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4.
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 However, when the catheterization table is withdrawn from its neutral position for fluoroscopy, it is unstable and unsuitable for resuscitation because of its cantilever structure. To stabilize the table in its withdrawn position, the use of a table-stabilizing stick might improve CPR quality.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stick on CPR quality, a CPR simulation mannequin was placed on a cardiac catheterization table that was withdrawn from the C-arm of the X-ray machine.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 In this simulation-based study, the use of a table-stabilizing stick in a cardiac catheterization table withdrawn from the C-arm of the X-ray machine improved the quality of CPR.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
5.
Rev Med Suisse ; 15(670): 2053-2055, 2019 Nov 06.
Artigo em Francês | MEDLINE | ID: mdl-31696681

RESUMO

Openly talking with caregivers and physicians about medical decisions to prolong life, such as cardiopulmonary resuscitation, offers patients the opportunity to ensure that these decisions will be in line with their values and expectations, and thereby promote their autonomy and responsibility in health care. In order to support -informed and shared decision-making, it is important to share with the patient relevant information concerning their life-threatening condition (including risks of cardiac arrest, risks associated with the resuscitation procedure, immediate and long-term survival, and the impact of the procedure on quality of life), and encourage a -holistic discussion of the goals of care.


Assuntos
Reanimação Cardiopulmonar , Tomada de Decisões , Médicos , Idoso , Reanimação Cardiopulmonar/efeitos adversos , Parada Cardíaca , Humanos , Relações Médico-Paciente , Qualidade de Vida
6.
Int J Surg ; 71: 132-139, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31561009

RESUMO

BACKGROUND & AIM: Active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR), which applies to cardiac arrests with contraindication of standard chest compressions (SCC) CPR, has been utilized in cardiac arrest. However, the efficacy and safety of AACD-CPR still remained controversy. This analysis was designed to comprehensively compare AACD versus SCC-CPR in patients with cardiac arrest. METHODS: We searched the Cochrane Library, PubMed, EMBASE, Web of Science and CNKI up to April 22, 2019. Mean difference (MD) and risk ratio (RR) with its 95% confidence intervals (CIs) were estimated to compare outcomes of the groups. Our primary outcomes were restoration of spontaneous circulation (ROSC) and short-term survival. Two reviewers assessed trial quality and extracted data independently. All statistical analyses were performed using standard statistical procedures provided in Review Manager 5.2 and Stata 12.0. RESULTS: A total of seventeen studies (N = 1647 patients) were identified for the present analysis. Compared with standard CPR, AACD-CPR was superior in restoration of spontaneous circulation (ROSC) and short-term survival, with pooled RRs of 1.38 (95% CI 1.23-1.55; P < 0.00001) and RRs of 2.05 (95% CI 1.69-2.50; P < 0.00001) respectively. In addition, significant superiority of AACD-CPR was found in incidence of fracture, long-term survival, pressure of end-tidal carbon dioxide (PETCO2), coronary perfusion pressure (CPP) and adverse events. No significant difference was observed in incidence of vomiting. CONCLUSIONS: Generally, in this combined analysis we found a statistically significant improvement in survival and ROSC with the use of AACD-CPR as compared with the use of standard CPR. There was also significant improvement in incidence of fracture, long-term survival, PETCO2 and CPP with AACD-CPR in comparison with standard CPR; results were not statistically different between the groups regarding to vomiting rate and adverse events. The standardized, diversified and individualized methods of clinical operation of AACD-CPR need exploration and expectingly serve as a guideline for clinical application of AACD-CPR in the future.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Ressuscitação/efeitos adversos , Ressuscitação/métodos , Abdome , Idoso , Contraindicações , Feminino , Humanos , Pressão Negativa da Região Corporal Inferior/efeitos adversos , Pressão Negativa da Região Corporal Inferior/métodos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pressão , Ensaios Clínicos Controlados Aleatórios como Assunto , Tórax , Resultado do Tratamento
7.
Life Sci ; 235: 116821, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31476306

