Refractory ventricular fibrillation during flight / Fibrilación ventricular refractaria en vuelo.

We report the case of a patient who presented an out-of-hospital cardiorespiratory arrest while being transported by the Helicopter Emergency Service, refractory to standard, electrical and medical treatment. The patient recovered spontaneous circulation after 58 minutes with heart arrest and 31 delivered shocks. The reanimation manoeuvres were monitored with capnography (titrated over 20 mmHg EtCO2). Upon arrival at the hospital, the patient went directly to the haemodynamic laboratory where a percutaneous coronary intervention was performed, with a stent in the right coronary artery. The patient was discharged after 8 days without any neurological handicap (cerebral performance category 1).

Fibrilación ventricular refractaria en vuelo / Refractory ventricular fibrillation during flight

Presentamos el caso de un paciente que sufrió una parada cardiorrespiratoria extrahospitalaria en helicóptero sanitario, refractaria a tratamiento médico y eléctrico convencional. El paciente recuperó la circulación espontánea tras 58 minutos en paro cardiaco y 31 descargas eléctricas, estando monitorizado en todo momento de la reanimación cardiopulmonar con capnografía (valores > 20 mm/Hg). A su llegada al hospital, se le realizó una angioplastia primaria, colocándosele un stent en la arteria coronaria derecha. El paciente fue dado de alta hospitalaria, sin secuelas neurológicas (categoría de función cerebral 1) (AU)

We report the case of a patient who presented an out-of-hospital cardiorespiratory arrest while being transported by the Helicopter Emergency Service, refractory to standard, electrical and medical treatment. The patient recovered spontaneous circulation after 58 minutes with heart arrest and 31 delivered shocks. The reanimation manoeuvres were monitored with capnography (titrated over 20 mmHg EtCO2). Upon arrival at the hospital, the patient went directly to the haemodynamic laboratory where a percutaneous coronary intervention was performed, with a stent in the right coronary artery. The patient was discharged after 8 days without any neurological handicap (cerebral performance category 1) (AU)

Assessment of the length of each hemodialysis session by on-line dialysate urea monitoring.

Hemodialysis (HD) prescription is usually based on the periodical measurement of the Kt/V achieved in a midweek dialysis session. The purpose of the study was to assess the duration of each HD session to achieve a target dose of dialysis. This allowed to determine whether a given dialysis session may be considered representative of the other HD sessions. Seventy-two HD sessions were studied in 4 stable patients, who were randomly dialyzed during 3 consecutive periods, each lasting 2 weeks, using a different blood flow rate (Qb) in each period: 400, 300 or 200 ml/min. All HD were prolonged to achieve an on-line dialysate urea monitor (UM) Kt/V of 1.2. The UM Kt/V was compared with the Kt/V calculated using pre-HD, post-HD and rebound (45 min post-HD) plasma water urea concentrations. Comparison of the duration of the second midweek dialysis session with the length of the other HD showed 95% concordance intervals (+/-2 SD) of +/-21.08 min for Qb 400, +/-26.88 min for Qb 300 and +/-37.02 min for Qb 200 ml/min. The 95% concordance intervals for whole body urea clearance were +/-32.0, +/-20.36 and +/-15.62 ml/min for Qb 400, 300 and 200 ml/min, respectively. No differences were observed between UM Kt/V and blood-based double-pool Kt/V obtained by the second-generation Daugirdas (1.18 +/- 0.08) and Garred (1.19 +/- 0.08) Kt/V formulas. In conclusion, a great variability was observed between different HD sessions with regard to the whole body urea clearance and the time required to attain a target Kt/V even when the HD characteristics remained constant. The length of every HD required to achieve a target dose of dialysis can be assessed by on-line dialysate urea monitoring.

Tacrolimus rescue therapy for cyclosporine-induced nephrotoxicity.

Following renal transplantation, the long-term use of cyclosporine can cause nephrotoxicity. This small study of ten patients looks at the effects of tacrolismus rescue therapy over a 6-month period. After conversion to tacrolismus, renal function improved in seven patients, progressive graft dysfunction slowed and almost stabilized in two patients, and, in the remaining patient, deterioration continued and hemodialysis treatment was initiated at the end of the study period. A greater number of patients and a longer follow up are necessary to confirm these initially impressive results.