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1.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(1): 74-78, 2021 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33565405

RESUMO

OBJECTIVE: To explore the effects of necroptosis specific inhibitor-1 (Nec-1) on brain injury in rats after cardiac arrest and its mechanism. METHODS: A total of 24 Sprague-Dawley (SD) rats were divided into Sham group, model group and Nec-1 group (n = 8 per group) according to random number table method. In the Sham group, only general surgical procedures were underdone without inducing cardiac arrest. In the model group, the rats were subjected to asphyxial cardiac arrest followed by cardiopulmonary resuscitation (CPR) at 6 minutes after cardiac arrest. In the Nec-1 group, Nec-1 of 1 mg/kg was administered after cardiac arrest, and CPR was performed at 6 minutes after cardiac arrest. At 72 hours after CPR, neurological deficit scores (NDS) were assessed, serum S100B levels were measured by enzyme linked immunosorbent assay (ELISA), receptor-interacting protein 3 (RIP3) expression in cerebral cortex and hippocampus was observed under immunofluorescence and positive rate was calculated, and the levels of RIP3 protein expression in brain were analyzed by Western blotting. RESULTS: At 72 hours after CPR, the rats in the model group showed obvious necroptosis and injury in brain. Compared with the Sham group, the NDS scores in the model group were significantly decreased [57.0 (52.7, 60.0) vs. 80.0 (80.0, 80.0), P < 0.05], the serum S100B was significantly increased (ng/L: 44.9±4.5 vs. 18.6±1.5, P < 0.05), the percentages of RIP3 positive cells in cerebral cortex and hippocampus were significantly elevated [cerebral cortex: (31.7±4.8)% vs. (11.6±3.2)%, hippocampus: (28.4±0.8)% vs. (10.9±0.6)%, both P < 0.05], and the levels of RIP3 protein expression in brain were significantly increased [RIP3 protein (RIP3/GAPDH): 0.708 (0.642, 0.722) vs. 0.408 (0.253, 0.504), P < 0.05]. After Nec-1 intervention, necroptosis and injury in brain were obviously improved. Compared with the model group, the NDS scores at 72 hours after CPR in the Nec-1 group were significantly increased [70.5 (68.5, 71.7) vs. 57.0 (52.7, 60.0), P < 0.05), the serum S100B was significantly decreased (ng/L: 31.9±2.7 vs. 44.9±4.5, P < 0.05), the percentages of RIP3 positive cells in cerebral cortex and hippocampus were significantly lowered [cerebral cortex: (23.7±4.1)% vs. (31.7±4.8)%,hippocampus: (20.4±0.4)% vs. (28.4±0.8)%, both P < 0.05], and the levels of RIP3 protein expression in brain were significantly declined [RIP3 protein (RIP3/GAPDH): 0.437 (0.379, 0.507) vs. 0.708 (0.642, 0.722), P < 0.05]. CONCLUSIONS: Nec-1 attenuated necroptosis of brain cells by inhibiting the expression of RIP3 protein, so as to reduce brain injury after cardiac arrest in rats.


Assuntos
Lesões Encefálicas , Reanimação Cardiopulmonar , Parada Cardíaca , Animais , Encéfalo , Modelos Animais de Doenças , Parada Cardíaca/complicações , Necroptose , Ratos , Ratos Sprague-Dawley
2.
PLoS One ; 15(12): e0243838, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33362276