RESUMO

AIMS: This study aims to examine the effects of electroacupuncture (EA) pretreatment on brain injury after cardiac arrest and cardiopulmonary resuscitation (CA/CPR) and its underlying mechanisms. MATERIALS AND METHODS: Adult male C57BL/6 mice were subjected to 6 min of cardiac arrest induced with a potassium chloride infusion and resuscitated by chest compressions and an epinephrine infusion. During the 3 days prior to CA/CRP, mice received EA pretreatment (1 mA, 2 Hz; daily session of 30 min) at the Baihui acupoint (GV20) once daily. Stimulation at a nonacupoint served as a control. In mechanistic studies, mice received the AKT inhibitor LY294002 or endothelial nitric oxide synthase (eNOS) inhibitor L-NIO 30 min before EA pretreatment. A neurological assessment was conducted 24 h after CA/CRP, followed by animal sacrifice and evaluation of physiological brain damage. KEY FINDINGS: CA/CPR resulted in severe brain injury as evidenced by neurological deficits and increased neuronal apoptosis, oxidative stress and the proinflammatory cytokines TNF-α and IL-6. EA pretreatment at the GV20 acupoint but not at a nonacupoint attenuated the neurological deficits and the pathological changes induced by CA/CPR. LY294002 or L-NIO eliminated the neuroprotective effects of the EA pretreatment. SIGNIFICANCE: This study showed that EA pretreatment at the GV20 acupoint can protect the brain from damage associated with globalized ischemia followed by reperfusion and that these protective effects occur via the AKT/eNOS signaling pathway.


Assuntos
Lesões Encefálicas/terapia , Reanimação Cardiopulmonar/efeitos adversos , Modelos Animais de Doenças , Eletroacupuntura/métodos , Parada Cardíaca/complicações , Fármacos Neuroprotetores , Óxido Nítrico Sintase Tipo III/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Animais , Lesões Encefálicas/etiologia , Lesões Encefálicas/metabolismo , Lesões Encefálicas/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Óxido Nítrico Sintase Tipo III/genética , Estresse Oxidativo , Proteínas Proto-Oncogênicas c-akt/genética
8.
Rev Bras Enferm ; 72(4): 1114-1118, 2019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432973

RESUMO

OBJECTIVE: to report the experience of conducting directed temperature control of a post-cardiopulmonary resuscitation patient, with reduced and basic inputs available at the institution. METHOD: an experience report of directed temperature control in patient (age 15 years), after four hours of cardiopulmonary resuscitation in an Intensive Care Unit of a hospital in São Paulo State countryside in 2016, according to the protocol suggested by the American Heart Association, in 2015. There were applications of cold compresses, plastic bags with crushed ice and rectal temperature control. RESULTS: after eight hours, temperature had reached 93.2 ºF. Body cooling was maintained for 24 hours. However, bags with crushed ice were used in the first 6 hours. CONCLUSION: conduct of nurses to obtain the body cooling with reduced and basic inputs was effective during the stay at the Intensive Care Unit.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Hipotermia Induzida/métodos , Peritonite/complicações , Dor Abdominal/etiologia , Adolescente , Apendicite/complicações , Apendicite/cirurgia , Regulação da Temperatura Corporal/fisiologia , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Feminino , Febre/etiologia , Humanos , Peritonite/cirurgia , Tomografia Computadorizada por Raios X/métodos , Vômito/etiologia
10.
Dis Markers ; 2019: 1802879, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31275442

RESUMO

Purpose: Postresuscitation neuroprognostication is guided by neurophysiological tests, biomarker measurement, and clinical examination. Recent investigations suggest that circulating microRNAs (miRNA) may help in outcome prediction after cardiac arrest. We assessed the ability of miR-574-5p to predict neurological outcome after cardiac arrest, in a sex-specific manner. Methods: In this substudy of the Target Temperature Management (TTM) Trial, we enrolled 590 cardiac arrest patients for which blood samples were available. Expression levels of miR-574-5p were measured by quantitative PCR in plasma samples collected 48 h after cardiac arrest. The endpoint of the study was poor neurological outcome at 6 months (cerebral performance category scores 3 to 5). Results: Eighty-one percent of patients were men, and 49% had a poor neurological outcome. Circulating levels of miR-574-5p at 48 h were higher in patients with a poor neurological outcome at 6 months (p < 0.001), both in women and in men. Circulating levels of miR-574-5p were univariate predictors of neurological outcome (odds ratio (OR) [95% confidence interval (CI)]: 1.5 [1.26-1.78]). After adjustment with clinical variables and NSE, circulating levels of miR-574-5p predicted neurological outcome in women (OR [95% CI]: 1.9 [1.09-3.45]), but not in men (OR [95% CI]: 1.0 [0.74-1.28]). Conclusion: miR-574-5p is associated with neurological outcome after cardiac arrest in women.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Parada Cardíaca/sangue , MicroRNAs/sangue , Doenças do Sistema Nervoso/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Reanimação Cardiopulmonar/métodos , Feminino , Parada Cardíaca/complicações , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Fatores Sexuais
11.
Crit Care Nurs Clin North Am ; 31(3): 437-452, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351560

