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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2614-2617, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018542

RESUMO

The main goal of this research is to evaluate the defibrillation efficacy with the high-frequency waveform on ventricular fibrillation in small animals. A biphasic defibrillator with adjustable frequency was designed for this study. This custom-designed defibrillator can be adjusted to generate four different frequencies of 125, 250, 500, and 1000 Hz. Six rat hearts were induced VT/VF by electrical induction using the waveform of these four frequencies. Success VT/VF-induction by applying those four frequencies were recorded and observed by optical mapping. The results showed that the VT/VF-induction success rate is increasing along with higher frequencies. The VT/VF-induction success rate is 16% in 125Hz and 250 Hz, 33% in 500 Hz, and 100% in 1000 Hz with S1-S2 protocol at 100 ms coupling interval. Also, using optical mapping technique, shock-induced optical potential showed that only high-frequency waveform exhibited the largest tissue responses in the middle position of the heart. In conclusion, high-frequency (1000Hz) defibrillation waveform has the highest defibrillation efficacy comparing to other lower frequencies used in this study.


Assuntos
Coração , Fibrilação Ventricular , Animais , Desfibriladores , Eletricidade , Masculino , Ratos , Registros , Fibrilação Ventricular/terapia
2.
Am J Cardiol ; 135: 177-180, 2020 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-32871109

RESUMO

Cardiac arrhythmia is a known manifestation of novel coronavirus 2019 (COVID-19) infection. Herein, we describe the clinical course of an otherwise healthy patient who experienced persistent ventricular tachycardia and fibrillation which is believed to be directly related to inflammation, as opposed to acute myocardial injury or medications that can prolong the QT interval.


Assuntos
Infecções por Coronavirus/complicações , Cardioversão Elétrica/métodos , Eletrocardiografia/métodos , Pneumonia Viral/complicações , Fibrilação Ventricular/complicações , Fibrilação Ventricular/terapia , Antiarrítmicos/uso terapêutico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Recuperação de Função Fisiológica , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/diagnóstico por imagem
3.
Int Heart J ; 61(5): 913-921, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921668

RESUMO

Previous study has identified marked differences in patient characteristics and causes of inappropriate shock (IAS) between Japan and the Western societies in terms of subcutaneous implantable cardioverter-defibrillator (S-ICD). However, evidence of IAS in Asian populations including Japan has been limited to one observational study.Thus, we conducted a single-center registry study that tracks the postoperative course of 61 consecutive patients who received S-ICD from February 2016 to January 2020. Our findings showed that IAS occurred in 9.8% of the study population (6/61), which is comparable to the previously reported incidence. Remarkably, T-wave oversensing did not result in an IAS (0/6). Instead, myopotential oversensing was determined to have caused the most IAS events (4/6), while atrial fibrillation ranked second (2/6). A provocation maneuver (e.g., abdominal clench, push-ups, lifting a heavy item) reproduced myopotential noise disguised as R-waves, which should potentially trigger an IAS if uninterrupted. R-wave amplitude of the IAS group appeared relatively low compared to that of the non-IAS group although this finding was not tested significant. Furthermore, no temporal changes were noted in R-wave amplitude between the time of implantation and IAS events, suggesting that it is neither constantly low nor acutely dropped R-wave amplitude but a relatively high noise level that drives IAS. All the myopotential-IAS patients were found to be male. Right-sided lead implantation was associated with a higher incidence of IAS.This study highlights the fact that IAS continues to occur due to myopotential noise oversensing instead of T-wave oversensing. To minimize the risk of IAS, it is desirable to search and secure high R-wave voltage.


