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1.
Medicine (Baltimore) ; 99(5): e19070, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000456

RESUMO

RATIONALE: Extracorporeal membrane oxygenation (ECMO) in multiple trauma patients with post-traumatic respiratory failure can be quite challenging because of the need for systemic anticoagulation, which may lead to excessive bleeding. In the last decade, there is a growing body of evidence that veno-venous ECMO (VV-ECMO) is lifesaving in multiple trauma patients with acute respiratory distress syndrome, thanks to technical improvements in ECMO devices. PATIENT CONCERNS: We report a case of a 17-year-old multiple trauma patient who was drunken and had confused mentality. DIAGNOSES: She was suffered from critical respiratory failure (life-threatening hypoxemia and severe hypercapnia/acidosis lasting for 70 minutes) accompanied by cardiac arrest and trauma-induced coagulopathy during general anesthesia. INTERVENTIONS: We decided to start heparin-free VV-ECMO after cardiac arrest considering risk of hemorrhage. OUTCOMES: She survived with no neurologic sequelae after immediate treatment with heparin-free VV-ECMO. LESSONS: Heparin-free VV-ECMO can be used as a resuscitative therapy in multiple trauma patients with critical respiratory failure accompanied by coagulopathy. Even in cases in which life-threatening hypoxemia and severe hypercapnia/acidosis last for >1 hours during CPR for cardiac arrest, VV-ECMO could be considered a potential lifesaving treatment.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Traumatismo Múltiplo/terapia , Adolescente , Transtornos da Coagulação Sanguínea/terapia , Feminino , Parada Cardíaca/terapia , Humanos , Síndrome do Desconforto Respiratório do Adulto/terapia
2.
Crit Care Resusc ; 22(1): 26-34, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32102640

RESUMO

BACKGROUND: Patients with prolonged cardiac arrest that is not responsive to conventional cardiopulmonary resuscitation have poor outcomes. The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest has shown promising results in carefully selected cases. We sought to validate the results from an earlier extracorporeal cardiopulmonary resuscitation (ECPR) study (the CHEER trial). METHODS: Prospective, consecutive patients with refractory in-hospital (IHCA) or out-of-hospital cardiac arrest (OHCA) who met predefined inclusion criteria received protocolised care, including mechanical cardiopulmonary resuscitation, initiation of ECMO, and early coronary angiography (if an acute coronary syndrome was suspected). RESULTS: Twenty-five patients were enrolled in the study (11 OHCA, 14 IHCA); the median age was 57 years (interquartile range [IQR], 39-65 years), and 17 patients (68%) were male. ECMO was established in all patients, with a median time from arrest to ECMO support of 57 minutes (IQR, 38-73 min). Percutaneous coronary intervention was performed on 18 patients (72%). The median duration of ECMO support was 52 hours (IQR, 24-108 h). Survival to hospital discharge with favourable neurological recovery occurred in 11/25 patients (44%, of which 72% had IHCA and 27% had OHCA). When adjusting for lactate, arrest to ECMO flow time was predictive of survival (odds ratio, 0.904; P = 0.035). CONCLUSION: ECMO for refractory cardiac arrest shows promising survival rates if protocolised care is applied in conjunction with predefined selection criteria.


Assuntos
Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/terapia , Reperfusão Miocárdica , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Reanimação Cardiopulmonar/mortalidade , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Parada Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
3.
Arch. bronconeumol. (Ed. impr.) ; 56(1): 23-27, ene. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186462

RESUMO

Introducción: El objetivo del estudio es evaluar las modificaciones del riesgo de mortalidad y morbilidad cardiorrespiratoria calculada mediante los modelos de riesgo Eurolung 1 y 2 en los últimos 20 años para identificar variaciones en la selección de los pacientes o en la práctica quirúrgica que hayan conducido a cambios en el riesgo de muerte y complicaciones tras resecciones anatómicas pulmonares. Método: Análisis retrospectivo de una serie de 2435 casos consecutivos sometidos a resección pulmonar anatómica. La población fue dividida en tres períodos de tiempo: 1994-2006 (976 casos), 2007-2015 (945 casos) y 2016-2017 (420 casos). Se aplicaron los modelos Eurolung 1 y 2 a la serie y se calculó la probabilidad individual de efectos adversos. Se comparó dicha probabilidad media, así como la prevalencia o las medias de cada una de las variables que constituyen los modelos en cada período y se representó gráficamente la evolución del riesgo. Resultados: Se observó un descenso progresivo de ambos efectos adversos a lo largo del tiempo. La prevalencia de las variables binarias, excepto enfermedad coronaria, fue mayor en el último período. El porcentaje de neumonectomías y de resecciones ampliadas descendió en los dos últimos períodos y el número de casos abordados por VATS se incrementó considerablemente en 2016-2017. Conclusiones: El descenso del número de neumonectomías y el incremento de la tasa de procedimientos mínimamente invasivos se consideran las variables más relacionadas con la disminución del riesgo. Otros cambios en las características clínicas de los pacientes no parecen haber influido en los resultados


