From flatline to lifeline: A scoping review of the Lazarus phenomenon.

BACKGROUND: The Lazarus phenomenon or autoresuscitation (autoROSC) is the return of spontaneous circulation (ROSC) after the termination of the cardiopulmonary resuscitation (CPR) efforts. PURPOSE: The purpose of the current scoping review is to present the available data in the literature regarding autoROSC. METHODS: We reviewed four scientific databases to identify all studies which reported autoROSC cases in patients who underwent CPR. We then extracted all information relevant to CPR and autoROSC. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS: We identified 66 studies describing 76 autoROSC cases. The majority of cardiac arrests were in-hospital (44, 57.89%). Median time from termination of CPR to autoROSC was 5 min. Regarding the outcome, 52 (77.61%) patients died and 11 (14.47%) patients had intact neurological outcome. A higher mortality rate was identified in patients with respiratory comorbidities. Overall, 24 (31.58%) patients survived. CONCLUSION: AutoROSC is probably an under-reported event in the medical community. Healthcare professionals should be aware of the phenomenon and actively monitor for it, when appropriate.

Tools and Modalities for Postural Ergonomics Research in Surgery and Neurosurgery.

Work-related musculoskeletal disorders (WMSDs) are common amongst neurosurgeons and can affect a surgeon's ability to operate. Performing surgical ergonomics research is important to minimize the prevalence and effect of WMSDs on the surgeons. The aim of this review is to highlight some of the most important objective and subjective tools available for surgical ergonomics research. Subjective tools can be divided into three categories: (1) questionnaires (either validated or non-validated) filled out by the participants, (2) survey assessments/standardized scoring systems filled out by the researchers, and (3) video analysis. Subjective tools have the drawbacks of recall bias and intra-rater and inter-rater variability. Some of the most important objective tools available are surface electromyography, force plate/pressure sensors analysis, inertial measurement units (IMUs) and kinematics data capturing using reflective markers. Although these modalities do not have the drawbacks that hinder the use of subjective tools, using most of them in the real-life operating theatre, with the exception of IMUs, is challenging. Conducting surgical ergonomics research is important to optimize the performance of neurosurgeons. The advancements towards wearable, wireless technologies will make it easier for surgeons to perform ergonomics research in the operating room.

The rs1333040 and rs10757278 9p21 locus polymorphisms in patients with intracranial aneurysm: a meta-analysis.

INTRODUCTION: The formation of intracranial aneurysms (IAs) has been associated with genetic polymorphisms. A few genome-wide (GWAS) and candidate gene association studies (CGAS) have reported that single nucleotide polymorphisms (SNPs) in locus 9p21 have been associated with the formation of IAs. MATERIALS & METHODS: We performed a meta-analysis of case-control studies to investigate the association of two SNPs (rs1333040, rs10757278), located at the 9p21 locus, with the formation of IAs. MEDLINE, EMBASE, Google Scholar and CENTRAL databases were comprehensively searched. RESULTS: For the rs1333040 (C > T) polymorphism, a significant association with IA was observed in the dominant [OR (95% CI): 1.39 (1.24, 1.56); Pz < 0.00001], recessive [OR (95% CI): 1.38 (1.28, 1.49); Pz < 0.00001] and over-dominant [OR (95% CI): 0.85 (0.79, 0.91); Pz < 0.00001] models. For the rs10757278(A > G) SNP, we observed a statistically significant association with IAs in the dominant [OR (95% CI): 1.41 (1.28, 1.56); Pz < 0.01] and recessive [OR (95% CI): 1.42 (1.29, 1.56); Pz < 0.01] models, while statistical significance was not revealed in the over-dominant model [OR (95% CI): 1.01 (0.93, 1.10); Pz=0.83]. DISCUSSION: A possible association between the two SNPs and IAs was indicated. The associations reported by our meta-analysis need to be further studied and validated by larger CGAS and GWAS.

Continuous chest compressions with asynchronous ventilation improve survival in a neonatal swine model of asphyxial cardiac arrest.

