Protection of intestinal immune barrier against ischemia/reperfusion injury in a swine model using anisodamine hydrobromide

Abstract Intestinal ischemia/reperfusion (I/R) causes barrier impairment and bacterial influx. This study explored the protective effects of anisodamine hydrobromide (AH) on intestinal I/R injury caused by cardiopulmonary resuscitation (CPR) after cardiac arrest (CA). After successful CPR, minipigs were randomly divided into two groups (n = 8): saline and AH (4 mg/kg), and then treated with saline or AH via central venous injection, respectively. The same procedures without ventricular fibrillation initiation were conducted in the Sham group (n = 8). Levels of interferon gamma (IFN-γ) and interleukin 4 (IL-4) were measured at different time points (0, 0.5, 1, 2, 4, and 6 h) in serum and 6 h in gut associated lymphoid tissues (GALTs) after the return of spontaneous circulation (ROSC) to evaluate changes in the proportion of T-helper type 1 (Th1) and T-helper type 2 (Th2). Moreover, the positive culture rates of GALTs were examined to evaluate bacterial translocation. AH treatment markedly alleviated aberrant arterial blood gas and hemodynamics as well as intestinal macroscopic and morphological changes after CPR. Moreover, AH treatment significantly increased IFN-γ and decreased IL-4 in both serum and GALTs. Furthermore, AH treatment dramatically decreased positive bacterial growth in GALTs. AH treatment mitigated immunosuppression caused by intestinal I/R and protected the intestinal immune barrier against bacterial translocation, thereby reducing the risk of secondary intestinal infection

Parada cardiorrespiratoria fuera del hospital: el largo camino haciala equidad en el acceso a la reanimación urgente / Out-of-hospital cardiac arrest: the long road to equitable emergency care access to resuscitation

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An automatic system for the comprehensive retrospective analysis of cardiac rhythms in resuscitation episodes.

AIM: An automatic resuscitation rhythm annotator (ARA) would facilitate and enhance retrospective analysis of resuscitation data, contributing to a better understanding of the interplay between therapy and patient response. The objective of this study was to define, implement, and demonstrate an ARA architecture for complete resuscitation episodes, including chest compression pauses (CC-pauses) and chest compression intervals (CC-intervals). METHODS: We analyzed 126.5h of ECG and accelerometer-based chest-compression depth data from 281 out-of-hospital cardiac arrest (OHCA) patients. Data were annotated by expert reviewers into asystole (AS), pulseless electrical activity (PEA), pulse-generating rhythm (PR), ventricular fibrillation (VF), and ventricular tachycardia (VT). Clinical pulse annotations were based on patient-charts and impedance measurements. An ARA was developed for CC-pauses, and was used in combination with a chest compression artefact removal filter during CC-intervals. The performance of the ARA was assessed in terms of the unweighted mean of sensitivities (UMS). RESULTS: The UMS of the ARA were 75.0% during CC-pauses and 52.5% during CC-intervals, 55-points and 32.5-points over a random guess (20% for five categories). Filtering increased the UMS during CC-intervals by 5.2-points. Sensitivities for AS, PEA, PR, VF, and VT were 66.8%, 55.8%, 86.5%, 82.1% and 83.8% during CC-pauses; and 51.1%, 34.1%, 58.7%, 86.4%, and 32.1% during CC-intervals. CONCLUSIONS: A general ARA architecture was defined and demonstrated on a comprehensive OHCA dataset. Results showed that semi-automatic resuscitation rhythm annotation, which may involve further revision/correction by clinicians for quality assurance, is feasible. The performance (UMS) dropped significantly during CC-intervals and sensitivity was lowest for PEA.

Potential impact of a prehospital redirection system for refractory cardiac arrest.