RESUMO

Cardiac surgical patients risk arrest from tamponade, profound bleeding, and hypovolemia, typically occurring within hours of intensive care admission and associated with diminished response to cardiopulmonary resuscitation (CPR). The Society of Thoracic Surgeons' evidence-based Expert Consensus Statement establishes a new standard for postsurgery arrest management, prioritizing defibrillation or pacing before CPR, restricting epinephrine use, and calling for prompt resternotomy if initial efforts fail. The protocol is summarized in a simple algorithm replacing advanced cardiac life support. This US cardiac surgical resuscitation standard is aligned with worldwide guidelines. Important information for protocol adoption and training is provided.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardioversão Elétrica/métodos , Guias como Assunto , Parada Cardíaca/terapia , Reanimação Cardiopulmonar/efeitos adversos , Cuidados Críticos , Humanos
12.
J Therm Biol ; 83: 1-7, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31331507

RESUMO

Spinal cord ischemia can result from cardiac arrest. It is an important cause of severe spinal cord injury that can lead to serious spinal cord disorders such as paraplegia. Hypothermia is widely acknowledged as an effective neuroprotective intervention following cardiac arrest injury. However, studies on effects of hypothermia on spinal cord injury following asphyxial cardiac arrest and cardiopulmonary resuscitation (CA/CPR) are insufficient. The objective of this study was to examine effects of hypothermia on motor deficit of hind limbs of rats and vulnerability of their spinal cords following asphyxial CA/CPR. Experimental groups included a sham group, a group subjected to CA/CPR, and a therapeutic hypothermia group. Severe motor deficit of hind limbs was observed in the control group at 1 day after asphyxial CA/CPR. In the hypothermia group, motor deficit of hind limbs was significantly attenuated compared to that in the control group. Damage/death of motor neurons in the lumbar spinal cord was detected in the ventral horn at 1 day after asphyxial CA/CPR. Neuronal damage was significantly attenuated in the hypothermia group compared to that in the control group. These results indicated that therapeutic hypothermia after asphyxial CA/CPR significantly reduced hind limb motor dysfunction and motoneuronal damage/death in the ventral horn of the lumbar spinal cord following asphyxial CA/CPR. Thus, hypothermia might be a therapeutic strategy to decrease motor dysfunction by attenuating damage/death of spinal motor neurons following asphyxial CA/CPR.


Assuntos
Parada Cardíaca/complicações , Hipotermia Induzida/métodos , Isquemia/terapia , Neurônios Motores/fisiologia , Paraplegia/terapia , Animais , Reanimação Cardiopulmonar/efeitos adversos , Parada Cardíaca/terapia , Isquemia/etiologia , Região Lombossacral/irrigação sanguínea , Região Lombossacral/fisiopatologia , Masculino , Paraplegia/etiologia , Ratos , Ratos Sprague-Dawley
13.
Mol Med Rep ; 20(2): 1250-1258, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31173195

RESUMO

Post­resuscitation myocardial dysfunction (PRMD) is a severe complication that arises in patients after cardiac arrest (CA). However, there are no safe or effective treatment strategies that are currently available to treat these patients. In the present study, it was investigated whether resveratrol administration could inhibit myocardial nitrative stress to alleviate PRMD. CA was induced in Sprague­Dawley rats by trans­oesophageal alternating electrical stimulation, followed by cardiopulmonary resuscitation. Rats were then randomly divided into a preconditioning or a postconditioning group. Left ventricular function (+dP/dtmax and ­dP/dtmin) was recorded for 4 h after the return of spontaneous circulation (ROSC), after which the animals were euthanized. Myocardial nitrative stress was analysed using enzyme­linked immunosorbent assay, western blotting and immunohistochemistry. Wortmannin (a PI3K inhibitor) was used to investigate the involvement of the PI3k/Akt signalling pathway in the cardio­protective activity of resveratrol. After ROSC, resveratrol improved PRMD compared to the vehicle control; however, resveratrol administration significantly improved PRMD in the preconditioning group compared to the postconditioning group. Likewise, resveratrol preconditioning significantly decreased the expression of iNOS and nitrotyrosine in rat hearts but did not significantly ameliorate myocardial nitrative stress. Wortmannin partially inhibited the protective effect of resveratrol preconditioning and resulted in the deterioration of cardiac function and increase in iNOS and nitrotyrosine levels. Resveratrol preconditioning could alleviate PRMD by inhibiting myocardial nitrative stress. The PI3K/Akt signalling pathway may be partially involved in the process.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Coração/fisiopatologia , Fosfatidilinositol 3-Quinases/metabolismo , /fisiopatologia , Proteínas Proto-Oncogênicas c-akt/metabolismo , Resveratrol/farmacologia , Transdução de Sinais , Animais , Masculino , Óxido Nítrico Sintase Tipo II/metabolismo , Fosforilação/efeitos dos fármacos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos , Tirosina/análogos & derivados , Tirosina/metabolismo , Função Ventricular Esquerda/efeitos dos fármacos
14.
Ann Surg ; 269(6): 1176-1183, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31082918

