[Quality of life after in-hospital cardiac arrest : An 11-year experience from an university center]. / Lebensqualität nach innerklinischem Herz-Kreislauf-Stillstand : 11-Jahres-Ergebnisse einer Universitätsklinik.

BACKGROUND: Cardiac arrest is a life-threatening condition requiring urgent medical care and is one of the leading causes of death worldwide. Given that in-hospital cardiac arrest (IHCA) is still poorly investigated, data on health-associated quality of life thereafter remains scarce. The available evidence is mostly transferred from out-of-hospital cardiac arrest studies, but the epidemiology and determinants of success might be different. The aim of the study was to investigate the change in the quality of life after in-hospital cardiac arrest and to identify potential risk factors for a poor outcome. MATERIAL AND METHODS: This retrospective analysis of data and prospective evaluation of quality of life included all patients surviving an IHCA and being treated by the emergency medical team between 2010 and 2020. The primary endpoint of the study was the quality of life after IHCA at the reference date. Secondary endpoints covered determination of risk factors and predictors of poor outcome after in-hospital cardiopulmonary resuscitation. RESULTS: In total 604 patients were resuscitated within the period of 11 years and 61 (10%) patients survived until the interview took place. Finally, 48 (79%) patients fulfilled the inclusion criteria and 31 (65%) were included in the study. There was no significant difference in the quality of life before and after cardiac arrest (EQ-5D-5L utility 0.79 vs. 0.78, p = 0.567) and in the EQ-5D-5L visual analogue scale (VAS) score. CONCLUSION: The quality of life before and after IHCA in survivors was good and comparable. The quality of life was mostly affected by reduced mobility and anxiety/depression. Future studies with larger patient samples should focus on potentially modifiable factors that could prevent, warn, and limit the consequences of in-hospital cardiac arrest. Moreover, research on outcomes of IHCA should include available tools for the quality of life assessment.

Oxygenation Performance of Different Non-Invasive Devices for Treatment of Decompression Illness and Carbon Monoxide Poisoning.

Study Objective: Application of high concentrations of oxygen to increase oxygen partial pressure (pO2) is the most important treatment for patients with carbon monoxide intoxication or divers with suspected decompression illness. The aim of this study was to evaluate the oxygenation performance of various non-invasive oxygen systems. Methods: The effect of different oxygen systems on arterial pO2, pCO2 and pH and their subjective comfort was evaluated in 30 healthy participants. Eight devices were included: nasal cannula, non-rebreather mask, AirLife Open mask, Flow-Safe II CPAP device, SuperNO2VA nasal PAP device, all operated with 15 L/min constant flow oxygen; nasal high-flow (50 L/min flow, 1.0 FiO2), non-invasive positive pressure ventilation (NPPV, 12 PEEP, 4 ASB, 1.0 FiO2) and a standard diving regulator (operated with pure oxygen). Results: Diving regulator, SuperNO2VA, nasal high-flow and NPPV achieved mean arterial pO2 concentrations between 538 and 556 mm Hg within 5 minutes. The AirLife Open mask, the nasal cannula and the non-rebreather mask achieved concentrations of 348-451 mm Hg and the Flow-Safe II device 270 mm Hg. Except for the AirLife open mask, pCO2 decreased and pH increased with all devices. The highest pH values were observed with NPPV, diving regulator, Flow-Safe II and nasal high-flow but apparent hyperventilation was uncommon. The AirLife Open and the non-rebreather mask were the most comfortable, the SuperNO2VA and the nasal cannula the most uncomfortable devices. Conclusion: A standard diving regulator and the SuperNO2VA device were equally effective in providing highest physiologically possible pO2 as compared to nasal high-flow and NPPV.

Systemic inflammation as fuel for acute liver injury in COVID-19.

BACKGROUND: A cytokine storm conceivably contributes to manifestations of corona virus disease (COVID-19). Inflammatory cytokines such as interleukin-6 (IL-6) cause acute liver injury while serum detectability indicates systemic inflammation. AIMS: We explored a link between systemic IL-6, related acute phase proteins and liver injury in hospitalized COVID-19 patients. METHODS: 655 patients with suspected COVID-19 were screened in the emergency department at the University Hospital of Innsbruck, Austria, between February and April 2020. 96 patients (∼15%) were hospitalized with COVID-19. 15 patients required intensive-care treatment (ICT). Plasma aminotransferases, alkaline phosphatase, bilirubin, and gamma glutamyl transferase, as well as IL-6, C-reactive protein (CRP), ferritin and lactate dehydrogenase (LDH) were determined by standard clinical assays. RESULTS: Of all hospitalized COVID-19 patients, 41 (42%) showed elevated aspartate aminotransferase (AST) concentration. COVID-19 patients with elevated AST exhibited significantly higher IL-6 (p < 0.001), ferritin (p < 0.001), LDH (p < 0.001) and CRP (p < 0.05) serum concentrations compared to patients with normal AST. Liver injury correlated with systemic IL-6 (p < 0.001), CRP (p < 0.001), ferritin (p < 0.001) and LDH (p < 0.001) concentration. In COVID-19 patients requiring ICT, correlations were more pronounced. CONCLUSION: Systemic inflammation could be a fuel for hepatic injury in COVID-19.

Livedo Racemosa - The Pathophysiology of Decompression-Associated Cutis Marmorata and Right/Left Shunt.

