by paged emergency physicians using the prompt intravenous administration of 1 mg of epinephrine. Neither laryngeal edema nor bronchial spasm was observed during the course of treatment, and she was discharged on the 4th day without any complications. The patient did not have a history of allergy, but had experienced a myocardial infarction and aortitis. She had undergone 11 angiographies and had been taking a beta-adrenergic receptor antagonist. Planned emergency medical backup is advisable to ensure resuscitation in the event of an anaphylactoid reaction to the use of contrast media in-hospital settings. PMID:12009227

  6. Anesthesia related Complications in Pediatric GI Endoscopy

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    A Sabzevari

    2014-04-01

    Full Text Available Introduction: Elective upper and lower GI endoscopy is usually performed in children on an outpatient basis with the child under sedation or general anesthesia (GA. The objective of this study was to describe Anesthesia related complications in   children undergoing elective GI endoscopy.   Materials and Methods: The study design was descriptive on 1388 patients undergoing elective GI endoscopy in Sheikh Hospital from 2009 to 2013. All patient received propofol or standard inhalational anesthesia. We examined patients’ demographic data  ,  location of GI endoscopy ,  perioperative vital singe ,  recovery time , respiratory and cardiac complications , post operative nausea and vomiting , agitation , diagnosis and outcome   Results: Pediatric patients aged 2 to 17 years. 29 % of elective GI endoscopy was upper GI endoscopy and 70.3 % was lower GI endoscopy and 0.7 was both of them. 47.7 % of Pediatric patients were female and 52.3 % was male. We haven’t significant or fatal anesthesia related respiratory and cardiac complications (no apnea, no cardiac arrest. 8 patients (0.5% have transient bradicardia in post operative care Unit. 83 patients (5.9% have post operative nausea and vomiting controlled by medication.  6 patients (0.4% have post operative agitation controlled by medication.   Conclusions: General anesthesia and deep sedation in children undergoing elective GI endoscopy haven’t significant or fatal anesthesia related complications. We suggest Anesthesia for infants, young children, children with neurologic impairment, and some anxious older children undergoing elective GI endoscopy. Keyword: Anesthesia, Complication, Endoscopy, Pediatric.

  7. Early glycogen synthase kinase-3β and protein phosphatase 2A independent tau dephosphorylation during global brain ischaemia and reperfusion following cardiac arrest and the role of the adenosine monophosphate kinase pathway.

    Science.gov (United States)

    Majd, Shohreh; Power, John H T; Koblar, Simon A; Grantham, Hugh J M

    2016-08-01

    Abnormal tau phosphorylation (p-tau) has been shown after hypoxic damage to the brain associated with traumatic brain injury and stroke. As the level of p-tau is controlled by Glycogen Synthase Kinase (GSK)-3β, Protein Phosphatase 2A (PP2A) and Adenosine Monophosphate Kinase (AMPK), different activity levels of these enzymes could be involved in tau phosphorylation following ischaemia. This study assessed the effects of global brain ischaemia/reperfusion on the immediate status of p-tau in a rat model of cardiac arrest (CA) followed by cardiopulmonary resuscitation (CPR). We reported an early dephosphorylation of tau at its AMPK sensitive residues, Ser(396) and Ser(262) after 2 min of ischaemia, which did not recover during the first two hours of reperfusion, while the tau phosphorylation at GSK-3β sensitive but AMPK insensitive residues, Ser(202) /Thr(205) (AT8), as well as the total amount of tau remained unchanged. Our data showed no alteration in the activities of GSK-3β and PP2A during similar episodes of ischaemia of up to 8 min and reperfusion of up to 2 h, and 4 weeks recovery. Dephosphorylation of AMPK followed the same pattern as tau dephosphorylation during ischaemia/reperfusion. Catalase, another AMPK downstream substrate also showed a similar pattern of decline to p-AMPK, in ischaemic/reperfusion groups. This suggests the involvement of AMPK in changing the p-tau levels, indicating that tau dephosphorylation following ischaemia is not dependent on GSK-3β or PP2A activity, but is associated with AMPK dephosphorylation. We propose that a reduction in AMPK activity is a possible early mechanism responsible for tau dephosphorylation. PMID:27177932

  8. ANÁLISIS DE LA CALIDAD DEL REGISTRO DE PARO CARDÍACO EN CASOS DE RESPONSABILIDAD MÉDICO LEGAL EN MÉDICOS GENERALES, 1999-2007 Quality of cardiac arrest records in cases of medical responsibility, 1999-2007

    Directory of Open Access Journals (Sweden)

    Gabriel Barragán

    2009-01-01

    Full Text Available Antecedentes. El registro del paro cardíaco es una actividad que se debe acompañar en la reanimación cerebro cardio pulmonar. En Colombia no existe un formato de registro oficial de paro cardiorrespiratorio, lo que dificulta la investigación en reanimación y la conducción de los procesos de responsabilidad médica que se deriven de esta atención. Objetivo. Analizar la calidad del registro de paro cardíaco en casos de responsabilidad médico legal iniciada a médicos generales que tuvieron asesoría científica del Fondo para Auxilio de Demandas de la Sociedad Colombiana de Anestesiología y Reanimación (SCARE-FEPASDE, 1999-2007. Material y métodos. Se realizó una investigación tipo serie de casos, en donde se incluyeron los casos de paro cardiorrespiratorio que tuvieron demanda médico legal y que fueron atendidos por médicos generales, entre 1999 y 2007, y que requirieron asesoría jurídica por SCAREFEPASDE. La información se registró en tablas de Excel®, según las recomendaciones Utstein. La calificación de calidad se hizo por tres médicos expertos en responsabilidad médica de manera independiente. Se utilizó un formato de calificación sobre la proporción de registros realizados sobre 25 ítem posibles. La calidad se consideró alta (mayor de 95% ítem, media (70-94% ítem y baja (menor de 70%. En los casos de desacuerdo se realizó consenso. Resultados. Se incluyeron en total 83 casos. La calidad del registro del paro fue media en 49 casos (59%, baja en 32 casos (39% y alta en dos casos. Conclusión. El registro de paro cardiorrespiratorio en casos de responsabilidad médica es de mediana calidad, por lo que no se alcanza a cumplir con los estándares internacionales y las guías al estilo Utstein.Background. Cardiac arrest must be recorded when occurring during cardiopulmonary resuscitation. There is no official registration form for cardiac arrest in Colombia, thereby hampering research in resuscitation and managing

  9. Study on the priority of coronary arteriography or therapeutic hypothermia after return of spontaneous circulation in patients with out-of-hospital cardiac arrest: results from the SOS-KANTO 2012 study.

    Science.gov (United States)

    Hagiwara, Shuichi

    2016-06-01

    Many emergency physicians struggle with the clinical question of whether to perform therapeutic hypothermia (TH) or coronary angiography (CAG) first after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). We analyzed the results of the SOS-KANTO 2012 study, which is a prospective, multicenter (67 emergency hospitals), observational study about OHCA conducted between January 2012 and March 2013 (n = 16,452). We compared two groups: the group in which TH was first performed (TH group), and the group in which CAG was performed first (CAG group) within 24 h after arrival. Two hundred and twenty-one patients were treated TH and CAG (TH group, 76 patients; CAG group, 145 patients). In addition, we selected patients who underwent coronary treatment. 164 patients underwent coronary treatment after CAG (TH group, 52 patients; CAG group, 112 patients). In patients in whom TH and CAG and coronary artery treatment were done, 42 patients (55.3 %) in the TH group and 86 patients (59.3 %) in the CAG group survived at 90 days. The cerebral performance category (CPC) 1 and 2 were 26.3 % (20 patients) in TH group, and 31.0 % (45 patients) in CAG group. In patients in whom TH and CAG with coronary artery treatment were performed, 29 patients (55.8 %) in the TH group and 64 patients (57.1 %) in the CAG group survived at 90 days. The rates of CPC 1 and 2 were 26.9 % (14 patients) in TH group, and 23.2 % (26 patients) in CAG group. There was no significant difference in 90-day survival between the two groups although it tended to be better in the CAG group than in the TH group. Whether TH or CAG was performed first did not affect the 90-day survival and 30-day neurological situation among patients with ROSC after OHCA.

  10. ECMO for Cardiac Rescue after Accidental Intravenous Mepivacaine Application

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    Michael Froehle

    2012-01-01

    Full Text Available Mepivacaine is a potent local anaesthetic and used for infiltration and regional anaesthesia in adults and pediatric patients. Intoxications with mepivacaine affect mainly the CNS and the cardiovascular system. We present a case of accidental intravenous mepivacaine application and intoxication of an infant resulting in seizure, broad complex bradyarrhythmia, arterial hypotension and finally cardiac arrest. The patient could be rescued by prolonged resuscitations and a rapid initiation of ECMO and survived without neurological damage. The management strategies of this rare complication including promising other treatment options with lipid emulsions are discussed.

  11. Status epilepticus and cardiopulmonary arrest in a patient with carbon monoxide poisoning with full recovery after using a neuroprotective strategy: a case report

    Directory of Open Access Journals (Sweden)

    Abdulaziz Salman

    2012-12-01

    Full Text Available Abstract Introduction Carbon monoxide poisoning can be associated with life-threatening complications, including significant and disabling cardiovascular and neurological sequelae. Case presentation We report a case of carbon monoxide poisoning in a 25-year-old Saudi woman who presented to our facility with status epilepticus and cardiopulmonary arrest. Her carboxyhemoglobin level was 21.4 percent. She made a full recovery after we utilized a neuroprotective strategy and normobaric oxygen therapy, with no delayed neurological sequelae. Conclusions Brain protective modalities are very important for the treatment of complicated cases of carbon monoxide poisoning when they present with neurological toxicities or cardiac arrest. They can be adjunctive to normobaric oxygen therapy when the use of hyperbaric oxygen is not feasible.

  12. Comparing percutaneous coronary intervention and thrombolysis in patients with return of spontaneous circulation after out-of-hospital cardiac arrest%介入与溶栓疗法救治院外心脏骤停的比较

    Institute of Scientific and Technical Information of China (English)

    李颖庆; 柳娜; 胡春林; 魏红艳; 李慧; 李欣; 廖晓星

    2013-01-01

    目的 汇集有关ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)所致院外心脏骤停(out-of-hospital cardiac arrest,OHCA)的文献,分别对冠脉介入(percutaneous coronary intervention,PCI)与静脉溶栓在自主循环恢复(return of spontaneous circulation,ROSC)后患者中的疗效进行比较;通过揭示两种疗法对此阶段患者存活出院及神经功能恢复方面的作用,明确ROSC阶段治疗的重要性,以期指导对由STEMI所致OHCA患者的救治.方法 本研究通过查询PUBMED和MEDLINE数据库,对1995年1月至2011年10月间的有关STEMI所致OHCA的研究文献进行了回顾性分析,以获得ROSC的OHCA患者为研究对象,相关患者的存活出院率和神经功能良好率作为此项研究的评判标准.共有18篇文献纳入此项研究,由于Meta分析必须是同期对照性研究,笔者将同一队列研究中获得ROSC后接受PCI的患者作为治疗组、拒绝PCI的患者作为对照组;与之相应,接受静脉溶栓的患者作为治疗组、拒绝静脉溶栓的患者作为对照组;然后,利用Review Manager 5.1软件对各自相应的治疗组与对照组间进行Meta分析.此外,也对PCI与静脉溶栓两种疗法对此类患者的出院率及神经功能良好率间的差异,采用Pearson x2进行比较.结果 在由STEMI所致OHCA的患者中,Meta分析显示了对ROSC后患者的存活出院率方面PCI[OR(odds ratio,优势比),1.65; 95%CI(confidence interval,可信区间),1.05-2.59,P<0.01]与静脉溶栓(OR,2.03; 95%CI,1.24 ~3.34,P<0.01)明显优于各自的对照组;总体比较中,静脉溶栓与PCI在此类患者的存活出院率(63.00%vs.65.19%,P=0.548)及神经功能恢复率(88.62% vs.91.25%,P=0.351)方面具有相似的结果.结论 对STEMI所致的OHCA患者,在ROSC后进行PCI或静脉溶栓能够提高存活出院率;静脉溶栓在救治此类患者中具有与PCI同等的效益.%Objective To evaluate the effect of percutaneous

  13. Four patients with Sillence type I osteogenesis imperfecta and mild bone fragility, complicated by left ventricular cardiac valvular disease and cardiac tissue fragility caused by type I collagen mutations

    DEFF Research Database (Denmark)

    Vandersteen, Anthony M; Lund, Allan M; Ferguson, David J P;

    2014-01-01

    showed unusual histology and abnormal collagen fibril ultra-structure at electron microscopy. The combined clinical, surgical, histological, ultra-structural, and molecular genetic data suggest the type I collagen defect as contributory to cardiac valvular disease. The degree of tissue fragility...... experienced at cardiac surgery in these individuals, also reported in a small number of similar case reports, suggests that patients with OI type I need careful pre-operative assessment and consideration of the risks and benefits of cardiac surgery. © 2013 Wiley Periodicals, Inc....