Assuntos
Desfibriladores Implantáveis , Cardioversão Elétrica/estatística & dados numéricos , Músculo Esquelético/fisiologia , Taquicardia Ventricular/diagnóstico , Fibrilação Ventricular/diagnóstico , Adolescente , Adulto , Idoso , Criança , Erros de Diagnóstico , Falha de Equipamento , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Adulto Jovem
6.
Am J Cardiol ; 131: 125-126, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32718558

RESUMO

A 64-year-old man with known coronary disease presented to the hospital with sinus bradycardia, chest pain, and normal cardiac enzymes. During an exercise stress test he developed ventricular fibrillation that spontaneously resolved.


Assuntos
Stents , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/terapia , Eletrocardiografia , Teste de Esforço , Massagem Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Remissão Espontânea
7.
PLoS One ; 15(5): e0232529, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32357163

RESUMO

Electrical defibrillation is a well-established treatment for cardiac dysrhythmias. Studies have suggested that shock-induced spatial sawtooth patterns and virtual electrodes are responsible for defibrillation efficacy. We hypothesize that high-frequency shocks enhance defibrillation efficacy by generating temporal sawtooth patterns and using rapid virtual electrodes synchronized with shock frequency. High-speed optical mapping was performed on isolated rat hearts at 2000 frames/s. Two defibrillation electrodes were placed on opposite sides of the ventricles. An S1-S2 pacing protocol was used to induce ventricular tachyarrhythmia (VTA). High-frequency shocks of equal energy but varying frequencies of 125-1000 Hz were used to evaluate VTA vulnerability and defibrillation success rate. The 1000-Hz shock had the highest VTA induction rate in the shorter S1-S2 intervals (50 and 100 ms) and the highest VTA defibrillation rate (70%) among all frequencies. Temporal sawtooth patterns and synchronous shock-induced virtual electrode responses could be observed with frequencies of up to 1000 Hz. The improved defibrillation outcome with high-frequency shocks suggests a lower energy requirement than that of low-frequency shocks for successful ventricular defibrillation.


Assuntos
Cardioversão Elétrica/métodos , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Animais , Modelos Animais de Doenças , Eletrodos , Fenômenos Eletrofisiológicos , Feminino , Ventrículos do Coração/fisiopatologia , Técnicas In Vitro , Modelos Cardiovasculares , Ratos , Ratos Sprague-Dawley , Taquicardia Ventricular/fisiopatologia , Interface Usuário-Computador , Fibrilação Ventricular/fisiopatologia , Função Ventricular , Imagens com Corantes Sensíveis à Voltagem/instrumentação , Imagens com Corantes Sensíveis à Voltagem/métodos
9.
Am J Emerg Med ; 38(7): 1481-1487, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32345562

RESUMO

BACKGROUND: Electrical storm is a dangerous condition presenting to the Emergency Department that requires rapid diagnosis and management. OBJECTIVE: This article provides a review of the diagnosis and management of electrical storm for the emergency clinician. DISCUSSION: Electrical storm is defined as ≥3 episodes of sustained ventricular tachycardia, ventricular fibrillation, or shocks from an implantable cardioverter defibrillator within 24 h. Patients may present with a wide array of symptoms. Initial evaluation should include an electrocardiogram with a rhythm strip and continuous cardiac monitoring, a medication history, assessment of hemodynamic stability, and identification of potential triggers. Management includes an antiarrhythmic and a beta blocker. Refractory patients may benefit from double-sequential defibrillation or more invasive procedures such as intra-aortic balloon pumps, catheter ablation and extracorporeal membrane oxygenation for critically ill patients. These patients will typically require admission to an intensive care unit. CONCLUSION: Electrical storm is a condition associated with significant morbidity and mortality. It is important for clinicians to be aware of the current evidence regarding the evaluation and management of these patients.