Introduction: The aim of this study is to evaluate changes in the risk of cardiorespiratory mortality and morbidity calculated by Eurolung risk models 1 and 2 in the last 20 years, and to identify variations in patient selection or surgical practice that might have altered the risk of death and complications after anatomical lung resections. Method: This was a retrospective analysis of a series of 2,435 consecutive patients who underwent anatomical lung resection. The population was divided into three time periods: 1994-2006 (976 cases), 2007-2015 (945 cases), and 2016-2017 (420 cases). Eurolung models 1 and 2 were applied to the series, and the individual probability of adverse effects was calculated. We compared this mean probability, and the prevalence or means of each of the variables included in the models in each period and plotted the evolution of the risk. Results: A progressive decrease was observed in both adverse effects over time. The prevalence of the binary variables, except for coronary heart disease, was higher in the last period. The percentage of pneumonectomies and extended resections fell in the last two periods and the number of cases treated with VATS increased substantially in 2016-2017. Conclusions: The decline in the number of pneumonectomies and the increase in the rate of minimally invasive procedures appear to be the variables most closely associated with decreased risk. Other changes in the clinical characteristics of the patients do not seem to have influenced the outcomes


Assuntos
Humanos , Gestão de Riscos , Medição de Risco/métodos , Neoplasias Pulmonares/epidemiologia , Pneumonectomia/métodos , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Indicadores de Morbimortalidade , Estudos Retrospectivos , Parada Cardíaca/terapia , Complicações Pós-Operatórias/mortalidade
6.
J Surg Res ; 246: 544-549, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31635832

RESUMO

BACKGROUND: Teamwork is a critical element of trauma resuscitation. Assessment tools such as T-NOTECHS (Trauma NOn-TECHnical Skills) exist, but correlation with patient outcomes is unclear. Using emergency department thoracotomy (EDT), we sought to describe T-NOTECHS scores during resuscitations. We hypothesized that patients undergoing EDT whose resuscitations had better scores would be more likely to have return of spontaneous circulation (ROSC). METHODS: Continuously recording video was used to review all captured EDTs over a 24-mo period. We used a modification of the validated T-NOTECHS instrument to measure five domains on a 3-point scale (1 = best, 2 = average, 3 = worst). A total T-NOTECHS score was calculated by one of three reviewers. The primary outcome was ROSC. ROSC was defined as an organized rhythm no longer requiring internal cardiac compressions. Associations between variables and ROSC were examined using univariate regression. RESULTS: Sixty-one EDTs were captured. Nineteen patients had ROSC (31%) and 42 (69%) did not. The median T-NOTECHS score for all resuscitations was 8 [IQR 6-10]. As demographic and injury data (age, gender, mechanism, signs of life) were not associated with ROSC in univariate analysis, they were not considered for inclusion in a multivariable regression model. The association between overall T-NOTECHS score and ROSC did not reach statistical significance, but examination of the individual components of the T-NOTECHS score demonstrated that, compared to resuscitations that had "average" (2) or "worst" (3) scores on "Assessment and Decision Making," resuscitations with a "best" score were 5 times more likely to lead to ROSC. CONCLUSIONS: Although the association between overall T-NOTECHS scores and ROSC did not reach statistical significance, better scores in the domain of assessment and decision making are associated with improved rates of ROSC in patients arriving in cardiac arrest who undergo EDT. LEVEL OF EVIDENCE: Level IV Therapeutic/Care Management.