RESUMO

BACKGROUND: Little is known of nosocomial infections (NI) in patients who suffer from in-hospital cardiac arrest who undergoing extracorporeal cardiopulmonary resuscitation. This study aimed to investigate clinical pictures of NI, and the association of NIs with clinical outcomes in in-hospital cardiac arrest patients who undergoing extracorporeal cardiopulmonary resuscitation. METHODS: To evaluate the incidence and clinical characteristics of NI in patients who undergoing extracorporeal cardiopulmonary resuscitation, a retrospective cohort study was conducted in a single tertiary referral center between January 2010 and December 2018. We included adult patients who undergoing extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest and excluded patients who were out-of-hospital cardiac arrest or failed ECMO implantation. Clinical characteristics and outcomes were compared between NI and Non-NI patients, or multidrug-resistant (MDR) and non-MDR. The independent risk factors associated with NIs were also analyzed using multivariable logistic regression model. RESULTS: Thirty-five (23.3%) patients developed a NI. These cases included 21 patients with a gram negative (G-) infection, 12 patients with a gram positive (G+) bacterial infection, and two patients with fungal infection. Pneumonia was the most common type of NIs, followed by catheter-related infection. The in-hospital mortality and neurologic outcomes at discharge were not different between the NI and non-NI groups. Multidrug-resistant (MDR) pathogens were detected in 10 cases (28.6%). The MDR NI patients had a higher ICU mortality than did those with non-MDR NI (80% vs. 32%, p = 0.028). Following multivariable adjustment, body mass index (adjusted OR 0.87, 95% CI, 0.77-0.97, p = 0.016) and cardiopulmonary resuscitation to pump on time (adjusted OR 1.04, 95% CI, 1.01-1.06, p = 0.001) were independent predictors of NI development. CONCLUSIONS: In patients who received extracorporeal cardiopulmonary resuscitation, NIs were not associated with an increase in in-hospital mortality. However, NIs with MDR organisms do increase the risk of in-hospital mortality. Lower body mass index and longer low flow time were significant predictors of NI development.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Infecção Hospitalar/complicações , Oxigenação por Membrana Extracorpórea/efeitos adversos , Parada Cardíaca/complicações , Parada Cardíaca/terapia , Idoso , Infecção Hospitalar/mortalidade , Resistência a Múltiplos Medicamentos , Feminino , Parada Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento
3.
Med. intensiva (Madr., Ed. impr.) ; 44(9): 566-576, dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-189899

RESUMO

La pandemia por SARS-CoV-2 ha generado nuevos escenarios que requieren modificaciones de los protocolos habituales de reanimación cardiopulmonar. Las guías clínicas vigentes sobre el manejo de la parada cardiorrespiratoria no incluyen recomendaciones para situaciones aplicables a este contexto. Por ello, el Plan Nacional de Reanimación Cardiopulmonar de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias, en colaboración con el Grupo Español de RCP Pediátrica y Neonatal y con el programa de Enseñanza de Soporte Vital en Atención Primaria de la Sociedad Española de Medicina Familiar y Comunitaria, ha redactado las siguientes recomendaciones, que están divididas en 5 partes que tratan los principales aspectos para cada entorno asistencial. En este artículo se presenta un resumen ejecutivo de las mismas


The SARS-CoV-2 pandemic has created new scenarios that require modifications to the usual cardiopulmonary resuscitation protocols. The current clinical guidelines on the management of cardiorespiratory arrest do not include recommendations for situations that apply to this context. Therefore, the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), in collaboration with the Spanish Group of Pediatric and Neonatal CPR and with the Teaching Life Support in Primary Care program of the Spanish Society of Family and Community Medicine (SEMFyC), have written these recommendations, which are divided into 5 parts that address the main aspects for each healthcare setting. This article consists of an executive summary of them


Assuntos
Humanos , Infecções por Coronavirus/diagnóstico , Reanimação Cardiopulmonar/normas , Reanimação Cardiopulmonar/instrumentação , Parada Cardíaca/complicações , Reação em Cadeia da Polimerase , Sociedades Médicas/normas , Segurança do Paciente , Infecções Respiratórias/prevenção & controle , Infecções Respiratórias/transmissão
4.
Medicine (Baltimore) ; 99(35): e21452, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871868

RESUMO

BACKGROUND: The effectiveness of therapeutic hypothermia (TH) for patients following cardiac arrest with non-shockable rhythm is debated. We plan to conduct a systematic review and meta-analysis with all available randomized controlled trials (RCTs) to explore the efficacy and safety of TH in in this population. METHODS: PubMed, EMBASE and Cochrane Library will be searched to identify RCTs published from inception through December 2020 without language restriction. Patients following cardiac arrest due to non-shockable rhythm will be included. The primary outcome is the hospital mortality. The secondary outcome is the favorable neurological outcome. The pooled effects will be analyzed as mean differences using the inverse-variance method for continuous data or as risk ratios using the Mantel-Haenszel method for dichotomous data. Subgroup and sensitivity analyses will be conducted. The Egger's test and/or the funnel plot will be used to test the publication bias. The grades of recommendation assessment, development, and evaluation (GRADE) methodology will be used to assess the quality of evidence. The trial sequential analysis will be used to test whether the meta-analysis is conclusive. RESULTS: The RCTs on the effectiveness of TH for patients following cardiac arrest with non-shockable rhythm will be systematically reviewed and advance evidence will be provided. CONCLUSION: Advanced evidence of TH for cardiac arrest due to non-shockable rhythm will be provided for physicians. PROSPERO REGISTRATION NUMBER: CRD42020161823.


