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1.
J Surg Res ; 245: 593-599, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31499365

RESUMO

BACKGROUND: After traumatic arrest, resuscitative thoracotomy is lifesaving in appropriately selected patients, yet data are limited regarding hospital course after intensive care unit (ICU) admission. The objective of this study was to describe the natural history of resuscitative thoracotomy survivors admitted to the ICU. MATERIALS AND METHODS: We conducted a retrospective review (January 1, 2012-June 30, 2017) of all adult trauma patients who underwent resuscitative thoracotomy after traumatic arrest at two adult level 1 trauma centers. Data evaluated include demographics, injury characteristics, hospital course, and outcome. RESULTS: Over 66 mo, there were 52,624 trauma activations. Two hundred ninety-eight patients underwent resuscitative thoracotomy and 96 (32%) survived to ICU admission. At ICU admission, mean age was 35.8 ± 14.5 y, 79 (82%) were male, 36 (38%) sustained blunt trauma, and the mean injury severity score was 32.3 ± 13.7. Eight blunt and 20 penetrating patients (22% and 34% of ICU admissions, respectively) survived to discharge. 67% of deaths in the ICU occurred within the first 24 h, whereas 90% of those alive at day 21 survived to discharge. For the 28 survivors, mean ICU length of stay was 24.1 ± 17.9 d and mean hospital length of stay was 43.9 ± 32.1 d. Survivors averaged 1.9 ± 1.5 complications. Twenty-four patients (86% of hospital survivors) went home or to a rehabilitation center. CONCLUSIONS: After resuscitative thoracotomy and subsequent ICU admission, 29% of patients survived to hospital discharge. Complications and a long hospital stay should be expected, but the functional outcome for survivors is not as bleak as previously reported.


Assuntos
Parada Cardíaca/cirurgia , Complicações Pós-Operatórias/epidemiologia , Ressuscitação/efeitos adversos , Toracotomia/efeitos adversos , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações , Adulto , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Centros de Reabilitação/estatística & dados numéricos , Ressuscitação/métodos , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgia , Adulto Jovem
2.
Int J Artif Organs ; 42(7): 362-369, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31238824

RESUMO

OBJECTIVE: Ex-vivo lung perfusion is a promising tool to evaluate and recondition marginal donor lungs usually after a cold static preservation. The concept of continuous organ perfusion is supposed to reduce ischemic damage; however, the optimal perfusion protocol has not been established yet. The aim of this study was to compare immediate ex-vivo lung perfusion (I-EVLP) to delayed ex-vivo lung perfusion (D-EVLP) after a certain cold static preservation period on lung function in a large animal model. METHODS: In a porcine model, lungs were procured after circulatory death and 60 min of no-touch warm ischemia. Lungs were preserved with single-flush cold low potassium dextran solution and prepared either for I-EVLP (n = 8) or stored cold for 9 h with subsequent D-EVLP (n = 8). Functional outcomes and morphology were compared during 4 h of ex-vivo lung perfusion, using STEEN SolutionTM as perfusion solution. RESULTS: Pulmonary functional data, perfusate activities of lactate dehydrogenase, alkaline phosphatase, and products of lipid peroxidation did not differ significantly. There was a trend toward lower wet-dry ratio (I-EVLP: 13.4 ± 2.9; D-EVLP: 9.1 ± 2.5) and higher ΔpO2 in D-EVLP group (I-EVLP: 209 ± 51.6 mmHg; D-EVLP: 236.3 ± 47.3 mmHg). CONCLUSION: In this donation-after-circulatory-death model, 9 h of cold static preservation followed by ex-vivo lung perfusion results in comparable pulmonary function to I-EVLP as indicated by oxygenation capacities and wet-dry ratio. Our findings indicate that prolonged cold static preservation prior to ex-vivo lung perfusion is as safe and effective as I-EVLP in the procurement of donor lungs.


