Novel patterns of left ventricular mechanical activity during experimental cardiac arrest in pigs.

We conducted an experimental study to evaluate the presence of coordinated left ventricular mechanical myocardial activity (LVMA) in two types of experimentally induced cardiac arrest: ventricular fibrillation (VF) and pulseless electrical activity (PEA). Twenty anesthetized domestic pigs were randomized 1:1 either to induction of VF or PEA. They were left in nonresuscitated cardiac arrest until the cessation of LVMA and microcirculation. Surface ECG, presence of LVMA by transthoracic echocardiography and sublingual microcirculation were recorded. One minute after induction of cardiac arrest, LVMA was identified in all experimental animals. In the PEA group, rate of LVMA was of 106+/-12/min. In the VF group, we identified two patterns of LVMA. Six animals exhibited contractions of high frequency (VFhigh group), four of low frequency (VFlow group) (334+/-12 vs. 125+/-32/min, p<0.001). A time from cardiac arrest induction to asystole (19.2+/-7.2 vs. 7.3+/-2.2 vs. 8.3+/-5.5 min, p=0.003), cessation of LVMA (11.3+/-5.6 vs. 4.4+/-0.4 vs. 7.4+/-2.9 min, p=0.027) and cessation of microcirculation (25.3+/-12.6 vs. 13.4+/-2.4 vs. 23.2+/-8.7 min, p=0.050) was significantly longer in VFlow group than in VFhigh and PEA group, respectively. Thus, LVMA is present in both VF and PEA type of induced cardiac arrest and moreover, VF may exhibit various patterns of LVMA.

Intra-arrest formation of right-heart thrombi -- a case illustrated by real-time ultrasonography.

The presence of free-floating right-heart thrombus has been reported in a cardiac arrest patient in the periarrest period. Free-floating right atrial thrombus is a rare phenomenon seen in patients developing severe pulmonary embolism, and is associated with increased mortality. However, there have been no previously reported cases of right-heart thrombus formation during a resuscitated cardiac arrest. We present the pre-hospital case of a woman in the clinical setting of cardiogenic shock due to acute myocardial infarction who developed asystolic cardiac arrest on the scene. Recent implementation of ultrasonography into the regional pre-hospital care protocol enabled sonographic investigation before and during cardiac arrest. This allowed detection of right atrial septal thrombus formation in the course of advanced life support and its migration through the tricuspid valve. The pathophysiological consequences, clinical significance and potential therapeutic options are discussed.

The practice of therapeutic mild hypothermia in cardiac arrest survivors in the Czech republic.

BACKGROUND: The proper performance of therapeutic mild hypothermia (TH) in cardiac arrest survivors is a prerequisite for achieving the best possible outcome. We analyzed the recent technical issues of in-hospital TH practices in the Czech Republic. METHODS: As the second project of the PRE-COOL (Pre-hospital Cooling in Cardiac Arrest Patients) working group, we compiled the directory of all non-surgical intensive care units (ICUs) in the Czech republic. A head physician of every ICU was provided a structured questionnaire in October 2008. RESULTS: From a total of 487 ICUs that were sent the questionnaire, 41.5% responded. We analyzed the responders that provide early post-resuscitation care, including TH (N=90). The site of TH initiation was most frequently an ICU bed (93.3%). A broad TH indication irrespective of the initial rhythm, cardiac arrest location or the presence of witnesses was reported by 48.9% of the responders. Up to 81.1% of the responding ICUs did not exclude from TH therapy patients who were developing post-resuscitation shock. Complex neuroprotective and cardioprotective approaches (TH, urgent coronary intervention, control of glycemia and early goal-directed hemodynamic support) were practiced at 52.2% of the ICUs. Of the responders, 54.4% cooled patients for 24 hours. The most frequently used cooling techniques were surface cooling with ice packs (88.9%) and intravenous cold infusion (84.4%). CONCLUSION: The survey revealed the recent practice of TH management of cardiac arrest survivors in the Czech republic. The modes of TH practice were different in many aspects, and unifying the basic components is advisable.

[ILCOR recommendation on signage of automated external defibrillators (AEDs)]. / Doporucení ILCOR pro oznacení automatizovaných externích defibrilátoru (AED).

Early defibrillation is a determinant of survival in both out-of-hospital and in-hospital cardiac arrests from ventricular fibrillation and pulseless ventricular tachycardia. The review summarizes importance of early defibrillation with automated external defibrillators (AED) and presents the International Liaison Committee on Resuscitation (ILCOR) recommendation for universal AED sign. The aim of the recommendation is to unify the AED signs worldwide and to spread the knowledge of this. The public in general, but healthcare professionals particularly, should be able to recognize AED location and use the device immediately in case of cardiac arrest.

[Current cooling methods for induction of mild hypothermia in cardiac arrest survivors]. / Soucasné ochlazovací metody pro indukci mírné hypotermie po srdecní zástave.

Induction of mild therapeutic hypothermia early after return of spontaneous circulation improves prognosis of cardiac arrest survivors. Rapid cooling of the patients and correct maintainance of the target therapeutic temperature followed by controlled slow rewarming can be achieved by several noninvasive and invasive methods of various efficacy. Elementary and the most frequently used methods are surface cooling via ice-packs and rapid intravenous administration of cold crystaloids. Mattress cooling systems and facilities for endovascular cathether-cooling are more sophisticated, manageable and ensure more precise titration of therapeutic temperature. Cooling caps and helmets leading to selective head cooling can be used as the complementary techniques. Several other methods are too instrumentation-intensive, too invasive or investigated in animal experiments only. Anyway, near future may bring a rapid development of new effective and safe cooling systems.