Myocardial infarction type 1 is frequent in refractory out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR).

Extracorporeal cardiopulmonary resuscitation (ECPR) is a last resort treatment option for refractory cardiac arrest performed in specialized centers. Following consensus recommendations, ECPR is mostly offered to younger patients with witnessed collapse but without return of spontaneous circulation (ROSC). We report findings from a large single-center registry with 252 all-comers who received ECPR from 2011-2019. It took a median of 52 min to establish stable circulation by ECPR. Eighty-five percent of 112 patients with out-of-hospital cardiac arrest (OHCA) underwent coronary angiography, revealing myocardial infarction (MI) type 1 with atherothrombotic vessel obstruction in 70 patients (63% of all OHCA patients, 74% of OHCA patients undergoing coronary angiography). Sixty-six percent of 140 patients with intra-hospital cardiac arrest (IHCA) underwent coronary angiography, which showed MI type 1 in 77 patients (55% of all IHCA patients, 83% of IHCA patients undergoing coronary angiography). These results suggest that MI type 1 is a frequent finding and - most likely - cause of cardiac arrest (CA) in patients without ROSC, especially in OHCA. Hospital survival rates were 30% and 29% in patients with OHCA and IHCA, respectively. According to these findings, rapid coronary angiography may be advisable in patients with OHCA receiving ECPR without obvious non-cardiac cause of arrest, irrespective of electrocardiogram analysis. Almost every third patient treated with ECPR survived to hospital discharge, supporting previous data suggesting that ECPR may be beneficial in CA without ROSC. In conclusion, interventional cardiology is of paramount importance for ECPR programs.

[Freiburg Cardiac Arrest Receiving Team (CART) : Interdisciplinary solution for the acute management of non-traumatic out-of-hospital cardiac arrest]. / Freiburger Cardiac Arrest Receiving Team (CART) : Konzept zur Strukturierung des Behandlungsablaufs nach nichttraumatischem außerklinischem Herz­Kreislauf-Stillstand in einem interdisziplinären Team.

Standard procedures and guidelines provide specific instructions for basic and advanced cardiac life support. Recommendations for the admission of patients from preclinical into clinical structures after successful cardiopulmonary resuscitation (CPR) are available, but only a few are detailed. In the presence of ST-elevation myocardial infarction after return of spontaneous circulation (ROSC), coronary angiography must be performed as soon as possible. However, acute management and consecutive diagnostic procedures after hospital admission are up to the doctor on duty, who can rely on standard internal hospital procedures at best. Despite the enormous progress and new findings in intensive care and emergency medicine, intra-hospital mortality, as well as long-term survival, after CPR remains low and depends on a wide variety of influencing factors. To optimize in-hospital acute care of successfully resuscitated patients, an interdisciplinary admission team, a so-called cardiac arrest receiving team (CART), has been implemented at the University Hospital of Freiburg, Germany. The aim of the CART is to provide primary care to resuscitated patients as quickly and in as standardized a manner as possible with predefined diagnostic and therapeutic pathways by a team with special expertise in the field of CPR and post-resuscitation management. Accordingly, clear criteria for procedures and the location of primary care (e.g. emergency room vs. cardiac catheter laboratory), the composition of the CART and concrete treatment measures were defined.

Treatment of a broncho-esophageal fistula complicated by severe ARDS.

INTRODUCTION: Broncho-esophageal fistula formation is a rare complication of tuberculosis, most often seen in immunocompromised patients. METHODS AND RESULTS: In this paper, we report the case of a young non-immunocompromised refugee from Somalia diagnosed with open pulmonary tuberculosis complicated by extensive osseous involvement and a broncho-esophageal fistula with consecutive aspiration of gastric contents. The patient rapidly developed a severe acute respiratory distress syndrome (ARDS) requiring venovenous extracorporeal membrane oxygenation (ECMO) therapy for nearly 2 months. The fistula was initially treated by standard antituberculous combination therapy and implantation of an esophageal and a bronchial stent. Long-term antibiotic treatment was instituted for pneumonia and mediastinitis. 7 months later, discontinuity resection of the esophagus was performed and the bronchial fistula covered by an intercostal muscle flap. DISCUSSION: This case illustrates that tuberculosis should always be suspected in patients from high-incidence countries in case of lung involvement and that an interdisciplinary approach including long-term intensive care management can enable successful treatment of tuberculosis with severe, near-fatal complications.

Therapeutic community treatment for alcohol abusers: a one-year multivariate outcome evaluation.

This article describes the development of an alcohol treatment unit in a Veterans Hospital. The focus is on therapeutic philosophy, staffing patterns, and a critical evaluation and examination of issues related to program evaluation. About March of 1975 the administrative staff of the Audie Murphy Veterans Administration Hospital began tooling up for a new psychiatric unit to deal exclusively with the problem of alcohol abuse. The unit was officially opened in June of 1975. This article provides a short descriptive overview of the development of the program, with a focus on its staffing pattern and the operationalization of its treatment philosophy. It presents an evaluation of the program, describing the methodology of evaluation preferred for this type of operation as developed from previous experience of the senior author.

The relationship of the intrauterine device, actinomycosis infection, and bowel abscesses.

PIP: A case study of the injurious effect of an IUD as a contributing factor to the development of an actinomycotic infection in the female genitalia and associated abdominal viscera is reviewed. A 38-year-old white woman presented with a 2-month history of pelvic cramps, menorrhagia, and "weakness." She also complained of occasional night sweats, a 6-pound weight loss, vaginal discharge, and a low-grade fever for 6 weeks prior to admission. The patient had no significant medical history except for a calcified pelvic mass (fibroid uterus); she had had a Dalkon Shield IUD in place for several years. The patient was admitted to the hospital gynecological service for removal of the IUD, dilatation and curettage, and probable hysterectomy. Cultures were taken of the IUD and the curettings. The mass involving the rectosigmoid as well as the enlarged fibroid uterus were confirmed on pelvic examinations. The histologic diagnosis of modern squamous metaplasia was made on microscopic examination. Fungal colonies in the detritus were noted on the IUD and curettings. The pelvic mass that was palpable on examination and associated with the fibroid uterus was found to be an abscess in juxtaposition to the sigmoid colon. The operative procedure included lysis of multiple adhesions, a subtotal hysterectomy and bilateral salpingo-oophorectomy, omentectomy with a transverse colon resection leaving a proximal colostomy and a distal mucous fistula. Microscopic examination of the abscesses was diagnostic for actinomycosis. Intravenous penicillin and clindamycin were used for treatment of the actinomycosis and bacteroids that were cultured from the abscesses. The IUD, colonic abscess, fallopian tubes, uterus, transverse colon and ovaries had microscopic evidence of actinomycotic infection. Review of the world literature reveals that the papers of Barth and Tietze are the 1st to indict the IUD as an etiologic factor for actinomycosis of the female genital organs.^ieng

Second-year alcoholism treatment outcome evaluation with a focus on Mexican-American patients.

This is an evaluation of an Alcohol Treatment Unit with a focus on a comparison of Mexican-American and Anglo-American outcomes. Social adjustment on a target cohort of 75 was measured on a standard rating instrument (SAI) 2 years after discharge from the hospital. The overall successfulness of the program was 39%; the validity of the Treatment Difficulty Scale (a composite index of anticipated treatment difficulty) was demonstrated for both ethnic groups and both first and second year outcome results; and the average stability of first year findings of SAI components as compared to second year results was shown to be 79%. Use of a standardized index of pretreatment patient characteristics was recommended to facilitate comparative program evaluation research.