Assuntos
Circulação Extracorpórea/métodos , Parada Cardíaca/cirurgia , Transplante de Pulmão/métodos , Preservação de Órgãos/métodos , Animais , Modelos Animais de Doenças , Suínos , Fatores de Tempo , Isquemia Quente
3.
Cardiovasc Pathol ; 41: 8-10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31004934

RESUMO

Acute aortic root thrombosis extended to coronary ostia is a rare but potentially life-threatening complication of aortic valve replacement with bioprosthetic substitutes. We aimed to present the case of a 72-year-old woman with symptomatic rheumatic valve disease and associated atrial fibrillation who underwent conventional mitroaortic valve replacement with two stented bioprostheses (pericardial and porcine, respectively). Eight days after surgery, she had cardiac arrest due to ventricular fibrillation, requiring immediate cardiopulmonary resuscitation. Left ventricle akinesia by echocardiography and troponin levels up to 35,000 ng/L pointed to coronary ischemia. Emergent coronary angiography showed a subocclusion of the left main trunk, with the suspicion of aortic root thrombosis. The patient was immediately reoperated, fresh thrombi were removed from the aortic root, and the aortic Magna Ease 21-mm bioprosthesis was replaced with a stentless Solo Smart 21-mm bioprosthesis. The patient died of septic complications.


Assuntos
Valva Aórtica/cirurgia , Bioprótese , Parada Cardíaca/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Trombose/etiologia , Idoso , Biópsia , Angiografia Coronária , Remoção de Dispositivo , Evolução Fatal , Feminino , Parada Cardíaca/diagnóstico por imagem , Parada Cardíaca/cirurgia , Humanos , Desenho de Prótese , Trombose/diagnóstico por imagem , Trombose/cirurgia , Resultado do Tratamento
5.
Eur J Trauma Emerg Surg ; 45(2): 231-243, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30008075

RESUMO

PURPOSE: Emergency department thoracotomy (EDT) is a potentially life-saving procedure, performed on patients suffering traumatic cardiac arrest. Multiple indications have been reported, but overall survival remains unclear for each indication. The objective of this systematic review is to determine overall survival, survival stratified by indication, and survival stratified by geographical location for patients undergoing EDT across the world. METHODS: Articles published between 2000 and 2016 were identified which detailed outcomes from EDT. All articles referring to pre-hospital, delayed, or operating room thoracotomy were excluded. Pooled odds ratios (OR) were calculated comparing differing indications. RESULTS: Thirty-seven articles, containing 3251 patients who underwent EDT, were identified. There were 277 (8.5%) survivors. OR demonstrate improved survival for; penetrating vs blunt trauma (OR 2.10; p 0.0028); stab vs gun-shot (OR 5.45; p < 0.0001); signs of life (SOL) on admission vs no SOL (OR 5.36; p < 0.0001); and SOL in the field vs no SOL (OR 19.39; p < 0.0001). Equivalence of survival was demonstrated between cardiothoracic vs non-cardiothoracic injury (OR 1.038; p 1.000). Survival was worse for USA vs non-USA cohorts (OR 1.59; p 0.0012). CONCLUSIONS: Penetrating injury remains a robust indication for EDT. Non-cardiothoracic cause of cardiac arrest should not preclude EDT. In the absence of on scene SOL, survival following EDT is extremely unlikely. Survival is significantly higher in the non-USA publications; reasons for this are highly complex. A UK multicentre prospective study which collects standardised data on all EDTs could provide robust evidence for better patient stratification.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Parada Cardíaca/cirurgia , Traumatismos Torácicos/cirurgia , Toracotomia/estatística & dados numéricos , Sistemas de Gerenciamento de Base de Dados , Parada Cardíaca/etiologia , Parada Cardíaca/fisiopatologia , Humanos , Traumatismos Torácicos/complicações , Traumatismos Torácicos/fisiopatologia , Resultado do Tratamento
6.
J Invasive Cardiol ; 30(12): 456-460, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30504514