Assuntos
Tomada de Decisão Clínica/métodos , Parada Cardíaca/terapia , Equipe de Assistência ao Paciente/organização & administração , Gravação em Vídeo , Ferimentos e Lesões/terapia , Adulto , Competência Clínica , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Pennsylvania , Ressuscitação/métodos , Toracotomia/métodos , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico
7.
J Surg Res ; 246: 6-18, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31541709

RESUMO

BACKGROUND: Remote ischemic postconditioning (RIPost) has been shown to reduce the ischemia-reperfusion injury of the heart and brain. However, the protection mechanisms have not yet been fully elucidated. We have observed that RIPost could alleviate the brain injury after cardiac arrest (CA). The aim of this study was to explore whether α7 nicotinic acetylcholine receptor (α7nAChR) mediates the neuroprotection of RIPost in a rat model of asphyxial CA. MATERIALS AND METHODS: Asphyxial CA model was induced by occlusion of the tracheal tube for 8 min and resuscitated later. RIPost produced by three cycles of 15-min occlusion and 15-min release of the right hind limb by a tourniquet was performed respectively at the moment and the third hour after restoration of spontaneous circulation. The α7nAChR agonist PHA-543613 and the antagonist methyllycaconitine (MLA) were used to investigate the role of α7nAChR in mediating neuroprotective effects. RESULTS: Results showed that α7nAChR was decreased in hippocampus and cortex after resuscitation, whereas RIPost could attenuate the reduction. The use of PHA-543613 provided neuroprotective effects against cerebral injury after CA. Furthermore, RIPost decreased the levels of neuron-specific enolase, inflammatory mediators, the number of apoptotic cells, and phosphorylation of nuclear factor-κB while increased the phosphorylation of signal transducer and activator of transcription-3. However, the above effects of RIPost were attenuated by α7nAChR antagonist methyllycaconitine. CONCLUSIONS: Neuroprotection of RIPost was related with the activation of α7nAChR, which could suppress nuclear factor-κB and activate signal transducer and activator of transcription-3 in a rat asphyxial CA model.


Assuntos
Parada Cardíaca/terapia , Hipóxia Encefálica/terapia , Pós-Condicionamento Isquêmico , Neuroproteção/fisiologia , Receptor Nicotínico de Acetilcolina alfa7/metabolismo , Aconitina/análogos & derivados , Aconitina/farmacologia , Animais , Asfixia/complicações , Compostos Bicíclicos Heterocíclicos com Pontes/farmacologia , Modelos Animais de Doenças , Parada Cardíaca/etiologia , Hipocampo/irrigação sanguínea , Hipocampo/patologia , Humanos , Hipóxia Encefálica/etiologia , Hipóxia Encefálica/patologia , Masculino , NF-kappa B/metabolismo , Neuroproteção/efeitos dos fármacos , Quinuclidinas/farmacologia , Ratos , Fator de Transcrição STAT3/metabolismo , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/fisiologia , Resultado do Tratamento , Receptor Nicotínico de Acetilcolina alfa7/agonistas , Receptor Nicotínico de Acetilcolina alfa7/antagonistas & inibidores
9.
Scand J Trauma Resusc Emerg Med ; 27(1): 116, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881900