AIM: A change in prehospital redirection practice could potentially increase the proportion of E-CPR eligible patients with out-of-hospital cardiac arrest (OHCA) transported to extracorporeal cardiopulmonary resuscitation (E-CPR) capable centers. The objective of this study was to quantify this potential increase of E-CPR candidates transported to E-CPR capable centers. METHODS: Adults with non-traumatic OHCA refractory to 15min of resuscitation were selected from a registry of adult OHCA collected between 2010 and 2015 in Montreal, Canada. Using this cohort, three simulation scenarios allowing prehospital redirection to E-CPR centers were created. Stringent eligibility criteria for E-CPR and redirection for E-CPR (e.g. age <60years old, initial shockable rhythm) were used in the first scenario, intermediate eligibility criteria (e.g. age <65years old, at least one shock given) in the second scenario and inclusive eligibility criteria (e.g. age <70years old, initial rhythm ≠ asystole) in the third scenario. All three scenarios were contrasted with equivalent scenarios in which patients were transported to the closest hospital. Proportions were compared using McNemar's test. RESULTS: The proportion of E-CPR eligible patients transported to E-CPR capable centers increased in each scenario (stringent criteria: 48 [24.5%] vs 155 patients [79.1%], p<0.001; intermediate criteria: 81 [29.6%] vs 262 patients [95.6%], p<0.001; inclusive criteria: 238 [23.9%] vs 981 patients [98.5%], p<0.001). CONCLUSIONS: A prehospital redirection system could significantly increase the number of patients with refractory OHCA transported to E-CPR capable centers, thus increasing their access to this potentially life-saving procedure, provided allocated resources are planned accordingly.

Cardiovascular Devices; Reclassification of External Cardiac Compressor; Reclassification of Cardiopulmonary Resuscitation Aids. Final order.

The Food and Drug Administration (FDA) is issuing a final order to reclassify external cardiac compressors (ECC) (under FDA product code DRM), a preamendments class III device, into class II (special controls). FDA is also creating a separate classification regulation for a subgroup of devices previously included within this classification regulation, to be called cardiopulmonary resuscitation (CPR) aids, and reclassifying these devices from class III to class II for CPR aids with feedback and to class I for CPR aids without feedback.

Dolicoectasia del tronco braquiocefálico objetivada en la valoración ecográfica previa traqueostomía percutánea / Innominate artery dolichoectasia identified during ultrasound assessment prior to percutaneous tracheostomy

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Classification of cardiopulmonary resuscitation chest compression patterns: manual versus automated approaches.

OBJECTIVES: New chest compression detection technology allows for the recording and graphical depiction of clinical cardiopulmonary resuscitation (CPR) chest compressions. The authors sought to determine the inter-rater reliability of chest compression pattern classifications by human raters. Agreement with automated chest compression classification was also evaluated by computer analysis. METHODS: This was an analysis of chest compression patterns from cardiac arrest patients enrolled in the ongoing Resuscitation Outcomes Consortium (ROC) Continuous Chest Compressions Trial. Thirty CPR process files from patients in the trial were selected. Using written guidelines, research coordinators from each of eight participating ROC sites classified each chest compression pattern as 30:2 chest compressions, continuous chest compressions (CCC), or indeterminate. A computer algorithm for automated chest compression classification was also developed for each case. Inter-rater agreement between manual classifications was tested using Fleiss's kappa. The criterion standard was defined as the classification assigned by the majority of manual raters. Agreement between the automated classification and the criterion standard manual classifications was also tested. RESULTS: The majority of the eight raters classified 12 chest compression patterns as 30:2, 12 as CCC, and six as indeterminate. Inter-rater agreement between manual classifications of chest compression patterns was κ = 0.62 (95% confidence interval [CI] = 0.49 to 0.74). The automated computer algorithm classified chest compression patterns as 30:2 (n = 15), CCC (n = 12), and indeterminate (n = 3). Agreement between automated and criterion standard manual classifications was κ = 0.84 (95% CI = 0.59 to 0.95). CONCLUSIONS: In this study, good inter-rater agreement in the manual classification of CPR chest compression patterns was observed. Automated classification showed strong agreement with human ratings. These observations support the consistency of manual CPR pattern classification as well as the use of automated approaches to chest compression pattern analysis.

Material del carro de reanimación cardiopulmonar pediátrica / Material for the pediatric resuscitation trolley

La parada cardiorrespiratoria y por tanto la necesidad de realizar una reanimación cardiopulmonar se puede presentar en cualquier lugar, tanto en el medio extrahospitalario como intrahospitalario. Por ese motivo, todos los centros sanitarios tanto hospitalarios, como de atención primaria y los servicios de emergencias extrahospitalarias, deben estar preparados para realizar una reanimación cardiopulmonar pediátrica y el tratamiento de otras urgencias vitales. Para ello, deben disponer de los medios materiales adecuados. El carro de parada o mesa de reanimación constituye un elemento asistencial indispensable en todo centro sanitario. El material que debe contener el carro de parada puede variar dependiendo del tipo de centro sanitario y el tipo de reanimación (p. ej., la reanimación neonatal). Debe existir al menos un carro en cada centro de atención primaria, unidad de cuidados intensivos pediátricos, servicio de urgencias, servicio de emergencias extrahospitalarias y planta de pediatría. El carro debe estar en un lugar fácilmente accesible y en él se debe colocar sólo el material imprescindible para las emergencias vitales. Deben existir los tamaños de cada instrumental necesarios para tratar a niños de cualquier edad, y el número suficiente de recambios de cada instrumento y medicación que puedan precisarse durante una reanimación. El material debe ser revisado periódicamente y todo el personal médico, de enfermería y auxiliar deberá conocer el contenido y la disposición del material y medicación del carro