RESUMO

OBJECTIVES: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is most commonly used in patients with cardiac arrest and cardiogenic shock. There are limited data on the use of VA-ECMO for elective, high-risk percutaneous coronary intervention (PCI). We examined the in-hospital and mid-term clinical outcomes in patients undergoing complex, high-risk PCI with VA-ECMO support. METHODS: . We conducted a retrospective review of ECMO-supported elective high-risk PCIs performed at our institution between May 2012 and May 2017. The electronic medical records and angiograms were individually reviewed. We assessed the in-hospital and mid-term major adverse cardiovascular and cerebrovascular event (MACCE) rates, and reviewed bleeding and vascular complications. RESULTS: Five patients underwent elective high-risk PCI with ECMO support. Mean age was 66.8 ± 8.6 years and all patients were men. The mean ejection fraction was 26.6 ± 18.0%. Most procedures were unprotected left main PCIs. All PCIs were successful; 1 patient required femoral artery surgical repair. The mean hospital stay post procedure was 6.4 ± 2.0 days. ECMO was successfully weaned in all cases, and the duration of ECMO was <24 hours in 4 cases. There was no occurrence of in-hospital and 1-year MACCE. CONCLUSION: ECMO can be successfully used for hemodynamic support during elective high-risk PCI.


Assuntos
Procedimentos Cirúrgicos Eletivos/métodos , Oxigenação por Membrana Extracorpórea/métodos , Parada Cardíaca/cirurgia , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/métodos , Choque Cardiogênico/cirurgia , Parada Cardíaca/complicações , Humanos , Infarto do Miocárdio/complicações , Fatores de Risco , Choque Cardiogênico/complicações , Resultado do Tratamento
7.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 43(10): 1112-1117, 2018 Oct 28.
Artigo em Chinês | MEDLINE | ID: mdl-30523232

RESUMO

OBJECTIVE: To investigate the changes of myocardial glucose metabolism in rabbit cardiac arrest models and the effect of hydrogen intervention by 18F-fluroro-2-deoxyglucose (18F-FDG) positron emission tomography (PET) imaging.
 Methods: Fifteen male New Zealand white rabbits were randomly divided into a hydrogen group (n=6), a control group (n=6) and a sham group (n=3). Cardiac arrest (CA) was induced by intravenous injection of potassium chloride. Conventional cardiopulmonary resuscitation (CPR) was initiated after five-minutes CA. The hydrogen group and the control group were mechanically ventilated into mixed gas with 4% hydrogen+96% oxygen and pure oxygen, respectively, for 30 minutes after CPR. Rats in the sham group was performed the same surgical procedure and was injected adrenaline and potassium chloride but did not induce CA. The vital signs at basic state and 30 min after return of spontaneous circulation (ROSC) were recorded in each group. The parameters of CPR were recorded in two CA groups. Myocardial glucose metabolism was assessed by positron emission tomography (PET) at basic state, 2 h and 24 h after ROSC. The maximum standardized uptake value (SUVmax) of 18F-FDG was measured.
 Results: There were no significant differences in the basal body weight and vital signs among the three groups. There was no significant difference in the blood glucose level before PET examination. The 18F-FDG SUVmax in the sham group at three time points was not significantly changed. In the hydrogen group and the control group, the 18F-FDG SUVmax at 2 h after ROSC were significantly higher than the basic level (1.89±0.47 vs 3.47±1.24 and 1.90±0.36 vs 4.26±0.80, respectively). Compared with the control group, the 18F-FDG SUVmax in the hydrogen group was lower at the point at 2 h after ROSC. The 18F-FDG SUVmax in the 2 CA group were down to the basic level at 24 h after ROSC (hydrogen group 2.02±0.64, control group 2.07±0.61).
 Conclusion: Myocardial glucose metabolism in CA rabbits was increased significantly after ROSC, and hydrogen intervention can reduce the degree of glucose metabolism.