  14. The impact of quality of cardiopulmonary resuscitation on post-resuscitation inflammatory reaction in a porcine cardiac arrest model%心肺复苏的质量对复苏后炎症反应的影响

    Institute of Scientific and Technical Information of China (English)

    武军元; 李春盛

    2008-01-01

    目的 评价临床上常见的不标准心肺复苏(N-CPR)和2005年国际CPR指南推荐的标准心肺复苏(S-CPR)对心脏停搏(CA)猪复苏后炎症反应的影响.方法 18头猪被随机均分成两组,经麻醉、插管、机械通气后,应用程控刺激方法制备心室纤颤(VF)模型.S-CPR组应用2005年指南推荐的CPR方式;N-CPR组模拟临床上经常出现的低质量CPR方式.VF 4 min后开始进行CPR,CPR 9 min后进行电除颤及高级生命支持,自主循环恢复(ROSC)后进行各项指标观察.24 h仍存活的猪经处死后取脑、心、肝、肾组织,应用免疫组化法检测核转录因子-kB(NF-kB)的表达.实验期间连续监测CPR后3、6和9 min的血流动力学变化,并抽取基础状态、CPR 9 rain、ROSC 4 h的静脉血,测定血清肿瘤坏死因子-a(TNF-α)、白细胞介素-1β(IL-1β)的浓度.结果 与N-CPR组比较,S-CPR组ROSC率(22.2%比88.9%)及24 h存活率(22.2%比88.9%)明显提高(P均<0.05);CPR后3、6和9 min心排血量(CO)和平均动脉压(MAP)也均显著升高(P均<0.01);并且CPR后9 min和ROSC 4 h血清促炎症因子TNF-α、IL-1β]水平和各组织NF-kB表达程度均降低.结论 高质量的CPR后不仅能提高CA猪的生存率,也明显改善CPR后的炎症反应.%Objective To evaluate the effects of quality of non-standard cardiopulmonary resuscitation (N-CPR)and new guidelines recommended standard CPR(S-CPR)on post-resuscitation inflammatory reaction in a cardiac arrest(CA)porcine model.Methods Eighteen pigs were randomly divided into two groups,and ventricular fibrillation(VF)was induced by programmed electrical stimulation after giving anesthesia,intubation tube and mechanical ventilation.S-CPR(n=9):CPR was consistent with recommendation of the 2005 guidelines.N-CPR(n=9):given CPR with low quality CPR usually instituded in clinic.After 4 minutes of untreated VF,CPR was started for 9 minutes.Defibrillation and advanced lire support were attempted at 13 minutes of CA

  15. The emergency care for patients with severe complications after cardiac interventional therapy%心脏介入治疗出现严重并发症的急救护理

    Institute of Scientific and Technical Information of China (English)

    李云

    2014-01-01

    Objective To investigate the emergency care measures for patients with severe complications after cardiac interventional therapy. Methods Among more than 2,000 patients who underwent cardiac intervention from May 2010 to May 2014 in our hospital, 30 cases happened serious complications, the incidence was approximately 1.50%. And selected these 30 patients with serious complications as study subjects, and the clinical data were retrospectively analyzed. And they all were timely processed by emergency nursing treatment, the corresponding emergency measures were taken according to the type of complications in patients with serious complications, and the effect of emergency nursing was summarized. Results 30 cases of severe complications included 13 cases of reflex hypotension, 7 cases of ventricular fibrillation, 6 cases of pneumothorax, 4 cases of acute cardiac tamponade. After all the patients underwent symptomatic emergency nursing treatment, the nurse attention were 100.00%. The success rate in addition to acute cardiac tamponade was 75.00%, the rest were 100.00%,it was shown that the success rate was vey high. Conclusion Cardiac interventional therapy is a common operation mode, the serious complications often can not be avoided, so we should take appropriate treatment and nursing measures in the light of these serious complications, and so can help doctors to improve operation treatment, to improve the success rate, and to improve the quality of life of patients.%目的:探讨心脏介入治疗患者出现严重并发症后的急救护理措施。方法我院2010年5月~2014年5月接诊心脏介入治疗患者2000余例,其中发生严重并发症30例,发生率约为1.50%。将这30例严重并发症患者作为研究对象,回顾性分析其临床资料,皆及时予以急救护理处理,根据患者具体的并发症类型采取对应的急救护理措施,总结急救护理效果。结果30例严重并发症包括13例反射性低血压、7

  16. Does electrophysiological testing have any role in risk stratification for sudden cardiac death?

    Institute of Scientific and Technical Information of China (English)

    Fei Lü; Wei Hua

    2010-01-01

    @@ Introduction Implantation of implantable cardioverter defibrillators (ICD) has widely been accepted for secondary prevention of sudden cardiac death (SCD) in cardiac arrest survivors.1 Currently there are increasing interests in primary prevention of SCD in selected high risk patients who have not experienced cardiac arrest.1

  17. Using a Combined Platform of Swarm Intelligence Algorithms and GIS to Provide Land Suitability Maps for Locating Cardiac Rehabilitation Defibrillators

    OpenAIRE

    KAFFASH-CHARANDABI, Neda; SADEGHI-NIARAKI, Abolghasem; Park, Dong-Kyun

    2015-01-01

    Background: Cardiac arrest is a condition in which the heart is completely stopped and is not pumping any blood. Although most cardiac arrest cases are reported from homes or hospitals, about 20% occur in public areas. Therefore, these areas need to be investigated in terms of cardiac arrest incidence so that places of high incidence can be identi-fied and cardiac rehabilitation defibrillators installed there.Methods: In order to investigate a study area in Petersburg, Pennsylvania State, and...

  18. 心脏骤停患者实施静注大剂量肾上腺素抢救的效果分析%Analysis of the Effect of Intravenous Injection of High Dose of Adrenaline for the Treatment of Patients with Sudden Cardiac Arrest

    Institute of Scientific and Technical Information of China (English)

    彭春晖

    2014-01-01

    Objective To investigate the clinical therapeutic effect of intravenous injection of high dose of adrenaline for the treat-ment of patients with sudden cardiac arrest. Methods The clinical data of 146 cases with sudden cardiac arrest treated by intra-venous injection of adrenaline in our hospital from April 2013 to April 2014 were analyzed retrospectively. According to the used dose of adrenaline, the patients were grouped, 79 cases with high dose of adrenaline, 67 cases with conventional dose of adrenaline were selected as the experimental group and the control group, respectively. And the success rate of cardiopulmonary resuscitation of the two groups was compared and analyzed. Results The success rate of cardiopulmonary resuscitation in the experimental group was significantly higher than that in the control group, there was significant difference between the groups (P<0.01). Conclusion Intravenous injection of high dose of adrenaline for patients with sudden cardiac arrest can achieve higher success rate of car-diopulmonary resuscitation, which is worthy of clinical application and promotion.%目的:探讨心脏骤停患者实施静注大剂量肾上腺素抢救的临床治疗效果。方法回顾性分析2013年4月-2014年4月入该院利用静脉注射肾上腺素抢救的心脏骤停患者146例的临床资料,依据肾上腺素使用剂量分组,大剂量79例纳入实验组,常规剂量67例纳入对照组,对两组患者心肺复苏成功率进行比较分析。结果实验组心肺复苏成功率明显高于对照组,差异有统计学意义(P<0.01)。结论对心脏骤停患者实施静注大剂量肾上腺素抢救具有较高的心肺复苏成功率,值得在临床使用推广。

  19. Prognostic value of dipyridamole thallium-201 screening to minimize perioperative cardiac complications in diabetics undergoing kidney or kidney-pancreas transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Mistry, B.M.; Solomon, H.; Hoff, J.; Aridge, D.L.; Lindsey, L.M.; Garvin, P.J. [Saint Louis Univ. Health Sciences Center, Div. of Abdominal Transplant, St. Louis, Missouri (United States); Bastani, B. [Saint Louis Univ. Health Sciences Center, Div. of Nephrology, St. Louis, Missouri (United States); Chaitman, B.R. [Saint Louis Univ. Health Sciences Center, Div. of Cardioiogy, St. Louis, Missouri (United States)

    1998-04-01

    To minimize perloperative cardiac events, we utilize a screening protocol consisting of intravenous dipyridamole thallium-201 myocardial imaging (DPT), with the selective use of coronary angiography based on the presence of reversible defect(s) on DPT test. A retrospective study was performed to determine the prognostic value of this protocol and to identify any clinical parameters predictive of an abnormal DPT test. To accomplish this, a detailed chart analysis of 176 consecutive kidney (n = 89) and kidney-pancreas (n = 87) transplant recipients who had undergone pre-transplant DPT testing was performed. The results of the DPT test were interpreted as normal in 111, fixed defect in 15, and reversible defect(s) in 50 patients. Forty-two of the 50 patients with reversible defect(s) underwent coronary angiography. Twelve of the 27 patients with significant coronary artery disease (CAD, > 50% stenosis in one or more coronary arteries) underwent pre-transplant revascularization and the remaining 15 were treated medically. Cardiac events (documented acute myocardial infarction or sudden cardiac death) within 6 wk of transplant were stratified by the results of this protocol. Also, various clinical parameters were compared between patients with normal and abnormal (fixed and reversible defect) DPT tests. Only one of the 111 (0.9%) transplant recipients with a normal DPT test had a perioperative cardiac event. None of the 15 (0%) patients with a fixed defect and none of the 15 (0%) patients with reversible defect(s), but a nonsignificant (<50% narrowing) coronary angiogram, had a perioperative cardiac event. Three of the 27 (11.1%) patients with reversible defect(s) and significant disease on coronary angiography, who had undergone pre-transplant revascularization of were managed medically, had a perioperative coronary event. Of 14 recipients parameters analyzed, age > 50 yr was the only variable predictive of an abnormal DPT test. (au) 33 refs.

  20. Effects of emergency admission to hospital time and ventricular fibrillation time on defibrillation results in patients with cardiac arrest%心搏骤停患者入急诊抢救室时机与心室纤颤时间对除颤效果的影响

    Institute of Scientific and Technical Information of China (English)

    符兆亮; 杨新疆; 潘科; 麦泉云

    2016-01-01

    Objective To find out the effects of admission to emergency department time on cardiopulmo-nary resuscitation (CPR)results and the effects of the defibrillation and CPR sequence and ventricular fibrilla-tion time on defibrillation results in patients with cardiac arrest. Methods An analysis of clinical data for 162 patients with cardiac arrest who were admitted to the emergency room at working time and spare time be-tween January 2011 and December 2014 was done.Based on the length between cardiac arrest attack and admis-sion to emergency department,patients were divided into 10 min group (30 cases).Each group was subdivided into an immediate defibrillation group and a CPR before defibrillation group.The successful rate of defibrillation at different time of ventricular fibrillation,and with the sequence of defibrillation and CPR was comparatively analyzed. Results Comparing the successful rate of defibrillation for cardiac arrest patients admitted to the emergency room at working time (daytime)with patients admitted to the emergency room at spare time (holidays and nighttime)showed there was no statistical difference (P>0.05).With ventricular fibrillation prolonging,defibrillation success rate was significantly de-creased.In ventricular fibrillation 10 min group,the success rate of de-fibrillation was 75.61%,56.00%,20.00%,respectively.Comparison of the defibrillation success rate in ven-tricular fibrillation>10 min group with 0.05).In ventricular fibrillation 4~10 min group,CPR before defibrillation subgroup had obviously higher success rate of defibrillation than immediate defibrillation subgroup,comparison between the two groups showed statistical difference (72.00% versus 40.00%,P 10 min group,CPR before defibrillation subgroup had obviously higher success rate of defibrillation than immedi-ate defibrillation subgroup,comparison between the two groups showed statistical difference (40.00% versus 0,P10 min组(30例)。每组患者再分为直接除颤组和

  1. 家猪心搏骤停后濒死呼吸规律的探讨%Regularity of agonal respiration after untreated cardiac arrest in a swine model

    Institute of Scientific and Technical Information of China (English)

    刘同英; 王立祥; 刘亚华; 崔晔; 陈婵; 江愿丽; 周满红

    2015-01-01

    目的 探讨心搏骤停(CA)家猪模型心室纤颤(VF)后濒死呼吸(AR)的发生情况及濒死呼吸频率(ARFR)的规律.方法 雄性健康家猪10只,体质量(25.0±3.0) kg.采用经心内膜交流电刺激诱发VF致CA,制模后观察8 min.记录8 min内每分钟出现AR的动物数及每分钟的ARFR,采用SPSS 19.0软件进行统计学分析.结果 VF致CA后8 min内所有动物均出现AR.1 min时有1只动物出现AR,ARFR为(0.2±0.1)次/min;2 min时有4只动物出现AR,ARFR为(1.2±1.0)次/min;3 min时有7只动物出现AR,ARFR为(2.7±1.4)次/min;4~5 min时全体动物均出现AR,4 min时ARFR为(3.7±1.6)次/min,5 min时ARFR为(3.2±1.9)次/min;6 min时有7只动物出现AR,ARFR为(1.3±1.0)次/min;7 min时全部动物均未出现AR;8 min时仅1只动物出现AR,ARFR为(0.2±0.1)次/min.10只动物平均于VF后(2.02±0.84) min首次出现AR,(5.21±1.12) min出现末次AR;4~5 min时为AR出现的高峰期,7 min后AR基本停止.CA后ARFR呈渐增-渐减模式,从(0.2±0.1)次/min逐渐升至(3.7±1.6)次/min,再降至(0.2±0.1)次/min.结论 AR是CA后的标志性征象之一.VF后均出现AR,且频发于CA后4~5 min,ARFR呈渐增-渐减模式.及时识别、有效处理AR将有助于提高心肺复苏成功率及复苏后存活率.%Objective To explore the regularity of incidence of agonal respiration (AR) and agonal respiration frequency rate (ARFR) during untreated cardiac arrest (CA) after ventricular fibrillation (VF) in a swine model.Methods Ten healthy male domestic pigs weighing (25.0± 3.0) kg were employed in this experiment.VF was induced by intraventricular shock with alternating current without treatment for 8 minutes.The incidence of AR and ARFR per minute were recorded for 8 minutes.Statistical analysis was performed using SPSS 19.0 system software.Results AR occurred in all animals after VF induced CA within 8 minutes.There was 1 animal showed AR at the first minute with ARFR (0.2±0.1) times/min,4 animals showed AR at the

  2. Pittsburgh Police Arrest Data

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Arrest data contains information on people taken into custody by City of Pittsburgh police officers. More serious crimes such as felony offenses are more likely to...