Assuntos
Parada Cardíaca/complicações , Hipotermia Induzida/métodos , Parada Cardíaca Extra-Hospitalar/etiologia , Parada Cardíaca Extra-Hospitalar/terapia , Mortalidade Hospitalar/tendências , Humanos , Doenças do Sistema Nervoso/epidemiologia , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(33): e21728, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872055

RESUMO

The benefit of any specific target range of blood glucose (BG) for post-cardiac arrest (PCA) care remains unknown.We conducted a multicenter retrospective study of prospectively collected data of all cardiac arrest patients admitted to the ICUs between 2014 and 2015. The main exposure was BG metrics during the first 24 hours, including time-weighted mean (TWM) BG, mean BG, admission BG and proportion of time spent in 4 BG ranges (<= 70 mg/dL, 70-140 mg/dL, 140-180 mg/dL and > 180 mg/dL). The primary outcome was hospital mortality. Multivariable logistic regression, Cox proportion hazard models and generalized estimating equation (GEE) models were built to evaluate the association between the different kinds of BG and hospital mortality.2,028 PCA patients from 144 ICUs were included. 14,118 BG measurements during the first 24 hours were extracted. According to TWM-BG, 9 (0%) were classified into the <= 70 mg/dL range, 693 (34%) into the 70 to 140 mg/dL range, 603 (30%) into the 140 to 180 mg/dL range, and 723 (36%) into the > 180 mg/dL range. Compared with BG 70 to 140 mg/dL range, BG 140 to 180 mg/dL range and > 180 mg/dL range were associated with higher hospital mortality probability. Proportion of time spent in the 70 to 140 mg/dL range was associated with good outcome (odds ratio 0.984, CI [0.970, 0.998], P = .022, for per 5% increase in time), and > 180 mg/dL range with poor outcome (odds ratio 1.019, CI [1.009, 1.028], P< .001, for per 5% increase in time). Results of the 3 kinds of statistical models were consistent.The proportion of time spent in BG range 70 to 140 mg/dL is strongly associated with increased hospital survival in PCA patients. Hyperglycemia (> 180 mg/dL) is common in PCA patients and is associated with increased hospital mortality.


Assuntos
Glicemia , Parada Cardíaca/mortalidade , Síndrome Pós-Parada Cardíaca/mortalidade , Idoso , China/epidemiologia , Feminino , Parada Cardíaca/complicações , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Parada Cardíaca/sangue , Estudos Retrospectivos
7.
J Vis Exp ; (162)2020 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-32925879

RESUMO

Hemorrhage constitutes the majority of potentially preventable deaths from trauma. There is growing interest in endovascular resuscitation techniques such as selective aortic arch perfusion (SAAP) for patients in cardiac arrest. This involves active perfusion of the coronary circulation via a thoracic aortic balloon catheter and is approaching clinical application. However, the technique is complex and requires refinement in animal models before human use can be considered. This paper describes a large animal model of exsanguination cardiac arrest treated with a bespoke SAAP system. Swine were anesthetized, instrumented and a splenectomy was performed before a controlled, logarithmic exsanguination was initiated. Animals were heparinized and the shed blood collected in a reservoir. Once cardiac arrest was observed, the blood was pumped through an extra-corporeal circuit into an oxygenator and then delivered through a 10 Fr balloon catheter placed in the thoracic aorta. This resulted in the return of a spontaneous circulation (ROSC) as demonstrated by ECG and aortic root pressure waveform. This model and accompanying SAAP system allow for standardized and reproducible recovery from exsanguination cardiac arrest.


Assuntos
Aorta Torácica/patologia , Exsanguinação/complicações , Parada Cardíaca/complicações , Perfusão , Anestesia Geral , Animais , Pressão Sanguínea , Artérias Carótidas/patologia , Cistostomia , Modelos Animais de Doenças , Artéria Femoral/patologia , Veia Femoral/patologia , Humanos , Laparotomia , Masculino , Esplenectomia , Suínos
8.
Am J Cardiol ; 133: 15-22, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-32811650