RESUMO

BACKGROUND: Cardiopulmonary resuscitation is the most urgent and critical step in the rescue of patients with cardiac arrest. However, only about 10% of patients with out-of-hospital cardiac arrest survive to discharge. Surprisingly, there is growing evidence that open-chest cardiopulmonary resuscitation is superior to closed-chest cardiopulmonary resuscitation. Meanwhile, The Western Trauma Association and The European Resuscitation Council encouraged thoracotomy in certain circumstances for trauma patients. But whether open-chest cardiopulmonary resuscitation is superior to closed-chest cardiopulmonary resuscitation remains undetermined. Therefore, the aim of this study was to summarize current studies on open-chest cardiopulmonary resuscitation in a systematic review, comparing it to closed-chest cardiopulmonary resuscitation, in a meta-analysis. METHODS: In this systematic review and meta-analysis, we searched the PubMed, EmBase, Web of Science, and Cochrane Library databases from inception to May 2019 investigating the effect of open-chest cardiopulmonary resuscitation and closed-chest cardiopulmonary resuscitation in patients with cardiac arrest, without language restrictions. Statistical analysis was performed using Stata 12.0 software. The primary outcome was return of spontaneous circulation. The secondary outcome was survival to discharge. RESULTS: Seven observational studies were eligible for inclusion in this meta-analysis involving 8548 patients. No comparative randomized clinical trial was reported in the literature. There was no significant difference in return of spontaneous circulation and survival to discharge between open-chest cardiopulmonary resuscitation and closed-chest cardiopulmonary resuscitation in cardiac arrest patients. The odds ratio (OR) were 0.92 (95%CI 0.36-2.31, P > 0.05) and 0.54 (95%CI 0.17-1.78, P > 0.05) for return of spontaneous circulation and survival to discharge, respectively. Subgroup analysis of cardiac arrest patients with trauma showed that closed-chest cardiopulmonary resuscitation was associated with higher return of spontaneous circulation compared with open-chest cardiopulmonary resuscitation (OR = 0.59 95%CI 0.37-0.94, P < 0.05). And subgroup analysis of cardiac arrest patients with non-trauma showed that open-chest cardiopulmonary resuscitation was associated with higher ROSC compared with closed-chest cardiopulmonary resuscitation (OR = 3.12 95%CI 1.23-7.91, P < 0.05). CONCLUSIONS: In conclusion, for patients with cardiac arrest, we should implement closed-chest cardiopulmonary resuscitation as soon as possible. However, for cardiac arrest patients with chest trauma who cannot perform closed-chest cardiopulmonary resuscitation, open-chest cardiopulmonary resuscitation should be implemented as soon as possible.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Parada Cardíaca/mortalidade , Humanos
10.
Scand J Trauma Resusc Emerg Med ; 27(1): 113, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842931

RESUMO

BACKGROUND: To date, the decision to set up therapeutic extra-corporeal life support (ECLS) in hypothermia-related cardiac arrest is based on the potassium value only. However, no information is available about how the analysis should be performed. Our goal was to compare intra-individual variation in serum potassium values depending on the sampling site and analytical technique in hypothermia-related cardiac arrests. METHODS: Adult patients with suspected hypothermia-related refractory cardiac arrest, admitted to three hospitals with ECLS facilities were included. Blood samples were obtained from the femoral vein, a peripheral vein and the femoral artery. Serum potassium was analysed using blood gas (BGA) and clinical laboratory analysis (CL). RESULTS: Of the 15 consecutive patients included, 12 met the principal criteria, and 5 (33%) survived. The difference in average potassium values between sites or analytical method used was ≤1 mmol/L. The agreement between potassium values according to the three different sampling sites was poor. The ranges of the differences in potassium using BGA measurement were - 1.6 to + 1.7 mmol/L; - 1.18 to + 2.7 mmol/L and - 0.87 to + 2 mmol/L when comparing respectively central venous and peripheral venous, central venous and arterial, and peripheral venous and arterial potassium. CONCLUSIONS: We found important and clinically relevant variability in potassium values between sampling sites. Clinical decisions should not rely on one biological indicator. However, according to our results, the site of lowest potassium, and therefore the preferred site for a single potassium sampling is central venous blood. The use of multivariable prediction tools may help to mitigate the risks inherent in the limits of potassium measurement. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03096561.


Assuntos
Testes Diagnósticos de Rotina/normas , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Hipotermia/complicações , Potássio/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Gasometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Deficiência de Potássio , Estudos Prospectivos
11.
Undersea Hyperb Med ; 46(5): 633-634, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683361

RESUMO

A 54-year-old man suffered a leg cramp while diving in the ocean at a depth of 20 meters. He began to surface, with his ascent based on a decompression table. He lost consciousness at the surface and was rescued by a nearby boat. The boat staff judged him to be in cardiac arrest, so they performed chest compressions. When the boat reached port where an ambulance was waiting, emergency medical technicians confirmed that the patient was in cardiac arrest; his initial rhythm was asystole. Treated with basic life support, the patient was then transported to a rendezvous point, where a physician-staffed helicopter waited. The patient remained in cardiac arrest, so the staff of the helicopter performed tracheal intubation with mechanical ventilation, securing a venous route, infusion of adrenaline, and mechanical chest compression. On arrival at our hospital 100 minutes after collapse, he remained in cardiac arrest. Continued advanced cardiac life support failed to obtain spontaneous circulation. Whole-body computed tomography (CT) at 120 minutes after the collapse showed multiple gas bubbles in the heart, aorta, inferior vena cava, cerebral artery, coronary artery and portal vein with lung edema. This is the first case to show gas in the bilateral coronary arteries on CT. The present case clearly demonstrates that decompression sickness can also induce acute coronary syndrome.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Doença da Descompressão/complicações , Embolia Aérea/diagnóstico por imagem , Síndrome Coronariana Aguda/etiologia , Aorta/diagnóstico por imagem , Reanimação Cardiopulmonar/métodos , Mergulho/efeitos adversos , Embolia Aérea/etiologia , Evolução Fatal , Coração/diagnóstico por imagem , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
12.
Orv Hetil ; 160(46): 1840-1844, 2019 11.
Artigo em Húngaro | MEDLINE | ID: mdl-31707816

