Global myocardial oedema in resuscitated out-of-hospital cardiac arrest patients assessed by cardiac magnetic resonance: a pilot study.

AIMS: Myocardial dysfunction is well described after out-of-hospital cardiac arrest (OHCA); however, the underlying mechanisms are not yet understood. We hypothesized that this dysfunction is associated to a global myocardial oedema. Using cardiac magnetic resonance (CMR), we assessed the presence of such oedema early after successful resuscitation from OHCA. METHODS AND RESULTS: Comatose patients resuscitated from OHCA and admitted to the cardiac intensive care unit were consecutively included and underwent CMR in general anaesthesia within 36 h after cardiac arrest with anaesthetic support. To assess global myocardial oedema, T1 and T2 segmented maps were generated from three representative short-axis slices, and values from each segment were then used to determine a mean global T1 and T2 time for each patient. Healthy subjects were used as controls. CMR was obtained in 16 patients and compared with nine controls. The OHCA patients were 60 ± 9 years old, and acute myocardial infarction (MI) was diagnosed in six cases. On admission, left ventricular ejection fraction assessed by transthoracic echocardiography was 35 ± 15%, and this improved significantly to 43 ± 14% during hospitalization (P < 0.05). Mean global T1 and T2 time was significantly higher in OHCA patients compared with the control group (1071 ms vs. 999 ms, P = 0.002, and 52 ms vs. 46 ms, P < 0.001, respectively), and this difference remained significant when segments involved in the MI were excluded. CONCLUSION: Assessed with CMR, we for the first time document an early global myocardial oedema in patients successfully resuscitated from OHCA.

A comprehensive hip fracture program reduces complication rates and mortality.

OBJECTIVES: To evaluate the rate of postoperative complications, length of stay, and 1-year mortality before and after introduction of a comprehensive multidisciplinary fast-track treatment and care program for hip fracture patients (the optimized program). DESIGN: Retrospective chart review with historical control. SETTING: Orthopedic ward (110 beds) at a university hospital (700 beds). PARTICIPANTS: Five hundred thirty-five consecutive patients aged 40 and older (94%>or=60) hospitalized for hip fracture between January 1, 2003, and March 31, 2004. Three hundred and thirty-six patients (70.3%) were community dwellers before the fracture and 159 (29.7%) were admitted from nursing homes. INTERVENTION: The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block; an earlier assessment by the anesthesiologist; and a more-systematic approach to nutrition, fluid and oxygen therapy, and urinary retention. RESULTS: In the intervention group, the rate of any in-hospital postoperative complication was reduced from 33% to 20% (odds ratio=0.61, 95% confidence interval=0.4-0.9; P=.002). Rates of confusion (P=.02), pneumonia (P=.03), and urinary tract infection (P<.001) were lower in the intervention group than in the control group, and length of stay was 15.8 days in the control group, versus 9.7 days in the intervention group (P<.001). For community dwellers, 12-month mortality was 23% in the control group versus 12% in the intervention group (P=.02). Overall 12-month mortality was 29% in the control group and 23% in the intervention group (P=.2). CONCLUSION: The optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality. Randomized clinical trials are needed to confirm these results and elucidate the elements of the program that have the greatest effect on clinical outcomes and mortality.

[Postoperative urinary retention. Clinical assessment versus ultrasound examination]. / Postoperativ urinretention. Klinisk vurdering versus ultralydskanning.

INTRODUCTION: Postoperative urinary retention can cause serious complications. An ultrasound bladderscanner has been shown to be useful in distinguishing between patients who need catheterisation and patients who do not. We wished to investigate if clinical assessment including inspection, percussion and palpation of the bladder is of any use in this perspective. In this study we compare clinical findings with ultrasound examinations. MATERIAL AND METHODS: Two trained doctors each investigated 25 postoperative patients clinically immediately after ultrasound examination in the recovery room. Ultrasound examination was carried out by trained nurses using BladderScan BVI 3000. Assessed and measured volumes as well as patient height, weight, asa-class and sex were registered. RESULTS: We found a high negative predictive value of 92% for a cut-off limit of 500 ml. The corresponding positive predictive value was a modest 38%. This tendency was seen for cut-off-limits exceeding 300 ml. CONCLUSION: Clinical assessment of bladder size might be useful in terms of ruling out a big volume postoperatively. Because of the low positive predictive value, we recommend verifying urinary retention judged by clinical assessment with ultrasound examination before catheterisation. Also, one has to remember that urinary retention occurs with different volumes in different patients.