Decompression sickness and arterial gas embolism, collectively known as decompression illness (DCI), are serious medical conditions that can result from compressed gas diving. DCI can present with a wide range of physiologic and neurologic symptoms. In diving medicine, skin manifestations are usually described in general as cutis marmorata (CM). Mainly in the Anglo-American literature the terms cutis marmorata, livedo reticularis (LR), and livedo racemosa (LRC) are used interchangeably but actually describe pathophysiologically different phenomena. CM is a synonym for LR, which is a physiological and benign, livid circular discoloration with a net-like, symmetric, reversible, and uniform pattern. The decompression-associated skin discolorations, however, correspond to the pathological, irregular, broken netlike pattern of LRC. Unlike in diving medicine, in clinical medicine/dermatology the pathology of livedo racemosa is well described as a thrombotic/embolic occlusion of arteries. This concept of arterial occlusion suggests that the decompression-associated livedo racemosa may be also caused by arterial gas embolism. Recent studies have shown a high correlation of cardiac right/left (R/L) shunts with arterial gas embolism and skin bends in divers with unexplained DCI. To further investigate this hypothesis, a retrospective analysis was undertaken in a population of Austrian, Swiss, and German divers. The R/L shunt screening results of 18 divers who suffered from an unexplained decompression illness (DCI) and presented with livedo racemosa were retrospectively analyzed. All of the divers were diagnosed with a R/L shunt, 83% with a cardiac shunt [patent foramen ovale (PFO)/atrium septum defect (ASD)], and 17% with a non-cardiac shunt. We therefore not only confirm this hypothesis but when using appropriate echocardiographic techniques even found a 100% match between skin lesions and R/L shunt. In conclusion, in diving medicine the term cutis marmorata/livedo reticularis is used incorrectly for describing the actual pathology of livedo racemosa. Moreover, this pathology could be a good explanation for the high correlation of livedo racemosa with cardiac and non-cardiac right/left shunts in divers without omission of decompression procedures.

High-sensitivity cardiac troponin T compared with standard troponin T testing on emergency department admission: how much does it add in everyday clinical practice?

BACKGROUND: We compared high-sensitivity cardiac troponin T (hs-cTnT) and standard cTnT for acute myocardial infarction (AMI) diagnosis in everyday clinical practice of an emergency department (ED). METHODS AND RESULTS: cTnT was measured in 2384 consecutive patients (60 ± 21 years, 52% female) on ED admission. Readmissions to the ED (n=720) and mortality (n=101) were followed for an average period of 239 ± 49 days. There were 53 AMIs (delay, 1 to 96 hours; median, 3 hours), 440 chest pain patients, 286 dyspnea patients, 785 acute or chronic cardiac diseases, and 540 neurological diseases, with the remaining having various internal diseases. The diagnostic performances of hs- and standard cTnT were comparable for AMI diagnosis (area under receiver operating characteristics curves [ROC AUC], 0.91 ± 0.02 versus 0.90 ± 0.03; P=0.31). Using the 99th-percentile cutoff, the sensitivities and specificities for AMI in the whole population were 91% and 74% for hs-cTnT and 89% and 80% for standard cTnT. hs-cTnT detected significantly more patients with cardiac diseases (ROC AUC, 0.77 ± 0.01 versus 0.67 ± 0.01; P<0.001). hs-cTnT and standard cTnT were significant predictors of ED readmissions but not of mortality, but both were not independent predictors of ED readmissions or the combined end point of readmission or mortality in binary logistic regression analysis. CONCLUSIONS: In unselected ED patients the diagnostic performances of hs-cTnT and standard cTnT for AMI diagnosis did not differ significantly. hs-cTnT detected significantly more cardiac diseases. hs-cTnT and standard cTnT were not independent predictors of ED readmissions and mortality from all causes.

The high-sensitivity cardiac troponin T assay is superior to its previous assay generation for prediction of 90-day clinical outcome in ischemic stroke.

BACKGROUND: Cardiac troponin T (cTnT) has been reported to be a predictor of stroke outcome. We hypothesized that the high-sensitivity cTnT (hs-cTnT) assay is superior to its previous assay generation for stroke outcome prediction. METHODS: cTnT was measured on emergency department admission in 60 consecutive patients (35 males, age 69.4 ± 13.9 years) with ischemic stroke. Adverse 90-day clinical outcome was defined as death or dependence (modified Rankin scale ≥ 3 or Barthel index < 75). RESULTS: Stroke aetiology was microangiopathy in three, macroangiopathy in 17, cardiac embolism in 26, dissection in one and unknown in 13 patients. At 90-day follow-up 16 (27%) patients had an adverse outcome. Receiver operating characteristics (ROC) curve analysis yielded a significantly better performance of hs-cTnT vs. cTnT (area under ROC curve: 0.80 [95% CI 0.68-0.89] vs. 0.70 [95% CI 0.57-0.82], p = 0.017). The optimal discriminator values according to ROC analysis were 5.1 ng/L (hs-cTnT assay) and 11 ng/L (4th generation cTnT assay) with: sensitivities 94% vs. 56%, specificities 57% vs. 84%, positive predictive values 44% vs. 56%, and negative predictive values 96% vs. 84%. CONCLUSIONS: Improvements in cTnT assay sensitivity and precision at the low measuring range resulted in a more accurate prediction of ischemic stroke outcome, particularly for ruling out worse outcome.