Assuntos
Glucose , Parada Cardíaca , Miocárdio/metabolismo , Tomografia por Emissão de Pósitrons , Animais , Reanimação Cardiopulmonar , Glucose/metabolismo , Parada Cardíaca/fisiopatologia , Parada Cardíaca/cirurgia , Masculino , Coelhos , Distribuição Aleatória , Ratos
8.
Cir Cir ; 86(4): 366-369, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30067722

RESUMO

Instituida bajo recomendaciones objetivas, la toracotomía en el departamento de urgencias (TDU) se ha descrito como una maniobra quirúrgica salvatoria de la vida en pacientes traumatizados in extremis. Sin embargo, hay pocos reportes acerca de la experiencia con su empleo en la actividad eléctrica sin pulso no traumática. Describimos el caso de una paciente obstétrica exanguinada por sangrado masivo transoperatorio, en la que se realizó una TDU con un resultado óptimo para la vida y la función neurológica. Adicionalmente, evaluamos la literatura correspondiente al tema, que en lo mejor de nuestro conocimiento es crítica para expandir los protocolos de abordaje del ritmo de paro cardiaco no traumático en los hospitales de alto volumen.Instituted under objective recommendations, Emergency Department Thoracotomy (EDT) has been described as a life-saving surgical maneuver in trauma patients arriving "in extremis." Nevertheless, there are few reports related to the experience regarding the use of the procedure in non-traumatic cardiopulmonary arrest. We describe the case of an obstetric patient exsanguinated by operative massive bleeding, where EDT was instituted reaching an optimal result for the survival and neurologic function. Additionally, we evaluate the literature related to this issue, which to the best of our knowledge, is critical to expand protocols of approach in non-traumatic cardiac arrest rhythm in high-volume hospitals.


Assuntos
Tratamento de Emergência/métodos , Parada Cardíaca/cirurgia , Toracotomia , Adulto , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/fisiopatologia , Hemorragia/complicações , Humanos , Gravidez , Complicações Hematológicas na Gravidez , Pulso Arterial
10.
A A Pract ; 11(12): 344-347, 2018 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-29965818

RESUMO

A patient recently treated with surgery and radiation for oropharyngeal cancer presented with impending hypoxic respiratory and cardiac arrest in a difficult airway scenario. A CriCath cannula in combination with the Ventrain device and its active expiratory ventilation technology enabled oxygenation and ventilation for 60 minutes until a surgical airway was established. This case report is the first to describe the intended use of Ventrain technology in an emergent "can't ventilate-can't intubate" scenario.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Parada Cardíaca/cirurgia , Intubação Intratraqueal/instrumentação , Idoso , Obstrução das Vias Respiratórias/etiologia , Cânula , Feminino , Parada Cardíaca/etiologia , Humanos , Neoplasias Orofaríngeas/complicações , Respiração Artificial/instrumentação , Resultado do Tratamento
11.
Int J Cardiol ; 269: 23-26, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30057166

RESUMO

OBJECTIVES: Despite numerous advances in the delivery of resuscitative care, cardiac arrest (CA) continues to be associated with high morbidity and mortality. We sought to examine the association between sex and presence of obstructive coronary artery disease (CAD), percutaneous coronary intervention (PCI), and mortality in adults with CA. METHODS: The study population included 208 consecutive patients hospitalized with CA who underwent resuscitation and subsequent coronary angiogram at an academic tertiary medical center. The primary outcome of interest was presence of obstructive CAD, defined as >1 coronary artery with >70% stenosis or >1 coronary bypass graft with >70% stenosis. RESULTS: Of the study population, 150 patients (72%) were men and 58 (28%) were women. Women had a trend toward lower rates of obstructive CAD (69% vs 80%, p = 0.09) and lower rates of multivessel CAD compared to their male counterparts, but no significant difference in rates of PCI (62% vs 53%, p = 0.26). While rates of therapeutic hypothermia and vasopressor requirement were similar in men and women, women were less likely to require percutaneous left ventricular support. In-hospital mortality rates were similar in men and women (23% vs 21%, p = 0.68). In multivariate analysis, sex was not independently associated with obstructive CAD or mortality. CONCLUSIONS: In this observational contemporary study of adults with CA undergoing coronary angiogram, although women had a trend toward lower rates of obstructive CAD, no significant difference in rates of PCI and in-hospital mortality were noted between men and women.