RESUMO

This study sought to evaluate long-term mortality and major adverse cardiac and cerebrovascular events (MACCE) in patients with cardiac arrest (CA) and cardiogenic shock (CS) complicating acute myocardial infarction (AMI). This was a retrospective cohort study using an administrative claims database. AMI patients from January 1, 2010 to May 31, 2018 were stratified into CA + CS, CA only, CS only, and AMI alone cohorts. Outcomes of interest were long-term mortality and MACCE (death, AMI, cerebrovascular accident, unplanned revascularization) in AMI survivors. A total 163,071 AMI patients were included with CA + CS, CA only, and CS only in 2.4%, 5.0%, and 4.0%, respectively. The CA + CS cohort had higher rates of multiorgan failure, mechanical circulatory support use and less frequent coronary angiography use. In-hospital mortality was noted in 10,686 (6.6%) patients - CA + CS (48.8%), CA only (35.9%), CS only (24.1%), and AMI alone (2.9%; p < 0.001). Over 23.5 ± 21.7 months follow-up after hospital discharge, patients with CA + CS (hazard ratio [HR] 1.36 [95% confidence interval {CI} 1.19 to 1.55]), CA only (HR 1.16 [95% CI 1.08 to 1.25]), CS only (HR 1.39 [95% CI 1.29 to 1.50]) had higher all-cause mortality compared with AMI alone (all p < 0.001). Presence of CS, either alone (HR 1.22 [95% CI 1.16 to 1.29]; p < 0.001) or with CA (HR 1.18 [95% CI 1.07 to 1.29]; p < 0.001), was associated with higher MACCE compared with AMI alone. In conclusion, CA + CS, CA, and CS were associated with worse long-term survival. CA and CS continue to influence outcomes beyond the index hospitalization in AMI survivors.


Assuntos
Parada Cardíaca/complicações , Parada Cardíaca/mortalidade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Choque Cardiogênico/complicações , Choque Cardiogênico/mortalidade , Adolescente , Adulto , Idoso , Feminino , Parada Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia , Estudos Retrospectivos , Choque Cardiogênico/terapia , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
Am J Cardiol ; 133: 48-53, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-32798042

RESUMO

Despite current guidelines recommending therapeutic hypothermia (TH) for post cardiac arrest comatose patient, its use remains limited. Randomized controlled trials (RCTs) have also reported conflicting results on the efficacy of TH. Therefore, we conducted an updated meta-analysis to evaluate the effect of TH in post cardiac arrest patients. We searched electronic databases for RCTs comparing TH (32°C to 34°C) with controls (normothermia or temperature ≥36°C) in comatose patients who sustained cardiac arrest. Mortality and neurological outcomes were the outcomes of interest. We used random effect meta-analysis to estimate risk ratio (RR) with 95% confidence interval (CI). Eight RCTs with a total of 2,026 patients (TH n = 1,025 and control n = 1,001) were included. Irrespective of initial rhythm, TH was associated with significant reduction in poor neurological outcomes (RR 0.87, 95% CI 0.77 to 0.98; p = 0.02) without any difference in mortality (RR 0.94, 95% CI 0.85 to 1.03; p = 0.17). In patients with initial shockable rhythm compared with control, TH reduced mortality (RR 0.85, 95% CI 0.73 to 0.99; p = 0.04) and poor neurological outcomes (RR 0.81, 95% CI 0.67 to 0.99; p = 0.04). Whereas, in patients with initial nonshockable rhythm, TH was associated with decreased poor neurological outcomes after excluding one trial (RR 0.95 95% CI 0.91 to 1.00; p = 0.05). In conclusion, TH is associated with improved neurological outcomes in all patients sustaining cardiac arrest and with decreased mortality in patients with initial shockable rhythm.


Assuntos
Parada Cardíaca/terapia , Hipotermia Induzida , Coma/etiologia , Coma/terapia , Parada Cardíaca/complicações , Humanos
10.
Neurology ; 95(5): e563-e575, 2020 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-32661097

RESUMO

OBJECTIVE: To determine cost-effectiveness parameters for EEG monitoring in cardiac arrest prognostication. METHODS: We conducted a cost-effectiveness analysis to estimate the cost per quality-adjusted life-year (QALY) gained by adding continuous EEG monitoring to standard cardiac arrest prognostication using the American Academy of Neurology Practice Parameter (AANPP) decision algorithm: neurologic examination, somatosensory evoked potentials, and neuron-specific enolase. We explored lifetime cost-effectiveness in a closed system that incorporates revenue back into the medical system (return) from payers who survive a cardiac arrest with good outcome and contribute to the health system during the remaining years of life. Good outcome was defined as a Cerebral Performance Category (CPC) score of 1-2 and poor outcome as CPC of 3-5. RESULTS: An improvement in specificity for poor outcome prediction of 4.2% would be sufficient to make continuous EEG monitoring cost-effective (baseline AANPP specificity = 83.9%). In sensitivity analysis, the effect of increased sensitivity on the cost-effectiveness of EEG depends on the utility (u) assigned to a poor outcome. For patients who regard surviving with a poor outcome (CPC 3-4) worse than death (u = -0.34), an increased sensitivity for poor outcome prediction of 13.8% would make AANPP + EEG monitoring cost-effective (baseline AANPP sensitivity = 76.3%). In the closed system, an improvement in sensitivity of 1.8% together with an improvement in specificity of 3% was sufficient to make AANPP + EEG monitoring cost-effective, assuming lifetime return of 50% (USD $70,687). CONCLUSION: Incorporating continuous EEG monitoring into cardiac arrest prognostication is cost-effective if relatively small improvements in sensitivity and specificity are achieved.


