[Prognosis of patients who recovered after an episode of sudden death]. / Pronóstico de los pacientes recuperados tras un episodio de muerte súbita.

OBJECTIVES: Sudden death constitutes a major sanitary problem with high mortality and serious neurological complications. The objective of this study was to analyze the prognosis and the characteristics of patients who initially recovered after an episode of cardiac arrest and who were admitted to the intensive care unit (ICU). METHOD: We retrospectively studied the clinical characteristics and outcome of 65 patients admitted to the Intensive Care Unit during a 3 years period with aborted sudden death. RESULTS: 65 patients, 44 (67.7%) men and 21 (32.3%) women. Middle ages 69.1 +/- 13.9. 29 (44.6%) out of hospital and 36 (55.4%) into hospital sudden death. Cardiopulmonary resuscitation was <10 minutes in 28 cases (43.1%), and > 10 minutes in 37 (56.9%). 36 (55.4%) of all sudden deaths were of cardiac origin. 37 patients (56.9%) died and 28 (43.1%) survived the episode. It was LET in 11 cases (16.9%). 29 (44.6%) of all had post- anoxic encephalopathy and most died before discharge from ICU. Of 28 survivors, 5 patients were discharged alive with post-anoxic encephalopathy (17.8%) and 23 were discharged without neurological disturbances (82.2%). This was more frequent when sudden death was into hospital (p 0.009) and cardiopulmonary resuscitation was < 10 minutes (p 0.045). CONCLUSIONS: High number of the patients admitted to a Intensive Care unit with aborted sudden death died during ICU stay. Many patients had post-anoxic encephalopathy and most of these died. So, up to 35% of the patients admitted after an episode of cardiac arrest were discharged alive and without severe neurological damage.

Liver transplant, in emergency 0 (UNOS Status 1).

INTRODUCTION: The emergency 0 (UNOS status 1) liver transplant (OLT) constitutes a challenge to the transplant team. The precarious condition of the patient and the use, sometimes forced by the instability of the patients, of marginal or different blood type grafts leads to worse results than in nonemergency OLT. Herein we have presented our experience with emergency 0 OLT in the first 5 years of our program. PATIENTS AND METHODS: Among the 167 OLTs performed in the first 5 years of our program, 10 were emergency 0 OLTs. The patients were transplanted within 72 hours of inclusion on the waiting list, seven within 24 hours. The indications for emergency OLT were fulminant liver failure (FLF) in six and graft failure in the first week post-OLT in four. RESULTS: All OLTs were performed with preservation of the vena cava (piggyback) and without venovenous bypass. There was 100% patient survival of those who required an emergency 0 OLT (follow-up period of 3 to 7 years). The graft survival in FLF was 50%. Emergency retransplant was necessary because of acute rejection due to ABO incompatibility in two patients, and due to arterial ischemia in another patient. The emergency retransplants were all successful. CONCLUSION: In our experience the emergency 0 OLT is a formidable challenge for the team, but we achieved a patient survival comparable to or even better than that of OLT for chronic liver disease.

[Encephalopathy by hyperammonemia in teenagers]. / Encefalopatía por hiperamoniemia en el adolescente.

BACKGROUND: Hyperammonemia causes several alterations, mainly in the central nervous system. If hepatic failure is not its etiology, other less frequent causes must be investigated in the search for a definitive diagnosis. CLINICAL CASE: We report the case of a 16 year old patient admitted for acute encephalopathy and hyperammonemia. After analysis, brain CT, ultrasound and abdominal Doppler, we began empirical treatment of hyperammonemia secondary to disorders of the urea cycle. We treated the brain edema and eliminated ammonia but we did not obtain favourable results and the patient died four days later. CONCLUSIONS: The complex management of hyperammonemia and the high morbidity and mortality involved require a multidisciplinary approach. Only early treatment and identification of the hyperammonemia's etiology can avoid high morbidity and mortality in these patients.