RESUMO

OBJECTIVE: We tested the hypothesis that systemic administration of an A2AR agonist will reduce multiorgan IRI in a porcine model of ECPR. SUMMARY BACKGROUND DATA: Advances in ECPR have decreased mortality after cardiac arrest; however, subsequent IRI contributes to late multisystem organ failure. Attenuation of IRI has been reported with the use of an A2AR agonist. METHODS: Adult swine underwent 20 minutes of circulatory arrest, induced by ventricular fibrillation, followed by 6 hours of reperfusion with ECPR. Animals were randomized to vehicle control, low-dose A2AR agonist, or high-dose A2AR agonist. A perfusion specialist using a goal-directed resuscitation protocol managed all the animals during the reperfusion period. Hourly blood, urine, and tissue samples were collected. Biochemical and microarray analyses were performed to identify differential inflammatory markers and gene expression between groups. RESULTS: Both the treatment groups demonstrated significantly higher percent reduction from peak lactate after reperfusion compared with vehicle controls. Control animals required significantly more fluid, epinephrine, and higher final pump flow while having lower urine output than both the treatment groups. The treatment groups had lower urine NGAL, an early marker of kidney injury (P = 0.01), lower plasma aspartate aminotransferase, and reduced rate of troponin rise (P = 0.01). Pro-inflammatory cytokines were lower while anti-inflammatory cytokines were significantly higher in the treatment groups. CONCLUSIONS: Using a novel and clinically relevant porcine model of circulatory arrest and ECPR, we demonstrated that a selective A2AR agonist significantly attenuated systemic IRI and warrants clinical investigation.


Assuntos
Agonistas do Receptor A2 de Adenosina/uso terapêutico , Reanimação Cardiopulmonar/efeitos adversos , Parada Cardíaca/terapia , Traumatismo por Reperfusão/prevenção & controle , Animais , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Feminino , Parada Cardíaca/complicações , Masculino , Traumatismo por Reperfusão/etiologia , Suínos
15.
PLoS One ; 14(5): e0216739, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31112576

RESUMO

The optimal strategy to ensure chest compression quality for patients being transported on a stretcher has not been established yet. We hypothesised that straddling cardiopulmonary resuscitation may improve chest compression quality in patients being transported on stretchers. We conducted a prospective randomised crossover study using manikins to investigate whether straddling cardiopulmonary resuscitation improves chest compression quality (depth, recoil, rate, correct hand position) performed on patients during stretcher transportation compared to walking cardiopulmonary resuscitation. Walking and straddling cardiopulmonary resuscitation were performed for 2 minutes each. The mean chest compression depth (mm) for 2 minutes was significantly greater in the straddling cardiopulmonary resuscitation group than in the walking cardiopulmonary resuscitation group (median, 51.3 [interquartile range, 46.7-55.5] versus 40.9 [34.6-50.1], P = 0.003). An adequate depth of chest compressions could not be achieved when walking cardiopulmonary resuscitation was performed by female participants, but the depth of chest compressions was within the acceptable range when female participants performed straddling cardiopulmonary resuscitation. On the other hand, the degree of deterioration was relatively small in male participants, even when they performed walking cardiopulmonary resuscitation. In patients with cardiac arrest being transported on a stretcher, straddling cardiopulmonary resuscitation improved the depth of chest compressions compared to walking cardiopulmonary resuscitation. Female rescuers, in particular, may consider using straddling cardiopulmonary resuscitation.