  3. The effect of cardiac massage by subdiaphragmatic compression on hemodynamics and apotosis of myocardial cells of rabbit with cardiac arrest during abdomen operations%膈肌下抬挤心脏复苏法对开腹手术中心搏骤停兔血流动力学及心肌细胞凋亡的影响

    Institute of Scientific and Technical Information of China (English)

    顾彩虹; 王立祥; 许铁; 刘克喜; 王言理

    2012-01-01

    Objective To observe the effect of cardiac massage by subdiaphragmatic compression (D-CPR) on the length of time required from cardiac arrest (CA) to restoration of spontaneous circulation (ROSC),hemodynamics,rate of ROSC,survival rate of 6 h,level of Caspase3 in myocardial cells and apoptosis index (AI) of myocardial cells and compare the effect of standard cardiac massage by chest compression (S-CPR) on those variables in order to choose the more effective resuscitation method for the patient with CA during abdomen operations.Methods A total of 32 healthy New Zealand rabbit were randomly (random number) divided into two groups,namely S-CPR group and D-CPR group (n =16 in each group).All of rabbits were anesthetized with ketamine and Shumianxin (a kind of hypnotics) by intraperitoneal injection,subsequently tracheotomy was made for endotracheal intubation,and right internal jugular vein was catheterized for monitoring central venous pressure (CVP) and left common carotid artery was for indwelling cannula to monitor arterial blood pressure.Lead-2 of ECG was placed.After laparotomy and vital signs of rabbits stabilized for 5 minutes,the endotracheal tube was clamped at the end expiration for 8 minutes to make asphyxial cardiac arrest model.The effects of two different methods were observed and compared in respects of changes in hemodynamics、length of time elapsed from CA to ROSC、ROSC rate and the survival rate in 6 h.The level of Caspase3 in myocardial cells and AI of myocardial cells were detected by using immunohistochemistry staining method and TUNEL,respectively 6 hours after successful resuscitation.Results ①The length of time consumed fiom CA to ROSC in D-CPR group was shorter than that in S-CPR group (P <0.05) ②Coronary perfusion pressure (CPP) and MAP 15 minutes after CPR were higher in D-CPR group than those in S-CPR group (P < 0.05).③SBP and DBP after ROSC were higher in D-CPR group than those in S-CPR group.④ROSC rate in D-CPR group was

  4. 1例有机磷中毒洗胃致呼吸心跳骤停患者的急救护理体会%Emergency Nursing of Patients with Respiratory and Cardiac Arrest Caused by Organophosphate Poisoning Gastric Lavage 1 Case

    Institute of Scientific and Technical Information of China (English)

    周丽芳

    2014-01-01

    Objective: Discussion on organic phosphorus gastric lavage with respiratory and cardiac arrest caused by emergency treatment and nursing of pesticide poisoning. Methods: Review the resume breathing heartbeat of organic phosphorus respiratory and cardiac arrest, 1 cases of gastric lavage in my April 23, 2013 poisoning patients after emergency case. Results:Patients recovered spontaneous breathing, heart rate,and cured. Conclusion:Take quick basic life support is critical to the success of cardiopulmonary resuscitation,Changes of medical staf to the strict observation condition in the emergency process ,Ef ective teamwork emergency work.%目的:探讨有机磷农药中毒洗胃致呼吸心跳骤停急救措施及护理方式。方法回顾性分析2013年4月23日我科1例洗胃过程中呼吸心跳骤停的有机磷中毒患者急救后恢复呼吸心跳的案例。结果患者恢复自主呼吸、心率,后痊愈出院。结论快速采取基本生命支持是心肺复苏成功的关键,医务人员在急救过程中要严密观察病情的变化,采取有效的团队配合开展急救工作。

  5. 心肺复苏中机械通气时机选择对急诊心博骤停患者预后的影响%Effects of mechanical ventilation timing during cardiopulmonary resuscitation on the prognosis of patients with cardiac arrest inemergency

    Institute of Scientific and Technical Information of China (English)

    付乐章

    2013-01-01

    目的探讨心肺复苏的机械通气时机选择对急诊心博骤停患者预后影响。方法选取在本院接受心博骤停自动循环恢复机械通气的50例患者为研究对象,按照机械通气的时间分为早期上机组24例,以及晚期上机组26例,统计两组患者的年龄、性别、心博骤停心率类型以及心博骤停的原因,同时统计两组患者心肺复苏成功效率、心博骤停24 h、有无角膜性反射、有无瞳孔反射、疼痛躲避反应、运动反应、出院时神经功能分类以及治愈出院率。对两组患者的各项指标进行相应比较。结果两组患者的年龄、性别、心博骤停心率类型以及心博骤停原因,两者差异无统计学意义( P>0.05);两组患者的心肺复苏率、24 h角膜反射(+)、24 h瞳孔反射(+)、24 h疼痛躲避反应(+)、24 h运动反应(+)以及其出院时神经功能分类等,其指标差异有统计学意义,早期上机组明显优于晚期上机组( P<0.05);两组患者成活出院率(45.5%∶40.0%)之间差异无统计学意义( P>0.05),其总成活出院率为33.41%。结论对心博骤停的患者应及早给予机械通气呼吸支持,从而促进患者心脏的恢复,以提高心博骤停疾病患者的治疗效果,提高心博骤停患者心肺复苏的成功率,并且对其神经功能的预后进行改善。%Objective To investigate the effects of mechanical ventilation timing during cardiopulmonary re-suscitation on the prognosis of patients with cardiac arrest in emergency .Methods 50 patients with cardiac arrest , receiving automatic cycle recovery of mechanical ventilation were divided into early treated group (24 cases) and later treated group (26 cases) according to the time of mechanical ventilation .Age ,gender ,type of heart rate ,etiological factor of cardiac arrest ,achievement ratio of cardiopulmonary resuscitation and corneal

  6. 妊娠合并心脏病心电图表现及心功能状况%ECG and cardiac function of pregnancy patients complicated with heart disease in 415 cases

    Institute of Scientific and Technical Information of China (English)

    王利果

    2014-01-01

    Objective To investigate the electrocardiogram( ECG)and cardiac function of pregnancy patients complicated with cardiac disease. Methods The clinical data of 415 cases of pregnant complicated with cardiac disease from January 2010 to June 2013 were retrospectively analyzed. Results The most common cardiac disease during pregnancy was arrhythmias with the NYHA grading I-Ⅱ( 49. 64%),which mainly occured in the idiopathic ventrieular arrhythmia,preexcitation syndrome,fol-lowed by preeclampsia-eclampsia with heart failure and congenital heart disease,with a frequency of 23. 86%and 16. 14%,re-spectively. The chief causes of NYHA gradingⅢ-IV during pregnancy were preeclampsia-eclampsia with heart failure,peripar-tum eardiomyopathy,congenital heart disease and rheumatic heart disease,ECGs of which mailly were sinus tachycardia,atrial fibrillatio and ST-T changes. Conclusion The main abnormal ECGs of pregnant patients complicated with heart disease were id-iopathic ventrieular arrhythmia,paroxysmal supraventricular tachycardia and sinus tachycardia,atrial fibrillatio and ST-Tchang-es. The pregnant women with heart disease complicated by rapid arrhythmia are liable to get deteriorated cardiac function.%目的:探讨妊娠合并不同类型心脏病的心电图表现及心功能状况。方法对2010年1月至2013年6月收治的415例妊娠合并心脏病患者的临床资料进行回顾性分析。结果妊娠合并心脏病以心律失常(206例,49.64%)和妊娠期高血压性心脏病(99例,23.86%)最为常见,先天性心脏病位居第三位(67例,16.14%)。妊娠合并心律失常以特发性室性心律失常、预激综合征为主,心功能多在NYHA I~Ⅱ级;妊娠合并非心律失常性心脏病异常心电图以窦性心动过速、心房纤颤、ST-T改变为主,主要病因为妊娠期高血压性心脏病、围生期心肌病、先天性心脏病及风湿性心脏病,心功能NYHAⅢ~Ⅳ级多见于该病。结论妊娠合

  7. Prospective evaluation of stress myocardial perfusion imaging for pre-operative cardiac risk assessment

    International Nuclear Information System (INIS)

    Full text: A prospective evaluation of patients who underwent stress myocardial perfusion imaging (MPI) to assess preoperative cardiac risk was undertaken. At the time of the scan patients were classified into 4 Clinical Risk groups (CR) based on known clinical data. On completion of the scan, the patient was then categorised into 4 Scan based Risk groups (SR), incorporating size of perfusion deficit, single versus multi-vessel disease and ejection fraction. Surgery at Austin and Repatriation Medical Centre within 6 months of scan and complications were identified using the hospital medical database. Major early cardiac events coded were death (cardiac related), myocardial infarction, unstable angina, acute pulmonary oedema, cardiac arrest, and urgent revascularisation. 208 patients have reached 6 months post-MPI scan. Of these 119 (57%) were identified as having surgery. Of the Scan Risk groups, 63% of normal, 57% of increased, and 47% of high and very high groups have had surgery. An abnormal scan is associated with a three-fold risk of cardiac complication (3.5% vs 11.3%). This is lower than most previous reports and may be due to higher representation of low risk surgical procedures (14% in this series), improved peri-operative care and/or the test result influence on management (suggested by decreasing surgical rate as SR estimate rose). Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  8. Acute Tension Pneumothorax Following Cardiac Herniation after Pneumonectomy

    OpenAIRE

    Daniel Steinmann; Eva Rohr; Andreas Kirschbaum

    2010-01-01

    A tension pneumothorax is one of the main causes of cardiac arrest in the initial postoperative period after thoracic surgery. Tension pneumothorax and cardiac herniation must be taken into account in hemodynamically unstable patients after pneumonectomy. We report an unusual case of successful treatment of acute tension pneumothorax following cardiac herniation and intrathoracic bleeding after pneumonectomy.

  9. 经膈肌下抬挤心脏方法对心脏停搏兔复苏的实验研究%An experimental study on cardiopulmonary resuscitation by cardiac massage under diaphragmatic muscle for rabbit with cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    王立祥; 丁春侠; 李旭; 顾彩虹; 孙鲲; 刘亚华

    2008-01-01

    Objective To compare the hemodynamic effect of standard-cardiopulmonary resuscitation (S-CPR) and of CPR by cardiac massage under the diaphragmatic muscle (D-CPR), and to evaluate the feasibility of D-CPR. Methods Twenty healthy New Zealand rabbits were randomly divided into two groups, one group receiving S-CPR (n= 10) and the other group receiving D-CPR (n=10). Cardiac arrest was induced by asphyxiation at the end expiration for 8 minutes. After the hemodynamic situation was stable for 5 minutes before asphyxiation, the readings of ascending aorta systolic pressure (AOS) and diastolic pressure (AOD), transcutaneous oxygen saturation (SpO2), right atrial systolic pressure (RASP), right atrial diastolic pressure (RADP), and electrocardiogram were recorded consecutively to the end of the experiment. The mean arterial pressure (MAP) of ascending aorta and coronary perfusion pressure (CPP) were calculated, The rate of restoration of spontaneous circulation (ROSC) and the survival rate in a short duration of 6 hours were observed. Results Five rabbits in S-CPR group and 8 in D-CPR group were successfully resuscitated and obtained ROSC (50%, 80%, P=20. 05). Six hours survival rate was 400% in S-CRP group and 500% in D-CPR group. The comparisons between the two groups on AOS, AOD, MAP and CPP respectively showed that at 1 minute and 5 minutes during resuscitation the respective variables were higher in the D-CPR group than that in the S-CPR group (all P<0. 05). Compared to the bemodynamics before asphyxiation, the MAP and CPP in the D-CPR group increased 54. 1% and 33.4% of basic value at 1 minute, and they were 60. 0% and 41.8% at 5 minutes, while the AOS and AOD in the S-CPR group only increased by an average of 37. 3% and 16.5% at 1 minute, and they were 38. 5% and 17. 1% at 5 minutes, respectively. After ROSC, the hemodynamic variations of the D-CPR rabbits were more stable than those of S-CPR rabbits. Conclusion D-CPR can provide higher arterial pressure, cardiac

  10. Fisioterapia pré-operatória na prevenção das complicações pulmonares em cirurgia cardíaca pediátrica Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery

    Directory of Open Access Journals (Sweden)

    Josiane Marques Felcar

    2008-09-01

    Full Text Available OBJETIVO: Avaliar a incidência e o risco de complicações pulmonares em crianças submetidas a intervenção fisioterapêutica pré e pós-operatória nas cirurgias cardíacas, bem como comparar com aquelas submetidas apenas a intervenção fisioterapêutica pós-operatória. MÉTODOS: Ensaio clínico aleatório, que incluiu 135 pacientes de zero a 6 anos com cardiopatias congênitas, submetidos à cirurgia cardíaca. Os pacientes foram aleatorizados para grupo intervenção (G1, que realizou fisioterapia pré e pós-operatória, ou para grupo controle (G2, somente fisioterapia pós-operatória. Para comparar as variáveis entre os grupos foi utilizado o teste de Mann-Whitney e o Qui quadrado. Foi calculado o risco absoluto e sua magnitude por meio do número necessário para tratar. A significância estatística foi estipulada em 5% (POBJECTIVE: To evaluate the occurrence and risk of pulmonary complications in children who underwent pre-and postoperative physiotherapeutic intervention in cardiac surgeries, as well as to compare these patients to those who underwent only postoperative physiotherapeutic intervention. METHODS: A randomized controlled trial was performed with 135 patients from 6 years of age and younger with congenital heart disease who had undergone cardiac surgery. Patients were randomly assigned to the intervention group (G1 in which they underwent pre- and postoperative physiotherapy or to the control group (G2 in which they underwent only postoperative physiotherapy. Mann-Whitney and the Chi-square tests were used to compare the variables between the groups. The magnitude of the absolute risk was calculated by the number of patients needed to treat. Statistical significance was set at 5% (P<0.05. RESULTS: 17 patients (25% in G1, and 29 patients (43.3% in G2 presented pulmonary complications (P= 0.025, pneumonia was the most frequent complication, and among the 17 patients in G1, seven (10.3% developed pneumonia, six (8

  11. Preoperative physical therapy for elective cardiac surgery patients

    NARCIS (Netherlands)

    Hulzebos, E.H.J.; Smit, Y.; Helders, P.P.J.M.; Meeteren, N.L.U. van

    2012-01-01

    BACKGROUND: After cardiac surgery, physical therapy is a routine procedure delivered with the aim of preventing postoperative pulmonary complications. OBJECTIVES: To determine if preoperative physical therapy with an exercise component can prevent postoperative pulmonary complications in cardiac sur

  12. Modified emergency department thoracotomy for postablation cardiac tamponade.

    Science.gov (United States)

    Wyatt, Thomas E; Haug, Eric W

    2012-04-01

    Cardiac dysrhythmias are a common problem in the United States. Radiofrequency ablation is being used more frequently as a treatment for these diagnoses. Although rare, serious complications such as cardiac tamponade have been reported as a result of ablation procedures. Traditionally, emergency department (ED) thoracotomy has been reserved for cases of traumatic arrest only. We report a case of a successful modified ED thoracotomy in a patient with postablation cardiac tamponade and subsequent obstructive shock who failed intravenous fluid resuscitation, pressor administration, and multiple attempts at pericardiocentesis. In this case, a modified approach was used to incise the pericardium. Although this was associated with large blood loss, we believed that using the traditional method of completely removing the pericardium would have resulted in uncontrolled hemorrhage. Instead, our method led to successful resuscitation of the patient until definitive care was available. A smaller pericardial incision than is traditionally used during ED thoracotomy deserves further consideration and research to determine whether and when it may be most useful as a temporizing treatment of cardiac tamponade when other methods have failed. PMID:22104519

  13. Cardiovascular complications of cirrhosis

    DEFF Research Database (Denmark)

    Møller, Søren; Henriksen, Jens Henrik

    2008-01-01

    and electrophysiological abnormalities, an entity that is different from alcoholic heart muscle disease. Being clinically latent, cirrhotic cardiomyopathy can be unmasked by physical or pharmacological strain. Consequently, caution should be exercised in the case of stressful procedures, such as large volume paracentesis......Cardiovascular complications of cirrhosis include cardiac dysfunction and abnormalities in the central, splanchnic and peripheral circulation, and haemodynamic changes caused by humoral and nervous dysregulation. Cirrhotic cardiomyopathy implies systolic and diastolic dysfunction....... The clinical significance of cardiovascular complications and cirrhotic cardiomyopathy is an important topic for future research, and the initiation of new randomised studies of potential treatments for these complications is needed.  ...