Cardiorespiratory arrest and the need for cardiopulmonary resuscitation can occur anywhere, both in the out-of-hospital and in-hospital settings. Therefore, all healthcare centers (hospitals, primary care facilities, out-of-hospital emergency services) must be prepared to initiate life support procedures in children and to treat other life-threatening emergencies. To achieve this objective, adequate material including a full crash cart or resuscitation trolley is essential and must be available in all healthcare centers. Specific items contained in the trolley can vary according to the characteristics of the facility and the most probable type of resuscitation needed (for example, neonatal resuscitation). At least one resuscitation trolley must be available in primary care centers, pediatric intensive care units, emergency departments, out-of-hospital emergency services, and pediatric wards. The trolley must be located in an easily accessible site and must contain only indispensable material. It is essential to include instruments in several sizes, covering children of all ages, as well as enough spare instruments and medications that could be required during resuscitation. The material must be checked periodically and all the staff (physicians, nurses, and auxiliary personnel) must be familiar with the trolley's contents and the location of all material and drugs

Validation of low-acuity emergency medical services dispatch codes.

BACKGROUND: Computer-aided dispatch systems are used to assess the severity of a 9-1-1 caller's complaint and then assign an appropriate level of emergency medical services (EMS) response. OBJECTIVE: To evaluate a group of low-acuity codes (defined as requiring advanced life support [ALS] intervention in fewer than 10% of cases) that has been derived and validated in one community. METHODS: All of the 9-1-1 medical calls assigned to these predetermined emergency medical dispatch codes between January 1, 2004, and July 1, 2004, were analyzed. ALS care was defined as receiving one or more of the following: pulse oximetry measurement, blood glucose measurement, cardiac defibrillation, administration of any medication, airway maneuvers, or the placement of an intravenous (IV) catheter. A more restrictive definition of ALS care (use of IV fluid bolus, medication administration, intubation, or defibrillation) was also calculated. RESULTS: A total of 1,799 calls were assigned low-acuity dispatch codes, and 1,597 met inclusion criteria. None of the 26 dispatch codes were found to be low-acuity by the study definition. Fifty-six percent of these patients received ALS care. Placement of an IV-catheter was the ALS intervention used most frequently (45% of cases), followed by pulse oximetry measurement (32%), glucose measurement (22%), medication administration (11%), intubation (0.13%), and defibrillation (0%). The medication administered most frequent was morphine. When using the more restrictive definition of acuity, patients in 19 of the 28 categories received ALS intervention less than 10% of the time. Patients in the other seven categories were considered high-acuity 13% to 36% of the time. CONCLUSION: Dispatch codes that had previously been determined to be low-acuity were found not to be so in this community. The variation in clinical practice is likely explained by a more precautionary approach to care in this EMS system and the increased use of analgesics. This study demonstrates the need to define the optimal subset of prehospital patients who would benefit from these treatments.

Recommendations of the international guidelines 2000 conference on cardiopulmonary resuscitation and emergency cardiac care: an overview.

The greatest potential for survival of sudden cardiac arrest can be achieved only by providing early intervention using evidence-based therapies that have been studied over time. Emergency cardiac care and the 2000 advanced cardiac life support guidelines encompass all therapies that have been shown to improve outcomes in patients who experience life-threatening events that involve the cardiovascular, cerebrovascular, and pulmonary systems. Early recognition of warning signs, activation of emergency medical systems within the community, basic cardiopulmonary resuscitation, early defibrillation, airway management, and intravenous medication administration are key factors in improving resuscitation outcomes.