Assuntos
Análise Custo-Benefício , Eletroencefalografia/economia , Parada Cardíaca/complicações , Monitorização Neurofisiológica/economia , Monitorização Neurofisiológica/métodos , Algoritmos , Árvores de Decisões , Humanos , Prognóstico , Convulsões/diagnóstico , Convulsões/etiologia , Sensibilidade e Especificidade
11.
Am J Cardiol ; 128: 127-133, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650906

RESUMO

We sought to study the feasibility of axillary artery as alternative access for mechanical circulatory support (MCS) in cardiogenic shock and high-risk percutaneous coronary intervention (HR-PCI) patients with severe occlusive peripheral artery disease (PAD). In patients with severe PAD, the iliofemoral artery may be so diseased preventing deployment of MCS, precluding the use of lifesaving therapy. In such circumstances, the axillary artery may be a viable access site. Records of all patients presenting with cardiogenic shock or HR-PCI requiring MCS through axillary artery access at our institution from January 2016 to September 2018 were examined. Demographics, clinical, procedural, and outcomes data were collected on all patients. A total of 48 patients presented with cardiogenic shock (60%) or HR-PCI (40%) requiring MCS via axillary artery due to prohibitive PAD (mean age 66 ± 11 years). Admission diagnoses were non-ST segment elevation myocardial infarction (38%), unstable angina (23%), ST segment elevation myocardial infarction (19%), and cardiac arrest (21%). Time from axillary access to activation of Impella was 11.9 ± 4 minutes. Four patients required concomitant Impella RP for right ventricular support due to biventricular cardiogenic shock. Twenty-two patients died before Impella was explanted due to multiorgan failure, stroke, and infection. None of the patients who died had vascular complications related to axillary access. Axillary artery appears to be a viable alternative access for large bore devices in patients with prohibitive PAD. As experience of the field with this approach grows, it may be the default access for deployment of large bore sheaths in the future.


Assuntos
Angina Instável/terapia , Artéria Axilar , Parada Cardíaca/terapia , Coração Auxiliar , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Choque Cardiogênico/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angina Instável/complicações , Estudos de Viabilidade , Feminino , Artéria Femoral , Parada Cardíaca/complicações , Humanos , Artéria Ilíaca , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Doença Arterial Periférica/complicações , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Choque Cardiogênico/etiologia , Volume Sistólico , Adulto Jovem
12.
Neurology ; 95(6): e653-e661, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32651293

RESUMO

OBJECTIVE: To determine the additional value of EEG reactivity (EEG-R) testing to EEG background pattern for prediction of good outcome in adult patients after cardiac arrest (CA). METHODS: In this post hoc analysis of a prospective cohort study, EEG-R was tested twice a day, using a strict protocol. Good outcome was defined as a Cerebral Performance Category score of 1-2 within 6 months. The additional value of EEG-R per EEG background pattern was evaluated using the diagnostic odds ratio (DOR). Prognostic value (sensitivity and specificity) of EEG-R was investigated in relation to time after CA, sedative medication, different stimuli, and repeated testing. RESULTS: Between 12 and 24 hours after CA, data of 108 patients were available. Patients with a continuous (n = 64) or discontinuous (n = 19) normal voltage background pattern with reactivity were 3 and 8 times more likely to have a good outcome than without reactivity (continuous: DOR, 3.4; 95% confidence interval [CI], 0.97-12.0; p = 0.06; discontinuous: DOR, 8.0; 95% CI, 1.0-63.97; p = 0.0499). EEG-R was not observed in other background patterns within 24 hours after CA. In 119 patients with a normal voltage EEG background pattern, continuous or discontinuous, any time after CA, prognostic value was highest in sedated patients (sensitivity 81.3%, specificity 59.5%), irrespective of time after CA. EEG-R induced by handclapping and sternal rubbing, especially when combined, had highest prognostic value. Repeated EEG-R testing increased prognostic value. CONCLUSION: EEG-R has additional value for prediction of good outcome in patients with discontinuous normal voltage EEG background pattern and possibly with continuous normal voltage. The best stimuli were clapping and sternal rubbing.