BACKGROUND: Guidelines for neonatal resuscitation recommend a 3:1 compression to ventilation ratio. However, this recommendation is based on expert opinion and consensus rather than strong scientific evidence. Our primary aim was to assess whether continuous chest compressions with asynchronous ventilations would increase return of spontaneous circulation (ROSC) rate and survival compared to the 3:1 chest compression to ventilation ratio. METHODS: This was a prospective, randomized, laboratory study. Twenty male Landrace-Large White pigs, aged 1-4 days with an average weight 1.650 ± 228.3 g were asphyxiated and left untreated until heart rate was less than 60 bpm or mean arterial pressure was below 15 mmHg. Animals were then randomly assigned to receive either continuous chest compressions with asynchronous ventilations (n = 10), or standard (3:1) chest compression to ventilation ratio (n = 10). Heart rate and arterial pressure were assessed every 30 s during cardiopulmonary resuscitation (CPR) until ROSC or asystole. All animals with ROSC were monitored for 4 h. RESULTS: Coronary perfusion pressure (CPP) at 30 s of CPR was significantly higher in the experimental group (45.7 ± 16.9 vs. 21.8 ± 6 mmHg, p < 0.001) and remained significantly elevated throughout the experiment. End-tidal carbon dioxide (ETCO2) was also significantly higher in the experimental group throughout the experiment (23.4 ± 5.6 vs. 14.7 ± 5.9 mmHg, p < 0.001). ROSC was observed in six (60%) animals treated with 3:1 compression to ventilation ratio and nine (90%) animals treated with continuous chest compressions and asynchronous ventilation (p = 0.30). Time to ROSC was significantly lower in the experimental group (30 (30-30) vs. 60 (60-60) sec, p = 0.021). Of note, 7 (77.8%) animals in the experimental group and 1 (16.7%) animal in the control group achieved ROSC after 30 s (0.02). At 4 h, 2 (20%) animals survived in the control group compared to 7 (70%) animals in the experimental group (p = 0.022). CONCLUSION: Continuous chest compressions with asynchronous ventilations significantly improved CPP, ETCO2, time to ROSC, ROSC at 30 s and survival in a porcine model of neonatal resuscitation.

Stress hormones kinetics in ventricular fibrillation cardiac arrest and resuscitation: Translational and therapeutic implications.

BACKGROUND: Knowing the kinetics of endogenous stress hormones during cardiac arrest and cardiopulmonary resuscitation (CRP) will help to optimize personalized physiology-guided treatment. The aim of this study was to examine the dynamic changes in stress hormones in a swine model of ventricular fibrillation (VF) cardiac arrest. METHODS: Ventricular fibrillation was induced in 10 healthy Landrace/Large White piglets, which were subsequently left untreated for 8 min. All animals were resuscitated according to the 2015 European Resuscitation Council guidelines. The concentration of adrenalin, noradrenalin, and cortisol was measured at baseline and at the 4th and 8th minute of VF-cardiac arrest, as well as at 30-min, 60-min, 24 h and 48 h post-ROSC. RESULTS: By the end of the 4th min of VF, the animals of the ROSC group exhibited significantly higher adrenaline levels compared to those of the no-ROSC group (7264 pg/ml vs. 1648 pg/ml, p = 0.03). Noradrenaline was higher in the ROSC group at the 4th min of VF (3021 pg/ml vs. 1626 pg/ml, p = 0.02). Cortisol levels in the ROSC group were significantly lower by the end of the 8th min of VF [16.25 ng/ml vs. 92.82 ng/ml, p = 0.03]. With a cut-off point of 5970 pg/ml, adrenaline at the 4th min of VF exhibited 100% sensitivity and 80% specificity for predicting ROSC. CONCLUSION: Higher endogenous adrenaline and lower endogenous cortisol levels were associated with ROSC.

Postural ergonomics and work-related musculoskeletal disorders in neurosurgery: lessons from an international survey.

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) affect a significant percentage of the neurosurgical workforce. The aim of the current questionnaire-based study was to examine the prevalence of WMSDs amongst neurosurgeons, identify risk factors, and study the views of neurosurgeons regarding ergonomics. METHODS: From June to August 2020, members of the "European Association of Neurosurgical Societies," the "Neurosurgery Research Listserv," and the "Latin American Federation of Neurosurgical Societies" were asked to complete an electronic questionnaire on the topics of WMSDs and ergonomics. RESULTS: A total of 409 neurosurgeons responded to the survey, with a 4.7 male to female ratio. Most of the surgeons worked in Europe (76.9%) in academic public hospitals. The vast majority of the participants (87.9%) had experienced WMSDs, mainly affecting the shoulder, neck, and back muscles. The most common operations performed by the participants were "Craniotomy for convexity/intrinsic tumors" (24.1%) and "Open lumbar basic spine" (24.1%). Neurosurgeons agreed that ergonomics is an underexposed area in the neurosurgical field (84.8%) and that more resources should be spend (87.3%) and training curricula changes should be made (78.3%) in order to alleviate the burden of WMSDs on neurosurgeons. Univariate analysis did not reveal any associations between the development of WMSDs and age, gender, tenure, average duration of operation, operating time per week, type of operation, and surgical approach. CONCLUSIONS: The problem of WMSDs ought to be more closely addressed and managed by the neurosurgical community. More studies ought to be designed to investigate specific ergonomic parameters in order to formulate practice recommendations.