Recomendaciones 2000 del european resuscitation council para el soporte vital básico en adultos

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Parada cardiopulmonar: reanimación cardiopulmonar

La morbimortalidad secundaria a la parada cardiorrespiratoria es elevada en nuestro medio, y lo más lamentable de esta situación es que en un porcentaje elevado de casos una actuación precoz podría hacer descender estas cifras. Las técnicas de resucitación cardiopulmonar son sencillas y las maniobras más básicas deberían divulgarse a toda la población mediante cursos reglados, lo cual podría aumentar la probabilidad de superviviencia de muchas víctimas. Las recomendaciones de la reanimación cardiopulmonar básica comprenden un conjunto de actuaciones dirigidas a la identificación de la víctima, el aviso a los sistemas de emergencia sanitaria y la sustitución temporal tanto de la función cardíaca como de la función pulmonar. La reanimación cardiopulmonar avanzada requiere un cierto nivel de entrenamiento y conocimiento del tratamiento de las causas más frecuentes de parada cardíaca: fibrilación ventricular, taquicardia ventricular sin pulso, asistolia y disociación electromecánica (AU)

Reanimación cardio-respiratoria en pediatría: la vida y la muerte están separadad por un latido

La reanimación cardio-pulmonar (RCP) pediátrica comprende una serie de maniobras que se dividen en dos grandes grupos: básicas y avanzadas. La RCP básica, que debe ser conocida por cualquier persona, aunque no sea del área mádica, no requiere un gran entrenamiento y consiste en los primeros gestos que se realizan en los minutos iniciales que siguen a un paro. Los mismos no requieren ninguna droga ni instrumental médico para reaminar con exito a un niño. Fundamentalmente, se utilizan las manos y la boca, aunque en un medio hospitalario se apoyan estas maniobras con oxígeno, bolsas, máscaras y otros elementos de oxigenoterapia. Estas maniobras se subdividen en tres pasos: A-apertura de vías aéreas; B

Perspectivas de la reanimación cardiopulmonar en Santiago de Cuba / Perspectives of Cardiopulmonary Resuscitation in Santiago de Cuba

Se realizó un estudio multicéntrico y descriptivo desde octubre de 1996 hasta diciembre de 1998 en el Hospital Prov. Docente "Dr. Ambrosio Grillo", Policlínico de Urgencia "Dr. Mario Muñoz Monroy" y Centro Cordinador de Santiago de Cuba, basado en 102 pacientes que sufrieron ataque cardíaco en los cuales se evaluó la perspectiva del desarrollo de la reanimación cardiopulmonar con la aplicación del soporte básico de vida y apoyo cardiológico al soporte de vida en el lugar de los hechos, así como desfibrilación temprana si es necesario. El infarto agudo del miocardio fue la causa más frecuente y peligrosa, pues se produjo en casi 6 de cada 10 pacientes, en tanto más del 50 por ciento de los afectados fueron atendidos después de los 5 minutos, para una posibilidad supervivencia menor de uno por cada 10. Las prácticas actuales de reanimación cardiopulmonar mostraron ser grandemente eficaces, unido a un tratamiento adecuado prescripto de forma inmediata

Perspectivas de la reanimación cardiopulmonar en Santiago de Cuba / Perspectives of Cardiopulmonary Resuscitation in Santiago de Cuba

Se realizó un estudio multicéntrico y descriptivo desde octubre de 1996 hasta diciembre de 1998 en el Hospital Prov. Docente "Dr. Ambrosio Grillo", Policlínico de Urgencia "Dr. Mario Muñoz Monroy" y Centro Cordinador de Santiago de Cuba, basado en 102 pacientes que sufrieron ataque cardíaco en los cuales se evaluó la perspectiva del desarrollo de la reanimación cardiopulmonar con la aplicación del soporte básico de vida y apoyo cardiológico al soporte de vida en el lugar de los hechos, así como desfibrilación temprana si es necesario. El infarto agudo del miocardio fue la causa más frecuente y peligrosa, pues se produjo en casi 6 de cada 10 pacientes, en tanto más del 50 por ciento de los afectados fueron atendidos después de los 5 minutos, para una posibilidad supervivencia menor de uno por cada 10. Las prácticas actuales de reanimación cardiopulmonar mostraron ser grandemente eficaces, unido a un tratamiento adecuado prescripto de forma inmediata (AU)

Do-not-resuscitate orders.

CPR is a procedure from which approximately 15% of patients survive to discharge. Patients have the right to request DNR orders and health professionals have an obligation to provide the information to make decisions. Physicians and patients should discuss advance directives before hospital admission. Patients without decision-making capacity are dependent on advance directives, surrogates or proxies for DNR orders. The most recent version of the Florida statute has improved the procedural mechanism for writing DNR orders but continues to need further refinement.