Assuntos
Eletroencefalografia , Parada Cardíaca/epidemiologia , Centros Médicos Acadêmicos/estatística & dados numéricos , Idoso , Analgésicos Opioides/uso terapêutico , Dano Encefálico Crônico/epidemiologia , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/fisiopatologia , Feminino , Parada Cardíaca/complicações , Parada Cardíaca/terapia , Hospitais de Ensino/estatística & dados numéricos , Humanos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Países Baixos/epidemiologia , Estimulação Física , Prognóstico , Estudos Prospectivos , Sensibilidade e Especificidade , Esterno , Resultado do Tratamento , Suspensão de Tratamento
13.
Int Heart J ; 61(4): 795-798, 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32684603

RESUMO

To investigate the association of shock on admission with predicting intensive care unit (ICU) mortality, hospital mortality, and neurological outcomes of post cardiac arrest patients.This was a retrospective study of cardiac arrest (CA) patients admitted to ICU. Student's t test and Chi-square test were performed to compare the difference of non-shock and shock group. Multivariable regression analysis was performed to investigate shock and its association with ICU mortality, hospital mortality, and neurologic outcomes and linear regression analysis to explore its correlation with length of stay in hospital.A total of 374 CA patients were analyzed, with 200 (53.5%) patients in the presence of shock on admission. Shock was significantly associated with higher ICU mortality (OR 2.42, 95% CI 1.60 to 3.68; P < 0.001), hospital mortality (OR 2.33, 95% CI 1.54 to 3.54; P < 0.001), and more unfavorable neurological outcomes (OR 1.98, 95% CI 1.30 to 3.02; P = 0.001). After adjusting for confounding factors, shock was still an independent predictor of ICU mortality (OR 2.40, 95% CI 1.30 to 4.43; P = 0.005).Shock on admission of CA patients was significantly associated with ICU mortality.


Assuntos
Parada Cardíaca/mortalidade , Choque/mortalidade , Idoso , Bélgica/epidemiologia , Feminino , Parada Cardíaca/complicações , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque/etiologia
14.
Neurology ; 95(4): e335-e341, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32482841

RESUMO

OBJECTIVE: To examine the prognostic ability of the combination of EEG and MRI in identifying patients with good outcome in postanoxic myoclonus (PAM) after cardiac arrest (CA). METHODS: Adults with PAM who had an MRI within 20 days after CA were identified in 4 prospective CA registries. The primary outcome measure was coma recovery to command following by hospital discharge. Clinical examination included brainstem reflexes and motor activity. EEG was assessed for best background continuity, reactivity, presence of epileptiform activity, and burst suppression with identical bursts (BSIB). MRI was examined for presence of diffusion restriction or fluid-attenuated inversion recovery changes consistent with anoxic brain injury. A prediction model was developed using optimal combination of variables. RESULTS: Among 78 patients, 11 (14.1%) recovered at discharge and 6 (7.7%) had good outcome (Cerebral Performance Category < 3) at 3 months. Patients who followed commands were more likely to have pupillary and corneal reflexes, flexion or better motor response, EEG continuity and reactivity, no BSIB, and no anoxic injury on MRI. The combined EEG/MRI variable of continuous background and no anoxic changes on MRI was associated with coma recovery at hospital discharge with sensitivity 91% (95% confidence interval [CI], 0.59-1.00), specificity 99% (95% CI, 0.92-1.00), positive predictive value 91% (95% CI, 0.59-1.00), and negative predictive value 99% (95% CI, 0.92-1.00). CONCLUSIONS: EEG and MRI are complementary and identify both good and poor outcome in patients with PAM with high accuracy. An MRI should be considered in patients with myoclonus showing continuous or reactive EEGs.


Assuntos
Eletroencefalografia/métodos , Parada Cardíaca/complicações , Imagem por Ressonância Magnética/métodos , Mioclonia/diagnóstico por imagem , Mioclonia/etiologia , Adulto , Idoso , Feminino , Humanos , Hipóxia-Isquemia Encefálica/complicações , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Mioclonia/fisiopatologia , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos
15.
Lancet Neurol ; 19(7): 611-622, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32562686

RESUMO

More patients are surviving cardiac arrest than ever before; however, the burden now lies with estimating neurological prognoses in a large number of patients who were initially comatose, in whom the ultimate outcome is unclear. Neurologists, neurointensivists, and clinical neurophysiologists must accurately balance the concern that overly conservative prognostication could leave patients in a severely disabled state, with the possibility that inaccurately pessimistic prognostication could lead to the withdrawal of life-sustaining treatment in patients who might otherwise have a good functional outcome. Prognostic tools have improved greatly, including electrophysiological tests, neuroimaging, and chemical biomarkers. Conclusions about the prognosis should be delayed at least 72 h after arrest to allow for the clearance of sedative drugs. Cognitive impairments, emotional problems, and fatigue are common among patients who have survived cardiac arrest, and often go unrecognised despite being related to caregiver burden and a decreased participation in society. Through simple screening, these problems can be identified, and patients can be provided with adequate information and rehabilitation.