Assuntos
Doença da Artéria Coronariana/mortalidade , Disparidades nos Níveis de Saúde , Parada Cardíaca/mortalidade , Intervenção Coronária Percutânea/mortalidade , Caracteres Sexuais , Idoso , Estudos de Coortes , Angiografia Coronária/mortalidade , Angiografia Coronária/tendências , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Feminino , Parada Cardíaca/diagnóstico por imagem , Parada Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Intervenção Coronária Percutânea/tendências , Estudos Retrospectivos , Resultado do Tratamento
12.
Unfallchirurg ; 121(10): 839-849, 2018 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-29872865

RESUMO

BACKGROUND: The European Resuscitation Council guidelines for resuscitation in patients with traumatic cardiac arrest recommend the immediate treatment of all reversible causes, if necessary even prior to continuous chest compression. In the case of cardiac tamponade immediate emergency thoracotomy should also be considered. OBJECTIVE: The authors report the case of a 23-year-old male patient with multiple injuries including blunt thoracic trauma, which caused a witnessed cardiac arrest. He successfully underwent prehospital emergency resuscitative thoracotomy. The lessons learned from this case on internal and external quality measures are discussed in detail. RESULTS: After 60 min of technical rescue, extensive trauma life support including intubation, chest decompression and bleeding control was carried out. The cardiovascular insufficiency progressively deteriorated and under the suspicion of a cardiac tamponade a prehospital emergency thoracotomy was carried out. After successful resuscitative thoracotomy and return of spontaneous circulation (ROSC) the patient was airlifted to the next level 1 trauma center for damage control surgery (DCS). The patient could be discharged 59 days after the accident and now 2 years later is living a normal life without neurological or cardiopulmonary limitations. Airway management, chest decompression including resuscitative thoracotomy, fluid resuscitation and blood products were the key components to ensure that the patient achieved ROSC. Advanced Trauma Life Support® as well as structural prerequisites made these measures and good results for the patient possible.


Assuntos
Parada Cardíaca/cirurgia , Traumatismo Múltiplo/terapia , Traumatismos Torácicos/cirurgia , Toracotomia/métodos , Ferimentos não Penetrantes/cirurgia , Serviços Médicos de Emergência/métodos , Parada Cardíaca/etiologia , Humanos , Masculino , Traumatismo Múltiplo/complicações , Ressuscitação/métodos , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Adulto Jovem
14.
Ugeskr Laeger ; 180(5)2018 01 29.
Artigo em Dinamarquês | MEDLINE | ID: mdl-29393026

RESUMO

In an advanced emergency medical service all parts of the advanced life support (ALS) algorithm can be provided. This evidence-based algorithm outlines resuscitative efforts for the first 10-15 minutes after cardiac arrest, whereafter the algorithm repeats itself. Restoration of spontaneous circulation fails in most cases, but in some circumstances the patient may benefit from additional interventional approaches, in which case transport to hospital with ongoing cardiopulmonary resuscitation is indicated. This paper has summarized treatments outside the ALS algorithm, which may be beneficial, but are not supported by firm scientific evidence.


Assuntos
Suporte Vital Cardíaco Avançado/métodos , Parada Cardíaca , Corticosteroides/uso terapêutico , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Algoritmos , Reanimação Cardiopulmonar/métodos , Cardioversão Elétrica/métodos , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/tratamento farmacológico , Parada Cardíaca/cirurgia , Parada Cardíaca/terapia , Humanos , Azul de Metileno/uso terapêutico , Intervenção Coronária Percutânea , Propanolaminas/uso terapêutico , Vasoconstritores/uso terapêutico
15.
Rev Colomb Psiquiatr ; 47(1): 65-70, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29428124