RESUMO

Long term survival of successfully resuscitated patients is primarily determined by their post-cardiac arrest neurological function. If the patient undergoes a long-term resuscitation or remains comatose as part of the post-cardiac arrest syndrome (PCAS), organ-specific intensive care is urged to aim hemodynamic stabilisation, normalisation of organ perfusion and prevention of injuries at cellular level. One of the basic measures of PCAS intensive care is to prevent hypoxic brain injury by mild therapeutic hypothermia (THT). The physiological changes of the human body at hypothermic conditions require high level monitoring and specially focused intensive care limiting its implementation. The multicentric, controlled, randomized targeted temperature management (TTM) trial published in 2013 compared the TTM against the THT in the treatment of PCAS patients. The equal outcome of the 2 methods has partly changed the practice of the intensivists in the treatment of such patients. This manuscript gives the pros and cons for each therapeutic method in post-resuscitation therapy. Nevertheless, the author shows the possible implementations and the DRG (diagnosis-related group) reimbursement of the method in Hungary. Orv Hetil. 2019; 160(46): 1840-1844.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca/terapia , Hipotermia Induzida/métodos , Hipóxia Encefálica/prevenção & controle , Neuroproteção , Humanos , Hungria , Ressuscitação
13.
Orv Hetil ; 160(46): 1832-1839, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31707820

RESUMO

Post-resuscitation brain injury forms the leading cause of death of patients after successful cardiopulmonary resuscitation that explains why post-resuscitation neuroprotection is the most important part of post-resuscitation therapy. The goals of the neuroprotection tools available today are preventing the evolution of primary and formation of secondary brain injury. We are going to summarize the neuroprotective possibilities that we can reach today. We will discuss the role of pharmacologic strategies including sedation, the modalities of upholding brain perfusion, the monitoring of proper hemodynamic variables and the practice of targeted temperature management. It is very important to avoid hypo- and hyperoxia, to keep normocapnia, normoglycemia and to control seizures during the management of post-cardiac arrest patients. There is still a lack of evidence to prove which pharmacologic agent may be effective in postresuscitation neuroprotection, however, there are some promising results regarding thiamine. Hemodynamic management guided by higher level hemodynamic monitoring may be beneficial in enhancing brain perfusion but more clinical studies are needed to investigate its usefulness. Targeted temperature management constitutes the main element of post-resuscitation neuroprotection, however, the details of its implementation raise several questions. Orv Hetil. 2019; 160(46): 1832-1839.


Assuntos
Lesões Encefálicas/prevenção & controle , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Hipotermia Induzida/métodos , Neuroproteção , Parada Cardíaca/complicações , Humanos , Fármacos Neuroprotetores/uso terapêutico
14.
Medicine (Baltimore) ; 98(45): e17853, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702646

RESUMO

BACKGROUND: The recommended chest compression technique for a single rescuer performing infant cardiopulmonary resuscitation is the two-finger technique. For 2 rescuers, a two-thumb-encircling hands technique is recommended. Several recent studies have reported that the two-thumb-encircling hands technique is more effective for high-quality chest compression than the two-finger technique for a single rescuer performing infant cardiopulmonary resuscitation. We undertook a systematic review and meta-analysis of infant manikin studies to compare two-thumb-encircling hands technique with two-finger technique for a single rescuer. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library for eligible randomized controlled trials published prior to December 2017, including cross-over design studies. The primary outcome was the mean difference in chest compression depth (mm). The secondary outcome was the mean difference in chest compression rate (counts/min). A meta-analysis was performed using Review Manager (version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). RESULTS: Six studies that had reported data concerning both chest compression depth and chest compression rate were included. The two-thumb-encircling hands technique was associated with deeper chest compressions compared with two-finger technique for mean chest compression depth (mean difference, 5.50 mm; 95% confidence interval, 0.32-10.69 mm; P = .04), but no significant difference in the mean chest compression rate (mean difference, 7.89 counts/min; 95% confidence interval, to 0.99, 16.77 counts/min; P = .08) was noted. CONCLUSION: This study indicates that the two-thumb-encircling hands technique is a more appropriate technique for a single rescuer to perform high-quality chest compression in consideration of chest compression depth than the two-finger technique in infant manikin studies.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Feminino , Dedos , Humanos , Lactente , Masculino , Manequins , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
J Interv Cardiol ; 2019: 1686350, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31772514