Assuntos
Desfibriladores Implantáveis , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/terapia , Agonistas Adrenérgicos beta/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Algoritmos , Antiarrítmicos/uso terapêutico , Diagnóstico Diferencial , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Anamnese , Exame Físico , Fatores de Risco , Taquicardia Supraventricular/diagnóstico
10.
Am J Cardiol ; 125(12): 1896-1900, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32305220

RESUMO

Patients with hypertrophic cardiomyopathy (HC) may require higher energies to terminate ventricular fibrillation (VF); thus, dual coil defibrillation leads are often implanted. However, single coil leads may be preferred in young patients. All patients with HCM implanted with a transvenous ICD from years 2000 to 2014 were included. Of 249 patients, 223 underwent VF testing including 150 with a dual coil lead and 73 a single coil. Patients tested with dual coil compared with single coil had lower successful VF energies (15.7 ± 6.1 joule to 20.2 ± 7.9 joule (p <0.0001)). Adequate safety margin for defibrillation was noted in 97.3% of patients. Notably, 6 (4 with single coil leads) had inadequate safety margins (defined as ≥10 joule). Three of these 6 patients required replacement of a single coil lead with a dual coil lead. The remaining 3 underwent waveform tilt alteration, higher energy ICD, or removal of the can from the shock vector. There were no clinical or implant predictors of inadequate safety margins. In follow-up of 16 ± 30 months (range 0 to 170), there were 24 arrhythmias including 13 VF, all successfully terminated. In conclusion, in HC patients undergoing ICD implantation, single coil leads can provide adequate safety margins. In conclusion, defibrillation testing should be considered in all HC patients undergoing ICD implantation, and should be performed in those undergoing implantation with a single coil lead.


Assuntos
Cardiomiopatia Hipertrófica/terapia , Desfibriladores Implantáveis , Fibrilação Ventricular/terapia , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
J Card Surg ; 35(7): 1425-1430, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32340068

RESUMO

BACKGROUND AND AIM: Acute type A aortic dissection (AAAD) is a life-threatening condition. The emergency operation usually results in 20% perioperative mortality. If preoperative cardiopulmonary resuscitation (CPR) is necessary, there is an increase in the rate of mortality. The aim of the present study was to report the outcomes of AAAD surgery in patients requiring preoperative CPR in a high-volume center. METHODS: A retrospective analysis of preoperative, intraoperative, postoperative, and follow-up data in patients requiring preoperative CPR in the setting of AAAD surgery was performed. RESULTS: Between January 2006 and December 2018, 637 patients underwent emergency surgery for AAAD. In total, 26 (4%) patients received CPR; the mean age was 63 ± 13 years; and 18 were male (69%). The reason for CPR was acute tamponade (N = 14, 54%), pulseless electrical activity (N = 5, 19%), asystole or ventricular fibrillation (N = 7, 27%), and four (15%) patients were not operated due to prolonged CPR and severe initial neurological impairment. There was no intraoperative mortality. The in-hospital mortality rate was 50% (N = 11), due to severe cerebral damage confirmed by computed tomography, and six patients (55%) were older than 70 years. The median follow-up was 35 months (7-149), which was 100% complete; two patients had permanent hemiplegia, one had anterior spinal syndrome, and other two died during the follow-up. The overall survival rate was 41% (n = 9). CONCLUSION: Surgery outcomes were still reasonable in AAAD patients requiring preoperative CPR in a high-volume center.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Reanimação Cardiopulmonar/estatística & dados numéricos , Cuidados Pré-Operatórios/estatística & dados numéricos , Doença Aguda , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/complicações , Aneurisma Aórtico/mortalidade , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/terapia , Seguimentos , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia
12.
Circ Arrhythm Electrophysiol ; 13(5): e007669, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32281407