Assuntos
Coma/etiologia , Coma/reabilitação , Parada Cardíaca/complicações , Hipóxia Encefálica/etiologia , Hipóxia Encefálica/reabilitação , Lesões Encefálicas/etiologia , Lesões Encefálicas/reabilitação , Humanos , Prognóstico
16.
Fetal Pediatr Pathol ; 39(3): 263-268, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32401577

RESUMO

Background: Cardiac damage is frequently referred to in patients with SARS-CoV-2, is usually diagnosed by enzyme elevations, and is generally thought to be due to underlying coronary artery disease. There are references to cardiomyopathies accompanying coronavirus, but there has been no histologic confirmation.Case report: A previously healthy 17 year male old presented in full cardiac arrest to the emergency department after a 2 day history of headache, dizziness, nausea and vomiting. Autopsy demonstrated an enlarged flabby heart with eosinophilic myocarditis. There was no interstitial pneumonia or diffuse alveolar damage. Postmortem nasopharyngeal swabs detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) known to cause coronavirus disease 2019 (COVID-19). No other cause for the eosinophilic myocarditis was elucidated.Conclusion: Like other viruses, SARS-CoV-2 may be associated with fulminant myocarditis.


Assuntos
Infecções por Coronavirus/mortalidade , Eosinofilia/mortalidade , Miocardite/mortalidade , Miocardite/virologia , Pneumonia Viral/mortalidade , Adolescente , Betacoronavirus , Infecções por Coronavirus/complicações , Eosinofilia/complicações , Evolução Fatal , Parada Cardíaca/complicações , Parada Cardíaca/virologia , Humanos , Masculino , Miocardite/complicações , Pandemias , Pneumonia Viral/complicações
17.
PLoS One ; 15(5): e0232984, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32396569

RESUMO

BACKGROUND: Cardiac arrest is rare in pregnancy, and up-to date competence can be difficult to assess and maintain. The objective of this study was to develop and validate a questionnaire to assess healthcare personnel experiences, self-assessed competence and perception of role and resposibility related to cardiac arrest and cardio-pulmonary resuscitation (CPR) in pregnancy. METHODS: The study had a cross-sectional design, developing and validating a questionnaire: the Competence in cardiac arrest and CPR in pregnancy (ComCA-P). Development and validation of the ComCA-P was conducted in three stages: 1) Literature review and expert group panel inputs, 2) a pilot study and 3) a cross-sectional questionnaire study. In stage one, the ComCA-P was developed over several iterations between the researchers, including inputs from an expert group panel consisting of highly competent professionals (n = 11). In stage two, the questionnaire was piloted in a group of healthcare personnel with relevant competence (n = 16). The ComCA-P was then used in a baseline study including healthcare personnel potentially involved in CPR in pregnancy (n = 527) in six hospital wards. Based on these data, internal consistency, intra-class correlations, and confirmatory factor analysis were utilized to validate the questionnaire. RESULTS: The expert group and pilot study participants evaluated the appropriateness, relevance and accuracy to be high. Formulation of the items was considered appropriate, with no difficulties identified related to content- or face validity. Cronbach's alpha was 0.8 on the thematic area self-assessment, and 0.73 on the theoretical knowledge area of the ComCA-P. On both the self-assessed competence items and the teoretical knowledge items, Kaiser-Meyer-Olkin was 0.8. Moreover, the Bertletts' test of sphericity was greater than the critical value for chi-square, and significant (p < .0001). CONCLUSIONS: Findings indicate that the ComCA-P is a valid questionnaire that can be used to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy.