  14. Cardiovascular complications of cirrhosis

    DEFF Research Database (Denmark)

    Møller, S; Henriksen, Jens Henrik Sahl

    2008-01-01

    and electrophysiological abnormalities, an entity that is different from alcoholic heart muscle disease. Being clinically latent, cirrhotic cardiomyopathy can be unmasked by physical or pharmacological strain. Consequently, caution should be exercised in the case of stressful procedures, such as large volume paracentesis......Cardiovascular complications of cirrhosis include cardiac dysfunction and abnormalities in the central, splanchnic and peripheral circulation, and haemodynamic changes caused by humoral and nervous dysregulation. Cirrhotic cardiomyopathy implies systolic and diastolic dysfunction....... The clinical significance of cardiovascular complications and cirrhotic cardiomyopathy is an important topic for future research, and the initiation of new randomised studies of potential treatments for these complications is needed....

  15. Rescue and nursing of complicated acute pericardial tamponade with cardiac interventional therapy%心脏介入治疗并发急性心包填塞的抢救与护理

    Institute of Scientific and Technical Information of China (English)

    李晓彤

    2012-01-01

    目的 总结心脏介入治疗并发12例急性心包填塞的护理经验.方法 回顾分析心脏介入治疗并发12例急性心包填塞患者的临床资料,总结护理要点.结果 急性心包填塞发生在冠状动脉介入治疗3例,射频消融术6例,永久起搏术1例,临时起搏术2例,无1例死亡.结论 严密观察病情,积极护理施救,加强心理护理,提高风险意识,各项护理环环相扣,从而保障患者的生命安全.%Objective To summarize the nursing experience of 12 cases of complicated acute pericardial tamponade with cardiac interventional therapy. Methods The clinical data of 12 complicated acute pericardial tamponade patients treated with cardiac interventional therapy were analyzed retrospectively,and nursing strategies were summarized as well. Results There were 3 cases of a-cute pericardial tamponade in coronary interventional therapy,6 cases of radiofrequency ablation,1 case of permanent pacing,and 2 cases of temporary pacing with no case of death. Conclusion The close observation of the disease,active care and rescue,enhancement of psychological nursing and risk awareness are interrelated. They can ensure the safety of patients.

  16. Evolution of the dragonfly head-arresting system

    OpenAIRE

    Gorb, S. N.

    1999-01-01

    The arrester or fixation system of the head in adult Odonata is unique among arthropods. This system involves the organs of two body segments: the head and the neck. It consists of a skeleton–muscle apparatus that sets the arrester parts in motion. The parts comprise formations covered with complicated microstructures: fields of microtrichia on the rear surface of the head and post-cervical sclerites of the neck. The arrester immobilizes the head during feeding or when the dragonfly is in tan...

  17. Rerouting surgery of cardiac type total anomalous pulmonary venous return in a premature newborn with very low birth weight.

    Science.gov (United States)

    Wu, En-Ting; Huang, Shu-Chien; Wu, Mei-Hwan; Wang, Jou-Kou; Chang, Chung-I

    2007-02-01

    Intracardiac repair for complex congenital heart defects in premature neonates with very low birth weight (VLBW) is still a challenge to pediatric cardiac surgeons. We report the successful rerouting of cardiac type total anomalous pulmonary venous return (TAPVR) in a premature newborn (36th gestational week) with VLBW (1250 g). She had severe hypoxemia and low cardiac output despite medical treatment. Rerouting surgery of TAPVR was performed under deep hypothermia circulatory arrest at the age of 20 days. The sternum was left open and approximated 2 days later. Follow-up echocardiography showed good ventricular function without pulmonary venous obstruction. The endotracheal tube was removed 7 days postoperatively. She was then discharged without complication. In conclusion, with improved cardiopulmonary bypass technique and perioperative care, open heart surgery can be performed in premature newborns with VLBW.

  18. Evolution of the dragonfly head-arresting system

    Science.gov (United States)

    Gorb, S. N.

    1999-01-01

    The arrester or fixation system of the head in adult Odonata is unique among arthropods. This system involves the organs of two body segments: the head and the neck. It consists of a skeleton–muscle apparatus that sets the arrester parts in motion. The parts comprise formations covered with complicated microstructures: fields of microtrichia on the rear surface of the head and post-cervical sclerites of the neck. The arrester immobilizes the head during feeding or when the dragonfly is in tandem flight. Thus, it may serve as an adaptation to save the head from violent mechanical disturbance and to stabilize gaze in a variety of behavioural situations. This study shows the evolutionary trend of the arrester in the order Odonata by using scanning electron microscopy and measurements of arrester structures in 227 species from 26 odonate families. The arrester design occurring in the Epiophlebiidae, Gomphidae, Neopetaliidae, Petaluridae and Chlorogomphinae is suggested to be the basic one. Two convergent pathways of head-arrester evolution among Zygoptera and Anisoptera are proposed. The possible functional significance of the arrester system is discussed.

  19. Surgical complications in neuromuscular scoliosis operated with posterior- only approach using pedicle screw fixation

    Directory of Open Access Journals (Sweden)

    Singh Surya Udai

    2009-05-01

    Full Text Available Abstract Background There are no reports describing complications with posterior spinal fusion (PSF with segmental spinal instrumentation (SSI using pedicle screw fixation in patients with neuromuscular scoliosis. Methods Fifty neuromuscular patients (18 cerebral palsy, 18 Duchenne muscular dystrophy, 8 spinal muscular atrophy and 6 others were divided in two groups according to severity of curves; group I ( 90°. All underwent PSF and SSI with pedicle screw fixation. There were no anterior procedures. Perioperative (within three months of surgery and postoperative (after three months of surgery complications were retrospectively reviewed. Results There were fifty (37 perioperative, 13 postoperative complications. Hemo/pneumothorax, pleural effusion, pulmonary edema requiring ICU care, complete spinal cord injury, deep wound infection and death were major complications; while atelectesis, pneumonia, mild pleural effusion, UTI, ileus, vomiting, gastritis, tingling sensation or radiating pain in lower limb, superficial infection and wound dehiscence were minor complications. Regarding perioperative complications, 34(68% patients had at least one major or one minor complication. There were 16 patients with pulmonary, 14 with abdominal, 3 with wound related, 2 with neurological and 1 cardiovascular complications, respectively. There were two deaths, one due to cardiac arrest and other due to hypovolemic shock. Regarding postoperative complications 7 patients had coccygodynia, 3 had screw head prominence, 2 had bed sore and 1 had implant loosening, respectively. There was a significant relationship between age and increased intraoperative blood loss (p = 0.024. However it did not increased complications or need for ICU care. Similarly intraoperative blood loss > 3500 ml, severity of curve or need of pelvic fixation did not increase the complication rate or need for ICU. DMD patients had higher chances of coccygodynia postoperatively. Conclusion

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

    Directory of Open Access Journals (Sweden)

    Artur Laizo

    2010-06-01

    Full Text Available OBJETIVO: Apresentar as complicações que aumentam a permanência na Unidade de Terapia Intensiva (UTI dos pacientes submetidos à cirurgia cardíaca. MÉTODOS: Foram analisados, retrospectivamente, 85 prontuários de pacientes submetidos à cirurgia cardíaca, no período de março a maio de 2009, na Santa Casa de Misericórdia de Juiz de Fora (MG e, destes pacientes, foram estudados 14 (16,47% que permaneceram por mais de 5 dias na UTI. Dentre os 85 pacientes, houve três óbitos, sendo dois pacientes operados em caráter de urgência, o que aumenta a morbidade, e um paciente que permaneceu internado e em ventilação mecânica (VM por 21 dias. RESULTADOS: O estudo demonstrou que as complicações que aumentaram o tempo de internação na UTI foram respiratórias e metabólicas, de acordo com a literatura. CONCLUSÃO: As complicações que aumentam o tempo de permanência na UTI são as relacionadas à função respiratória, doença pulmonar obstrutiva crônica, tabagismo, congestão pulmonar, desmame da VM prolongado, diabetes, infecções, insuficiência renal, acidente vascular encefálico e instabilidade hemodinâmica.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 Misericórdia 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

  1. 心肺复苏中单用肾上腺素或联合血管加压素治疗的Meta分析%Co-administration of vasopressin and epinephrine versus epinephrine alone in the treatment of patients with cardiac arrest: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    李慧; 荆小莉; 李欣; 詹红; 熊艳; 廖晓星

    2010-01-01

    目的 在心搏骤停实施心肺复苏过程中,联合应用血管紧张素和肾上腺素的效果是否优于单用肾上腺素目前尚无统一的结论,本研究拟针对现有临床资料进行荟萃分析.方法 在NED-LINE及EMBASE数据库中检索关于比较成人心肺复苏时单用肾上腺素或联合应用血管紧张素的所有临床研究,首要观察指标为复苏后自主循环恢复率(ROSC).结果 在检索到的485篇文章中,6篇为随机对照临床研究.荟萃分析结果显示,除复苏后24 h生存率联合用药优于单用肾上腺素(OR值为2.99,95%CI 1.43~6.28)外,其余各项指标比较差异均无统计学意义.结论 荟萃分析中仅有包含122例患者的24 h生存率组联合用药优于单用肾上腺素,因此尚不支持复苏中应用血管加压素联合肾上腺素.%Objective The combination of vasopressin and epinephrine has long been thought to be more effective then epinephrine alone in cardiopulrnonary resuscitation (CPR), evidence is not enough to make such a clinical recommendation. This meta-analysis compared the efficacy of vasopressin and epinephrine used together versus epinephrine alone in cardiac arrest (ca) in order to verify the truth. Method MEDLINE and EMBASE were searched for the data of randomized trials in comparing the results of co-administration of vasopressin and epinephrine with epinephrine alone in adults with cardiac arrest. The primary outcome was the restoration of spontaneous circulation (ROSC). Results Six randomized trials in 485 articles were analyzed. We failed to get the results supporting the effectiveness of this combination therapy, except for the rate of 24 hours survival (OR: 2.99,95%CI:1.43 ~ 6.28). No evidence supported that vasopressin combined with epinephrine was better than epinephrine alone in ROSC. Conclusions This systematic review indicates the combination of vasopressin and epinephrine is better for the rate of 24 hpurs survival in only 122 patients. Further

  2. Cardiac tumours in infancy

    OpenAIRE

    Yadava, O.P.

    2012-01-01

    Cardiac tumours in infancy are rare and are mostly benign with rhabdomyomas, fibromas and teratomas accounting for the majority. The presentation depends on size and location of the mass as they tend to cause cavity obstruction or arrhythmias. Most rhabdomyomas tend to regress spontaneously but fibromas and teratomas generally require surgical intervention for severe haemodynamic or arrhythmic complications. Other relatively rare cardiac tumours too are discussed along with an Indian perspect...

  3. Cardiovascular complications in acromegaly.

    Science.gov (United States)

    Vitale, G; Pivonello, R; Lombardi, G; Colao, A

    2004-09-01

    Cardiovascular morbidity and mortality are increased in acromegaly. In fact, GH and IGF-I excess induces a specific cardiomyopathy. The early stage of acromegaly is characterized by the hyperkinetic syndrome (high heart rate and increased systolic output). Frequently, concentric biventricular hypertrophy and diastolic dysfunction occur in acromegaly, leading to an impaired systolic function ending in heart failure if the disease is untreated or unsuccessfully untreated. Besides, abnormalities of cardiac rhythm and of valves have been also described in acromegaly. The coexistence of other complications, such as arterial hypertension and diabetes, aggravates the acromegalic cardiomyopathy. The suppression of GH/IGF-I following an efficacious therapy could decrease left ventricular mass and improve cardiac function. In conclusion, a careful evaluation of cardiac function, morphology and activity seems to be mandatory in acromegaly.

  4. Capnography during cardiac resuscitation: a clue on mechanisms and a guide to interventions

    OpenAIRE

    Gazmuri, Raúl J.; Kube, Erika

    2003-01-01

    Measurement of the end-tidal partial pressure of carbon dioxide (PETCO2) during cardiac arrest has been shown to reflect the blood flow being generated by external means and to prognosticate outcome. In the present issue of Critical Care, Grmec and colleagues compared the initial and subsequent PETCO2 in patients who had cardiac arrest precipitated by either asphyxia or ventricular arrhythmia. A much higher PETCO2 was found immediately after intubation in instances of asphyxial arrest. Yet, a...

  5. [Complications of cocaine addiction].

    Science.gov (United States)

    Karila, Laurent; Lowenstein, William; Coscas, Sarah; Benyamina, Amine; Reynaud, Michel

    2009-06-20

    Addiction is a chronic relapsing disorder characterized by repetitive and compulsive drug-seeking behavior and drug abuse despite negative health or social consequences. Cocaine addiction is a significant worldwide public health problem, which has somatic, psychological, psychiatric, socio-economic and judicial complications. Some of the most frequent complications are cardiovascular effects (acute coronary syndrome, cardiac arrhythmias, increased blood pressure); respiratory effects (fibrosis, interstitial pneumonitis, pulmonary hypertension, alveolar haemorrhage, asthma exacerbation; emphysema), neurological effects (strokes, aneurysms, seizures, headaches); risk for contracting HIV/AIDS, hepatitis B and C, sexual transmitted disease and otolaryngologic effects. Other complications are not discussed here. The vast majority of studies indicate that there are cognitive deficits induced by cocaine addiction. Attention, visual and working memories, executive functioning are affected in cocaine users. Psychiatric complications found in clinical practice are major depressive disorders, cocaine-induced paranoia, cocaine-induced compulsive foraging and panic attacks. PMID:19642439

  6. [Cardiac evaluation before non-cardiac surgery].