RESUMO

INTRODUCTION: Bipolar disorder is a chronic and recurrent mood disease that includes symptoms that fluctuate from euphoria to depression. As a mood disorder, itis one of the main contraindications for transplantation procedures. The case is presented of a patient with bipolar disorder who had a heart transplant after a cardiac arrest. Heart transplantation is the treatment of choice in patients with heart failure and arrhythmias that do not respond to conventional treatment. METHODS: Case report and narrative review of literature. CASE REPORT: A 34-year-old woman with bipolar disorder diagnosed when she was 13, treated with lithium and aripiprazole. She required a heart transplant as the only therapeutic option, after presenting with ventricular tachycardia refractory to conventional treatment. The patient did not suffer an emotional decompensation with the removal of the lithium and aripiprazole that were associated with prolonged QTc interval, and remained eurhythmic throughout the process. DISCUSSION: Heart transplantation can be performed safely and successfully in patients with bipolar disorder, when suitably followed-up by a liaison psychiatry group. CONCLUSIONS: Bipolar disorder should not be considered as an absolute contraindication for heart transplantation.


Assuntos
Transtorno Bipolar/complicações , Parada Cardíaca/cirurgia , Transplante de Coração/métodos , Adulto , Feminino , Humanos
16.
J Vis Exp ; (131)2018 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-29364254

RESUMO

BACKGROUND: Evaluating mild to moderate cognitive impairment in a global cerebral ischemia (i.e. cardiac arrest) model can be difficult due to poor locomotion after surgery. For example, rats who undergo surgical procedures and are subjected to the Morris water maze may not be able to swim, thus voiding the experiment. New Method: We established a modified behavioral spontaneous alternation T-maze test. The major advantage of the modified T-maze protocol is its relatively simple design that is powerful enough to assess functional learning/memory after ischemia. Additionally, the data analysis is simple and straightforward. We used the T-maze to determine the rats' learning/memory deficits both in the presence or absence of mild to moderate (6 min) asphyxial cardiac arrest (ACA). Rats have a natural tendency for exploration and will explore the alternate arms in the T-maze, whereas hippocampal-lesioned rats tend to adopt a side-preference resulting in decreased spontaneous alternation ratios, revealing the hippocampal-related functional learning/memory in the presence or absence of ACA. RESULTS: ACA groups have higher side-preference ratios and lower alternations as compared to control. Comparison with Existing Method(s): The Morris water and Barnes maze are more prominent for assessing learning/memory function. However, the Morris water maze is more stressful than other mazes. The Barnes maze is widely used to measure reference (long-term) memory, while ACA-induced neurocognitive deficits are more closely related to working (short-term) memory. CONCLUSIONS: We have developed a simple, yet effective strategy to delineate working (short-term) memory via the T-maze in our global cerebral ischemia model (ACA).


Assuntos
Parada Cardíaca/fisiopatologia , Transtornos da Memória/diagnóstico , Animais , Parada Cardíaca/diagnóstico , Parada Cardíaca/cirurgia , Masculino , Transtornos da Memória/fisiopatologia , Ratos
17.
Europace ; 20(8): 1362-1366, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29267867

RESUMO

Aim: Although the efficacy of cardiac pacing in patients with neurally mediated syncope (NMS) and documented asystole is established, a more robust point estimate of the benefit, which is not possible with any individual study, is lacking. Methods and results: We undertook a meta-analysis of individual participant data from four studies that reported follow-up data on syncope recurrence with cardiac pacing in patients with NMS who had had an electrocardiographic (ECG) documentation of an asystolic event by means of implantable loop recorder (ILR). Of a total of 1046 patients, who had ILR implanted, 383 (36.6%) patients had an ECG documentation of a diagnostic event during mean follow-up of 13 ± 10 months. Of these, 201 (52%) patients, corresponding to 19.2% of the total ILRs, had an asystolic event of 12.8 ± 11.0 s duration documented and met the criteria for pacemaker therapy. Follow-up was available in 121 (60%) of those patients with asystolic events. Syncope recurred after pacing in 18 (14.9%) patients with an actuarial rate of 13% [95% confidence interval (CI) ±6] at 1 year, 21% (95%CI ±10) at 2 years, and 24% (95%CI ±11) at 3 years. On multivariable Cox regression analysis, positive tilt test response was the only significant predictor of syncope recurrence with a hazard ratio (95% CI) of 4.3 (1.4-13). On the contrary, type of asystolic event (sinus arrest or atrioventricular block), prodrome, cardiac abnormalities, number and duration of history of syncope, age, and gender were not predictors of recurrence of syncope. Conclusion: A long asystolic pause, suitable for pacemaker therapy, was found in one of five patients with ILR. After pacemaker implantation, most of these patients remained free of syncope recurrence for up to 3 years. The benefit of pacemaker was greater in patients with negative tilt test.