Drones for Automated External Defibrillator Delivery: Where Do We Stand?

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is an important cause of mortality and disability worldwide. The health care community hoped that, with the development of the automated external defibrillator (AED), the mortality and functional outcomes of patients with OHCAs would improve. Despite their effectiveness, their use in OHCA has not yet become common practice. Unfortunately, in 18-59% of cases, public access AEDs were deemed to be in poorly accessible areas or not available all of the time. OBJECTIVE: We present the existing literature on the implementation of drone delivery of AEDs to improve the response time of the emergency medical services. DISCUSSION: Test flights and mathematical/geographic models have been used to assess the effectiveness of drones in delivering AEDs to patients with OHCA. The results of those studies showed promising outcomes given that drone usage led to improved delivery times of AEDs compared with emergency medical services delivery. CONCLUSIONS: While drones have the potential to dramatically improve cardiac arrest patient care, further studies are needed to evaluate their effectiveness in real-life clinical scenarios.

GFAP and UCHL1 in Non-traumatic SAH: The Story thus Far. A Systematic Review of the Literature.

OBJECTIVE: Non-traumatic subarachnoid hemorrhage (SAH) is associated with a high percentage of misdiagnosis and poor prognosis. Biomarkers could be useful in the identification, treatment/management guidance, and outcome improvement of SAH patients. The current systematic review aims to investigate the potential role of biomarkers GFAP (Glial Fibrillary Acidic Protein) and UCH-L1 (Ubiquitin C-Terminal Hydrolase L1) in the diagnosis and prognosis of non-traumatic SAH. METHODS: A systematic search of PubMed, Scopus, and Web of Science databases was conducted from their inception through February 2023. RESULTS: 17 studies met the inclusion criteria and were included in this review. The vast majority of the included studies (82%) were on GFAP. Most studies used blood and/or CSF samples and incorporated multiple measurements through the initial hospitalization days. The majority of identified studies reported significantly higher levels of GFAP and UCHL1 in SAH patients with poor outcomes. There was notable variation in the specimen type and the timing of sampling. CONCLUSION: Quantification of GFAP and UCHL1 through the initial days of hospitalization shows promise in the prediction of SAH patient outcomes. Further research is nevertheless warranted to confirm these findings and further clarify the use of the two biomarkers in SAH diagnosis and the prediction of severity and secondary events.

Over 30 Years of DiI Use for Human Neuroanatomical Tract Tracing: A Scoping Review.

In the present study, we conducted a scoping review to provide an overview of the existing literature on the carbocyanine dye DiI, in human neuroanatomical tract tracing. The PubMed, Scopus, and Web of Science databases were systematically searched. We identified 61 studies published during the last three decades. While studies incorporated specimens across human life from the embryonic stage onwards, the majority of studies focused on adult human tissue. Studies that utilized peripheral nervous system (PNS) tissue were a minority, with the majority of studies focusing on the central nervous system (CNS). The most common topic of interest in previous tract tracing investigations was the connectivity of the visual pathway. DiI crystals were more commonly applied. Nevertheless, several studies utilized DiI in a paste or dissolved form. The maximum tracing distance and tracing speed achieved was, respectively, 70 mm and 1 mm/h. We identified studies that focused on optimizing tracing efficacy by varying parameters such as fixation, incubation temperature, dye re-application, or the application of electric fields. Additional studies aimed at broadening the scope of DiI use by assessing the utility of archival tissue and compatibility of tissue clearing in DiI applications. A combination of DiI tracing and immunohistochemistry in double-labeling studies have been shown to provide the means for assessing connectivity of phenotypically defined human CNS and PNS neuronal populations.