    Science.gov (United States)

    Menzenbach, Jan; Boehm, Olaf

    2016-07-01

    Before non-cardiac surgery, evaluation of cardiac function is no frequent part of surgical treatment. European societies of anesthesiology and cardiology published consensus-guidelines in 2014 to present a reasonable approach for preoperative evaluation. This paper intends to differentiate the composite of perioperative risk and to display the guidelines methodical approach to handle it. Features to identify patients at risk from an ageing population with comorbidities, are the classification of surgical risk, functional capacity and risk indices. Application of diagnostic means, should be used adjusted to this risk estimation. Cardiac biomarkers are useful to discover risk of complications or mortality, that cannot be assessed by clinical signs. After preoperative optimization and perioperative cardiac protection, the observation of the postoperative period remains, to prohibit complications or even death. In consideration of limited resources of intensive care department, postoperative ward rounds beyond intensive care units are considered to be an appropriate instrument to avoid or recognize complications early to reduce postoperative mortality. PMID:27479258

  7. Ventricular Arrhythmias in Apparently Normal Hearts: Who Needs an Implantable Cardiac Defibrillator?

    Science.gov (United States)

    Tan, Alex Y; Ellenbogen, Kenneth

    2016-09-01

    Idiopathic ventricular tachycardia is often considered a benign form of ventricular arrhythmia in patients without apparent structural heart disease. However, a subset of patients may develop malignant ventricular arrhythmias and present with syncope and sudden cardiac arrest. Survivors of cardiac arrest are candidates for implantable cardiac defibrillators (ICDs). The indications for ICDs in patients with less than a full-blown cardiac arrest presentation but with electrocardiographically high-risk ectopy features remain uncertain. This article addresses some of the uncertainties and pitfalls in ICD risk stratification in this patient group and explores potential mechanisms for malignant conversion of benign premature ventricular complexes to sustained arrhythmia.

  8. Ventricular Arrhythmias in Apparently Normal Hearts: Who Needs an Implantable Cardiac Defibrillator?

    Science.gov (United States)

    Tan, Alex Y; Ellenbogen, Kenneth

    2016-09-01

    Idiopathic ventricular tachycardia is often considered a benign form of ventricular arrhythmia in patients without apparent structural heart disease. However, a subset of patients may develop malignant ventricular arrhythmias and present with syncope and sudden cardiac arrest. Survivors of cardiac arrest are candidates for implantable cardiac defibrillators (ICDs). The indications for ICDs in patients with less than a full-blown cardiac arrest presentation but with electrocardiographically high-risk ectopy features remain uncertain. This article addresses some of the uncertainties and pitfalls in ICD risk stratification in this patient group and explores potential mechanisms for malignant conversion of benign premature ventricular complexes to sustained arrhythmia. PMID:27521094

  9. 急性大面积脑梗死患者院内转送途中频发心脏骤停的抢救%Emergency treatment of frequent cardiac arrest of patients with acute massive cerebral infarction in the hospital transfer way

    Institute of Scientific and Technical Information of China (English)

    王秋芳

    2015-01-01

    This paper summarizes the emergency ambulance of cardiac arrest of 1 patient with acute massive cerebral infarction and cerebral hernia in the hospital transfer way.The emergency nursing points are accurate condition assessment before transfer, active and full preparation,skilled and effective rescue measures,efficient life support.The patient is given decompressive craniectomy in the neurosurgery department,and safe returns to the neurology department at 14 days after operation.After a period of treatment,the patient is transferred to the rehabilitation department to do extremity rehabilitation training.%本文总结1例急性大面积脑梗死并发脑疝患者院内转运途中出现心脏骤停的紧急救护,急救护理要点:转运前准确的病情评估,积极、充分的准备,娴熟、有效的抢救措施,高效的生命支持.患者于神经外科行去骨瓣减压术后14 d安返神经内科,经过一段治疗后转至康复科做肢体康复训练.

  10. Cardiac abnormalities in acromegaly. Pathophysiology and implications for management.

    Science.gov (United States)

    Vitale, Giovanni; Pivonello, Rosario; Lombardi, Gaetano; Colao, Annamaria

    2004-01-01

    Cardiovascular disease is claimed to be one of the most severe complications of acromegaly, contributing significantly to mortality in this disease. In fact, an excess of growth hormone (GH) and insulin-like growth factor 1 (IGF-I) causes a specific derangement of cardiomyocytes, leading to abnormalities in cardiac muscle structure and function, inducing a specific cardiomyopathy. In the early phase of acromegaly the excess of GH and IGF-I induces a hyperkinetic syndrome, characterized by increased heart rate and increased systolic output. Concentric hypertrophy is the most common feature of cardiac involvement in acromegaly, found in more than two thirds of patients at diagnosis. This abnormality is commonly associated with diastolic dysfunction and eventually with impaired systolic function ending in heart failure, if the GH/IGF-I excess is left untreated. In addition, abnormalities of cardiac rhythm and of heart valves have also been described in acromegaly. The coexistence of other complications, such as arterial hypertension and diabetes mellitus, aggravates acromegalic cardiomyopathy. Successful control of acromegaly induces a decrease in left ventricular mass and an improvement in diastolic function, while the effects of GH/IGF-I suppression on systolic function are more variable. However, since cardiovascular alterations in young patients with short disease duration are milder than in those with longer disease duration, it is likely to be easier to reverse and/or arrest acromegalic cardiomyopathy in young patients with early-onset disease. In conclusion, careful assessments of cardiac function, morphology, and activity are required in patients with acromegaly. An early diagnosis and prompt effective treatment are important in order to reverse acromegalic cardiomyopathy.

  11. 婴儿室间隔缺损合并肺动脉高压的早期外科治疗%Early cardiac surgical treatment of infants with ventricular septal defect complicated with pulmonary hypertension

    Institute of Scientific and Technical Information of China (English)

    石磊; 范太兵; 李群; 徐红亮; 李斌; 裴宇; 杨玉奇

    2010-01-01

    目的 分析460例婴儿室间隔缺损合并肺动脉高压的手术结果,验证早期外科治疗的可行性及优越性.方法 2003年1月至2009年3月我科连续行体外循环心内直视术纠治室间隔缺损伴肺动脉高压患儿460例,其中小婴儿组(6个月以下)132例,大婴儿组(6个月以上)328例.结果 本组婴儿中死亡16例,病死率3.4%,小婴儿组与大婴儿组分别死亡6例(4.5%)和10例(3.0%).其余患儿并发症有低心排、肺炎、肺不张、心律失常、切口感染等,经过治疗后均痊愈.小婴儿组与大婴儿组手术时间、体外循环时间、术后呼吸机辅助时间、术后监护时间、术后住院时间及死亡率比较差异均无统计学意义.结论 婴儿室间隔缺损合并肺动脉高压早期行外科手术治疗安全、可靠,并发症少、痛死率低;可避免患儿反复发生肺炎以及发生器质性肺高压丧失治疗机会.%Objective To analyze the surgical outcome of 460 infants with VSD complicated with PH, to investigate the feasibility and advantage of early open-heart surgery. Methods Four hundred and sixty infants with VSD and PH underwent extracorporeal circulation open -heart surgery from Jan 2003 to Mar 2009 in our hospital. Among which, there were 132 little infants(younger than 6 months)and 328 big infants (older than 6 months). Results Sixteen of all patients died, and the overall in- hospital mortality was 3.4%. The mortality of little infants group and big infants group were 4.5% (6 cases died)and 3.0% (10 cases died)respectively. Other complications were low cardiac output, pneumonia, atelectasis, arrhythmia, wound infection and so on, and they were cured. There were no significant differences in operation time, extracorporeal circulation time, duration of postoperative respiratory machine assisted ventilation, postoperative monitoring duration, postoperative hospitalization duration and mortality rate between the two groups. Conclusions The effect of

  12. Glicemia perioperatória e complicações pós-operatórias em cirurgia cardíaca pediátrica Perioperative blood glucose level and postoperative complications in pediatric cardiac surgery

    Directory of Open Access Journals (Sweden)

    Rodrigo Leal Alves

    2011-11-01

    veis intraoperatórios mais elevados de glicemia estão associados com maior morbidade no pós-operatório de cirurgia cardíaca pediátrica.BACKGROUND: Anesthesia for pediatric cardiac surgery is systematically performed in severely ill patients under abnormal physiological conditions. In the intraoperative period, there are significant variations in blood volume, body temperature, plasma composition, and tissue blood flow, in addition to activation of inflammation, with important consequences. Serial measurements of blood glucose levels can indicate states of exacerbation of the neuroendocrine-metabolic response to trauma, serving as prognostic markers of morbidity in that population. OBJECTIVE: To correlate perioperative blood glucose levels of children undergoing cardiac surgery with the occurrence of postoperative complications, and to compare intraoperative blood glucose levels according to perioperative conditions. METHODS: Information regarding the surgical/anesthetic procedure and perioperative conditions of patients was collected from the medical records. The mean perioperative blood glucose levels in the groups of patients with and without postoperative complications and the frequencies of perioperative conditions were compared by use of odds ratio and non-parametric univariate analyses. RESULTS: Higher intraoperative blood glucose levels were observed in individuals who had postoperative complications. Prematurity, age group, type of anesthesia, and character of the procedure did not influence the mean intraoperative blood glucose level. The use of extracorporeal circulation (ECC was associated with higher blood glucose levels during surgery. In procedures with ECC, higher blood glucose levels were observed in individuals who had infectious and cardiovascular complications. In surgeries without ECC, that association was observed with infectious and hematological complications. CONCLUSION: Higher intraoperative blood glucose levels are associated with higher morbidity

  13. Complications - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Complications measures - state data. This data set includes state-level data for the hip/knee complication measure, and the Agency for Healthcare Research and...

  14. Complications - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Complications - provider data. This data set includes provider data for the hip/knee complication measure, and the Agency for Healthcare Research and Quality (AHRQ)...

  15. Complications - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Complications - national data. This data set includes national-level data the hip/knee complication measure, and the Agency for Healthcare Research and Quality...

  16. Nursing students’ knowledge about arrest rhythms and their treatment

    Directory of Open Access Journals (Sweden)

    Aikaterini Kyrgianidou

    2014-04-01

    Full Text Available Cardiovascular diseases are one of the leading causes of death worldwide. Knowledge of health professionals for the arrest rhythms, is considered particularly important for the early recognition and proper treatment. Aim: The purpose of the present study was to assess the knowledge of nursing students on arrest rhythms and how to treat them. Material and Methods: The sample studied included 151 students from the Department of Nursing A' (n = 60, 40% and B' (n = 91, 60%, TEI of Athens, of whom 83% (n=125 were women and 17% (n=26 were men with a mean age of 23 years. Data collection was performed with specially designed questionnaire, that apart from demographics and students’ education level, it included ten questions about arrest rhythms’ knowledge and also self-assessment questions of their level of knowledge. The data were analyzed with the SPSS package v.19, using the criteria t-Test and χ2. Results: Of all the participants in the research, 95% (n = 144 did not answer correctly more than 6 questions from a total of 10. The students of the Department of Nursing A’ recognized with greater accuracy the arrest rhythms (p = 0.003. Those studying in lower semester acknowledged best the arrest rhythms (p = 0.002. Students who had recently attended course in basic or advanced resuscitation recognized best the arrest rhythms (p = 0.006. Older students knew better right treatment of the arrest rhythms (p = 0.037. Also, students who had attended the course of cardiac nursing in the last year, knew better the right treatment (p <0.001. Finally, the level of self-assessment was in line with the actual level of knowledge of students (p = 0.05. Conclusions: Continuous attendance of courses, education on certified programs and refresh courses help to maintain a good level of knowledge for longer periods.

  17. Comparative studies of defibrillation effect of biphasic and unilateral wave defibrillator for out-of-hospital cardiac arrest%不同波形自动除颤仪在院外心肺复苏中的疗效比较

    Institute of Scientific and Technical Information of China (English)

    刘成杰; 关紫云; 李晚泉; 何明丰

    2012-01-01

    Objective To test different automated external defibrillators ( AED) waveforms in order to improve the CPR for the patients with out - of - hospital cardiac arrest. Methods In a randomized controlled trial, patients with out - of - hospital cardiac arrest requiring defibrillation were treated with 1 of 2 AED protocols. The experimental group was treated with biphasic defibrillator, the control group was treated with a unilateral waveform defibrillator. The rate of terminating arrhythmia, the rates of restoration of spontaneous circulation, survival rates to hospital were compared between low -energy biphasic defibrillation group and high - energy unilateral defibrillation. Results 830 patients were included in the final analysis. Experimental patients(n =417) had small energy 150 ~ 200 J while the controls(n =413) had 300 ~ 360 J. Different proportions survived to hospital admission (43.4% versus 27. 1% ,P <0.05) , survived to hospital discharge( 13. 4% versus 9. 8% ,P < 0. 05) , achieved return of spontaneous circulation before physician arrival ( 49. 4% versus 30. 9% , P < 0. 05 ) , and survived to 1 year( P = 0. 45 ) . Conclusion Biphasic wave defibrillator has better hemodynamic effect, which suggests that biphasic wave method results in more successful rate of resuscitation and survival to hospital admission.%目的 探讨抢救院外心脏骤停患者的最佳自动除颤仪(AED)治疗方案,旨在提高心脏按压时间和心肺复苏的效果.方法 通过前瞻性随机对照研究,对院外因室颤或者心脏停跳需要除颤的患者使用两种不同的除颤方法,试验组(n=417)采用双相波除颤仪,能量150~200 J;对照组(n=413)采用单相波除颤仪,能量300~360 J.主要观察低能量双相与高能量单相除颤两组患者心律失常成功终止率、自主循环恢复率、复苏后存活到院率.结果 共对符合研究要求的830例患者进行了分析研究.试验组患者的安全存活到院率、电击后自主循

  18. Effect of enhanced external counterpulsation on endothelial function in dog model of cardiac arrest%增强型体外反搏对心脏骤停犬血管内皮的影响

    Institute of Scientific and Technical Information of China (English)

    刘荣; 廖晓星; 李欣; 胡春林; 黄国庆; 戴刚; 伍贵富

    2012-01-01

    Objective To invesligale ihe effecls of enhanced exlernal counlerpulsalion (EECP) on vascular endolhelial funclion in ihe model of CA - ROSC ( cardiac arresl and relurn of spontaneous circulalion) dog. Methods Animal models of CA were induced in beagle dogs wilh allernaling current. Afler ROSC by cardiopulmonary resuscilalion (CPR) , 16 dogs were randomized Lo eilher ihe EECP or conlrol group ( n = 8 per group) . Each dog of EECP group accepled ihree 1 - h sessions of EECP. Blood serum were separated respectively al baseline before CA, al ROSC 4 h, ROSC 26 h, ROSC 50 h, and ROSC 72 h. The serum concentrations of endothelin - 1 ( ET - 1) and nitric oxide ( NO) of each group were measured by using enzyme linked immunosorbent assay ( ELISA) . Intracranial microcirculation was monitored with a Multichannel Laser Doppler system at the same time points. Results There was no significant difference in baseline values, those of CA model established and serum ET - 1, NO and ratio of ET - I/NO between two groups before CA (P >0. 05) . The mean values of serum ET - 1 in the EECP group were lower than that in the control group at the four points of ROSC 4 h, 26 h, 50 h, 72 h, P < 0. 05 or P < 0. 01. The mean values of serum NO in the EECP group were higher than that in the control group at the three points of ROSC 4 h, 26 h, 50 h, P < 0. 05 or P < 0. 01. The mean values of ET - 1/ NO ratio in the EECP group were lower than that in the control group at the four points of ROSC 4 h, 26 h, 50 h, 72 h, P<0.05 or P < 0.01. The mean values of intracranial microcirculation perfusion in the EECP group were higher than that in the control group at the four points of ROSC 4 h, 26 h, 50 h, 72 h, all P <0. 01. Conclusion EECP can increase NO level of CA dogs, and reduce serum ET - 1 level, reduce ratio of ET - I/NO. EECP may adjust endothelial vasomotion and to increase the perfusion of microcirculation, to ease the damage of endothelial function of CA model.%目的 观察增强型体外

  19. Stroke and cardiac cell death: Two peas in a pod.

    Science.gov (United States)

    Gonzales-Portillo, Chiara; Ishikawa, Hiroto; Shinozuka, Kazutaka; Tajiri, Naoki; Kaneko, Yuji; Borlongan, Cesar V

    2016-03-01

    A close pathological link between stroke brain and heart failure may exist. Here, we discuss relevant laboratory and clinical reports demonstrating neural and cardiac myocyte cell death following ischemic stroke. Although various overlapping risk factors exist between cerebrovascular incidents and cardiac incidents, stroke therapy has largely neglected the cardiac pathological consequences. Recent preclinical stroke studies have implicated an indirect cell death pathway, involving toxic molecules, that originates from the stroke brain and produces cardiac cell death. In concert, previous laboratory reports have revealed a reverse cell death cascade, in that cardiac arrest leads to ischemic cell death in the brain. A deeper understanding of the crosstalk of cell death pathways between stroke and cardiac failure will facilitate the development of novel treatments designed to arrest the global pathology of both diseases thereby improving the clinical outcomes of patients diagnosed with stroke and heart failure.