RESUMO

BACKGROUND: There is paucity of data regarding radiofrequency ablation for ventricular tachycardia (VT) in patients with cardiogenic shock and concomitant VT refractory to antiarrhythmic drugs on mechanical support. METHODS: Patients undergoing VT ablation at our center were enrolled in a prospectively maintained registry and screened for the current study (2010-2017). RESULTS: All 21 consecutive patients with cardiogenic shock and concomitant refractory ventricular arrhythmia undergoing bailout ablation due to inability to wean off mechanical support were included. Median age was 61 years, 86% were men, median left ventricular ejection fraction was 20%, 81% had ischemic cardiomyopathy, and PAINESD score was 18±5. The type of mechanical support in place before the procedure was intra-aortic balloon pump in 14 patients (67%), Impella CP in 2, extracorporeal membrane oxygenation in 2, extracorporeal membrane oxygenation and intra-aortic balloon pump in 2, and extracorporeal membrane oxygenation and Impella CP in 1. Endocardial voltage maps showed myocardial scar in 19 patients (90%). The clinical VTs were inducible in 13 patients (62%), whereas 6 patients had premature ventricular contraction-induced ventricular fibrillation/VT (29%), and VT could not be induced in 2 patients (9%). Activation mapping was possible in all 13 with inducible clinical VTs. Substrate modification was performed in 15 patients with scar (79%). After ablation and scar modification, the arrhythmia was noninducible in 19 patients (91%). Seventeen (81%) were eventually weaned off mechanical support successfully, but 6 (29%) died during the index admission from persistent cardiogenic shock. Patients who had ventricular arrhythmia and cardiogenic shock on presentation had a trend toward lower in-hospital mortality compared with those who presented with cardiogenic shock and later developed ventricular arrhythmia. CONCLUSIONS: Bailout ablation for refractory ventricular arrhythmia in cardiogenic shock allowed successful weaning from mechanical support in a large proportion of patients. Mortality remains high, but the majority of patients were discharged home and survived beyond 1 year.


Assuntos
Circulação Assistida , Ablação por Cateter , Oxigenação por Membrana Extracorpórea , Frequência Cardíaca , Choque Cardiogênico/terapia , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Idoso , Antiarrítmicos/uso terapêutico , Circulação Assistida/efeitos adversos , Circulação Assistida/instrumentação , Circulação Assistida/mortalidade , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Resistência a Medicamentos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Frequência Cardíaca/efeitos dos fármacos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Recidiva , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Volume Sistólico , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/mortalidade , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/mortalidade , Fibrilação Ventricular/fisiopatologia , Função Ventricular Esquerda
14.
Am J Cardiol ; 125(8): 1162-1169, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32087999

RESUMO

The aim of the present study was to determine whether free thyroxine (FT4) and calculated thyroid parameters predict the incidence of ventricular arrhythmias in euthyroid heart failure patients with implantable cardioverter-defibrillators (ICD). In this open-label prospective cohort study, 115 consecutive euthyroid patients (mean age 62.9 ± 1.3 years; 87% male; ischemic cardiomyopathy 63%) scheduled for primary prevention ICD implantation or exchange were enrolled. Serum concentrations of thyrotropin (thyroid-stimulating hormone) and FT4 were measured 1 day before device operation. Primary and secondary end points were defined as occurrence of appropriate ICD therapy (AIT) and cardiovascular death, respectively. During a mean follow-up of 1,191 ± 35 days, 24 patients (21%) experienced AIT, and cardiovascular death was observed in 10 patients (9%). Patients with AIT had higher FT4 concentrations compared with those without AIT (18.9 ± 0.48 vs 16.2 ± 0.22 pmol/L, p <0.001). FT4 was an independent predictor of AIT in an adjusted Cox regression (hazard ratio = 1.47, p <0.001). Kaplan-Meier analysis demonstrated that Jostel's thyroid-stimulating hormone index, reflecting the central component of the hypothalamus-pituitary-thyroid loop, and SPINA-GT as surrogate markers for thyroid's secretory capacity predicted AIT incidences. None of the indices predicted cardiovascular death. In conclusion, FT4 concentration predicts an increased incidence of ventricular arrhythmias in euthyroid patients receiving ICDs for primary prevention. Our data suggest that both impending primary hyperthyroidism and an increased thyroid homeostasis set point may increase the rate of AIT in this patient population.