RESUMO

Objectives: (1) To examine the incidence and outcomes of in-hospital cardiac arrests (IHCAs) in a large unselected patient population who underwent coronary angiography at a single tertiary academic center and (2) to evaluate a transitional change in which the cardiologist is positioned as the cardiopulmonary resuscitation (CPR) leader in the cardiac catheterization laboratory (CCL) at our local tertiary care institution. Background: IHCA is a major public health concern with increased patient morbidity and mortality. A proportion of all IHCAs occurs in the CCL. Although in-hospital resuscitation teams are often led by an Intensive Care Unit- (ICU-) trained physician and house staff, little is known on the role of a cardiologist in this setting. Methods: Between 2012 and 2016, a single-center retrospective cohort study was performed examining 63 adult patients (70 ± 10 years, 60% males) who suffered from a cardiac arrest in the CCL. The ICU-led IHCAs included 19 patients, and the Coronary Care Unit- (CCU-) led IHCAs included 44 patients. Results: Acute coronary syndrome accounted for more than 50% of cardiac arrests in the CCL. Pulseless electrical activity was the most common rhythm requiring chest compression, and cardiogenic shock most frequently initiated a code blue response. No significant differences were observed between the ICU-led and CCU-led cardiac arrests in terms of hospital length of stay and 1-year survival rate. Conclusion: In the evolving field of Critical Care Cardiology, the transition from an ICU-led to a CCU-lead code blue team in the CCL setting may lead to similar short-term and long-term outcomes.


Assuntos
Cateterismo Cardíaco , Reanimação Cardiopulmonar , Unidades de Cuidados Coronarianos , Parada Cardíaca/terapia , Síndrome Coronariana Aguda/epidemiologia , Idoso , Estudos de Coortes , Angiografia Coronária , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Estudos Retrospectivos
16.
J Interv Cardiol ; 2019: 6303978, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31772537

RESUMO

Rapid defibrillation and high-quality cardiopulmonary resuscitation (CPR) are necessary for patients with cardiopulmonary arrest, one of the most serious and frequently encountered complications in cardiac catheterization laboratories. However, when the catheterization table is withdrawn from its neutral position for fluoroscopy, it is unstable and unsuitable for resuscitation because of its cantilever structure. To stabilize the table in its withdrawn position, the use of a table-stabilizing stick might improve CPR quality. To investigate the effect of using a cardiac catheterization table-stabilizing stick on CPR quality, a CPR simulation mannequin was placed on a cardiac catheterization table that was withdrawn from the C-arm of the X-ray machine. CPR quality was assessed with or without the use of a table-stabilizing stick under the table. The CPR quality assessment (Q-CPR) scores were 79.6 ± 11.4% using the table-stabilizing stick and 47.7 ± 30.3% without the use of the stick device (p = 0.02). In this simulation-based study, the use of a table-stabilizing stick in a cardiac catheterization table withdrawn from the C-arm of the X-ray machine improved the quality of CPR.


Assuntos
Cateterismo Cardíaco , Reanimação Cardiopulmonar , Falha de Equipamento , Parada Cardíaca/terapia , Mesas Cirúrgicas/normas , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/métodos , Humanos , Manequins , Treinamento por Simulação
17.
Geriatr Nurs ; 40(6): 645-647, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31733825

RESUMO

There is mounting evidence that Family Presence During Resuscitation (FPDR) can benefit family members who wish to observe the resuscitation efforts of a loved one. Given that older patients have poor resuscitation outcomes, presence of a family advocate could add value to the process of end of life decision making. A review of the current literature from the perspectives of patients, families, and health-care providers will help in reassessing family involvement during resuscitation and developing best practices for health care facilities.