  20. Effects of esmolol combined with epinephrine on survival at early postresuscitation stage after cardiac arrest: experiment with rabbits%肾上腺素联合4-苯丙酸甲酯盐酸盐改善心跳骤停动物复苏早期生存率的研究

    Institute of Scientific and Technical Information of China (English)

    李响; 李培杰; 徐福林; 邓星奇; 王成碧

    2011-01-01

    Objective To investigate the effects of esmolol combined with epinephrine during cardiopulmonary resuscitation (CPR) on the survival at early postresuscitation stage after cardiac arrest Methods Thirty-six rabbits underwent tracheotomy and intratracheal intubation and then were randomly divided into 3 groups: Group A (n=6, control group without further operation), Group B (n=15, undergoing external electric shock to cause ventricular fibrillation and heart arrest and then bolus infusion of 0.01 mg/kg epinephrine via catheter during CPR), ad Group C (n=15, undergoing external electric shock to cause ventricular fibrillation and heart arrest and then bolus infusion of 0.01 mg/kg epinephrine combined with 0.2 mg/kg esmolol via catheter during CPR) . Blood samples were collected from the femoral artery 15 min before ventricular fibri11ation and 30,60, 120, 180, and 240 min after the initiation of CPR to measure the plasma levels of B-type natriuretic peptide (BNP) and cardiac troponin T (cTnT) by ELISA to evaluate the degree of cardiac injury, The number of defibrillation was recorded and the survival rate was observed for 72 h. Results Thirteen rabbits in Group C survived, a number significantly higher than that in Group B (7, P<0.05). Electric defibrillation was conducted 1.5 times in Group C, significantly less than in Group B (3 times). During the 72 h follow up after CPR the average survival time of Group C was 43 h, significantly longer than that of Group B (19 h, P<0.05). There were not significant differences in the blood BNP and cTnT levels among these 3 groups before the experiment (all P>0.05). After the successful resuscitation the BNP and cTnT levels of Groups B and C were all significantly higher than those of Group A (all P<0.05), however, the blood BNP and cTnT levels of Group C were both significantly lower than those of Group B (both P<0.05). Conclusion Esmolol has the potential to reduce the myocardial injury and improve the survival at the

  1. Historical highlights in cardiac pacing.

    Science.gov (United States)

    Geddes, L A

    1990-01-01

    The benchmarks in cardiac pacing are identified, beginning with F. Steiner (1871), who rhythmically stimulated the chloroform-arrested hearts of 3 horses, 1 donkey, 10 dogs, 14 cats, and 8 rabbits. The chloroform-arrested heart in human subjects was paced by T. Greene in the following year (1872) in the UK. In 1882, H. Ziemssen in Germany applied cardiac pacing to a 42-year old woman who had a large defect in the anterior left chest wall subsequent to resection of an enchondroma. Intentional cardiac pacing did not occur until 1932, when A.A. Hyman in the US demonstrated that cardiac pacing could be clinically practical. Hyman made a batteryless pacemaker for delivery in induction shock stimuli (60-120/min) to the atria. His pacemaker was powered by a hand-wound, spring-driven generator which provided 6 min of pacemaking without rewinding. Closed-chest ventricular pacing was introduced in the US in 1952 by P.M. Zoll et al. Zoll (1956) also introduced closed-chest ventricular defibrillation. W.L. Weirich et al. (1958) demonstrated that direct-heart stimulation in closed-chest patients could be achieved with slender wire electrodes. S. Furman and J.B. Schwedel (1959) developed a monopolar catheter electrode for ventricular pacing in man. In the same year, W. Greatbatch and W.M. Chardack developed the implantable pacemaker. PMID:18238328

  2. Exploring the Frontier of Electronic Health Record Surveillance: The Case of Post-Operative Complications

    Science.gov (United States)

    FitzHenry, Fern; Murff, Harvey J.; Matheny, Michael E.; Gentry, Nancy; Fielstein, Elliot M.; Brown, Steven H; Reeves, Ruth M; Aronsky, Dominik; Elkin, Peter L.; Messina, Vincent P.; Speroff, Theodore

    2013-01-01

    Background The aim of this study was to build electronic algorithms using a combination of structured data and natural language processing (NLP) of text notes for potential safety surveillance of nine post-operative complications. Methods Post-operative complications from six medical centers in the Southeastern United States were obtained from the Veterans Affairs Surgical Quality Improvement Program (VASQIP) registry. Development and test datasets were constructed using stratification by facility and date of procedure for patients with and without complication. Algorithms were developed from VASQIP outcome definitions using NLP coded concepts, regular expressions, and structured data. The VASQIP nurse reviewer served as the reference standard for evaluating sensitivity and specificity. The algorithms were designed in the development and evaluated in the test dataset. Results Sensitivity and specificity in the test set were 85% and 92% for acute renal failure, 80% and 93% for sepsis, 56% and 94% for deep vein thrombosis, 80% and 97% for pulmonary embolism, 88% and 89% for acute myocardial infarction, 88% and 92% for cardiac arrest, 80% and 90% for pneumonia, 95% and 80% for urinary tract infection, and 80% and 93% for wound infection, respectively. A third of the complications occurred outside of the hospital setting. Conclusions Computer algorithms on data extracted from the electronic health record produced respectable sensitivity and specificity across a large sample of patients seen in six different medical centers. This study demonstrates the utility of combining natural language processing with structured data for mining the information contained within the electronic health record. PMID:23673394

  3. Microvascular hemodynamics in human hypothermic circulatory arrest and selective antegrade cerebral perfusion

    NARCIS (Netherlands)

    P.W.G. Elbers; A. Ozdemir; R.H. Heijmen; J. Heeren; M. van Iterson; E.P.A. van Dongen; C. Ince

    2010-01-01

    Objective: The behavior of the human microcirculation in the setting of cardiac arrest is largely unknown. Animal experiments have consistently revealed that global hemodynamics do not necessarily reflect microvascular perfusion. In addition, the time it takes for capillary blood flow to stop after

  4. External cardiac compression may be harmful in some scenarios of pulseless electrical activity.

    LENUS (Irish Health Repository)

    Hogan, T S

    2012-10-01

    Pulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient\\'s cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless

  5. Complicated Pancreatitis

    NARCIS (Netherlands)

    Bakker, O.J.

    2015-01-01

    Research questions addressed in this thesis: What is the accuracy of serum blood urea nitrogen as early predictor of complicated pancreatitis? ; What is difference in clinical outcome between patients with pancreatic parenchymal necrosis and patients with extrapancreatic necrosis without necrosis

  6. Pregnancy Complications

    Science.gov (United States)

    ... 639-2888 Contact Media Pregnancy Complications Recommend on Facebook Tweet Share Compartir On this Page Before Pregnancy ... if necessary. Mental Health Conditions Some women experience depression during or after pregnancy. Symptoms of depression are: ...

  7. Diphtheria Complications

    Science.gov (United States)

    ... Search The CDC Cancel Submit Search The CDC Diphtheria Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Diphtheria Home About Diphtheria Causes and Transmission Symptoms Complications ...

  8. A Literature Review Revisiting Phenytoin-Induced Sinus Arrest.

    Science.gov (United States)

    Parsai, Shireen; Hariri, Imad; Taleb, Mohammad; Yoon, Youngsook

    2016-01-01

    Classically, phenytoin (PTN) infusion for the treatment of status epilepticus has been proven to be associated with cardiovascular toxicity, including dysrhythmias, hypotension, and cardiovascular collapse. Subsequently, fosphenytoin (FOS) was introduced on the market in 1997 with claims of having less cardiac toxicity. However, since then, many accounts of cardiac events have been reported undermining these claims. FOS gained popularity due to its water solubility, which allows 3 times faster infusion in comparison with PTN with less venous irritation and local toxicity. FOS is the phosphate ester prodrug of PTN and is rapidly converted to PTN independent of the dose and rate of administration. Intravenous FOS and PTN are bioequivalent. Adverse cardiac effects of both intravenous FOS and PTN have been correlated to the rate of infusion, concentration of the agent, known risk factors, or pre-existing hypersensitivity, and most cases have been identified after infusing a loading dose of these medications. This case report is unique, in that, the patient developed sinus arrest while concurrently receiving oral PTN and intravenous FOS. Clinicians should be more cognizant of the association of FOS and PTN with adverse cardiac events. Baseline electrocardiogram should be obtained on all patients prescribed FOS or PTN to identify underlying cardiac problems that may place the patient in a higher risk category. Telemetry should be performed on all patients receiving PTN in an inpatient setting. PMID:25549077

  9. A Literature Review Revisiting Phenytoin-Induced Sinus Arrest.

    Science.gov (United States)

    Parsai, Shireen; Hariri, Imad; Taleb, Mohammad; Yoon, Youngsook

    2016-01-01

    Classically, phenytoin (PTN) infusion for the treatment of status epilepticus has been proven to be associated with cardiovascular toxicity, including dysrhythmias, hypotension, and cardiovascular collapse. Subsequently, fosphenytoin (FOS) was introduced on the market in 1997 with claims of having less cardiac toxicity. However, since then, many accounts of cardiac events have been reported undermining these claims. FOS gained popularity due to its water solubility, which allows 3 times faster infusion in comparison with PTN with less venous irritation and local toxicity. FOS is the phosphate ester prodrug of PTN and is rapidly converted to PTN independent of the dose and rate of administration. Intravenous FOS and PTN are bioequivalent. Adverse cardiac effects of both intravenous FOS and PTN have been correlated to the rate of infusion, concentration of the agent, known risk factors, or pre-existing hypersensitivity, and most cases have been identified after infusing a loading dose of these medications. This case report is unique, in that, the patient developed sinus arrest while concurrently receiving oral PTN and intravenous FOS. Clinicians should be more cognizant of the association of FOS and PTN with adverse cardiac events. Baseline electrocardiogram should be obtained on all patients prescribed FOS or PTN to identify underlying cardiac problems that may place the patient in a higher risk category. Telemetry should be performed on all patients receiving PTN in an inpatient setting.

  10. Protection of anisodamine on the mitochondrial injury induced by oxidative stress in swine with cardiac arrest%山莨菪碱对心搏骤停猪氧化应激致心肌线粒体损伤的保护作用

    Institute of Scientific and Technical Information of China (English)

    刘亚华; 张杰; 代正; 周满红; 李玉华; 尹雪莲; 张维; 沈洪

    2013-01-01

    目的 通过观察心搏骤停(CA)猪血浆和心肌氧化-抗氧化指标及心肌线粒体结构的变化,探讨山莨菪碱对氧化应激所致心肌缺血/再灌注(I/R)损伤的保护作用.方法 23头健康雄性家猪,按随机数字表法分为假手术组(n=5)、肾上腺素组(n=9)和山莨菪碱组(n=9),用交流电刺激法建立CA模型.在CA前、CA 8 min及自主循环恢复(ROSC)即刻、30 min、24 h留取血标本,ROSC 24 h处死动物留取心肌.采用分光光度法检测丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性;高效液相色谱法测定心肌ATP含量;激光共聚焦显微镜下检测线粒体活性氧簇(ROS)水平;透射电镜下观察心肌组织超微结构,并对线粒体损伤程度进行评分.结果 山莨菪碱组ROSC 30 min和24 h时MDA含量(μmol/L)均较肾上腺素组明显减少(30 min:43.38±8.12比55.47±10.97,24 h:29.96±6.04比37.87±7.85,均P<0.05);24h时心肌SOD活性(U/mg)及ATP含量(μmol/g)也均较肾上腺素组显著升高(SOD:1.35±0.50比0.54±0.19,ATP:4.17±1.06比2.95±0.94,P<0.01和P<0.05),线粒体ROS含量(RFU)水平降低(88.00±17.67比107.00±21.35,P<0.05),心肌MDA(μmol/mg)含量有所减少,但差异无统计学意义(16.66±2.89比19.28±3.90,P>0.05).透射电镜下观察显示,肾上腺素组心肌细胞排列紊乱,线粒体排列及形态与假手术组有明显差异[线粒体损伤评分(分):0.41±0.08比0.12±0.01,P<0.01];山莨菪碱组线粒体损伤程度较肾上腺素组明显减轻(线粒体损伤评分:0.21±0.05比0.41±0.08,P< 0.05).结论 山莨菪碱可能通过调节氧自由基代谢,从而减轻氧化应激所致心肌线粒体结构和功能的损伤.%Objective To investigate the protection of anisodamine on cardiac ischemia/reperfusion (I/R) injury by oxidative stress by observing the changes in oxidation and antioxidant markers in plasma and myocardium,and the damage of cardiac mitochondria structure in pigs with cardiac arrest (CA

  11. 犬心脏停搏复苏后脑氧供需变化及高血压性再灌流的影响%Changes of supply and demand in cerebral oxygen after resuscitation from cardiac arrest and the effect of hypertensive reperfusion in dogs

    Institute of Scientific and Technical Information of China (English)

    杜权; 马永达; 葛衡江; 刘怀琼; 李阳

    2004-01-01

    目的观察犬心脏停搏(cardiac arrest,CA)复苏后再灌流期间脑氧代谢情况变化及高血压性再灌流的影响.方法建立犬电击引起室颤(ventricularfibriHation,VF)性CA 8 min后开胸心肺复苏(CPR)模型,动物随机分两组:正常血压性再灌流(NT)组(n=6),高血压性再灌流(HT)组(n=6),在自主循环恢复(ROSC)后,MAP在NT组维持于CA前基础值水平,而HT组维持于基础值的110%~115%.取动脉血及脑矢状窦血行血气分析,观察CA前及CA再灌流后30、60、120、240 min的脑动脉-矢状窦氧含量差(ca-ssDO2)及矢状窦氧分压(PssO2)变化.结果与基础值比较,CA后再灌流30min,NT组Ca-ssDO2显著下降(P<0.05),PsO2显著升高(P<0.01),直至再灌流240 min,Ca-ssDO2升高显著(P<0.01),PssO2下降显著(P<0.01).两组间比较,再灌流30min,HT组Ca-ssDO2下降显著(P<0.01),PssO2升高显著(P<0.01),但此后4 h内两组脑氧代谢值差别不显著(P>0.05).结论CA复苏后脑氧供需关系失衡,高血压性再灌流进一步增加CA后早期脑氧供应.