Assuntos
Cardiomiopatias/terapia , Isquemia Miocárdica/terapia , Taquicardia Ventricular/epidemiologia , Tireotropina/sangue , Tiroxina/sangue , Fibrilação Ventricular/epidemiologia , Idoso , Estimulação Cardíaca Artificial/estatística & dados numéricos , Cardiomiopatias/complicações , Estudos de Coortes , Desfibriladores Implantáveis , Cardioversão Elétrica/estatística & dados numéricos , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Prevenção Primária , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Taquicardia Ventricular/prevenção & controle , Taquicardia Ventricular/terapia , Fibrilação Ventricular/prevenção & controle , Fibrilação Ventricular/terapia
15.
J Vis Exp ; (155)2020 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-32065144

RESUMO

Cardiopulmonary resuscitation after cardiac arrest, independent of its origin, is a regularly encountered medical emergency in hospitals as well as preclinical settings. Prospective randomized trials in human subjects are difficult to design and ethically ambiguous, which results in a lack of evidence-based therapies. The model presented in this report represents one of the most common causes of cardiac arrests, ventricular fibrillation, in a standardized setting in a large animal model. This allows for reproducible observations and various therapeutic interventions under clinically accurate conditions, hence facilitating the generation of better evidence and eventually the potential for improved medical treatment.


Assuntos
Suporte Vital Cardíaco Avançado , Fibrilação Ventricular/terapia , Animais , Débito Cardíaco , Reanimação Cardiopulmonar , Descarboxilação , Modelos Animais de Doenças , Masculino , Oxigênio/metabolismo , Suínos , Fibrilação Ventricular/fisiopatologia
16.
JACC Cardiovasc Interv ; 13(4): 539-541, 2020 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-32081249
17.
PLoS One ; 15(1): e0228111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31990926

RESUMO

BACKGROUND: The aim of this study was to investigate whether 33% duty cycle increases end-tidal carbon dioxide (ETCO2) level, a surrogate measurement for cardiac output during cardiopulmonary resuscitation (CPR), compared with 50% duty cycle. METHODS: Six pigs were randomly assigned to the DC33 or DC50 group. After 3 min of induced ventricular fibrillation (VF), CPR was performed for 5 min with 33% duty cycle (DC33 group) or with 50% duty cycle (DC50 group) (phase I). Defibrillation was delivered until return of spontaneous circulation (ROSC) thereafter. After 30 min of stabilization, the animals were re-assigned to the opposite groups. VF was induced again, and CPR was performed (phase II). The primary outcome was ETCO2 during CPR, and the secondary outcomes were coronary perfusion pressure (CPP), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and right atrial pressure (RAP). RESULTS: Mean ETCO2 was higher in the DC33 group compared with the DC50 group (22.5 mmHg vs 21.5 mmHg, P = 0.018). In a linear mixed model, 33% duty cycle increased ETCO2 by 1.0 mmHg compared with 50% duty cycle (P < 0.001). ETCO2 increased over time in the DC33 group [0.6 mmHg/min] while ETCO2 decreased in the DC50 group [-0.6 mmHg/min] (P < 0.001). Duty cycle of 33% increased SAP (6.0 mmHg, P < 0.001), DAP (8.9 mmHg, P < 0.001) RAP (2.6 mmHg, P < 0.001) and CPP (4.7 mmHg, P < 0.001) compared with the duty cycle of 50%. CONCLUSION: Duty cycle of 33% increased ETCO2, a surrogate measurement for cardiac output during CPR, compared with duty cycle of 50%. Moreover, ETCO2 increased over time during CPR with 33% duty cycle while ETCO2 decreased with 50% duty cycle.