Assuntos
Tomada de Decisões , Família/psicologia , Guias como Assunto , Ressuscitação , Pessoal de Saúde/psicologia , Parada Cardíaca/terapia , Humanos , Ressuscitação/mortalidade , Ressuscitação/psicologia
18.
N Engl J Med ; 381(24): 2327-2337, 2019 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-31577396

RESUMO

BACKGROUND: Moderate therapeutic hypothermia is currently recommended to improve neurologic outcomes in adults with persistent coma after resuscitated out-of-hospital cardiac arrest. However, the effectiveness of moderate therapeutic hypothermia in patients with nonshockable rhythms (asystole or pulseless electrical activity) is debated. METHODS: We performed an open-label, randomized, controlled trial comparing moderate therapeutic hypothermia (33°C during the first 24 hours) with targeted normothermia (37°C) in patients with coma who had been admitted to the intensive care unit (ICU) after resuscitation from cardiac arrest with nonshockable rhythm. The primary outcome was survival with a favorable neurologic outcome, assessed on day 90 after randomization with the use of the Cerebral Performance Category (CPC) scale (which ranges from 1 to 5, with higher scores indicating greater disability). We defined a favorable neurologic outcome as a CPC score of 1 or 2. Outcome assessment was blinded. Mortality and safety were also assessed. RESULTS: From January 2014 through January 2018, a total of 584 patients from 25 ICUs underwent randomization, and 581 were included in the analysis (3 patients withdrew consent). On day 90, a total of 29 of 284 patients (10.2%) in the hypothermia group were alive with a CPC score of 1 or 2, as compared with 17 of 297 (5.7%) in the normothermia group (difference, 4.5 percentage points; 95% confidence interval [CI], 0.1 to 8.9; P = 0.04). Mortality at 90 days did not differ significantly between the hypothermia group and the normothermia group (81.3% and 83.2%, respectively; difference, -1.9 percentage points; 95% CI, -8.0 to 4.3). The incidence of prespecified adverse events did not differ significantly between groups. CONCLUSIONS: Among patients with coma who had been resuscitated from cardiac arrest with nonshockable rhythm, moderate therapeutic hypothermia at 33°C for 24 hours led to a higher percentage of patients who survived with a favorable neurologic outcome at day 90 than was observed with targeted normothermia. (Funded by the French Ministry of Health and others; HYPERION ClinicalTrials.gov number, NCT01994772.).


Assuntos
Reanimação Cardiopulmonar , Coma/complicações , Parada Cardíaca/terapia , Hipotermia Induzida , Idoso , Temperatura Corporal , Encefalopatias/etiologia , Feminino , Seguimentos , Parada Cardíaca/complicações , Parada Cardíaca/mortalidade , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/terapia , Método Simples-Cego
19.
Scand J Trauma Resusc Emerg Med ; 27(1): 93, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640797

RESUMO

BACKGROUND: Studies have shown that providing adequate ventilation during CPR is essential. While hypoventilation is often feared by most caregivers on the scene, the most critical problem remains hyperventilation. We developed a Ventilation Feedback Device (VFD) for manual ventilation which monitors ventilatory parameters and provides direct feedback about ventilation quality to the rescuer. This study aims to compare the quality of conventional manual ventilation to ventilation with VFD on a simulated respiratory arrest patient. METHODS: Forty healthcare providers were enrolled and instructed to ventilate a manikin simulating respiratory arrest. Participants were instructed to ventilate the manikin for 5 min with and without the VFD in random order. They were divided in two groups of 20 people, one group ventilating through a mask and the other through an endotracheal tube. RESULTS: Ventilation with the VFD improved from 15 to 90% (p < 0.001) with the mask and from 15 to 85% (p < 0.001) with the endotracheal tube (ETT) by significantly reducing the proportion of hyperventilation. The mean ventilation rates and tidal volumes were in the recommended ranges in respectively 100% with the mask and 97.5% of participants with the ETT when using the VFD. CONCLUSION: VFD improves the performance of manual ventilation by over 70% in different simulated scenarios. By providing the rescuer direct feedback and analysis of ventilatory parameters, this device can significantly improve ventilation while performing CPR and thus save lives.


Assuntos
Parada Cardíaca/terapia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Adulto , Estudos Cross-Over , Retroalimentação , Feminino , Humanos , Masculino , Manequins , Volume de Ventilação Pulmonar
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