Assuntos
Reanimação Cardiopulmonar/métodos , Macas (Leitos) , Transporte de Pacientes , Adulto , Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/normas , Estudos Cross-Over , Estudos de Viabilidade , Feminino , Humanos , Masculino , Manequins , Projetos Piloto , Estudos Prospectivos , Segurança , Fatores Sexuais , Caminhada
16.
Ann Thorac Surg ; 108(3): 749-755, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30981847

RESUMO

BACKGROUND: This study aimed to develop a risk prediction model for neurologic outcomes in patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). METHODS: Between May 2004 and April 2016, a total of 274 patients who underwent ECPR were included in this analysis. The primary outcome was neurologic status on discharge from the hospital, as assessed by Cerebral Performance Categories (CPC) scale. To develop a new predictive scoring system, backward stepwise elimination and a z-score-based scoring scheme were used on the basis of logistic regression analyses. RESULTS: A total of 95 patients (34.7%) survived until discharge. Of these, 78 patients (28.5%) had favorable neurologic outcomes (CPC scores of 1 or 2). In the multivariable logistic regression analysis, significant predictors of poor neurologic outcome included age older than 65 years, initial Sequential Organ Failure Assessment score greater than 13 points, first monitored arrest rhythm, low-flow time longer than 30 minutes, initial pulse pressure less than 25 mm Hg, initial mean arterial pressure less than 70 mm Hg, and serum glucose level greater than 300 mg/dL. There was also a significant interaction between age and low-flow time. The newly developed neurologic outcome score after ECPR (nECPR) more effectively predicted poor neurologic outcome (C-statistic, 0.867; 95% confidence interval, 0.823 to 0.912) than the former ECPR score (p = 0.019) and the survival after venoarterial ECMO score (p < 0.001). CONCLUSIONS: The investigators created a risk prediction model for neurologic outcomes using independent predictors and the interaction between age and low-flow time, and this new scoring system could predict early neurologic prognosis more effectively in ECPR-treated patients. It may be help guide decisions in ECPR management for intensivists, cardiovascular surgeons, or cardiologists.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Parada Cardíaca/terapia , Doenças do Sistema Nervoso/etiologia , Centros Médicos Acadêmicos , Adulto , Fatores Etários , Estudos de Coortes , Feminino , Seguimentos , Parada Cardíaca/mortalidade , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/fisiopatologia , Valor Preditivo dos Testes , Curva ROC , República da Coreia , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Estatísticas não Paramétricas
17.
Ren Fail ; 41(1): 278-283, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31014141

RESUMO

OBJECTIVE: In the current study, we investigated the incidence of acute kidney injury (AKI) induced by cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) and whether such an AKI can recover spontaneously in rats. METHODS: We used transesophageal alternating current stimulation to establish 7 min of CA rat model followed by conventional CPR. The experimental rats were randomly divided into three groups (n = 20 per group) according to the different time points after restoration spontaneous circulation (ROSC): the ROSC 24 h, ROSC 48 h, and ROSC 72 h group. The diagnosis of rat AKI refers to the 2012 KDIGO adult AKI diagnostic criteria. The severity of AKI quantified by the serum creatinine (SCR), blood urea nitrogen (BUN) levels and histological features of renal tissue. RESULTS: The incidence rates of AKI in ROSC 24 h, ROSC 48 h, and ROSC 72 h group were 65%, 45%, and 42.9%. Moreover, the values of SCR and BUN were highest at ROSC 24 h, and then gradually decreased with the time of ROSC. The histological changes of the renal tissues such as glomerular collapse, renal tubular cell swelling, and inflammatory cell infiltration had also observed. CONCLUSION: The incidence of AKI in rats was high after suffering from CA and CPR, but renal function improved with the prolongation of ROSC time, indicating the ability of the kidney to self-repair.


Assuntos
Lesão Renal Aguda/epidemiologia , Reanimação Cardiopulmonar/efeitos adversos , Parada Cardíaca/terapia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/patologia , Animais , Nitrogênio da Ureia Sanguínea , Reanimação Cardiopulmonar/métodos , Creatinina/sangue , Modelos Animais de Doenças , Parada Cardíaca/complicações , Humanos , Incidência , Rim/patologia , Masculino , Ratos , Ratos Sprague-Dawley , Fatores de Tempo
18.
Med Hypotheses ; 126: 129-130, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31010488

RESUMO

Cognitive impairment (CI) is a common morbidity after cardio-pulmonary resuscitation (CPR) with long time persistence. Brain hypoxia is believed to be the main but not the single etiology of post CPR cognitive impairment. Theta and lower theta waves of the EEG have essential role in proper functioning of the memory performance. Both endotracheal intubation and atropine administration in CPR process can abolish these waves. We hypothesize that CI in CPR survivors can be caused by disturbance in aforementioned waves due to endotracheal intubation and atropine administration.