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

    Directory of Open Access Journals (Sweden)

    Andrea Aguilera-Campos

    2012-02-01

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

  13. 1. Predictors of cardio pulmonary resuscitation outcome in post-operative cardiac children

    OpenAIRE

    Nasser, B.

    2016-01-01

    Outcome of cardiopulmonary resuscitation (CPR) in children with congenital heart disease has improved and many children survived after in hospital cardiac arrestthe purpose of this study is to determine predictor of poor outcome after CPR in critical children undergoing cardiac surgerywe conducted a retrospective chart review and data analysis of all CPR records and charts of all postoperative cardiac children who had cardiac arrest and required resuscitation from 2012 till 2015. Demographic,...

  14. Cooling Therapy Might Not Help All Cardiac Arrest Patients

    Science.gov (United States)

    ... The findings were published Oct. 4 in the Journal of the American Medical Association . Dr. Gregg Fonarow is a professor of ... University of California, Los Angeles; Oct. 4, 2016, Journal of the American Medical Association HealthDay Copyright (c) 2016 HealthDay . All rights ...

  15. Anesthesia-related cardiac arrest in children. An update.

    Science.gov (United States)

    Morray, Jeffrey P

    2002-03-01

    The improvement in mortality rates for anesthetized children over the past 50 years reflects the many improvements that have been made in pediatric perioperative care. The modern pediatric anesthesiologist is better trained than the predecessors of half a century ago, and has a vastly improved arsenal of monitoring devices and anesthetic agents from which to choose. The modern pediatric perioperative environment is better equipped to meet the unique needs of children. Techniques practiced by surgeons, nurses, radiologists, and pharmacologists help create a far more sophisticated infrastructure than existed 50 years ago. Given these changes, it is not surprising that outcomes for patients have improved. PMID:11892500

  16. How Can Death Due to Sudden Cardiac Arrest Be Prevented?

    Science.gov (United States)

    ... you to. You should still follow a heart-healthy lifestyle, even if you take medicines to treat your ... contributes to other heart problems. Following a heart-healthy lifestyle can help you lower your risk for CHD, ...

  17. Prediction of time of death after withdrawal of life-sustaining treatment in potential donors after cardiac death

    NARCIS (Netherlands)

    Wind, Jentina; Snoeijs, Maarten G. J.; Brugman, Cees A.; Vervelde, Janneke; Zwaveling, Janharm; van Mook, Walther N.; van Heurn, Ernest L.

    2012-01-01

    Objective: Organ donation after cardiac death increases the number of donor organs. In controlled donation after cardiac death donors, the period between withdrawal of life-sustaining treatment and cardiac arrest is one of the parameters used to assess whether organs are suitable for transplantation

  18. Effects of different cardiopulmonary resuscitation qualities on hemodynamics and aerobic metabolism in pigs with cardiac arrest%心肺复苏质量对心博骤停猪血流动力学及氧代谢的影响

    Institute of Scientific and Technical Information of China (English)

    刘朝霞; 李春盛

    2008-01-01

    目的 应用O-CPR技术控制心肺复苏(CPR)质量,以观察在心脏骤停动物模型实施不同质量的CPR对复苏期间血流动力学和氧代谢的影响.方法 18头体质量为(30±1)kg的北京长白猪麻醉后,右侧股静脉送入Swan-Ganz导管并连接爱德华VigianceⅡ连续心排血量监测仪,左侧颈内静脉置管并放置电极到右心室,并分别行主动脉、右心房置管,连续记录血流动力学各指标,然后使用医用程控刺激仪电击致动物心博骤停,在室颤4 min后,将实验猪随机分为2组,标准CPR组和不标准CPR组,利用飞利浦HeartStart MRx监护仪/除颤器的O-CPR进行质量控制,监测胸外按压的深度、频率和回弹等.其中标准CPR组在复苏时进行标准胸外按压,频率为100次/min,按压通气比为30:2,按压深度为38~51 mm,胸廓充分回弹;不标准CPR组按压频率和按压通气比不变,但是按压深度为标准按压的60%~70%,每次胸廓回弹均不完全.在按压和通气9 min后开始电除颤.在各个时间点监测心排血量(CO)、平均主动脉压(MAP)等,计算冠脉灌注压(CPP),监测动静脉血气并计算氧输送量(DO2)和氧耗量(VO2)等,记录复苏成功的实验猪头数.数据处理采用SPSS 11.5统计软件进行y2检验和两个样本的t检验.结果 标准CPR组的自主循环恢复(ROSC)的成功率达90.9%,明显高于不标准者的28.6%(P=0.013),标准CPR组主要血流动力学指标CPP、CO、MAP高(P<0.05),全身血液氧合程度好,D02和VO2高于对照组(P<0.05).结论 在室颤心脏骤停猪模型中,应用规范化标准心肺复苏较不标准者能够明显提高CPP和CO2改善复苏期间的血流动力学,并可以提高DO2和VO2,对氧代谢的改善产生积极作用,因此ROSC成功率明显提高.%Objective To investigate the effects of different cardiopulmonary resuscitation (CPR) qualifies under Q-CPR control on hemodynamics and aerobic metabolism in pigs with cardiac arrest. Method After eighteen

  19. The Walk to Save: Benefits of Inpatient Cardiac Rehabilitation.

    Science.gov (United States)

    Rion, Joann H; Kautz, Donald D

    2016-01-01

    Hospital immobilization after a cardiac event can cause complications. The pathophysiology of complications, research concerning benefits of early ambulation, and recommendations from the American College of Sports Medicine are discussed. PMID:27522842

  20. Rationale and design of the Pan-African Sudden Cardiac Death survey

    DEFF Research Database (Denmark)

    Bonny, Aimé; Ngantcha, Marcus; Amougou, Sylvie Ndongo;

    2014-01-01

    of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. CONCLUSION......: This study will provide comprehensive, contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world....

  1. Two unsung heroes of closed-chest cardiac pacing: Green and McWilliam.

    Science.gov (United States)

    Geddes, L A

    1994-07-01

    In the latter half of the last century, cardiorespiratory arrest was not uncommon due to the anesthetic used (chloroform). Animal studies showed that the heart could be paced. One physician (Green) resuscitated 5 of 7 cardiac arrest patients with single stimuli applied to body surface electrodes. Another (McWilliam) issued a proposal for adoption of closed-chest pacing and provided information on the procedure. The following historical footnote describes these pioneering events in the history of cardiac pacing. PMID:7937239

  2. Cardiac power index, mean arterial pressure, and Simplified Acute Physiology Score II are strong predictors of survival and response to revascularization in cardiogenic shock.

    Science.gov (United States)

    Popovic, Batric; Fay, Renaud; Cravoisy-Popovic, Aurelie; Levy, Bruno

    2014-07-01

    Short-term prognostic factors in patients with cardiogenic shock (CS) have previously been established using only hemodynamic parameters without taking into account classic intensive care unit (ICU) severity score or organ failure/support. The aim of this study was to assess early predictors of in-hospital mortality of a monocentric cohort of patients with ST-elevation myocardial infarction complicated by early CS. We retrospectively studied 85 consecutive patients with CS complicating acute myocardial infarction and Thrombolysis in Myocardial Infarction flow grade 3 after percutaneous coronary revascularization. All patients were managed according to the following algorithm: initial resuscitation by a mobile medical unit or in-hospital critical care physician unit followed by percutaneous coronary revascularization and CS management in the ICU. Prehospital CS was diagnosed in 69% of cases, initially complicated by an out-of-hospital cardiac arrest in 64% of cases. All patients were treated with vasopressors, 82% were ventilated, and 22% underwent extrarenal epuration. The 28-day mortality rate was 39%. Under multivariate analysis, initial cardiac power index, mean arterial pressure of less than 75 mmHg at hour 6 of ICU management, and Simplified Acute Physiology Score II were independent predictive factors of in-hospital mortality. In conclusion, parameters directly related to cardiac performance and vascular response to vasopressors and admission Simplified Acute Physiology Score II are strong predictors of in-hospital mortality.

  3. Acute kidney injury after pediatric cardiac surgery

    OpenAIRE

    Sarvesh Pal Singh

    2016-01-01

    Acute kidney injury is a common complication after pediatric cardiac surgery. The definition, staging, risk factors, biomarkers and management of acute kidney injury in children is detailed in the following review article.

  4. Cardiac Malpositions

    Energy Technology Data Exchange (ETDEWEB)

    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

    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.

  5. Sudden Cause of Cardiac Death—Be Aware of Me: A Case Report and Short Review on Brugada Syndrome

    Directory of Open Access Journals (Sweden)

    Jagadeesh K. Kalavakunta

    2010-01-01

    Full Text Available Introduction. Brugada syndrome accounts for about 4% of sudden cardiac deaths (SCD. It is characterized by an ST-segment elevation in the right precordial electrocardiogram (EKG leads. Case Presentation. We describe a 39-year-old healthy Caucasian man who was admitted to the intensive care unit after being cardioverted from ventricular fibrillation (VF arrest. His past history was significant for an episode of syncope one month prior to this presentation for which he was admitted to an outlying hospital. EKG during that admission showed ST elevations in V1 and V2 leads, a pattern similar to Type 1 Brugada. A diagnosis of Brugada syndrome was missed and the patient had a cardiac arrest a month later. We discuss a short review of Brugada syndrome and emphasize the need to look for it in patients presenting with SCD and malignant arrhythmias. Conclusion. Physicians should always consider Brugada syndrome in the differential diagnosis of ST-segment elevation in anterior precordial leads of EKG and associated VT/VF. Although more than 17 years have passed since the first case was reported, increased awareness of this syndrome is needed to identify patients with EKG changes and treat them accordingly to prevent incidence of (SCD and its deleterious complications.

  6. Early clinical outcome and complications related to balloon kyphoplasty

    Directory of Open Access Journals (Sweden)

    Martin Bergmann

    2012-06-01

    Full Text Available The treatment of painful osteoporotic vertebral compression fractures using transpedicular cement augmentation has grown significantly over the last two decades. The benefits of balloon kyphoplasty compared to conservative treatment remain controversial and are discussed in the literature. The complication rates of vertebroplasty and kyphoplasty are considered to be low. The focus of this study was the analysis of acute and clinically relevant complications related to this procedure. In our department, all patients treated between February 2002 and February 2011 with percutaneous cement augmentation (372 patients, 522 augmented vertebral bodies were prospectively recorded. Demographic data, comorbidities, fracture types, intraoperative data and all complications were documented. The pre- and postoperative pain-level and neurological status (Frankel-Score were evaluated. All patients underwent a standardized surgical procedure. Two hundred and ninety-seven patients were treated solely by balloon kyphoplasty; 216 females (72.7% and 81 males (27.3%. Average patient age was 76.21 years (±10.71, range 35-98 years. Average American Society Anestesiologists score was 3.02. According to the Orthopedic Trauma Association classification, there were 69 A 1.1 fractures, 177 A 1.2 fractures, 178 A 3.1.1 fractures and 3 A 3.1.3 fractures. Complications were divided into preoperative, intraoperative and postoperative events. There were 4 pre-operative complications: 3 patients experienced persistent pain after the procedure. In one case, the pedicles could not be visualized during the procedure and the surgery was terminated. One hundred and twenty-nine (40.06% of the patients showed intraoperative cement leaking outside the vertebras, one severe hypotension and tachycardia as reaction to the inflation of the balloons, and there was one cardiac arrest during surgery. Postoperative subcutaneous hematomas were observed in 3 cases, 13 patients developed a

  7. Cardiac Penetrating Injuries and Pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    CHEN Shifeng

    2002-01-01

    Objective To discuss the early diagnosis and treatment of cardiac penetrating injuries and pseudoaneurysm. Methods 18 cases of cardiac penetrating injuries, in which 2 cases were complicated with pseudoaneurysm, were diagnosed by emergency operation and color Doppler echocardiography between May 1973 and Dec. 2001 in our hospital. The basis for emergency operation is the injured path locating in cardiac dangerous zone, severe shock or pericardial tamponade. ResultsAmong 18 cases of this study, 17 cases underwent emergency operation. During the operation, 11 cases were found injured in right ventricle, 2 cases were found injured in right atrium, 1 case was found injured in pulmonary artery,4 cases were found injured in left ventricle, 2 cases were found complicated with pseudoaneurysm. 17cases underwent cardiac repair including 1 case of rupture of aneurysm. 1 case underwent elective aneurysm resection. In whole group, 15 cases survived(83.33% ), 3 cases died( 16.67%). The cause of death is mainly hemorrhagic shock. Conclusion Highly suspicious cardiac penetrating injuries or hemopericaridium should undergo direct operative exploration. Pseudoaneurysm should be resected early,which can prevent severe complications.