Assuntos
Reanimação Cardiopulmonar/normas , Competência Clínica , Parada Cardíaca/complicações , Parada Cardíaca/terapia , Complicações Cardiovasculares na Gravidez/terapia , Reanimação Cardiopulmonar/métodos , Cesárea , Estudos Transversais , Prova Pericial , Análise Fatorial , Estudos de Viabilidade , Feminino , Pessoal de Saúde , Humanos , Projetos Piloto , Gravidez , Reprodutibilidade dos Testes , Inquéritos e Questionários
18.
Clin Med (Lond) ; 20(4): e66-e71, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32430344

RESUMO

BACKGROUND: COVID-19 poses many challenges to healthcare systems and workers. Responding to medical emergencies in patients with suspected COVID-19 will require new guidelines and protocols. Simulation can support their development. METHODS: We organised seven simulations involving patients with suspected COVID-19 for staff at Brighton and Sussex University Hospitals. Participants completed pre- and post-simulation questionnaires. RESULTS: Fifty-six staff participated and they reported being significantly less prepared to respond to an emergency in a patient with suspected COVID-19 than in one in whom it is not suspected. The simulations significantly improved the participants' confidence in responding to emergencies in patients with suspected COVID-19. Numerous challenges were identified along the themes of equipment, personnel, communication and procedures. CONCLUSIONS: Low-fidelity simulation can provide relevant and timely information on how prepared health systems and their workforce are to respond to emergencies. We urge NHS trusts nationally to implement simulations to identify problems and develop effective solutions.


Assuntos
Infecções por Coronavirus/complicações , Parada Cardíaca/complicações , Parada Cardíaca/terapia , Pneumonia Viral/complicações , Autoeficácia , Treinamento por Simulação/métodos , Idoso , Comunicação , Emergências , Humanos , Masculino , Pandemias , Simulação de Paciente , Equipamento de Proteção Individual , Projetos Piloto , Inquéritos e Questionários
19.
Med. intensiva (Madr., Ed. impr.) ; 44(4): 233-228, mayo 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-190575

RESUMO

OBJETIVO: Los valores de capnometría durante la resucitación son un factor predictor de la evolución de los riñones obtenidos a partir de donantes en asistolia no controlada. DISEÑO: Cohorte de comienzo retrospectivo de 37 donantes en asistolia y cohorte de validación de 55 trasplantados de riñón, entre 2013-2017. Ámbito: Población atendida por el servicio de urgencias y derivada al Hospital Universitario 12 de Octubre, Madrid, como potenciales donantes en asistolia no controlada. PACIENTES: Cincuenta y cinco trasplantados renales con hemodiálisis, procedentes de donantes en asistolia no controlada. INTERVENCIONES: Determinaciones de capnometría y capnografía en pacientes candidatos a donación en asistolia no controlada. Variables: Calores de capnometría inicial y en el momento de la transferencia en el hospital para su comparación con la viabilidad de los riñones extraídos; fallo renal y retraso en función renal. RESULTADOS: Treinta y siete potenciales donantes de los que se consiguen 30 utilizados, de los cuales se trasplantan 55 riñones. El resto de ellos fueron descartados por mala perfusión o signos de isquemia. Se encontró una asociación (p = 0,016) entre valores de capnometría durante la resucitación en los donantes utilizados (μ, = 22,8 mmHg) frente a los donantes no utilizados para el trasplante (μ, = 17,35 mmHg). CONCLUSIONES: Se ha demostrado que los valores de capnometría durante las maniobras de resucitación ofrecen un marcador a tener en cuenta en relación con la viabilidad de los órganos a trasplantar en la donación en asistolia no controlada


OBJECTIVE: The capnometry values during resuscitation are an evolutive predictor of kidneys obtained from uncontrolled non-heart beating donors. DESIGN: The study comprised a retrospective onset cohort of 37 non-heart beating donors and a validation cohort of 55 trasplanted kidneys in the period 2013-2017. Scope: The population served by the emergency service and referred to Hospital Universitario Doce de Octubre (Madrid, Spain) as potential uncontrolled non-heart beating donors. PATIENTS: A total of 55 renal transplant patients subjected to hemodialysis and with grafts from uncontrolled non-heart beating donors. INTERVENTIONS: Capnometry and capnography measurements in potential uncontrolled non-heart beating donors. Variables: Capnometry values recorded initially and at transfer in hospital for comparison with the viability of the extracted kidneys; renal failure and delayed renal function. RESULTS: A total of 55 out of 74 extracted kidneys were trasplanted (74.3%). The rest were ruled out due to poor perfusion or signs of ischemia. An association was observed (P = .016) between the capnometry values during resuscitation in the grafted kidneys (μ = 22.8 mmHg) and in the kidneys discarded for transplantation (μ = 17.35 mmHg). CONCLUSIONS: Capnometry during resuscitation serves as a marker to be taken into account in relation to the viability of the trasplanted organs in uncontrolled non-heart beating donors


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Transplante de Rim , Parada Cardíaca/complicações , Doadores de Tecidos , Estudos de Coortes , Reanimação Cardiopulmonar , Estudos Retrospectivos , Análise Estatística
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