Assuntos
Estimulação Cardíaca Artificial , Eletrocardiografia/instrumentação , Parada Cardíaca/cirurgia , Marca-Passo Artificial , Síncope Vasovagal/terapia , Telemetria/instrumentação , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Feminino , Parada Cardíaca/diagnóstico , Parada Cardíaca/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Intervalo Livre de Progressão , Recidiva , Fatores de Risco , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/fisiopatologia , Teste da Mesa Inclinada , Fatores de Tempo , Resultado do Tratamento
18.
Acta Neurochir (Wien) ; 160(2): 393-395, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29248962

RESUMO

A 41-year-old man was diagnosed with chronic pulmonary thromboembolism and underwent pulmonary thromboendarterectomy (PTE) with deep hypothermia and circulatory arrest. Five days after the operation, chorea emerged in the lower extremities. The patient was referred to our hospital for disabling chorea 16 years after PTE. Neurological examination revealed choreatic movements in the four extremities. Brain magnetic resonance images indicated atrophy in the bilateral head of the caudate nuclei. The patient underwent deep brain stimulation (DBS) of the bilateral globus pallidus interna (GPi). Continuous GPi-DBS diminished the choreatic movements. GPi-DBS may be a treatment option for sustained choreatic movements after PTE.


Assuntos
Coreia/terapia , Estimulação Encefálica Profunda , Endarterectomia/efeitos adversos , Globo Pálido/fisiopatologia , Complicações Pós-Operatórias/terapia , Embolia Pulmonar/cirurgia , Adulto , Coreia/etiologia , Parada Cardíaca/complicações , Parada Cardíaca/cirurgia , Humanos , Hipotermia/complicações , Hipotermia/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Embolia Pulmonar/complicações
20.
J Visc Surg ; 154 Suppl 1: S35-S41, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28941568

RESUMO

Resuscitation thoracotomy is a rarely performed procedure whose use, in France, remains marginal. It has five specific goals that correspond point-by-point to the causes of traumatic cardiac arrest: decompression of pericardial tamponade, control of cardiac hemorrhage, performance of internal cardiac massage, cross-clamping of the descending thoracic aorta, and control of lung injuries and other intra-thoracic hemorrhage. This approach is part of an overall Damage Control strategy, with a targeted operating time of less than 60minutes. It is indicated for patients with cardiac arrest after penetrating thoracic trauma if the duration of cardio-pulmonary ressuscitation (CPR) is <15minutes, or <10minutes in case of closed trauma, and for patients with refractory shock with systolic blood pressure <65mm Hg. The overall survival rate is 12% with a 12% incidence of neurological sequelae. Survival in case of penetrating trauma is 10%, but as high as 20% in case of stab wounds, and only 6% in case of closed trauma. As long as the above-mentioned indications are observed, resuscitation thoracotomy is fully justified in the event of an afflux of injured victims of terrorist attacks.


Assuntos
Parada Cardíaca/cirurgia , Traumatismos Cardíacos/cirurgia , Técnicas Hemostáticas , Ressuscitação/métodos , Traumatismos Torácicos/cirurgia , Toracotomia , Parada Cardíaca/etiologia , Traumatismos Cardíacos/complicações , Humanos , Traumatismos Torácicos/complicações
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