  8. The nursing measures of acute myocardial infarction with cardiac arrest and the value of it preventing the multiple organ failure%急性心肌梗死合并心肺骤停护理措施及预防多脏器衰竭的价值

    Institute of Scientific and Technical Information of China (English)

    钟旭

    2014-01-01

    目的:探讨急性心肌梗死合并心肺骤停护理措施,并分析其预防多脏器衰竭的临床价值。方法选择患者80例,分为两组,各40例,观察组实施本研究护理干预方法,对照组则实施常规护理,比较两组心跳恢复时间、呼吸恢复时间,并统计两组发生的并发症及整体抢救成功率。结果观察组心跳恢复时间和呼吸恢复时间均显著快于对照组(P <0.05),观察组发生肋骨骨折、急性肾功能衰竭及脑梗死的比例显著低于对照组(P <0.05),且抢救成功率显著高于对照组(P <0.05)。结论有效的护理配合对于提高患者抢救成功率,减少全身重要脏器损伤具有积极意义。%Objective To study the care measures of acute myocardial infarction with cardiopulmonary arrest, and to analyze the value of it in preventing multiple organ failure. Methods 80 patients were divided into two groups, each 40 cases, the observation group were used the nursing interventions in this study, the control group were implemented routine care, then heart rate recovery time, breathing recovery time were compared and complications occurred and overall success rate in both groups were statisticed. Results The observation group with heartbeat and breathing recovery time were significantly faster than control group(P < 0.05),the occurrence of rib fractures,acute renal failure and cerebral infarction in the observation group was significantly lower than that of control group(P < 0.05),the success rescue rate was significantly higher than that of the control group(P < 0.05). Conclusion Effective nursing meatures is of positive significance to improve the success rate of patients, and to reduce body organs injury.

  9. Review of interventional procedures in the very low birth-weight infant (<1.5 kg): complications, lessons learned and current practice

    Energy Technology Data Exchange (ETDEWEB)

    Laffan, Eoghan E. [Children' s Hospital of Eastern Ontario, Department of Diagnostic Imaging, Ottawa, ON (Canada); McNamara, Patrick J.; Whyte, Hilary; L' Herault, Johanne [The Hospital for Sick Children, Division of Neonatology, Toronto, ON (Canada); Amaral, Joao; Temple, Michael; John, Philip; Connolly, Bairbre L. [The Hospital for Sick Children, The Image-Guided Therapy Unit, Toronto, ON (Canada)

    2009-08-15

    Interventional radiology (IR) procedures in very low birth-weight (VLBW) infants (<1.5 kg) are challenging due to size, immaturity, comorbidities and lack of devices of suitable size. Infants are moved from the neonatal intensive care unit to the IR suite, further exposing them to risk. Our purpose was to review our experience of interventional procedures in VLBW infants, specifically complications and potential risks. VLBW infants referred for image-guided therapy between 1998 and 2005 were identified and medical records reviewed. ''Complications'' were divided into: major or minor, periprocedural or postprocedural, and intervention-/device-related, patient-related or equipment-related. Transport risk index of physiological stability (TRIPS) scores were calculated. A total of 116 infants (68 male, 48 female) underwent 176 procedures (159 vascular access-related and 17 nonvascular). Of 158 complications identified, 116 were major and 42 were minor. Major complications included hypothermia (n=33), line manipulations/removals (n=25), bleeding (n=12), thrombosis (n=4), cardiac arrest (n=3), tamponade (n=2), and multiorgan failure (n=1). Of the complications, 119 were categorized as intervention-/device-related, 32 patient-related and 7 equipment-related. There were no significant differences between pre- and postprocedural TRIPS scores. Successful completion of IR procedures in the VLBW infant is possible, but complications still occur in these fragile infants. (orig.)

  10. Review of interventional procedures in the very low birth-weight infant (<1.5 kg): complications, lessons learned and current practice

    International Nuclear Information System (INIS)

    Interventional radiology (IR) procedures in very low birth-weight (VLBW) infants (<1.5 kg) are challenging due to size, immaturity, comorbidities and lack of devices of suitable size. Infants are moved from the neonatal intensive care unit to the IR suite, further exposing them to risk. Our purpose was to review our experience of interventional procedures in VLBW infants, specifically complications and potential risks. VLBW infants referred for image-guided therapy between 1998 and 2005 were identified and medical records reviewed. ''Complications'' were divided into: major or minor, periprocedural or postprocedural, and intervention-/device-related, patient-related or equipment-related. Transport risk index of physiological stability (TRIPS) scores were calculated. A total of 116 infants (68 male, 48 female) underwent 176 procedures (159 vascular access-related and 17 nonvascular). Of 158 complications identified, 116 were major and 42 were minor. Major complications included hypothermia (n=33), line manipulations/removals (n=25), bleeding (n=12), thrombosis (n=4), cardiac arrest (n=3), tamponade (n=2), and multiorgan failure (n=1). Of the complications, 119 were categorized as intervention-/device-related, 32 patient-related and 7 equipment-related. There were no significant differences between pre- and postprocedural TRIPS scores. Successful completion of IR procedures in the VLBW infant is possible, but complications still occur in these fragile infants. (orig.)

  11. Complicated Pancreatitis

    OpenAIRE

    Bakker, O.J.

    2015-01-01

    Research questions addressed in this thesis: What is the accuracy of serum blood urea nitrogen as early predictor of complicated pancreatitis? ; What is difference in clinical outcome between patients with pancreatic parenchymal necrosis and patients with extrapancreatic necrosis without necrosis of the pancreatic parenchyma? ; What is the impact of organ failure on mortality in necrotizing pancreatitis? ; Based on individual patient data from randomized trials, does early enteral tube feedin...

  12. Cardiac abnormalities after subarachnoid hemorrhage

    NARCIS (Netherlands)

    Bilt, I.A.C. van der

    2016-01-01

    Aneurysmal subarachnoid hemorrhage(aSAH) is a devastating neurological disease. During the course of the aSAH several neurological and medical complications may occur. Cardiac abnormalities after aSAH are observed often and resemble stress cardiomyopathy or Tako-tsubo cardiomyopathy(Broken Heart Syn

  13. Epidural analgesia for cardiac surgery

    NARCIS (Netherlands)

    V. Svircevic; M.M. Passier; A.P. Nierich; D. van Dijk; C.J. Kalkman; G.J. van der Heijden

    2013-01-01

    Background A combination of general anaesthesia (GA) with thoracic epidural analgesia (TEA) may have a beneficial effect on clinical outcomes by reducing the risk of perioperative complications after cardiac surgery. Objectives The objective of this review was to determine the impact of perioperativ

  14. Cardiac effects of vasopressin.

    Science.gov (United States)

    Pelletier, Jean-Sébastien; Dicken, Bryan; Bigam, David; Cheung, Po-Yin

    2014-07-01

    Vasopressin is an essential hormone involved in the maintenance of cardiovascular homeostasis. It has been in use therapeutically for many decades, with an emphasis on its vasoconstrictive and antidiuretic properties. However, this hormone has a ubiquitous influence and has specific effects on the heart. Although difficult to separate from its powerful vascular effects in the clinical setting, a better understanding of vasopressin's direct cardiac effects could lead to its more effective clinical use for a variety of shock states by maximizing its therapeutic benefit. The cardiac-specific effects of vasopressin are complex and require further elucidation. Complicating our understanding include the various receptors and secondary messengers involved in vasopressin's effects, which may lead to various results based on differing doses and varying environmental conditions. Thus, there have been contradictory reports on vasopressin's action on the coronary vasculature and on its effect on inotropy. However, beneficial results have been found and warrant further study to expand the potential therapeutic role of vasopressin. This review outlines the effect of vasopressin on the coronary vasculature, cardiac contractility, and on hypertrophy and cardioprotection. These cardiac-specific effects of vasopressin represent an interesting area for further study for potentially important therapeutic benefits. PMID:24621650

  15. Internal carotid artery pseudoaneurysm with life-threatening epistaxis as a complication of deep neck space infection.

    Science.gov (United States)

    da Silva, Paulo Sérgio Lucas; Waisberg, Daniel Reis

    2011-05-01

    Pseudoaneurysm of the cervical internal carotid artery is a very rare, potentially fatal complication of a neck space infection in children associated with high mortality and morbidity. A 3-year-old boy presented with spontaneous massive epistaxis 45 days after a deep neck space infection caused by a peritonsillar abscess. During nasopharyngeal packing, he evolved with cardiac arrest. Intra-arterial angiography was then performed that revealed a large pseudoaneurysm. Endovascular treatment using detachable balloons achieved complete exclusion of the pseudoaneurysm. The child made an uneventful recovery and was discharged with mild left hemiparesis and no deficit of sensory or cognitive functions. Pseudoaneurysms of the internal carotid artery after a deep neck space infection can be associated with delayed and potentially fatal massive epistaxis. Furthermore, a regional (ie, extranasal) blood vessel should be promptly investigated when there are signs of hypovolemic shock. A high level of suspicion and definitive treatment are essential for successful management of these patients.

  16. 33 CFR 154.822 - Detonation arresters, flame arresters, and flame screens.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Detonation arresters, flame arresters, and flame screens. 154.822 Section 154.822 Navigation and Navigable Waters COAST GUARD... BULK Vapor Control Systems § 154.822 Detonation arresters, flame arresters, and flame screens. (a)...

  17. Major complications after radiofrequency ablation for liver tumors: Analysis of 255 patients

    Institute of Scientific and Technical Information of China (English)

    Wen-Tao Kong; Wei-Wei Zhang; Yu-Dong Qiu; Tie Zhou; Jun-Lan Qiu; Wei Zhang; Yi-Tao Ding

    2009-01-01

    AIM: To investigate the major complications after radiofrequency ablation (RFA) for the treatment of liver tumors and analyze possible risk factors that precipitate these complications.METHODS: From March 2001 to April 2008, 255 patients with liver tumors (205 male, 50 female;age range, 18-89 years; mean age, 56.0 years) who received RFA were enrolled in this study. Of these patients, 212 had hepatocellular carcinoma, 39 had metastatic liver tumors and four had cholangiocellular carcinoma. One hundred and forty eight patients had a single tumor, and 107 had multiple tumors. Maximum diameter of the tumors ranged 1.3-20 cm (mean,5.1 cm). All patients were treated with a cooledtip perfusion electrode attached to a radiofrequency generator (Radionics, Burlington, MA, USA). RFA was performed via the percutaneous approach ( n = 257),laparoscopy ( n = 7), or open surgical treatment ( n = 86). The major complications related to RFA were recorded. The resultant data were analyzed to determine risk factors associated these complications.RESULTS: Among the 255 patients, 425 liver tumors were treated and 350 RFA sessions were performed.Thirty-seven (10%) major complications were observed which included 13 cases of liver failure, 10 cases of hydrothorax requiring drainage, three cases of tumor seeding, one case of upper gastrointestinal bleeding, one case of intrahepatic abscess, one case of bile duct injury, one case of cardiac arrest, and five cases of hyperglycemia. Seven patients had more than two complications. Liver failure was the most severe complication and was associated with the highest mortality. Eleven patients died due to worsening liver decompensation. Child-Pugh classification ( P = 0.001)and choice of approach ( P = 0.045) were related to post-treatment liver failure, whereas patient age,tumor size and number were not significant factors precipitating this complication.CONCLUSION: RFA can be accepted as a relatively safe procedure for the treatment of liver

  18. Expression of Occludin protein and its influence on blood brain barrier after cardiopulmonary resuscitation in sudden cardiac arrest rats%大鼠心脏骤停心肺复苏后脑Occludin蛋白表达及其对血脑屏障的影响

    Institute of Scientific and Technical Information of China (English)

    张慧利; 罗序睿; 李爱连; 张洁

    2016-01-01

    Objective To investigate the expression of Occludin protein after cardiopulmonary resuscitation (CPR) in sudden cardiac arrest rats and its effect on blood brain barrier.Methods Totally 200 Sprague-Dawley male rats were randomly divided into control group (n =100) and CPR group (n =100).Only arteriovenous and endotracheal intubations were given in control group,without choking and CPR;sudden cardiac arrest model was established,then CPR was performed in CPR group.Fifty rats were sacrificed with decollation to collect the brain tissue 2,6,12,24 and 48 h after postoperative stable phase (10 min after operation) in control group and 2,6,12,24 and 48 h after return of spontaneous circulation (ROSC) in CPR group (n =10 at each time points);the Occludin expression in the brain tissue was measured by immunohistochemistry.Fifty rats were injected with 3 mg/kg Evans blue via caudal veins,then were sacrificed with decollation 2 h later to collect the brain tissue;the brain barrier permeability rates of Evans blue were measured by fluorescence spectrophotometer.Results The cell number of positive Occludin protein and Evans blue content in brain tissue were not significantly different between groups (P > 0.05).Along with time,the cell number of positive Occludin protein in brain tissue firstly decreased then increased in CPR group,being significantly lower than that in control group at all the time points [(68.2± 1.0)/high power field vs (86.8 ± 1.3)/high power field,(42.1 ± 1.6)/high power field vs (85.1 ±2.7)/high power field,(18.1 ± 1.1)/high power field vs (84.9 ±2.8)/high power field,(37.8 ± 0.7)/high power field vs (82.1 ± 3.1)/high power field,(61.2 ± 1.0)/high power field vs (83.8 ± 2.5)/high power field] (P < 0.05);along with time,the contents of Evans blue in brain tissue firstly increased then decreased in CPR group,being significantly higher than that in control group at all time points [(0.496 ± 0.042) μg/gvs (0.245 ±0.012) μg/g,(0.704±0.021)

  19. Cardiac rehabilitation

    Science.gov (United States)

    ... attack or other heart problem. You might consider cardiac rehab if you have had: Heart attack Coronary heart disease (CHD) Heart failure Angina (chest pain) Heart or heart valve surgery Heart transplant Procedures such as angioplasty and stenting In some ...

  20. The influence of motor activity on the development of cardiac arrhythmias during experimental emotional stress

    Science.gov (United States)

    Ulyaninskiy, L. S.; Urmancheyeva, T. G.; Stepanyan, Y. P.; Fufacheva, A. A.; Gritsak, A. V.; Kuznetsova, B. A.; Kvitka, A. A.

    1982-01-01

    Experimental emotional stress which can produce various disorders of cardiac rhythm: sinus tachycardia, atrial fibrillation, ventricular, extrasystoles and paroxysmal ventricular tachysystoles was studied. In these conditions the adrenalin content in the blood and myocardium is increased 3 to 4 times. It is found that moderate motor activity leads to a relative decrease of adrenalin in the myocardium and arrest of cardiac arrhythmias.