Assuntos
Ondas Encefálicas , Reanimação Cardiopulmonar/efeitos adversos , Disfunção Cognitiva/fisiopatologia , Parada Cardíaca/terapia , Hipóxia Encefálica/fisiopatologia , Atropina/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico , Eletroencefalografia , Humanos , Intubação Intratraqueal , Modelos Teóricos , Neurônios/metabolismo , Bulbo Olfatório/fisiopatologia
19.
Med Klin Intensivmed Notfmed ; 114(4): 313-318, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-30923852

RESUMO

BACKGROUND: The assessment of the neurological prognosis after cardiac arrest should be made using a multimodal approach involving clinical, physical and laboratory findings. Here, biomarkers are of high importance. The reliable prognostication has far-reaching consequences for the patient on the further course of therapy and rehabilitation. OBJECTIVES: Which biomarkers help in prognosis estimation and therapy target definition and are currently used in daily clinical practice? MATERIALS AND METHODS: Presentation of the multimodal approach for prognosis generation in patients after resuscitation with hypoxic-ischemic encephalopathy with special consideration and discussion of various biomarkers. RESULTS AND CONCLUSION: Neuron-specific enolase (NSE) is the best-established predictive biomarker in patients with hypoxic-ischemic encephalopathy after cardiac arrest. In combination with other methods (clinical examination, physical testing) and considering possible interfering factors (hemolysis, tumor diseases), NSE is used after 48-72 h with a cutoff value of 90 ng/ml. Most other biomarkers have so far only been studied in smaller groups or individual studies and thus cannot currently be routinely used outside of studies.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Biomarcadores/sangue , Reanimação Cardiopulmonar/efeitos adversos , Objetivos , Parada Cardíaca/sangue , Humanos , Fosfopiruvato Hidratase , Valor Preditivo dos Testes , Prognóstico
20.
Exp Neurol ; 317: 100-109, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30822422

RESUMO

Nighttime lighting is one of the great conveniences of modernization; however, there is mounting evidence that inopportune light exposure can disrupt physiological and behavioral functions. Hospital patients may be particularly vulnerable to the consequences of light at night due to their compromised physiological state. Cardiac arrest/cardiopulmonary resuscitation (CA) was used to test the hypothesis in mice that exposure to dim light at night impairs central nervous system (CNS) recovery from a major pathological insult. Mice exposed to dim light at night (5 lx) had higher mortality in the week following cardiac arrest compared to mice housed in dark nights (0 lx). Neuronal damage was significantly greater in surviving mice exposed to dim light at night after CA versus those housed in dark nights. Dim light at night may have elevated neuronal damage by amplifying pro-inflammatory pathways in the CNS; Iba1 immunoreactivity (an indication of microglia activation) and pro-inflammatory cytokine expression were elevated in mice exposed to dim light at night post-CA. Furthermore, selective inhibition of IL-1ß or TNFα ameliorated damage in mice exposed to dim light at night. The effects of light at night on CA outcomes were also prevented by using a wavelength of nighttime light that has minimal impact on the endogenous circadian clock, suggesting that replacing broad-spectrum nighttime light with specific circadian-inert wavelengths could be protective. Together, these data indicate that exposure to dim light at night after global cerebral ischemia increases neuroinflammation, in turn exacerbating neurological damage and potential for mortality.


Assuntos
Isquemia Encefálica/patologia , Iluminação , Animais , Reanimação Cardiopulmonar/efeitos adversos , Morte Celular , Corticosterona/metabolismo , Citocinas/sangue , Escuridão , Parada Cardíaca/patologia , Parada Cardíaca/fisiopatologia , Parada Cardíaca/terapia , Hipocampo/patologia , Inflamação/patologia , Interleucina-1beta/antagonistas & inibidores , Interleucina-1beta/biossíntese , Masculino , Camundongos , Atividade Motora , Neurônios/patologia , Recuperação de Função Fisiológica , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/biossíntese
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