Assuntos
Dióxido de Carbono/análise , Débito Cardíaco/fisiologia , Reanimação Cardiopulmonar/métodos , Fibrilação Ventricular/terapia , Fibrilação Ventricular/veterinária , Animais , Pressão Arterial/fisiologia , Pressão Atrial/fisiologia , Capnografia , Dióxido de Carbono/fisiologia , Circulação Cerebrovascular/fisiologia , Modelos Animais de Doenças , Masculino , Monitorização Fisiológica , Estudos Prospectivos , Suínos , Volume de Ventilação Pulmonar/fisiologia , Fibrilação Ventricular/fisiopatologia
19.
Am J Emerg Med ; 38(6): 1211-1217, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31937443

RESUMO

BACKGROUND: Double sequential defibrillation (DSD) has been proposed as a viable treatment option for patients in refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) out-of-hospital cardiac arrests (OHCA). However, currently there is insufficient evidence to support a widespread implementation of this therapy. STUDY OBJECTIVES: The aim of this scoping review was to summarize the current available evidence of DSD for patients with refractory VF/pVT OHCA as well as to identify gaps in the literature that may require further research. METHODS: We conducted a comprehensive literature search of MEDLINE via PubMed, Embase via Ovid, and Scopus on August 19, 2019. We also checked reference lists of relevant papers to identify additional studies. Any controlled clinical study design (randomized controlled trials and non-randomized controlled trials), and observational studies (cohort studies and case-control studies) providing information on resuscitative parameters, survival rates and neurological outcomes in adults (≥ 18 years old) treated with DSD for refractory VF/pVT OHCA were included. Two investigators independently conducted the literature search, study selection, and data extraction. RESULTS: The search yielded 1612 unique records, of which 4 peer-reviewed articles were found relating to the research purpose, totaling 1061 patients of who 20.5% (n = 217) received DSD. Most studies evaluated if pre-hospital DSD was associated with improved survival to discharge after refractory VF/pVT. No randomized controlled trials were identified. CONCLUSION: To date, it is difficult to conclude the real benefit of DSD for patients in refractory VF based on the available evidence. The findings of this scoping review suggest there is limited evidence to support at large-scale the use of DSD for refractory VF/pVT OHCA. Further research is needed to better characterize and understand the use of DSD for refractory VF/pVT, in order to implement best practices to maximize the effectiveness and efficiency of care.


Assuntos
Cardioversão Elétrica/métodos , Cardioversão Elétrica/normas , Parada Cardíaca Extra-Hospitalar/terapia , Fibrilação Ventricular/terapia , Adulto , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/epidemiologia , Taxa de Sobrevida , Fatores de Tempo , Fibrilação Ventricular/epidemiologia
20.
Medicine (Baltimore) ; 99(2): e18658, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914051

RESUMO

RATIONALE: Despite increasing number of left ventricular assist device (LVAD) implantation, standardized cardiopulmonary resuscitation (CPR) protocol for patients with LVAD, especially in out-of-hospital settings are not well known. PATIENT CONCERNS: A 41-year-old LVAD implanted man became cardiac arrest in an out-of-hospital setting. Bystander CPR was started and the patient was brought to our hospital without noticing LVAD. Upon arrival, the medical staff noted the LVAD and that the battery of the LVAD was exhausted. DIAGNOSIS: Cardiac arrest on LVAD. INTERVENTIONS: It took 50 minutes to change the battery, then the patient has become ventricular fibrillation; hence, we introduced extracorporeal membranous oxygenation and defibrillated the patient. After the sinus rhythm was restored, the LVAD started working uneventfully. OUTCOMES: The patient became brain dead. LESSONS: There are several difficulties in treating these patients. First, hemodynamic collapse is difficult to diagnose. Second, chest compression for LVAD implanted patients remains controversial. Third, education to first responders who are not familiar with LVAD are not enough. Appropriate education for those issues is needed.


Assuntos
Reanimação Cardiopulmonar/métodos , Coração Auxiliar , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Cardioversão Elétrica , Fontes de Energia Elétrica , Oxigenação por Membrana Extracorpórea , Humanos , Masculino , Parada Cardíaca Extra-Hospitalar/complicações , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia
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